Pharyngitis: symptoms and treatment of chronic form

Introduction

Chronic pharyngitis is a prolonged inflammatory process of the mucous membrane of the back wall of the pharynx. This is a longer lasting inflammation than acute pharyngitis. Chronic pharyngitis manifests itself in a series of relapses - during an exacerbation, the symptoms return again, and after some time they fade again. Such inflammation can last for years, greatly reducing the patient’s quality of life. Another unpleasant point is the risk of complications: it always persists as long as there is a chronic source of infection in the throat.

Most often, chronic pharyngitis develops due to untreated acute pharyngitis. Also at risk are people whose pharynx is exposed to the negative effects of external factors:

smoking,
abuse of alcoholic beverages;
polluted air in the place of residence;
inhalation of harmful substances, dusty, polluted air in production.

The main signs of chronic pharyngitis are dryness, soreness and discomfort in the throat.

The disease can manifest itself in several forms. Pharyngitis can develop as an independent disease, or can be combined with chronic tonsillitis. This combination of two ENT conditions is called tonsillopharyngitis.

Recommendations for the occurrence of pharyngitis in adults and children

Soreness and dryness, as the first symptoms of an acute inflammatory process, can be alleviated:

drinking plenty of warm liquids;
rinsing with saline solutions or antiseptics;
using painkillers in the form of lozenges;
active humidification of the air in the room.

Uncomplicated acute pharyngitis does not always require medical intervention. With the right approach, you can independently cope with the symptoms and achieve a full recovery. But the absolute criterion for visiting a doctor, especially when treating pharyngitis in children, is the appearance of respiratory problems.

If inflammatory symptoms do not subside within 48 hours, and after starting active therapy you notice an increase in pain, you should also contact an otolaryngologist. If intensive treatment measures are not taken in a timely manner, the risk of developing serious complications increases. Inflammation of the trachea, middle ear or bronchial tree, as well as purulent abscesses on the tonsils or in the retropharyngeal space will require surgical intervention.

Causes and course of the disease

Contributors to the occurrence of this disease are: often recurrent acute inflammation of the posterior wall of the pharynx (acute pharyngitis), diseases in the paranasal sinuses, chronic tonsillitis, acute tonsillitis (angina), and inflammatory diseases of the nasal cavity that last for a long time.

The development of chronic pharyngitis is also influenced by the following factors:

Unfavorable ecological and climatic environmental conditions - dry air, elevated air temperature, dust, gas pollution and dustiness, exposure to harmful chemicals;
Smoking and alcohol abuse;
Disorders in the endocrine system, causing hormonal imbalance;
Diseases affecting the gastrointestinal tract;
Allergy;
Dental caries;
Too spicy food, etc.

Classification of the disease

Chronic pharyngitis has three forms:

catarrhal,
hypertrophic (increase in the size of the mucous membrane of the posterior pharyngeal wall),
atrophic (reduction in size and drying of the mucous membrane of the posterior pharyngeal wall).

The catarrhal form of chronic pharyngitis is characterized by fairly persistent diffuse venous hyperemia (plethora), pastiness (dough-likeness) of the mucous membrane, which occurs due to expansion and stasis (stagnation) in small-caliber veins.

In the hypertrophic form of chronic pharyngitis, thickening is observed in all layers of the mucous membrane, an increase in the number of layers of the epithelium, while the cylindrical ciliated epithelium is replaced by squamous epithelium. The altered epithelium tends to form growths, cystic expansions, thickenings and bays, which are very reminiscent of the lacunae of the palatine tonsils. There is an expansion of small vessels and capillaries. The submucosal layer of the posterior pharyngeal wall thickens and becomes saturated with cellular elements. In connection with the above changes, the mucous membrane becomes denser and thicker, lymphatic and blood vessels dilate, and lymphocytes accumulate in the perivascular space (cracks that exist in the outer membranes of the vessels of the spinal cord and brain).

Lymphatic formations, which look like very small granules scattered throughout the mucous membrane, expand and thicken. The mucous membrane is hyperemic, and hypersecretion is observed (increased secretion production). The hypertrophic process is usually localized on the posterior or lateral wall of the pharynx.

