Acute Pharyngitis

Acute pharyngitis is an inflammation of the pharynx, the mucous membranes, and the underlying tissues and lymphoid structures.[1] It often follows acute rhinitis or tonsillitis or can be part of an upper respiratory tract infection. It may also be a local manifestation of a systemic illness or a preliminary symptom of an acute infectious disease.

The inflammation can affect the entire pharynx or only a part of it. Viruses are the most common cause, accounting for 80-90% of cases in both adults and children.[1][2] Common viruses include those responsible for the common cold and flu, such as Rhinovirus, Coronavirus, and Adenovirus.[1][3] Bacterial infections, though less frequent, can also cause pharyngitis, with Group A Streptococcus (strep throat) being the most common bacterial culprit.[2][4] In severe cases, the infection is often caused by hemolytic streptococcus.

Several factors can trigger the onset of acute pharyngitis, including exposure to dampness and cold, fatigue, and excessive smoking or alcohol consumption. Existing conditions like sinusitis, adenoiditis, or tonsillitis, or chronic systemic diseases that lower the body’s resistance can also lead to its development. Environmental pollution, such as exposure to harmful gases or high concentrations of dust, and working in high-temperature environments can also be contributing factors. Additionally, acute pharyngitis can be an early symptom of infectious diseases like measles, scarlet fever, influenza, and epidemic cerebrospinal meningitis.

Acute pharyngitis can be classified into three types:

• Acute simple pharyngitis

• Acute necrotic pharyngitis

• Acute edematous pharyngitis

Treatment

General recommendations for patients include getting plenty of rest, staying hydrated by drinking lots of water, and consuming easily digestible foods. It is also important to maintain regular bowel movements. For severe throat pain, oral acetylsalicylic acid may be recommended.

Local treatments for the throat can include gargling with a compound borax solution or warm saline solution. Alkaline gargles can help to thin and loosen thick mucus. In the early stages of the illness, applying iodine glycerin or silver nitrate to the pharyngeal wall can help reduce inflammation. If the inflammation spreads to the larynx, medication can be administered through nebulizer inhalation therapy. The use of aerosolized hormones can improve symptoms and quality of life.

Antibiotics are a common treatment, with penicillin often being the first choice due to its effectiveness against hemolytic streptococcus.[5]

For necrotizing pharyngitis, it is best to perform a bacterial culture to identify the appropriate antibiotic. High-dose intravenous penicillin is often the first choice, or an antibiotic selected based on drug sensitivity tests. For this type of pharyngitis, the oropharynx can be rinsed with a potassium permanganate solution. However, it is important to avoid scraping or removing the necrotic tissue locally to prevent severe bleeding, and the use of caustic medications is prohibited.

For acute edematous pharyngitis caused by an allergic reaction, once diagnosed, intravenous dexamethasone and antihistamines should be administered.[6] This can provide relief, but close monitoring of the patient’s breathing is necessary. Oxygen may be given if needed. If the larynx is affected, it should be treated as angioneurotic edema of the larynx, and in some cases, a tracheotomy may be necessary.