Chronic pharyngitis refers to persistent inflammation of the pharyngial mucosa.
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage, habitual alcohol and tobacco consumption, and, in rare cases, throat cancer, are also potential factors.
Types
Chronic pharyngitis is categorized into three types:
Hypertrophic Pharyngitis: Thickened and congested pharyngeal mucous membrane.
Atrophic Pharyngitis: A later stage of hypertrophic pharyngitis, characterized by a thin, whitish membrane.
Chronic Granular Pharyngitis: Notable for numerous swollen lymph follicles on the pharyngeal wall.
Clinical manifestations
Symptoms of chronic pharyngitis can vary but often include a persistent sore throat, fever, headache, difficulty swallowing, hoarseness, swollen lymph nodes in the neck, and intermittent postnasal drip.
Management
Chronic pharyngitis may indicate an underlying medical condition of greater significance. Without appropriate medical guidance, these conditions could remain undiagnosed.
The medical management of chronic pharyngitis focuses on alleviating symptoms, minimizing exposure to irritants, and addressing any underlying conditions in the upper respiratory, pulmonary, or gastrointestinal systems that may contribute to a persistent cough.
Nasal congestion can be relieved through short-term use of nasal sprays or medications containing phenylephrine or ephedrine sulfate. Allergy sufferers may be prescribed antihistamine-decongestant medications such as pseudoephedrine or brompheniramine. In most cases, persistent bacterial infections can be treated with antibiotics. For pain relief, patients can use acetaminophen or ibuprofen.
The non-pharmacological strategies include staying hydrated, using humidifiers, avoiding irritants, moderating alcohol and caffeine intake, maintaining a healthy diet, gargling with salt water, resting the voice, quitting smoking, managing reflux, and practicing good hygiene. These measures effectively reduce throat irritation and prevent infections, enhancing overall throat health.
Tonsillectomy, the surgical removal of tonsils, is often considered a potential treatment for chronic pharyngitis, especially in recurrent throat infections. For example, if a patient has had seven episodes in the past year or at least five episodes per year for two years, healthcare providers may suggest a tonsillectomy. The decision for tonsillectomy is typically made based on the severity and frequency of the condition, and it is a decision made by healthcare professionals.
Patient Education
Educating patients about self-care involves avoiding alcohol, tobacco, secondhand smoke, and cold or environmental/occupational pollutants. Patients can minimize exposure to pollutants by wearing a disposable facemask, preferably an N95 mask, which filters out 95% of small particles, including molds and dust. Encourage ample fluid intake to support the patient's hydration, and suggest gargling with a warm saline solution to relieve throat discomfort. Additionally, using throat lozenges can help keep the throat moistened.
