Chronic pharyngitis (simplechronicpharyngitis) is a chronic inflammation of the pharyngeal mucosa, mostly caused by recurrent episodes of acute pharyngitis or incomplete treatment, as well as the stimulation of adjacent organ lesions such as sinusitis, tonsillitis, nasopharyngitis, bronchitis, etc.. Excessive smoking and alcohol, dust and harmful gas stimulation is also a common cause. The disease is often part of the upper respiratory tract inflammation, and is associated with certain systemic conditions such as anemia, diabetes, constipation, heart disease, nephritis, cirrhosis of the liver and other local peripheral circulation disorders. During the attack of chronic simple pharyngitis, the pharynx can have various sensations, such as foreign body sensation, dryness, burning, slight pain, etc. The pharyngeal secretions are increased and sticky, so there is often throat clearing action, spitting white mucous sputum, and in severe cases, it can cause irritating cough and nausea, vomiting. The examination of the pharynx shows diffuse congestion of the mucosa, dilated blood vessels, dark red color, with a small amount of mucous secretions, swelling or relaxation of the uvula and prolongation.
Pathologically, chronic pharyngitis can be divided into the following five categories.
1, chronic simple pharyngitis This type is more common and manifests as chronic congestion of the pharyngeal mucosa. The lesions are mainly concentrated in the mucosal layer of the pharynx, which has more lymphoid tissue infiltration around the blood vessels, and leukocyte and plasma cell infiltration is also seen. The mucosa and submucosa connective tissue hyperplasia, can be accompanied by mucus gland hypertrophy, glandular hypersecretion, mucus secretion increased and more viscous.
2, chronic hypertrophic pharyngitis, also known as chronic granular pharyngitis and pharyngolateral inflammation, chronic simple pharyngitis can form chronic hypertrophic pharyngitis, this type is also very common in the clinic. The mucosal layer of the pharynx is congested and thickened, and there is extensive connective tissue and lymphoid tissue hyperplasia in the mucus glands and lymphoid tissue proliferation around the mucus glands. The inflammatory exudate in the mucus glands may be enclosed in them, forming a cystic white spot at the top of the lymphatic granular bulge, and a yellowish-white exudate may be seen when it breaks down. This type of chronic pharyngitis often involves the lymphatic tissue of the lateral pharyngeal cord, making it hyperplastic and hypertrophic, in the form of striae.
3, atrophic and dry pharyngitis is less common in the clinic. The initial mucus gland secretion is reduced, and the secretions are thick and dry. Following the chronic inflammation of the submucosa, the gradual mechanization and contraction, compression of the glands and blood vessels, so that the glandular secretion is reduced and nutritional disorders, resulting in the mucosa and submucosa gradually atrophy thinning. The posterior wall of the pharynx can have a dry crust or pus crust attached, usually accompanied by odor.
4, chronic allergic pharyngitis, also known as chronic allergic pharyngitis. For the occurrence of IgE-mediated type I allergic reaction in the pharyngeal mucosa. Allergens stimulate the pharyngeal mucosa, so that the synthesis of IgM plasma cells into the synthesis of IgE plasma cells, IgE and attached to the surface of mast cells, basophils, so that the pharyngeal mucosa in a state of sensitization. When the same allergen comes into contact with the organism again, the allergen binds to IgE on the surface of the mediator cells, resulting in the degranulation of the mediator cells and the release of various inflammatory mediators including histamine and synthetic prostaglandins, which can cause capillary dilation, increased vascular permeability, and increased glandular secretion, causing allergic reactions. The food allergens mainly cause allergic reactions through the complement C3 and C4 pathways. Chronic allergic pharyngitis is often associated with systemic allergic diseases or allergic rhinitis, but can also develop alone. In seasonal chronic allergic pharyngitis, the symptoms can have seasonal changes. If you are allergic to food, the symptoms associated with chronic pharyngitis can occur after eating allergenic foods.
5. Chronic reflux pharyngitis is associated with gastroesophageal reflux. Gastric juices directly damage the pharyngeal mucosa due to gastroesophageal reflux or cause chronic inflammation of the pharyngeal mucosa and submucosa through nerve reflexes.
Etiology: Recurrent episodes of acute pharyngitis are the main cause of chronic pharyngitis.
