Disorders of pharynx, dr.sithanandhakumar,25.07.2016

Disorders of pharynxpharyngeal poucheagle’s syndrome

Dr. Sithananda Kumar . RAsst. ProfessorDepartment of ENTMGMC&RI

DISORDERDERS OF PHARYNX•Acute pharyngitis

•Chronic pharyngitis

•Viral pharyngitis

•Keratosis pharynx

Acute pharyngitis•viral, bacterial, fungal

•Viral more common than bacterial

• Acute streptococcal pharyngitis (Group A beta-hemolytic streptococci) – associated with rheumatic fever and post streptococcal glomerulonephritis.

Clinical features•Viral and bacterial pharyngitis cannot be differentiated clinically

•Viral pharyngitis milder than bacterial pharyngitis

•Acute pharyngitis- mild , moderate , severe

Management •Throat swab

•Saline gargling

•Mild , moderate – oral penicillin's

•Severe - parenteral penicillin's , macrolides

Chronic pharyngitis• chronic inflammatory condition of the pharynx

• Characterized by hypertrophy of mucosa, seromucinous glands, sub epithelial lymphoid follicles

• Chronic pharyngitis is of two types: 1. Chronic catarrhal pharyngitis.2. Chronic hypertrophic (granular) pharyngitis

Etiology • Focus of infection in nose, PNS, Tonsils

• Mouth breathing

• Gastro-esophageal reflux

• Chronic irritation

• Voice abuse

• Environmental pollution

Clinical features•Discomfort or pain in the throat

•Foreign body sensation in throat

•Voice fatigue

•Cough

Signs Chronic catarrhal pharyngitis •congestion of posterior pharyngeal wall

•Mucous secretion in posterior pharyngeal wall

Chronic hypertrophic (granular) pharyngitis •Pharyngeal wall appears thick and edematous with congested mucosa and dilated vessels

•Posterior pharyngeal wall -studded with reddish nodules (granular pharyngitis)

•Lateral pharyngeal bands hypertrophied

•Uvula elongated and edematous

Treatment

•Identifying and treating the cause

•Mandl’s paint

•Saline gargling

Herpangina •Caused by Group A coxsackie virus

•mostly affects children

•Characteristic features include fever, sore throat and vesicular eruption on the soft pal- ate and pillars

•Vesicles are small and surrounded by a zone of erythema.

KERATOSIS PHARYNGITIS• Benign condition

• Horny excrescences on the surface of tonsils, pharyngeal wall or lingual tonsils

• Appear as white or yellowish dots

• These excrescences are the result of hypertrophy and keratinization of epithelium.

• Firmly adherent and cannot be peeled off

• No accompanying inflammation nor any constitutional symptoms

Pharyngeal pouch• Pulsion hypopharyngeal diverticulum

• Hypopharyngeal mucosa herniates through the Killian’s dehiscence

• Weak area between the thyropharyngeal and cricopharyngeal parts of the inferior constrictor muscle

• spasm of cricopharyngeal sphincter

• In coordinated contractions during deglutition

• Patients are usually old adults

• Herniation of pouch starts in the midline and then comes to lie on the left

• Mouth of the sac is wider than the opening of esophagus and food preferentially enters the sac

• Halitosis

• Dysphagia and regurgitation of food days after ingestion

• Dysphagia may increase after a few swallows(the pouch gets filled with the food and then presses on the esophagus.

• Gurgling sound during swallowing

• Regurgitation of undigested food at night (due to recumbent position) results in coughing and choking

• Loss of weight and malnourishment

• Aspiration pneumonia

• Patients with pharyngeal pouch can be associated hiatus hernia

• Rarely carcinoma can develop in long-standing cases of pharyngeal pouch(squamous cell carcinoma)

• Diagnosis by barium swallow

• Treatment -excision of pouch and cricopharyngeal myotomy

• Dohlman’s procedure

• Endoscopic laser treatment

Eagles syndrome• Due to elongated styloid process or calcification of stylohyoid ligament

• Pain in the tonsillar fossa and upper neck which radiates to the ipsilateral ear

• Aggravated on swallowing

• Diagnosis –transoral palpation of the styloid process in the tonsillar fossa

• Radiograph anteroposterior view with open mouth or lateral view of skull

• Asymptomatic – No treatment

• Symptomatic styloid process can be excised by transoral or cervical approach.