ACUTE AND CHRONIC

DISEASES OF THE PHARYNX

Department of ENT diseases of Tashkent Medical

Academy
THE FLOORS OF THE
PHARYNX
The pharynx is a place of crossing
over the respiratory and digestive tract.
The lower boundary of the pharynx
serves as a place of transition in her
esophagus at 6 cervical vertebrae.
There are three of the pharynx:
Upper – nasopharynx
Medium – oropharynx
Lower – hypopharynx
  The pharynx connects the nose and
mouth from above, from below the
larynx and esophagus. The pharynx is
formed by muscles fibrous membranes
and inside is lined with mucous
membrane. The length of the throat of
her adult set to the lower end is 14 cm
(12-15), the transverse size of the
average equal to 4.5 cm
SAGITTAL SECTION OF THE
PHARYNX
LIMFADENOIDNOE PHARYNGEAL
RING OF PIROGOV-VALDEER

I and II - palatine tonsil

III - nasopharyngeal
IV - lingual
V and VI - tubal

Besides, there is accumulation of

tissue limfadenoidnoy on the
back of the pharynx, in the lateral
ridges and the lingual surface of
the epiglottis.
THE FUNCTIONS OF THE
PHARYNX
Swallowing and sucking
Voice-and speech production.
Breath
Defensive when eating and breathing
CLASSIFICATION OF ANGINA
OF B.S.PREOBRAJENSKIY
Catarrhal
• Follicular
• Lacunar
• Fibrinous
• Herpetic
• Necrotizing (gangrenous)
• Abscess (abscess intratonzillyarny)
• Mixed forms
PHARYNGOSCOPE WITH
CATARRHAL ANGINA
On faryngoscopy swollen
tonsils, a few, highly reddened,
their surface is covered with a
mucous discharge. The mucosa
around the tonsils is more or
less hyperemic, but diffuse
hyperemia oropharynx is not
available, which is typical for
acute pharyngitis. In more
severe cases are petechial
hemorrhages in the mucosa.
PHARYNGOSCOPE WITH
LACUNAR ANGINA
On the swollen and reddened
mucosa tonsils are formed from the
depths of the lacunae tonsillis white or
yellow caps, consisting of bacteria,
epithelial cells and rejected by a large
number of white blood cells. On the
surface of the tonsils is often formed
yellowish-white coating, which does
not go beyond the tonsils. In the
lacunar angina affected the entire
fabric of the amygdala, which,
because of the swell and increases in
volume. Plaque formation in the gaps
distinguish this form of diphtheria, in
which, apart from the lacunae,
prominent location and affected
mucosa of the tonsils.
PHARYNGOSCOPE WITH
FOLLICULAR ANGINA
Reddened and swollen on
the mucous membrane on
both tonsils appears a
significant amount of round-
the size of a pinhead, rising
slightly yellowish or
yellowish-white dots, which
are festering follicles tonsils.
Yellowish-white spots
gradually increased and
suppurate opened.
PHARYNGOSCOPE WITH
FLEGMANOZ ANGINA
Sharp protrusion tonsils,
palatal arches and soft palate to
the midline (globular formation
on the one hand the throat),
tongue is displaced in the
opposite direction, intensity, and
bulging bright redness in the
area of ​greatest bulging with
pressure-fluctuation, tongue
coated with a thick coating and
sticky saliva.
PLACE OF OPENING OF A
PERITONSILLAR ABSCESS
PERITONSILLAR TISSUE
INCISION
EXPANSION OF THE CAVITY
RETROPHARYNGEAL ABSCESS
When viewed from the back
of the throat or the feeling
of a finger is determined by
the fluctuating vapor
protruding tumor. Abscess
can spread to the region of
large vessels of the neck or
down on prespinal fascia
into the chest cavity and
cause purulent
mediastinitis.
THE LOCATION AND SIZE OF THE
OPENING OF RETROPHARYNGEAL
ABSCESS
 THE SCHEME OPENED
RETROPHARYNGEAL ABSCESS