1, the pharynx adjacent to the upper respiratory tract lesions such as nasal cavity, sinuses, nasopharynx chronic inflammation, can be due to inflammatory secretions through the posterior nostril backflow to the pharynx stimulation of the pharyngeal mucosa; chronic rhinitis, nasal septal deviation, chronic sinusitis, adenoid hypertrophy, snoring or nasal cavity sinus and nasopharynx occupying lesions and other diseases due to the impact of nasal ventilation, resulting in long-term open mouth breathing, causing long-term excessive dryness of the pharyngeal mucosa and lead to chronic Chronic pharyngitis; chronic inflammation of chronic tonsillitis can spread directly to the back wall of the pharynx, causing chronic pharyngitis; oral inflammation if not controlled in a timely manner, with the spread of inflammation can also lead to chronic pharyngitis.
2, climate and geographical environmental changes in temperature, humidity changes, poor air quality, tobacco and alcohol stimulation, spicy irritating food, dust, harmful gases and radioactive irradiation is also the cause of chronic pharyngitis.
3, occupational factors such as teachers, singers and susceptible physical factors can also cause the disease.
4, systemic factors such as anemia, indigestion, gastroesophageal reflux, heart disease (due to blood circulation disorders affecting the pharynx venous reflux caused by local stasis in the pharynx), chronic bronchitis, bronchial asthma, rheumatism, liver, kidney disease, etc., can also cause chronic pharyngitis. Endocrine disorders, autonomic dysfunction, infection with Mycobacterium odoratum and Mycobacterium diphtheriae, vitamin deficiency and immune dysfunction are related to atrophic and dry pharyngitis.
5, allergic factors inhalation allergens (including seasonal and perennial allergens), drugs, chemical irritants in the work environment and food allergens can cause allergic pharyngitis.
Clinical manifestations
Chronic pharyngitis is most often seen in adults, but can also occur in children. None of the systemic symptoms are obvious, and local symptoms predominate. The symptoms of chronic pharyngitis are similar and varied, such as pharyngeal discomfort, foreign body sensation, pharyngeal secretions that cannot be easily removed, itching, burning, dryness or irritation in the pharynx, and slight pain. The irritating cough and nausea often appear in the morning due to chronic inflammation of the posterior pharyngeal wall, which usually results in sticky secretions, and nocturnal open-mouth breathing due to nasal, sinus, and nasopharyngeal lesions. Frequent swallowing may be manifested due to foreign body sensation in the pharynx. Those who have little pharyngeal secretions and do not easily cough up often show a habitual dry cough and throat-clearing coughing action, if coughing or throat-clearing force can cause bleeding in the pharyngeal mucosa, resulting in secretions with blood.
1, chronic simple pharyngitis examination can be seen in the pharyngeal mucosa chronic congestion, small blood vessels varicose, dark red, the surface of a small amount of sticky secretions.
2, chronic hypertrophic pharyngitis pharyngeal examination can be seen in the posterior wall of the pharynx multiple granular follicular bulge, chronic congestion, sometimes fused into one, in the top of the lymphatic granular bulge can form a cystic white point, broken when visible yellow-white exudate, pharyngeal lateral cord lymphatic tissue can be thickened in the form of strips.
3, chronic atrophic pharyngitis or chronic dry pharyngitis pharynx with dry crust, accompanied by bad breath. Examination of the pharyngeal mucosa dry, thin, heavy scaly, shiny. The lesion may be covered with purulent dry crusts and may cause tinnitus and hearing loss if the lesion continues to the eustachian tube. If it spreads to the larynx, it can cause hoarseness.
4, reflux pharyngitis pharyngeal specialist examination as chronic simple and hypertrophic pharyngitis, pharyngeal reflux may be accompanied by vocal cord nodules, vocal cord polyps and hoarseness.
These symptoms are often aggravated by excessive use of the voice, sudden changes in climate, changes in ambient temperature and humidity, especially in atrophic and dry pharyngitis.
The diagnosis is based on the patient’s history of continuous pharyngeal discomfort for more than 3 months, combined with the patient’s chronic congestion of the pharyngeal mucosa, small vascular varices, dark red color, a small amount of mucous secretions on the surface or multiple granular follicles bulging from the posterior pharyngeal wall with chronic congestion, thickening of the lymphatic tissue of the lateral pharyngeal cord in the form of striae, or dry, thin pharyngeal mucosa covered with purulent dry crust, chronic pharyngitis can be diagnosed, but it should be noted that many systemic diseases (especially tumors) may only be diagnosed in the early stages. However, it should be noted that many systemic diseases (especially tumors) may only have symptoms similar to those of chronic pharyngitis in their early stages. Therefore, when the complaints and physical findings do not match or there are other suspicions, the diagnosis of chronic pharyngitis should not be made hastily, but a detailed history must be taken and a comprehensive examination of the nose, pharynx, larynx, trachea, esophagus and neck and even occult lesions of the whole body must be performed to avoid missing the diagnosis. For the diagnosis of chronic allergic pharyngitis, in addition to the corresponding history of allergen exposure, the corresponding symptoms and signs, skin allergen tests, total IgE and serum specific IgE tests should be done to clarify the allergens. Gastroesophageal reflux-related tests are feasible for chronic reflux pharyngitis.
