Chronic pharyngitis is a diffuse chronic inflammation of the mucosa, submucosal tissue, and lymphoid tissue of the pharynx, often associated with chronic inflammatory conditions of the upper respiratory tract. It is more commonly observed in adults, characterized by a prolonged course and persistent symptoms, with difficulty achieving complete resolution.
Etiology
Local Factors
These include:
- Recurrent episodes of acute pharyngitis.
- Chronic nasal and respiratory tract inflammation, prolonged mouth breathing, repeated irritation of the pharynx by inflammatory secretions, or the influence of chronic tonsillitis and periodontitis.
- Excessive smoking and alcohol consumption, exposure to dust, spicy foods, harmful gases, or allergens.
Systemic Factors
These include anemia, indigestion, pharyngolaryngeal reflux, chronic lower respiratory tract inflammation, cardiovascular diseases, endocrine disorders, rheumatic fever, vitamin deficiencies, and immune dysfunction.
Pathology
Chronic Simple Pharyngitis
The pharyngeal mucosa exhibits congestion, connective tissue and lymphoid tissue hyperplasia in the submucosa, thickening of the squamous epithelial layer, and an increase in subepithelial small blood vessels accompanied by lymphocyte infiltration. Mucous glands are hypertrophic and show increased secretion.
Chronic Hypertrophic Pharyngitis
Mucosal thickening and congestion are more pronounced, with extensive connective tissue and lymphoid tissue hyperplasia in the submucosa. Lymphoid tissue proliferation around the mucous glands forms multiple granular elevations on the posterior pharyngeal wall. Lymphoid hyperplasia in the lateral pharyngeal bands is also common, presenting as cord-like thickened structures.
Atrophic and Dry Pharyngitis
This is rare in clinical practice, with unclear etiology. Patients often coexist with atrophic rhinitis. The main pathological changes include reduced glandular secretion, mucosal atrophy, thinning, and dryness.
Clinical Manifestations
There are usually no obvious systemic symptoms. Patients may report a foreign body sensation, itching, burning, dryness, or mild pain in the throat. The presence of sticky secretions adhered to the posterior pharyngeal wall can provoke frequent irritation and coughing, especially in the morning, accompanied by nausea. No sputum or only small granular mucous-like secretions may be coughed up. Patients with atrophic pharyngitis may occasionally expel foul-smelling crusts.
Examinations
Chronic Simple Pharyngitis
The mucosa appears congested with dilated blood vessels. Scattered lymphoid follicles are observed on the posterior pharyngeal wall, often accompanied by small amounts of thick, sticky secretions adhering to the mucosal surface.
Chronic Hypertrophic Pharyngitis
The mucosa is thickened and congested, with significant lymphoid hyperplasia on the posterior pharyngeal wall. These appear as multiple scattered elevations or fused patches. The lateral pharyngeal bands are also congested and hypertrophic.
Atrophic and Dry Pharyngitis
The mucosa is dry, atrophic, and thinned, appearing pale and shiny. Sticky secretions or foul-smelling yellow-brown crusts may be present.
Diagnosis
Diagnosis is typically not difficult. However, it is important to note that many systemic diseases present with early symptoms resembling chronic pharyngitis. Thorough inquiry into the patient’s medical history and comprehensive examinations of the nose, pharynx, larynx, trachea, esophagus, neck, and the entire body for hidden abnormalities are essential. Particular attention should be given to the possibility of early-stage malignancies. A diagnosis of chronic pharyngitis should not be made without excluding these conditions.
Treatment
Etiological Treatment
Emphasis is on outdoor activities and avoidance of harmful habits such as smoking and alcohol use. Efforts to maintain clean and fresh indoor air and active management of chronic conditions such as rhinitis and tracheobronchitis are important. Treatment of relevant systemic diseases is also necessary.
Local Treatment
Chronic Simple Pharyngitis
Common treatments include gargling with compound borax solution, furacilin solution, or compound chlorhexidine solution. Tilting the head back and pronouncing an “ah” sound during gargling allows the rinsing solution to clean the posterior pharyngeal wall. Iodine lozenges may also be used.
Chronic Hypertrophic Pharyngitis
In addition to the treatments mentioned above, laser therapy or low-temperature plasma therapy may be applied. When lymphoid follicular hyperplasia is extensive, treatment is typically conducted in stages. Medication (e.g., silver nitrate), cryotherapy, or electrocautery may also be utilized, although the treatment area should not be excessively broad.
Atrophic and Dry Pharyngitis
Application of 2% iodoglycerol to the pharynx can improve local blood circulation and stimulate glandular secretion. Administration of vitamins A, B, C, and E may promote epithelial growth of the mucosa.