An autopsy should be
performed with care to
avoid flowing of pus in the
larynx and vertebral lesions
and blood vessels. After
opening the abscess
immediately tilted his head
down sick.
CHRONIC TONSILLITIS
 CHRONIC TONSILLITIS
Etiology Clinic
 Microbial flora Subjective symptoms
(streptococcus and staphylococcus)  Drying, scratch, foreign body sensation in
Patogenesis the throat
 Toxic component
 Recurrent sore throat
 Allergic component
 Pain in the heart and large joints
 Neuro-reflex component
 Allocation of purulent plugs
 Violation of the immune processes
 Bad breath
Factors causing Objective symptoms
 Recurrent angina
 Umbilicus adhesion tonsils with bows
 Chronic source of infection (sinusitis,
 Purulent follicles in the tonsils
carious teeth and other)  Cchanges in septic arches (symptoms
 Reduction of general and local protective of Giza, Zach, Preobrajenskiy)
factors.  Abnormal discharge in the gaps
 Harmful environmental factors pus and caseous plug)
Classification
 Increase in regional lymph nodes
 Compensated form
 Low-grade fever
 Decompensated form
 Changes in the forms of the tonsils
(hypertrophy, atrophy)
 Simple
 Toxico-allergic form I degree
 Toxico-allergic form II degree
 Classification of chronic tonsillitis
(Preobrajenskiy - Palchun)
Chronic tonsillitis

Simple form Toxico-allergic form

I - degree II -degree
Comorbidity

Comorbidity

Comorbidity Directly related
to disease pathogenesis
 CHRONIC TONSILLITIS
Treatment Prophylaxis

 Rinsing and alkaline disinfectants  Prevention and etiology causing facto
 Lavage lacunae of tonsils rs
 Applique drugs (lubrication,  Individual and social prevention
forward into the gaps of tonsils)
 Physiotherapy (UV , ultrahigh,
electrophoresis)
 Hyposensitization treatment
 General strengthening therapy
 Low-frequency ultrasound treatment
 Bilateral tonsillectomy
 Ultrasound and cryosurgery
 CHRONIC PHARYNGITIS
Etiology
 Microbial flora
Pathogenesis
 Toxic component
 Allergic component
Factors causing
 Smoking, drinking alkogol
 Increased dustiness and
increase aerating
 Metabolic disorder, lack of
vitamins
 Pocket of infection (chronic
tonsillitis, sinusitis)
Clinical forms
 Catarrhal
 Atrophic
 Hypertrophic
Clinic
Subjective symptoms
 Drying, scratch, foreign body
sensation in the throat
 Persistent cough
 Pain when swallowing
Objective symptoms
 Edema and hyperemia of the mucous
membrane
 Muco-purulent discharge (in the back
of the throat)
 Lymphoid appearance of granules in
the rear and side walls of the pharynx
 Swelling and redness on the side walls
of the pharynx
 Bad breath
 Low-grade fever
 CHRONIC PHARYNGITIS
Treatment Prophylaxis
 Rinsing the nose and  Prevention and etiology causi
paranasal sinuses ng factors
 Alkaline inhalation and garg  Individual and social
ling prevention
 lubrication of the
pharynx drugs (lugol,
Jõks, chlorhexidine)
 Drop in oil droplets nose
 Phonophoresis
 Vitamin therapy
 Galvanokaustika and cryosu
rgery
 Adenoids
(nasopharyngeal tonsil hypertrophy)
Etiology Diagnosis
 frequent colds  general inspection
 the metabolism of protein  anterior and posterior rhinoscopy
 disturbance of endocrine function
 endoscopic examination of the
 harmful environmental factors
nasopharynx
 genetic predisposition
 finger study nasopharyngeal
Узига хос хусусиятлари
 in children 2-12 years Differential diagnosis
 occurs more frequently with  with hypertrophic rhinitis
hypertrophy tonsils  with choanal polyp
Degrees of hypertrophy
nasopharyngeal tonsil  with juvenile angiofibroma
 I degree – димог 1/3 епади
 II degree – димог 2/3 епади Treatment
 III degree – димогни бутунлай  adenotomia
епади
 Adenoids
Clinic
Subjective symptoms Objective symptoms
 respiratory failure through the  exterior signs of adenoidizm
nose  abnormal growth of the tooth-jaw
 frequent colds system
 hearing loss  hypertrophy of tonsils
 reduced memory and  signs of evaporation of the nasal
performance mucosa
 periodic headache  mucus from the nose
 sleep disturbances  respiratory failure through the
nose
 snoring
 conductive hearing loss
 "Closed" snuffles
 HYPERTROPHY OF TONSILS
Etiology
 frequent colds
 the metabolism of protein
 disturbance of endocrine function
 harmful environmental factors
 genetic predisposition
Special features
 in children 2-12 years
 occurs more frequently with
adenoids
Degree of hypertrophy of tonsils
 I degree –closes the 1/3 between the
arches and uvula
 II degree – closes the 2/3 between
the arches and uvula
 III degree – covers more than 2 / 3
between arches and uvula
Diagnosis
 pharyngoscope
 probing and palpation of the
tonsillar
Differential diagnosis
 with chronic tonsillitis
Clinic
Subjective symptoms
 speech disorder
 difficulty swallowing
 violation of mouth breathing
 sleep disturbances and snoring
Objective symptoms
 hypertrophy of tonsils
 tonsil of soft consistency and a smooth
surface
 in lakunes there is no abnormal
discharge
Treatment
 rinse binders and lubricating agents caut
erizing (on hypertrophy I-II degree)
 tonzillotomiya (on hypertrophy II-III
degree)
 PHARYNGEAL FOREIGN BODY