Differential diagnosis
1, chronic tonsillitis can also be manifested as pharyngeal foreign body sensation, pharyngeal itching, dryness, pain, irritating dry cough and other uncomfortable symptoms, which can be accompanied by intermittent coughing in the pharynx of small rice-sized yellow bean residue with a foul odor. Patients with chronic tonsillitis may have hyperplastic tonsils, scarring of the tonsil surface, unevenness, adhesions with surrounding tissues or emboli in the tonsillar fossa.
2.Benign and malignant masses in the pharynx or adjacent areas are benign masses such as papilloma, fibroma, hemangioma, lipoma, smooth muscle tumor and nerve sheath tumor in the oropharynx and hypopharynx, nasopharynx, larynx and esophagus, and malignant tumors such as squamous cell carcinoma, sarcoma and lymphoma in the oropharynx and hypopharynx. Oropharyngeal, hypopharyngeal, nasopharyngeal and laryngeal lesions can be detected through otorhinolaryngological examination, nasal endoscopy and fiberoptic laryngoscopy; early esophageal cancer patients often have only pharyngeal discomfort or posterior sternal pressure before swallowing dysfunction appears, which is easily confused with chronic pharyngitis and should be diagnosed through esophagogram and esophagoscopy. For patients above middle age, if there are no previous obvious symptoms of pharyngitis and pharyngeal discomfort occurs, corresponding detailed examination should be performed.
3. Stem syndrome, hyoid syndrome and pharyngeal susceptibility syndrome may have the same pharyngeal symptoms. They can be differentiated from chronic pharyngitis by palpation, stem and hyoid bone x-ray, cervical spine x-ray and CT scan.
4. In addition to pulmonary tuberculosis with pharyngeal tuberculosis, patients with pulmonary tuberculosis are usually accompanied by chronic pharyngitis.
5, gammaglobulin deficiency This disease occurs in children and young people, with a history of recurrent acute or chronic respiratory tract inflammation, the pharyngeal changes are a significant reduction or loss of lymphatic tissue.
Treatment
1, remove the cause of the disease quit smoking and alcohol, actively treat the original cause of chronic pharyngitis (acute pharyngitis, chronic inflammation of the nose and nasopharynx, reflux gastroesophageal disease, improve the work and living environment).
2, lifestyle changes to carry out appropriate physical exercise, normal work and rest, light diet, maintain a good psychological state to enhance their overall immune function to improve the local functional state of the pharyngeal mucosa.
3.Local treatment
(1) chronic simple pharyngitis commonly used compound borax, furacilin solution, etc. gargle to keep the mouth and throat clean; or containing iodine throat tablets, mint throat tablets and other throat tablets for the treatment of chronic inflammation of the pharynx; Chinese medicine preparations such as chronic pharyngitis also has a certain effect; locally available compound iodine glycerin, 5% silver nitrate solution or 10% weak protein silver solution coated pharynx, astringent and anti-inflammatory effect; ultrasonic nebulization can relieve Chronic pharyngitis symptoms; generally do not need antibiotic treatment.
(2) Chronic hypertrophic pharyngitis is more difficult to treat and can be referred to chronic simple pharyngitis. In addition to the above methods, the lymphatic follicles in the back wall of the pharynx can also be treated with chemical drugs or electrocoagulation, freezing or laser treatment methods. Chemical drugs are mostly used to cauterize the hypertrophic lymphatic follicles with 20% silver nitrate or chromic acid solution. The electrocoagulation method is rarely used nowadays because of more side effects, and laser or radiofrequency therapy is mostly used to treat lymphatic follicles in the posterior pharyngeal wall. The above methods of treating lymphatic follicles may increase mucosal scarring and have the potential to aggravate symptoms. In addition, ultrasonic nebulization therapy, local ultraviolet light irradiation and transheat therapy also have auxiliary effects on hypertrophic pharyngitis.
