Faringitis

Inflammation of Pharynx Pharyngitis • Inflammation of the mucosal lining of the pharynx. Acute
Nonspecific Pharyngitis: • Is viral infection in association with common cold and influenza, followed by
secondary bacterial infection. Clinical picture Symptoms: Fever, headache, malaise, sore throat,
dysphagia and otalgia. Signs: diffuse congestion of the pharyngeal mucosa and tonsils with enlarged
tender cervical lymph nodes. Treatment: • Rest, fluids, analgesics, antipyretics, antibiotics, and
antiseptic gurgle.

Tonsilitis
Tonsillitis Acute Tonsillitis • Acute non-specific inflammation of the palatine tonsils. Aetiology: •
Causative organism: Group A β-haemolytic Strept. (the commonest), Strept. pneumoniae, Staph. aureus
and Haemophilus influenzae. Symptoms: • Sore throat, dysphagia and foetor oris associated with ear
ache. • High fever, malaise and arthralgia. Signs: • High fever with tachycardia proportionate to the rise
of temperature. • Local: manifestations are according to the types of tonsillitis, if acute catarrhal
tonsillitis: shows congested tonsils. If acute follicular tonsillitis: shows congested tonsils with yellowish
spots on the surface, spots may coalesce to form yellowish membrane which can be easily removed. If
acute parenchymatous tonsillitis shows markedly swollen congested oedematous tonsils and enlarged
tender cervical lymph nodes. Complications: The most important are: • Chronic tonsillitis. • Peritonsillar
abscess. • Parapharyngeal and retropharyngeal abscess. • Acute glomerulo-nephritis. • Acute rheumatic
fever, often after a latent period of about 6 weeks.

Differential diagnosis: From many conditions causing acute pharyngitis, the most important are: •
Scarlet fever. • Diphtheria. • Vincent's angina. • A granulocytosis. • Glandular fever (Infectious
mononucleosis). Treatment: • Rest, fluids, soft diet, analgesics, antipyretics and mouth wash. • Systemic
antibiotics: penicillin or amoxicillin for 10 days.

Laringitis
Aetiology: • Usually viral infection followed by secondary bacterial infection. Predisposing factors:
Rhinitis, sinusitis, pharyngitis, smoking. Clinical picture: Symptoms: • Hoarseness of voice is the main
symptom. • Dry cough and feeling of discomfort in the throat especially on talking. Signs: • Congestion
and oedema of the laryngeal mucosa mainly the vocal folds. Treatment: • Local treatment: § Voice rest,
avoid laryngeal irritants as smoking and steam inhalation as Tincture Benzoin co. • General treatment: §
Antibiotics, cough suppressants.

Difteria
Diphtheria (Faucial Diphtheria) • Acute specific infectious disease caused by Corynebacterium
diphtheria. It is a serious condition; fortunately now it is very rare disease due to obligatory
immunization. Age: Children 2-5 years. Aetiology: • Causative organism: Gram positive bacilli
Corynebacterium diphtheria. Transmission: Droplet infection from patient or carrier with incubation
period: 2-5 days. Pathology: It is an acute membranous inflammation of the mucous membrane. There is
a pseudomembrane at the site of infection. The organism causes necrosis of the superficial layer of
epithelium. An adherent false membrane is formed. It is composed of necrotic mucosa, fibrin, bacteria,
RBCs and inflammatory cells. Systemic: Toxemia due to absorbed exotoxin. It has high affinity to cardiac
and neural tissues and may affect kidney and liver. Clinical picture: Symptoms: • Insidious onset of low
grade fever, sore throat, severe toxemia and malaise. Signs: • Moderate fever (38-39°C) with rapid weak
pulse not synchronous with the temperature. • False membrane (pseudomembrane) is formed on the
tonsils, pharynx and may extend to the larynx. The membrane is greyish- yellow in colour and usually
unilateral. It is adherent to the tissues and reccurs rapidly when removed. • Bilateral enlarged cervical
glands (bull's neck). Investigations: • Throat swab from the membrane is examined for diphtheria bacilli
by direct smear stained with gram stain and culture on Loffler's serum or blood agar. Differential
diagnosis: From other causes of membrane on the tonsil and pharynx: Acute follicular tonsillitis,
Vincent's angina, Moniliasis or Blood diseases (Agranulocytosis, acute leukaemia, infectious
mononucleosis)