Nutrients Clinic
 bones (especially the fish-bone) Subjective symptoms
 solid food particles  stabbing pain when swallowing
 foreign body sensation

items
 needles, coins Objective symptoms
 denture teeth, the particles of toys  pain on palpation
 foreign body sensation
localization  hyperemia and edema around the
foreign body
 of tonsils  hypersialosis
 in vallekula and pyriform sinuses  shortness of breath
 In sides of the pharynx  low-grade fever
 in tonsil tongue
Treatment
 removal of foreign body
special features
 anti-inflammatory therapy
 more common in older people and
children  gargling
Diagnosis Prophylaxis
 anamnesis  pay attention to children
 endoscopy ENT – organs  health work
 X-ray
 BURN THE THROAT
Etiology
 unpleasant experience (attempt)  erosion, ulcers
 trauma  hypersialosis
 alcohol poisoning  shortness of breath
Types of burns  low-grade fever
 chemical Diagnosis
 thermal  anamnesis
 electrical  endoscopy ENT – organs
 radial  contrast radiography of the esophagus
Process
 esophagoscopy
 always occurs with burn the mouth and
esophagus Treatment
Clinic  neutralize poison
Subjective symptoms  antishock therapy and disintoxication
 sharp pain when swallowing throat  anti-inflammatory therapy
widening
 symptomatic treatment
 malaise, weakness
 topical treatment
 headache
Objective symptoms Prophylaxis
 redness and swelling of the mucous  labeling of chemicals
membranes of the mouth and pharynx  injury prevention in the industry
 colorful attacks related chemical  health work
composition
 SYPHILIS OF THE PHARYNX
Diagnosis
Etiology
 Endoscopy ENT – organs
 Specific pathogen - treponema
pallidum  general examination
Route of infection  Detection of the pathogen in the
lesion focus
 Oral
 serological diagnosis
 Genital
Differential diagnosis
Особенности патогенеза
 With angina
 Infection is usually an injury of
the mucous membrane  With tuberculosis of the pharynx
 The process often one-sided  With leukoplakia
 Sick newborn infants may  With tumor
Treatment
 Total specific treatment
 Local - rinse disinfectant (hydrogen
peroxide, a decoction of camomile,
etc.)
 SYPHILIS OF THE PHARYNX
Clinic
Subjective symptoms
 Discomfort in the throat
 general malaise
Objective symptoms
primary period
 Chancre in the oral mucosa, the
tongue, soft palate, at the bow,
palatine tonsil; forms: erosive,
ulcerative, unilateral regional
lymphadenitis
secondary period
(6-8 weeks)
Pink-red flushing and swelling of
the mucous membrane of the soft
palate, arches, tonsils, at least -
pustular - ulcerative syphiloderm,
papules, including erosive, plaque
on the tongue, hard palate, palatal
bow; spotted (rozeoleznaya) or
papular rash on the skin, lymph
