sore throat

Pharyngitis: description

The term pharyngitis (pharyngitis) actually stands for a pharyngeal inflammation: It is so inflamed here, the mucous membrane lining the pharynx. Physicians distinguish two forms of disease here – the acute and chronic pharyngitis:

An acutely inflamed pharyngitis (acute pharyngitis) is very common and usually accompanies a cold or a flu infection.

If the pharyngitis persists for more than three months, doctors speak of chronic pharyngitis. It is not the result of infection but of persistent, mucosal irritating factors such as tobacco smoke or chemical pollutants.

Pharyngitis: symptoms

The symptoms of acute and chronic pharyngitis are similar in part, but there are also differences:

Acute pharyngitis: symptoms

An acute pharyngitis usually announces with a scratching and burning in the throat. This further develops into sore throats, which often radiate up to the ears. Those affected also have pain when swallowing. The dry and rough sensation in the throat causes the patients to clear their throat often or to cough. The pharyngeal mucous membrane is reddened and – in case of additional cold – verschleimt.

If the pharyngitis is caused by the typical pathogens of acute respiratory diseases, often more complaints come along. Cold and other cold symptoms such as hoarseness or coughing, possibly also increased body temperature are typical.

In some cases, bacteria additionally colonize the virally inflamed pharyngeal mucosa (bacterial superinfection). This is usually recognized by the fact that high fever and headache are associated with the other pharyngitis symptoms. In addition, the mucous membrane in the neck is then crimson, the tonsils are swollen and have whitish-yellow coverings (tonsillitis, tonsillitis). If the patient no longer has almonds, the side strands are often crimson and swollen (sacral gangrene, lateral angina). These lateral strands are lymphatic channels that run down from the upper posterior pharyngeal wall on both sides.

Chronic pharyngitis: symptoms

The symptoms of chronic pharyngitis develop slowly over weeks. The throat feels dry, which is why people often swallow or clear their throat. Also, a feeling of lump in the throat can occur. Drowsiness (when swallowed), feeling thirsty and coughing are also symptoms of chronic pharyngitis.

The other symptoms depend on the type of chronic pharyngitis:

• Atrophic form (pharyngitis sicca): Most common form of chronic pharyngitis. The mucous membrane of the pharynx is dry, pale, especially delicate and thin (atrophic), shiny like an ivory, and covered with a little viscous mucus.
• Hypertrophic form: Throat mucosa is thickened, reddened and covered with tough mucus. There are either lenticular lymph nodules on the posterior pharyngeal wall (pharyngitis granulosa) or thickened bulging lateral strands (pharyngitis lateralis).

Pharyngitis: causes and risk factors

Acute and chronic pharyngitis have very different causes:

Acute pharyngitis: causes

Acute pharyngitis generally develops as part of a cold or influenza infection. This means: The cause of pharyngitis are usually viruses that are responsible for the typical respiratory diseases. These include adenoviruses, rhinoviruses, influenza viruses and parainfluenza viruses.

Occasionally, the viral causes of systemic diseases (whole-body disorders) also lead to acute pharyngitis. These include cytomegaloviruses, Epstein-Barr viruses (pathogens of Pfeiffer’s glandular fever), measles and rubella viruses. Only rarely are other viruses responsible for an acute pharyngitis, such as the herpes simplex virus.

The virus infection in acute pharyngitis can weaken the immune system so that even bacteria settle on the inflamed mucosa (especially beta-hemolytic streptococci). Doctors speak here of a bacterial superinfection. A purely bacterial pharyngitis, however, is very rare. Since it is caused by pathogens, the acute pharyngitis is contagious.

Chronic pharyngitis

Chronic pharyngitis, in contrast to acute pharyngitis, is not caused by viruses or bacteria and is therefore not infectious. The cause of chronic inflammation in the pharynx is rather a persistent mucosal irritation. This can have very different reasons:

• excessive tobacco or alcohol consumption
• Heartburn (regurgitation of acid stomach acid into the throat)
• dry room air in overheated rooms
• frequent inhalation of chemical fumes or dust in the workplace
• obstructed nasal breathing (for instance because of a nasal septum curvature or greatly enlarged pharyngeal tonsils)
• repeated inflammation of the paranasal sinuses
• Radiotherapy in the head or neck region
• Hormone conversion during menopause
• excessive or incorrect use of voice (such as constant hawking and coughing)

A chronically inflamed pharynx may also develop in association with chronic inflammation of adjacent organs and tissues. These include, for example, chronic runny nose (nasal mucosal inflammation), chronic angina (tonsillitis) and chronic bronchitis.

Pharyngitis: examinations and diagnosis

The doctor will first ask you about your specific complaints, for example, how long they have had a sore throat and if there are any other complaints. In chronic pharyngitis, he will ask about possible triggers, such as tobacco or alcohol abuse or chemical stress.

Important information provides the doctor with the mirror examination of the neck: He examines the pharyngeal mucosa using a small flashlight, a headlamp or a frontal mirror. In addition, he presses the tongue of the patient with a mouth spatula down to get a better look.