Complications: • Diphtheria exotoxins have a special affinity to nervous, cardiac and renal tissue. •
Paralysis may occur after 2-3 weeks. § Head and neck: - Paralysis of the soft palate leads to nasal
regurge, nasal tone, and uvula deviation to the normal side. - Paralysis of the eye muscles cause lack of
accomodation, diplopia and squint. - Paralysis of the pharynx causes dysphagia. - Paralysis of the larynx
leads to stridor. § Chest muscles: - Including the diaphragm and intercostal muscles cause respiratory
failure. § Heart failure may occur early due to toxic myocarditis or late due to vagal neuritis. §
Respiratory obstruction by the membrane of diphtheria. § Acute nephritis (Albuminuria). Treatment: •
Antitoxic serum: 40000 - 100000 units according to the severity and extension of the diphtheric
membrane and the weight of the child is given immediately if diphtheria is suspected (S.C., I.M., or I.V.).
• Antibiotics: penicillin acts against the organism. • Rest in bed. • Isolation in a fever hospital until 3
successive swabs are -ve. • Treatment of complications e.g tracheostomy for laryngeal obstruction.
Prophylaxis: • Passive immunization: 3000-10000 I.U. of antitoxic serum given for contacts. • Active
immunization is usually given in the triple vaccine D.P.T. (diphtheria, pertussis and tetanus) to infant. It
is given in 3 doses one every 2 months, starting at the age of 2 months with a booster dose at 1.5 and 6
years old. • Tonsillectomy in diphtheric carrier.

Aspirasi
Incidence: usually in children and elderly. Types: Coins, fish bone, dentures or piece of meat. Site: At the
cricopharyngeus sphincter. Symptoms: Dysphagia. Investigation: Plain X-ray confirms the diagnosis.
Treatment: Removal by hypopharyngoscopy under general anaesthesia.

Abses peritonsilar
• It is suppuration of the peritonsillar space between the capsule of the tonsil and the superior
constrictor muscle. It starts as peritonsillitis and later on suppuration occurs. Fig. (10) Aetiology • Acute
follicular tonsillitis, when suppuration involves the crypts of the supratonsillar fossa that are closely
related to the capsule of the tonsil. Clinical picture: • The onset is usually preceeded by acute follicular
tonsillitis, Symptoms: • Fever, headache, malaise and aneroxia. • Local: The same symptoms of acute
tonsillitis but become more severe. § The pain is sever progressive and throbbing and may be referred
to the ear. § Painful dysphagia: This causes accumulation of saliva and leads to drooling. § Trismus: due
to spasm of the muscles of mastication. § Torticollis: towards the affected side. It is due to spasm of the
sternomastoid. § Change of voice (hot potato voice): due to accumulation of saliva, trismus, oedema and
painful mobility of the palate. Signs: • Proportional fever and tachycardia. • Local: § Unilateral swelling
of the soft palate and medial displacement of the soft palate and oedematous uvula with limited
mobility and downward and medial displacement of the tonsil. Enlarged tender cervical lymph nodes.
Differential Diagnosis: • Tumours of the tonsil (biopsy) and carotid aneurysm (blood on aspiration).
Complications: • Rupture: inhalation of discharge. • Spread of infection: Parapharyngeal abscess. •
Laryngeal oedema and suffocation. Treatment: • Conservative: Systemic antibiotic (I.V.), anti-
inflammatory analgesic, throat irrigation with warm saline in the stage of peritonsillitis before
suppuration. • Surgical: Fig. (11) Incision and drainage of the pus under local or general anaesthesia. It is
opened with quinsy knife. The incision is done at either: § The most pointing point (the best). § Through
the crypta magna. § Half cm lateral to the meeting point between a horizontal line at the base of the
uvula and a vertical line at the attachment of the anterior pillar with the tongue. • Tonsillectomy: Some
surgeons do quinsy tonsillectomy or after one month to prevent abscess recurrence.

Pseudo-croop acute epiglottitis

Aetiology: • The most common pathogen is Haemophilus influenza type B. Clinical picture: Age: infants
and children are more common than adults. Symptoms: • Rapidly progressive fever, anorexia and
malaise. • Inspiratory stridor, rapidly progressive, and potentially fatal. • Painful swallowing with
drooling and hot potato muffled voice. Signs: • Examination by tongue depressor may induce laryngeal
spasm, which may be fatal • Lateral view X-ray neck shows marked thickened epiglottis. Treatment: • It
is an emergency condition as it is life threatening. § Great care of the airway is mandatory. So
endotracheal intubation is usually needed and rarely tracheostomy. § Medical treatment as acute non
specific laryngitis in children

Croup

• It is more common in infants, especially below 2 years of age. Aetiology: • Viral infection of the
mucosal lining of the whole respiratory tract. Usually starts as simple acute rhino-pharyngitis. Clinical
picture: Symptoms: • Progressive biphasic stridor and respiratory distress. • Fever, anorexia and
malaise. Croupy cough, with expectoration of very thick tenacious sputum. Signs: difficult examination. •
Hyperemia and oedema of the mucosa of the subglottic region, trachea and bronchi. The mucosa is
covered with very viscid muco-purulent exudate. Treatment: • Similar to acute non specific laryngitis in
children. • Tracheostomy may be needed: to bypass obstruction and aspirate thick secretions.