(3) Atrophic and dry pharyngitis is generally treated as chronic simple pharyngitis, but cautery method should not be used. Small doses of iodine can be taken or applied locally to the pharynx to promote increased mucosal epithelial secretion; ultrasonic nebulization therapy can also reduce the symptoms of dryness. Vitamin A, B2, C and E can be taken to promote the growth of mucosal epithelial tissue in the pharynx. For patients with dry pharyngitis, caution should be exercised when considering tonsillectomy to avoid aggravation of the disease after surgery.
(4) Chronic allergic pharyngitis avoid exposure to various possible allergens, application of antihistamines or mast cell stabilizers, local or short-term systemic application of glucocorticoids and immunomodulators, etc.
(5) Chronic reflux pharyngitis avoid foods that promote gastric acid secretion, such as chocolate, spicy and stimulating foods to reduce the reflux situation in the throat to reduce the irritation of the pharyngeal mucosa; control the amount of food and water intake 3 to 4 hours before bedtime. In addition to the general treatment of chronic pharyngitis, gastric acid inhibitors and gastric mucosal protectors can be used in conjunction with treatment, as well as active treatment of stomach disorders.
Predisposed people
1. Long-term smokers and drinkers who often irritate the pharynx.
2, the pharynx has a history of disease, such as rhinitis, sinusitis people, easy to make the pharynx infected resulting in chronic pharyngitis.
3, often in the dusty, irritating odor of the work environment of people, prone to chronic pharyngitis.
4, the immune system is also prone to chronic pharyngitis, such as diabetics, cardiovascular patients are significantly higher than the normal population.
5, a few cervical spondylosis can also cause chronic pharyngitis, cervical spine osteophytes, compression of nerves, may also directly or indirectly stimulate the pharynx and cause inflammatory symptoms.
6, dry cough for a month or two is not good, most likely due to respiratory allergies triggered by chronic pharyngitis.
Note: There are many people who, once diagnosed with chronic pharyngitis, ask their doctors to prescribe antibiotics for treatment, and some patients even buy antibiotics from pharmacies to take on their own. They think that since chronic pharyngitis is an inflammatory condition, it should be treated with antibiotics, which is wrong. Chronic pharyngitis generally does not need to be treated with antibiotics because chronic pharyngitis is not a bacterial infection. Misuse of antibiotics is harmful but not beneficial for chronic pharyngitis because misuse of antibiotics may lead to dysbiosis of the normal flora in the throat. In addition, misuse of antibiotics can also cause bacterial resistance, leading to more and more high-grade antibiotics and longer and longer dosing times. It should be noted that if the patient has fever, acute congestion and swelling of the pharyngeal mucosa, and increased white blood cells in routine blood tests, he should be treated with broad-spectrum antibiotics under the guidance of a doctor, or the corresponding antibiotics should be selected according to the drug allergy test, but only for 3~5 days, and the drug should be stopped after the acute symptoms disappear. At the same time, patients need to take rest, drink more water, and eat liquid food.
Prognosis: chronic simple pharyngitis can be relieved until cured after controlling various causative factors, maintaining good living habits and applying various treatments, otherwise it may be extended to become chronic hypertrophic pharyngitis; chronic hypertrophic pharyngitis and chronic atrophic or chronic dry pharyngitis are poorly treated and the symptoms are prone to recurrence; chronic allergic pharyngitis can be relieved until it disappears after getting rid of allergens; chronic reflux pharyngitis can be relieved until it disappears after controlling gastroesophageal The symptoms of chronic reflux pharyngitis can be significantly relieved until cured after controlling gastroesophageal reflux.
Prevention
1, eat foods rich in collagen and elastin, such as pig’s feet, pig skin, hoof, fish, beans, seafood, etc., is conducive to the repair of chronic pharyngitis damage parts.
2, more intake of food rich in B vitamins, such as animal liver, lean meat, fish, fresh fruit, green vegetables, milk, beans, etc., is conducive to promoting the repair of the damaged pharynx and eliminating inflammation of the respiratory mucosa.
3, eat less or do not eat fried, spicy and irritating food, such as: doughnuts, sesame balls, fried cake, chili, garlic, pepper, etc.
4, often drink some pharyngeal fluid therapeutic drinks, the following two examples for reference: green tea and honey drink: green tea 5 grams, the right amount of honey. Green tea in a cup, brewed into boiling water, add honey to drink, 1 dose daily. It can clear the heat and throat, moisten the lungs and produce fluid. Lily and mung bean soup: 20 grams of lily, 50 grams of mung beans, the right amount of rock sugar. Boil lily and mung beans with water, add rock sugar and drink, 1 dose daily. It can clear heat and moisten the lung, nourish yin and produce body fluid.