Pharyngitis - Sore Throat

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, is the inflammation of the pharynx.

Shutterstock Sore throat and pain when swallowing are the characteristic symptoms of pharyngitis.

Located in the back of the mouth, the pharynx is a muscle-membranous canal that allows food to enter the esophagus.
Pharyngitis can be due to different causes, including viruses (main culprits), bacteria, allergies, ascent of gastric juice from the stomach, etc.
Those who suffer from pharyngitis experience an unpleasant sensation in the throat and suffer from pain when swallowing; furthermore, if an infectious agent is causing the inflammation, the patient is also likely to exhibit the disorders of the related infectious disease (eg fever).
Generally, pharyngitis heals in a few days and without special treatments; if, however, the symptoms persist, more in-depth diagnostic tests and specific therapy may be required.

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What is the Pharynx: a brief review

Shutterstock The sections that make up the pharynx (highlighted in red) and the anatomical parts adjacent to them (in black). Anatomically, the pharynx extends from the base of the skull to the 6th cervical vertebra. From here on, begins the esophagus, a tube about 25-30 centimeters long which serves to carry food into the stomach; food that does not take the way of the larynx, thanks to the presence of the epiglottis. From the site: memorize.com

The pharynx is a muscle-membranous duct about 13 centimeters long, covered by a mucous membrane and located between the nasal cavity and the esophagus. To be more precise, the pharynx resides:

• Postero-inferior to the nasal cavity (i.e. behind and lower than the nasal cavity)
• Posterior to the mouth
• Superior to the laryngeal to the esophagus

The pharynx constitutes a fundamental tract of both the upper airways and the upper digestive tract, as it allows at the same time the progression of food towards the esophagus and the passage of air introduced with breathing and destined for the lungs.

In the pharynx, three compartments can be recognized: the nasopharynx (or nasopharynx), the oropharynx and the hypopharynx (or laryngopharynx).

The nasopharynx is the upper part of the pharynx, placed in direct contact with the choanas, or the two posterior openings of the nasal cavity.

The oropharynx is the intermediate portion of the pharynx, located between the nasopharynx and the epiglottis (the latter represents the upper end of the larynx); in front of it, it has the oral cavity, with which it communicates through the so-called isthmus of the jaws.

Finally, the hypopharynx is the terminal portion of the pharynx, which introduces food into the esophagus; being located a little lower than the epiglottis, only food and not air pass through it (as is the case for the nasopharynx and oropharynx).
The hypopharynx is positioned about the same level as the 6th cervical vertebra and about the same level as the cricoid cartilage belonging to the larynx.

For further information: Pharynx: Anatomy and Functions or exposure to toxic chemicals.

A more accurate description of the possible causes of pharyngitis is given in the following sub-chapters.

Viral pharyngitis: the causes

The main and most common viruses capable of causing pharyngitis are:

• Cold viruses, such as: Rhinovirus, Coronavirus, Parainfluenza virus, Syncytial Respiratory Virus, Adenovirus, Enterovirus and Metapneumovirus;
• The flu virus;
• The mononucleosis virus, or Epstain-Barr virus;
• The measles virus;
• The chickenpox virus (also called Herpes virus 3 or Varicella-zoster virus).

Bacterial pharyngitis: the causes

Shutterstock A Streptococcus bacterium, a possible causative agent of pharyngitis.

The main bacteria capable of inflaming the pharynx are:

• Streptococcushemolytic beta of group A (it is also the cause of scarlet fever);
• Streptococcus pneumoniae;
• Haemophilus influenzae;
• Bordetella pertussis (causative agent of whooping cough);
• Bacillus anthracis;
• Corynebacterium diphtheriae (causative agent of diphtheria);
• Neisseria Gonorrhoeae;
• Chlamydophila pneumoniae;
• Mycoplasma pneumoniae.

Streptococcal pharyngitis

When it is caused by the bacterium of the genus Streptococcus, sore throat is also called streptococcal pharyngitis.