If the doctor discovers whitish deposits on the pharyngeal wall (suspected bacterial superinfection), he may take a swab to perform a rapid streptococcal test. If the patient has throat as well as earache, the doctor will also examine the ears. Maybe it’s just radiating pain from the pharyngitis, or maybe a middle ear infection.

If the pharyngitis persists for a long time, the doctor can use the mirror examination to determine the type of disease – chronic pharyngitis with tissue loss (atrophic form) or tissue swelling (hypertrophic form). If the cause of chronic pharyngitis is obstructed nasal breathing, he also examines the nose.

Pharyngitis: treatment

The treatment of pharyngitis depends mainly on whether it is an acute or chronic disease and whether – in acute pharyngitis – additionally bacteria have settled.

Acute pharyngitis: therapy

An acute pharyngitis is usually triggered by viruses. So it can only be treated symptomatically. For example, analgesic and antipyretic preparations (with active ingredients such as ibuprofen or paracetamol) are used. Beneficial for sore throats are lozenges, sprays or gargles with locally anesthetizing agents.

In addition, the doctor prescribed for a pharynx antibiotics, if bacteria have also taken root in the throat or cause the infection. Most of these are streptococci, which is why the doctor generally prescribes penicillin – an antibiotic that works well against these bacteria.

Chronic pharyngitis: therapy

If you want to get rid of chronic pharyngitis, you must first eliminate the triggering stimulus (tobacco, alcohol, chemicals, etc.) or at least avoid as much as possible. The cooperation of the patient is required, for example when it comes to abstaining from tobacco and nicotine.

The elimination of the cause of irritation usually already causes the inflammation to heal itself within a few weeks. This healing process can be supported, for example, with anti-inflammatory agents (ibuprofen, diclofenac, etc.), inhalations and gargles (with salt water or salve solution) and lozenges (with sage, salt, hyaluronic acid or Icelandic moss).

If a radiation treatment in the head or neck region has damaged the salivary glands and thus reduced the production of saliva, one can spray the throat with artificial saliva. This helps against dryness-related chronic pharyngitis.

Surgery is sometimes necessary if the cause of chronic pharyngitis is obstructed nasal breathing. For example, the surgeon may straighten a curved nasal septum or enlarge the openings of the paranasal sinuses.

A surgical intervention also helps with lateral pharyngitis: the proliferating, excess (hypertrophic) tissue of the lateral cords is either etched or removed with a laser.

When the chronic pharyngitis occurs in conjunction with chronic tonsillitis, almonds are often surgically removed.

Pharyngitis: home remedies

In order to recover as quickly as possible, many patients with acute pharyngitis use home remedies. Hot neck wraps or warm milk with honey keep the neck pleasantly warm. The same applies to warm herbal teas.

When making tea you can also support the healing process with the right medicinal herb: chamomile, for example, has an anti-inflammatory, ribwort soothing and bacteriostatic, and thyme and sage bacterium and virus-inhibiting. When the fever starts, it is advisable to drink lime blossom or elder flower tea – this stimulates sweat secretion. For dry, irritating cough, Mallow leaves and flowers, marshmallow root, ribwort and Icelandic moss are recommended.

Many medicinal herbs can be used in an acute pharyngitis not only in Teeform, but also for steam inhalations (such as chamomile or eucalyptus).

Mucosal-irritating factors such as nicotine, alcohol and spicy spices should be avoided with pharyngitis – especially in chronic pharyngitis. Who suffers from a pharyngitis sicca, should keep his throat mucosa as moist as possible. This means, for example: drink plenty of food, ventilate overheated rooms regularly in winter, and install water evaporators.

Pharyngitis: Disease course and prognosis

Acute pharyngitis is generally harmless and heals by itself within a few days, preferably with bed rest, home remedies, and if needed painkillers from the pharmacy.

Complications of acute pharyngitis

If bacteria are involved in the game, usually a purulent pharyngitis, which should be absolutely treated by a doctor. Otherwise there are serious complications, such as chronic tonsillitis. Such persistent tonsillitis can in turn be the starting point for severe sequelae such as rheumatic fever, kidney, heart or joint inflammation. In unfavorable cases, the affected organs carry permanent damage, such as heart valve defects.

As a further complication of a bacterial infection in the pharyngeal region, the local inflammation may spread to the surrounding connective tissue and lead to an encapsulated collection of pus (abscess) – for example near the tonsils (peritonsillar abscess). Such an abscess must be treated with antibiotics and possibly also punctured and emptied. So you want to prevent the inflammation spreads to other parts of the body, such as in the chest and to the heart (mortal danger!).

Acute pharyngitis can spread to the larynx or vocal cords (laryngitis). The patient becomes hoarse or has no voice at all. The most important tips for a laryngitis are: Do not talk or whisper and drink a lot (hot drinks!).

Course of chronic pharyngitis

Duration of chronic sore throat depends on whether and how quickly you can eliminate the triggering stimuli (tobacco, alcohol, chemical pollution, etc.).