1. Dr. Abdullah R. Alkhalil College Of Medicine University Of Duhok
Chronic Pharyngitis
Dr. Abdullah R. Alkhalil
College Of Medicine
University Of Duhok

2. Chronic Pharyngitis Common condition
Male to Female Ratio is 1:1 “ Women seek medical attention more than Men”
One of the most troublesome symptom due to difficulty in diagnosis and in treatment
Wide variety of causes
Idiopathic!!!

3. Chronic Pharyngitis Nonspecific chronic simple pharyngitis Specific
syphilis TB

4. Chronic Pharyngitis Symptoms include Cervical pain Choking sensation
Chronic cough
Constant throat clearing
Dysphagia “ Improved with eating!”
Food sticking in throat

5. Chronic Pharyngitis Globus sensation Halitosis Hoarseness
Unilateral otalgia
Pharyngeal tightness
Sore throat

6. Chronic Pharyngitis
Etiology:

7. Chronic Pharyngitis BE AWARE OF THESE SYMPTOMS: Dysphagia Weight loss
Hoarseness
Haematemesis
Haemoptysis
Unilateral earache with normal eardrum
Neck swelling
Neurology

8. Chronic Pharyngitis SIGNS: Non specific Granular pharyngitis Halitosis
Tonsillar enlargment
tonsilolith

9. Chronic Pharyngitis

10. Chronic Pharyngitis
Treatment: Difficult Treat underlying causes

12. Peritonsillar abscess (Quinsy)
Etiology:
 The infection spreads to the peritonsillar area (peritonsillitis). This region comprises loose connective tissue  susceptible to formation of abscess.
Both aerobic and anaerobic bacteria can be causative. Commonly involved species include streptococci, staphylococci and hemophilus.
Epidemiology:
- occur as complication of acute tonsillitis.
- more in adults (15-30) than in children.

13. Peritonsillar abscess (Quinsy)
Clinical features
Fever, dehydration.
severe dysphagia
Edema of soft palate
Uvular deviation (downward and medially)
Involvement of motor branch of CN V  increased salivation and trismus (Persistent contraction of the masseter muscles due to failure of central inhibition)
Hot potato voice
Unilateral referred otalgia

14. Peritonsillar abscess (Quinsy)

15. Peritonsillar abscess (Quinsy)

16. Peritonsillar abscess (Quinsy)
Complications:
Airway obstruction
Bacteremia
Aspiration pneumonia secondary to rupture of abscess

17. Peritonsillar abscess (Quinsy)
Treatment:
Preferably admitted to hospital and treated with analgesics and antibiotics.
In a patient with an early peritonsillar abscess which is really a peritonsillar cellulitis incision and drainage are not recommended.

18. Peritonsillar abscess (Quinsy)
Treatment:
surgical incision and drainage of pus forming outside the capsule -- relieving the pain dramatically.
Under general anesthesia – in children and anxious pts.

19. Peritonsillar abscess (Quinsy)

20. Retropharyngeal Abscess
Retropharyngeal Space:
Entire length of neck.
Anterior border - pharynx and esophagus (buccopharyngeal fascia)
Posterior border - alar layer of deep fascia
Superior border - skull base
Inferior border – superior mediastinum
Combines with buccopharyngeal fascia at level of T1-T2
Midline raphe connects superior constrictor to the deep layer of deep cervical fascia.
Contains retropharyngeal nodes.

21. Retropharyngeal Abscess

22. Retropharyngeal Abscess
Most common symptoms
Sore throat
Odynophagia
Neck swelling
Neck Pain

23. Retropharyngeal Abscess
Pediatric
Fever
Decreased oral intake
Odynophagia
Malaise
Torticollis
Neck pain
Otalgia
Trismus
Neck swelling
Vocal quality change
Worsening of snoring, sleep apnea

24. Retropharyngeal Abscess
Imaging:
Lateral neck plain film
Screening exam
No benefit in pts with DNI based on strong clinical suspicion.
Normal:
7mm at C-2
14mm at C-6 for kids
22mm at C-6 for adults
Technique dependent
Extension
Inspiration
Sensitivity 83%, compared to CT 100%

25. Retropharyngeal Abscess

26. Retropharyngeal Abscess

27. Retropharyngeal Abscess
Treatment:
Initial therapy
Cover Gram positive cocci and anaerobes
If pt is diabetic, should consider covering gram negatives empirically.
Clindamycin, 2nd generation cephalosporin.
gentamicin and flagyl - developing nations.
IV abx alone (based on retro and parapharyngeal infections)
Patient stability and nature of lesion.
Cellulitis/phlegmon by CT.
Abscesses in clinically stable patient.
If no clinical improvement in hours proceed to surgical intervention.

28. Retropharyngeal Abscess
Treatment:
External drainage
Landmarks
Tip of greater horn of hyoid
Cricoid cartilage
Styloid process
SCM
Transoral drainage
Parapharyngeal, retropharyngeal abscesses
Great vessels lateral to abscess
Tonsillectomy for exposure
Needle aspiration

30. Retropharyngeal Abscess
Complications:
Airway obstruction
Trach 10 – 20%
Ludwig’s angina - 75%
Mediastinitis – 2.7%
UGI bleeding
Sepsis
Pneumonia
IJV thrombosis
Skin defect
Vocal cord palsy
Pleural effusion
Hemorrhage
% mortality
Multiple space involvement