A.

Anatomy and Physiology

The pharynx is part of both the respiratory and digestive system. Both systems have
entrances to the pharynx but they are separated from each other by the soft palate. During exercise
or during respiratory distress, the mouth can be used as an additional opening of the respiratory
system and then the oropharynx also becomes an air-way.
The pharynx can be split into different regions - the oropharynx, laryngeal pharynx also
referred as the oesophageal pharynx and the nasopharynx.
The opening of the larynx is on the floor of the pharynx. Caudal and dorsal to the laryngeal
opening is the opening into the oesophagus. In the dorsal region of the nasopharynx, there are
paired openings into the auditory tubes.
The lining of the middle ear cavity and auditory tube is continuous with that of the
nasopharynx.
The pharynx is located between the base of the skull and the first two cervical vertebrae
dorsally and the larynx ventrally. The mandible, pterygoid muscles and hyoid apparatus are located
laterally. Laterally, two pairs of palatopharyngeal arches are present from the soft palate to the
oesophagus.
The walls of the pharynx contain striated muscle. During swallowing, the soft palate is raised
which divides the pharynx into dorsal and ventral sections.
The dorsal compartment is the nasopharynx and the rostral compartment is the oropharynx.
The laryngeal pharynx is separated from the oropharynx by the epiglottis. Tonsils are present on
the lateral walls of the oropharynx and are covered by flaps of mucosa.
The tonsils are two masses of lymphoid tissue placed one in each tonsillar fossa and
projecting into the oropharynx. These are dense compact bodies of lymphoid tissue that are located
in the lateral wall of the oropharynx, bounded by the palatoglossus muscle anteriorly and the
palatopharyngeus and superior constrictor muscles posteriorly and laterally.
Each tonsil is composed of tissue similar to lymph nodes, covered by pink mucosa.
Running through the mucosa of each tonsil are pits, called crypts.
The tonsils are also a part of the lymphatic circle which surrounds the oropharynx called
the walder's ring and also helps to fight infections. However, removal of the tonsils does not seem to
increase susceptibility to infection. Tonsils vary widely in size and swell in response to infection.
The mucous membrane and their pharyngeal surface is marked by small apertures which indicates
the opening of the crypts. The epithelial lining of the crypts are reflected from the surface covering
In the neighboring part of the pharynx near the Eustachian tube, the upper part of the pharynx and
the base of the tongue, there are masses of lymphoid tissue similar to the structure of the tonsils
which also contains crypts
B. Pathophysiology
Tonsillopharyngitis is acute infection of the pharynx or palatine tonsils or both. Symptoms may
include sore throat , dysphagia, cervical lymphadenopathy, and fever . Diagnosis is clinical,
supplemented by culture or swift antigen test. Treatment is dependent on symptoms and involves
antibiotics .
Tonsillopharyngitis is usually viral, most regularly caused by the adjectives cold viruses
(adenovirus, rhinovirus, influenza , coronavirus, respiratory syncytial virus), but occasionally by
Epstein-Barr virus , herpes simplex virus , cytomegalovirus , or HIV . In Some cases, the cause is
bacterial . Group A -hemolytic streptococcus (GABHS) is most adjectives, but Staphylococcus
aureus, Streptococcus pneumoniae, Mycoplasma pneumoniae, and Chlamydia pneumoniae are

sometimes involved. Rare causes include pertussis , Fusobacterium, diphtheria , syphilis , and
gonorrhea.
The inflammation and infection of tonsil crypts rather than the tonsils themselves.