Atrophic chronic pharyngitis is characterized by dryness of the pharyngeal mucosa and its thinning. The cylindrical ciliated epithelium transforms into flat epithelium, which has several layers. At the same time, keratinization is observed in its surface layer. The number of glands decreases, and their canals become overgrown (obliteration process). The mucous membrane looks as if it was covered with varnish.

Quite often, chronic pharyngitis has a mixed form, when, against the background of atrophic changes in the mucous membrane, there are areas of its hypertrophy, which have a dull grayish color with infiltrates that have the form of granules and a rich red color. With a sufficiently pronounced inflammatory reaction, inhibition of factors that are responsible for the state of local immunity is noted.

Symptoms of chronic pharyngitis

If chronic pharyngitis has a catarrhal or hypertrophic form, then patients complain of tickling, soreness and soreness in the throat. They feel awkward when swallowing and feel as if there is some kind of foreign body in their throat. The listed symptoms are more pronounced in the hypertrophic form, in which patients are bothered by mucopurulent discharge, which quite often flows down the back wall of the pharynx.

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Acute pharyngitis

Most often, acute pharyngitis is infectious in nature and in 70% of cases is associated with acute respiratory viral infections (ARVI)1,4. In the autumn-winter period of epidemics, rhinoviruses predominate among pathogens (80%), adenoviruses, influenza and parainfluenza viruses are slightly less common1,4.

Pharyngitis can also be caused by bacteria. Among them, group A beta-hemolytic streptococcus is considered especially dangerous. It is found with pharyngitis in 15-30% of children and 5-17% of adults1. In 90% of cases, the disease is caused by several microbes at once1. Much less often, inflammation of the pharynx is caused by fungal flora1.

Pharyngitis can also be the result of allergic reactions or accompany infections such as measles, rubella and scarlet fever1. In each case, the treatment will be different. Therefore, before looking for a cure for pharyngitis, you need to make sure that it is not a symptom of other diseases.

Acute pharyngitis is sometimes caused by factors that have nothing to do with the activity of microbes: damage to the mucous membrane of the pharynx by rough food, bones and other foreign bodies, thermal and chemical burns of the mucous membrane, for example, when consuming too hot and spicy food or strong alcohol1,4.

Symptoms of acute pharyngitis

The clinical picture may include1:

sore and sore throat;
feeling of dryness;
pain when swallowing, especially with an “empty” throat;
general malaise (weakness, lethargy and drowsiness during the day);
increased body temperature;
unpleasant sensations of tingling and congestion in the ears associated with inflammation of the nasopharynx;
enlargement and tenderness of the lymph nodes located under the lower jaw1,4.

When examining the throat, the mucous membrane looks red, and individual inflamed lymphoid nodules are visible on its surface1.

Diagnosis of the disease

Making a diagnosis is usually not difficult. The main diagnostic method is pharyngoscopy - direct examination of the pharynx. To identify the causative agent of the disease, the patient is sent by an ENT doctor to conduct a series of laboratory tests: a general, biochemical blood test, and a throat smear.

To identify the cause of chronic pharyngitis, additional tests may be needed to locate the site of primary infection. The patient may undergo:

X-ray or CT scan of the paranasal sinuses;
endoscopy of the nasopharynx;
gastroscopy.

When are antibiotics needed?

If, after the results of a pharyngeal smear are obtained, it is determined that the disease is bacterial in nature, antibiotic drugs are prescribed. Antibiotics for pharyngitis can be prescribed for local (local) or general action. The choice of a specific drug depends on the patient’s condition and his individual characteristics. Thus, during pregnancy, a woman (if antibiotics cannot be avoided) is prescribed mainly local drugs for irrigating the pharynx, since they penetrate into the systemic bloodstream to a lesser extent.

The use of antibiotics is required in order to stop the proliferation of the pathogen and destroy it. Thanks to this, drugs in this category help prevent the spread of the inflammatory process to surrounding tissues. In the first days of taking antibiotics, an increase in temperature is the norm, since due to the large number of dead pathogens, the body becomes intoxicated. The duration of taking antibiotics is at least 5 days. If you stop the course earlier, bacteria resistant to the drug will form, which will make its use ineffective. Each specific drug has its own contraindications, which must be taken into account when prescribing the drug.