Other Causes of Pharyngitis

Episodes of pharyngitis can also occur as a result of:

• Allergies. The pharynx of people allergic to mold, dust, pollen or animal hair is subject to repeated inflammation. In all these circumstances, so-called post-nasal (or nasopharyngeal) drip occurs, due to a massive presence of mucus at the point of communication between the nasal cavity and the nasopharynx.
• Dryness of the home or work environment. Heating buildings (houses, offices, etc.) warmer can dry out the air. If you breathe in for several hours. dry air can inflame the pharynx, as it causes nasal congestion and causes you to breathe through your mouth.
  Dry air pharyngitis is a frequent problem for those who sleep in heated (and not humidified) rooms all night.
• Chronic inhalation of irritants. Polluted air, cigarette smoke, and toxic fumes from some industrial plants contain throat irritants, which can inflame various sections of the pharynx.
• Excessive strain of the pharyngeal muscles. The muscles of the pharynx are like the muscles of the legs and arms; therefore, if subjected to excessive effort (such as when talking for a long time or screaming), they get tired and inflamed, causing all the typical sensations of a sore throat.
• Rising acid content of the stomach (gastric reflux), towards the esophagus, pharynx and sometimes even the larynx. People with recurrent episodes of gastroesophageal reflux (NB: gastroesophageal reflux disease) or pharyngolaryngeal are subject to frequent inflammation not only of the esophagus (esophagitis), but also of the pharynx and larynx (laryngitis). inflammatory process are the acidity of the rising gastric juices and the extreme sensitivity of the aforementioned anatomical structures.
• AIDS. The early stages of AIDS are characterized by a series of symptoms, reminiscent of a flu. Among the various ailments, there is also a sore throat.
  Furthermore, AIDS patients are immunosuppressed individuals (i.e. with poor immune defenses) and this predisposes them to various infectious diseases, some of which inflame the pharynx.
• Throat cancer and mouth cancer. Sore throat is one of the symptoms of cancer of the pharynx, larynx or tongue. Other symptoms are usually associated with it, such as swallowing problems, hoarseness, strange noises when breathing, blood in saliva and the appearance of bumps on the neck.
• Peritonsillar abscesses epiglottitis. A peritonsillar abscess is a collection of pus, bacteria, cellular debris and plasma, located between the tonsils and pharynx, and due to an "infection.
  Epiglottitis, on the other hand, is inflammation of the epiglottis, the valve in the larynx that regulates the passage of air into the trachea and prevents the food introduced from obstructing the airways; severe epiglottitis can cause severe breathing problems.
  Peritonsillar abscesses and epiglottitis are two conditions to be kept under close observation, as, if neglected, they could lead to serious complications.

Pharyngitis: Risk Factors

Anyone can get pharyngitis, however they are more susceptible:

• Children and adolescents;
• Smokers those who chronically breathe secondhand smoke;
• Those who suffer from allergies;
• Those who, for work reasons, breathe chemical irritants, toxic dusts etc.
• Those who suffer from chronic disinusitis. Chronic sinusitis is an inflammatory condition that affects the nasal and paranasal sinuses;
• Those who frequent or live in crowded places, such as students, kindergarten children, military barracks, prisoners, etc.
• People with a fragile immune system (immunosuppressed). The immune system is the body's protective barrier against pathogens and threats from the external environment; therefore, those who are immunosuppressed are more prone to contracting viral, bacterial, fungal infections, etc.
  AIDS, diabetes, taking corticosteroids, chemotherapy, leukemia, taking immunosuppressive drugs (for example after an organ transplant) and aplastic anemia are just some of the causes that depress the immune system of a person.

of sore throat strongly depend on the triggering causes, therefore each patient represents a case in itself.
Nonetheless, most episodes of pharyngitis are characterized by:

• Pain or itching in the back of the mouth
• Pain that becomes more acute each time you swallow or speak
• Difficulty swallowing as in normal conditions;
• Dry throat;
• Swollen and inflamed lymph nodes in the neck and jaw
• Swollen and red tonsils
• Presence of white-colored plaques or pus on the tonsils;
• Hoarse (hoarseness) and / or weak voice.

For further information: Pharyngitis Symptoms

Symptoms of Viral or Bacterial Pharyngitis

If pharyngitis is the result of a "viral or bacterial infection, in addition to the previously reported manifestations, the patient may also complain of: fever above 38 ° C, chills, cough, runny nose, sneezing, muscle and joint pain, sore head, nausea and vomiting.

Pharyngitis: when to worry

If the patient is a child, you should contact your doctor if you have difficulty breathing, difficulty swallowing and persistent drooling in the mouth (a sign of a swallowing problem).

If, on the other hand, the patient is an adult, it is advisable to call the doctor in the presence of:

• Persistent sore throat (persistent s "means in existence for more than a week), which, instead of improving over time, shows a tendency to worsen;
• Difficulty swallowing, breathing difficulties and / or problems opening the mouth;
• Joint pain
• Earache
• Rash (or rash or rash);
• Blood in saliva or phlegm
• High fever;
• Recurrent episodes of sore throat;
• Bumps on the neck
• Persistent hoarseness (in existence for more than two weeks).

(or anamnesis).

Then, depending on the situation and if there are doubts about the causes, the doctor may order a throat swab, a blood test and / or allergy tests.