nodes poliadenit.
Tertiary period
Single gumma (ulcers, defects) in
hard or soft palate
 NASOPHARYNGEAL FIBROMA
Objective symptoms
Contributing factors  Congestion and inflammation in the nasal cavity
 Endocrine functions and the pharynx
Tumor type  nodular, firm, bright red swelling in the
 basal nasopharynx
 Wing-maxillary  Possible facial asymmetry
 Sphene-ethmoid  Violation of nasal breathing
Localization  "Closed" snuffles
 Pharyngeal fascia, the main body of the Complications
nasopharynx  Germination in the nasal cavity and paranasal
 The periosteum of the cervical vertebrae or sinuses
the sphenoid bone  Germination in the cranial cavity
Особенности  Germination in orbit
 Develops, usually in boys aged 12 -20 years  Germination in pterygopalatine fossa
Clinic  hemorrhagic anemia
Subjective symptoms Diagnosis
 Progressive difficulty in nasal breathing  Front and rear rhinoscopy
 Repeated nosebleeds  A digital examination of nasopharynx
 Changes in voice  Craniography and carotid angiography
 Periodic headache  computed tomography
 Malaise, sleep disturbance  biopsy
Treatment
 Sclerotherapy
 Surgical removal of the tumor, with preliminary
ligation of the external carotid artery
 CANCER OF THE TONSILS
Classification Contributing factors
 Т1<2 см, Т2>2 – 4 см, Т3>4см, Т4 –  Smoking
spread to the bone and muscle;  Carious teeth and other foci of infection
 N1 – lymph nodes are moving on the  (micro) trauma tonsils
affected side Diagnosis
 N2 – lymph nodes are moving in the  Endoscopy ENT – organs
opposite side or both sides  Palpation, probing
 N3 – lymph nodes are still  cytological examination
 M1 – presence of distant metastases  Biopsy
--------------------------------------------------  Radiography of the thoracic cavity,
 Stage I – T1N0M0 cranium
Differential diagnosis
 Stage II – T2N0M0
 With benign tumors of the pharynx
 Stage III – T3N0M0
 With paratonzillyarnym abscess
 Stage IV – T4N0 - 1M0  With angina Simanovsky – Vincent
T1 - 4N2 -3M0  With Hodgkin's
T1 - 4N0 -3M1
 With syphilis of the pharynx
 CANCER OF THE TONSILS
Clinic
Subjective symptoms
 Awkwardness when swallowing
 Spontaneous pain in the throat,
radiating to the jaw and the ear
 Violation of swallowing, choking
 Changes in voice
 Malaise
Objective symptoms
 Seal with tonsil surface roughness
 Ulceration and infiltration of
tonsils with the transition to a
side wall of the pharynx and the
tongue
 Restricting the mobility of tongue
 Lockjaw masticatory muscles
 The increase in regional lymph
nodes
 Increased salivation with blood
 Fetid breath
Treatment
 radiation therapy
 surgical treatment
 combined treatment
 Chemotherapy
 symptomatic treatment