Side effects from taking general antibiotics may include:

fever;
joint pain;
disturbances in intestinal function;
general weakness.

Such manifestations are considered normal and, as a rule, do not require replacement of the drug. However, if they develop, you must inform your doctor about this.

For pharyngitis, penicillin drugs or cephalosparins are most often used. If they are not tolerated by the patient, treatment is carried out using Azithromycin, Amoxiclav, Lincomycin, Erythromycin or Amoxicillin. Antibiotics for pharyngitis in adults and children are prescribed the same.

In the chronic form of the disease, pharyngitis without antibiotics is treated only until it worsens. If this occurs, antibiotics are prescribed.

Treatment of chronic pharyngitis

The goal of treatment on an outpatient basis is to relieve subjective discomfort in the pharynx and normalize the pharyngoscopy picture. It is necessary to carry out sanitation of foci of infection that have arisen in the upper respiratory tract. For all forms of chronic pharyngitis, a prerequisite is quitting smoking and compliance at work and at home with all measures to protect the respiratory tract from harmful factors.

Inhalation gives a good effect. In this case, aerosols from decoctions of chamomile, eucalyptus, sage, mineral alkaline water are used in combination with oil mixtures from sea buckthorn, rose hips, etc.

When treating the hypertrophic form of chronic pharyngitis, cauterization of granules and lateral ridges of the pharynx is used. It can be medicinal, using medicinal solutions (silver nitrate or triacetic acid) or physical, using physical factors (radio wave coagulation, ultrasonic coagulation, laser exposure, cryotherapy, cold and argon plasma, etc.).

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In the treatment of chronic atrophic pharyngitis, the mucous membrane is lubricated with iodine-glycerin, and gargling with water-glycerin and alkaline solutions is prescribed.

Chronic pharyngitis often occurs as a consequence of a disease of the gastrointestinal tract. In this case, it is necessary to consult a gastroenterologist and, under his supervision, treat dysbiosis and examine the flora in the gastrointestinal tract.

If the cause of the development of chronic pharyngitis is diseases or disorders of the hormonal, endocrine and cardiovascular systems, it is necessary to undergo examination by a specialized specialist and continue treatment with his participation.

Physiotherapy is often prescribed to treat chronic pharyngitis. You can use electrophoresis in the submandibular areas using a 0.5% solution of nicotinic acid, exposure to a low-energy therapeutic laser or alternating magnetic field, ultrasonic medicinal irrigation of the posterior pharyngeal wall, ultraviolet irradiation and vibroacoustic therapy sessions.

Treatment of viral pharyngitis.

As already mentioned, antibiotic therapy for viral pharyngitis will not be an effective treatment. Moreover, there is no so-called causal treatment. Viral pharyngitis is a disease that goes away on its own; treatment is symptomatic. The most widely used antipyretic drugs are those whose active ingredient is paracetamol. Antipyretic and anti-inflammatory drugs are also used

- these include, for example, compounds related to non-steroidal anti-inflammatory drugs, the active ingredient of which is ibuprofen.

For nasal discharge, topical medications are used to relieve nasal congestion. Thanks to local action, active ingredients

almost immediately enter the infected area. In case of fever, it is also recommended to drink plenty of fluids to keep the body hydrated.

Many medications used to treat viral pharyngitis are available without a prescription. So you can buy them yourself without visiting a doctor. However, you should read these instructions carefully and adhere to the prescribed doses. In addition to symptomatic treatment

Rest and reduction in physical activity are also necessary.

Complication

Possible complications of chronic pharyngitis are:

Peritonsillar abscess is a purulent inflammation that develops due to bacterial pharyngitis caused by streptococcal infection.
A retropharyngeal abscess is a purulent inflammation of the tissue located in the retropharyngeal space.
Laryngitis is an inflammatory process affecting the mucous membrane of the larynx.
Chronic bronchitis develops when the infection descends lower into the bronchi and causes inflammation in them.
Systemic inflammatory diseases (glomerulonephritis, myocarditis, rheumatism) - chronic inflammation of the pharynx can cause complications on the kidneys, heart and joints.
Atrophic processes of the pharyngeal mucosa. The most dangerous consequence of this condition is the development of oncological processes in the pharynx.