Physical examination

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During the physical examination, the doctor visits the patient and asks him to describe the symptoms felt.
The visit consists in "observing the throat, ears and nasal nostrils with a micropile and adequate instrumentation, palpation of the neck and submandibular regions in search of any enlarged lymph nodes and" auscultation of the thorax with a phonendoscope.

Anamnesis

Analyzing a patient's medical history means asking the patient what particular illnesses he or she suffered in the past, what is his state of health at the time of the check (apart from sore throat), what drugs he is taking, what work he does, if is a smoker etc.
Such questions could be used by the doctor to explain non-infectious pharyngitis.

Throat Swab and Blood Test

Doctors give the patient a throat swab and blood test to determine if an infectious disease is present and, if so, identify it.
More in detail, throat swab and blood tests make it possible to trace any pathogens (both viruses and bacteria) responsible for the symptoms in progress.
In both cases, these are quick, inexpensive and completely harmless procedures for the patient.

Allergic tests

If there is a suspicion that pharyngitis is due to an allergy to some volatile or non-volatile substances (eg: dust, toxic substances, mold, pollen, animal hair, etc.), the doctor certainly resorts to allergic tests.

Pharyngitis: who to contact?

Generally, when an individual suffers from recurrent or chronic sore throat, his general practitioner directs him to an otolaryngologist, which is a doctor who specializes in treating diseases of the ear, nose and mouth.

Conditions similar to pharyngitis

Conditions that can be mistaken for pharyngitis are tonsillitis, laryngitis, and throat ulcers.

, while in the second it is necessary to set up a therapy based specifically on the triggering causes (causal therapy).

For further information: Drugs for the treatment of Pharyngitis

Sore Throat: Remedies to Relieve Symptoms

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To mitigate the symptoms of a sore throat, especially if a virus is causing it, doctors recommend:

• Rest, sleeping 7-8 hours a night and not straining your voice.
• Get plenty of fluids, especially water, to avoid becoming dehydrated. Alcoholic beverages and coffee should be avoided until the symptoms have completely resolved.
• Gargling with solutions based on heated water and salt, as they are very useful in relieving inflammation of the throat.
• Make hot-humid inhalations, to alleviate the feeling of dry throat and free the respiratory tract from mucus. Always with the same purposes, doctors also recommend hot showers and the use, in the rooms where you spend most of your time, of a portable humidifier to make the air less dry.
• Take anti-inflammatory and pain relieving medications, such as acetaminophen, ibuprofen or aspirin. These medicines are particularly indicated when the patient experiences an annoying pain in the throat, headache, fever, discomfort in swallowing, joint pain, etc.
  Attention: Individuals under the age of 16 should not be given aspirin, as it could cause the so-called Reye's syndrome.
• Do not smoke, avoid breathing second-hand smoke and do not frequent dusty and dry environments.

Bacterial Pharyngitis: Treatment and Remedies

If you have severe or potentially life-threatening bacterial pharyngitis, doctors opt for antibiotic therapy. The most prescribed antibiotic medicines are penicillin and its derivatives.
The route of administration is usually oral and treatment usually lasts until symptoms resolve.

Warning: important note on the use of antibiotics

The intake of antibiotics must take place only and exclusively on the recommendation of the treating physician.
Taking antibiotics without a specific reason or without a real need leads to the proliferation of bacteria resistant to the antibiotics themselves; in this regard, it should be borne in mind that mild bacterial infections associated with pharyngitis can resolve spontaneously.

The patient should comply with the doses and methods of administration established by the doctor, as any premature termination of treatment or incorrect use of the antibiotic can make the therapy carried out up to that point completely in vain.

(especially after using the bathroom) with soap and water or, alternatively, with alcohol-based wipes;

Avoid sharing food, cutlery, glasses, etc with other people;

Avoid resting your mouth on public telephones;

Regularly clean, with appropriate detergents, the home telephone, the television remote control, the computer keyboard, etc .;

If you are traveling, sanitize the hotel room or apartment where you are staying;

Finally, avoid direct contact with people suffering from any viral or bacterial disease.

To prevent pharyngitis associated with causes other than infectious diseases it is good practice:

• If you are dealing with toxic chemicals, irritating dusts, etc., wear air filter masks;
• If you live in a particularly polluted city, avoid spending too much time outdoors on days of heavier smog;
• Not smoking;
• Avoid breathing secondhand smoke;
• Finally, humidify your home or workplace to prevent the air from drying out too much.

Antonio Griguolo

Graduated in Biomolecular and Cellular Sciences, he obtained a Specialized Master in Journalism and Institutional Communication of Science