Why does pharyngitis occur?

An inflammatory reaction on the pharyngeal mucosa can be caused by:

exposure to too cold or hot air;
contact with aggressive chemicals;
too dusty and polluted atmosphere;
smoking as a special case of inhalation of toxins;
traumatic damage to the mucous membrane as a result of surgical interventions or removal of foreign objects from the pharynx.

Very often the cause is infection. Inflammation can be caused by both bacteria (mainly streptococci and staphylococci), viruses and even fungi (for example, the genus Candida). Infectious agents can immediately affect the mucous membrane of the pharynx or spread to it from the teeth and sinuses. Therefore, to get rid of pharyngitis, it is necessary to first destroy third-party infectious foci.

In addition to direct causes, inflammation can be caused by:

decreased immunity;
vitamin deficiency;
pathologies of the digestive tract and liver;
cardiovascular, renal and pulmonary failure;
difficulty breathing through the nose;
allergic disorders;
endocrine system disorders.

Prevention of chronic pharyngitis

Prevention of chronic pharyngitis includes significant adjustments to habits and lifestyle - this is the only way you will reduce the risks of developing the disease.

Preventive measures to prevent the development of chronic pharyngitis include:

timely treatment of acute pharyngitis and other inflammatory ENT diseases;
reducing cases of contact with irritating harmful substances at work and allergens;
cessation of smoking and drinking alcoholic beverages;
treatment of gastrointestinal diseases;
limiting the consumption of spicy and sour foods;
strengthening the immune system;
avoiding crowded places during ARVI epidemics;
maintaining the required level of humidity and temperature in the room.

Where to treat chronic pharyngitis in Moscow?

Treatment of chronic pharyngitis in Moscow is carried out in various medical institutions, ranging from district clinics to large multidisciplinary network clinics. The cost of treatment and the quality of services in this case cannot be the same everywhere.

The most affordable way to treat the disease is to enroll in a clinic at your place of residence. Affordable, but not the simplest or most effective. As a rule, in district clinics, appointments with an otorhinolaryngologist are quite dense, and it is very difficult to get a ticket “here and now.” You will have to wait about two weeks for an appointment (during this time, the exacerbation of chronic pharyngitis will only gain momentum), or try to get through the “live” queue, sitting all day at the ENT doctor’s office. By the way, it is not always possible to do this the first time.

Now about the quality of treatment - the doctor in the clinic has the task of accepting as many patients as possible. Everything is logical: there are many patients, one doctor. This means that the consultation time is very limited in time. But in the 10 minutes allocated for each patient, it is impossible to fully collect anamnesis and conduct an examination, let alone give effective prescriptions and carry out therapeutic manipulations. Another problem of district clinics is the lack of sophisticated, modern equipment, so the choice of treatment procedures used by the doctor is very limited. Treatment often comes down to prescribing medications that only relieve symptoms for a short time. Treatment for chronic pharyngitis can be very long and tedious.

Many patients are treated in multidisciplinary network clinics, with which they have an agreement to provide treatment under the VHI policy. In such clinics, the treatment process itself often becomes a secondary issue. It takes a doctor a lot of time to fill out medical documentation correctly, because filling it out incorrectly can lead to problems with the insurance company. Therefore, an impressive part of the reception is spent on “paper” work. Another drawback of such clinics, which patients often complain about, is the appointment of unnecessary procedures and unnecessary consultations. Network clinics need a constant flow of patients: the more people come, the more doctors or services they visit, the better. The quality of treatment under such conditions fades into the background.

The third option is treatment in highly specialized private clinics that deal with one particular medical area. Insurance companies are not interested in such clinics, so there will be no flow of people here. Highly specialized clinics, as a rule, are well equipped with medical equipment, which allows high-quality diagnostics and treatment to be carried out in one place. For the treatment of chronic pharyngitis, which requires increased attention and experience of an ENT doctor, this option is the most acceptable.