Diagnosis and treatment of chronic pharyngitis in children (Alexandrov)

Author:

• Ustinova Marina Ivanovna

  otorhinolaryngologist of the highest qualification category

5.00 (Votes: 1)

Pharyngitis is a replenishment of the mucous membrane and lymphoid tissue of the oropharynx. Pharyngitis can be caused by both viral and bacterial infections. As a rule, the share of viral infections of the pharynx in children accounts for about 70%.

Causes of pharyngitis in children

Pharyngitis occurs due to the ingress of various viruses and bacteria.

There are also a number of factors

that increase the likelihood
of developing the disease:

• hypothermia;
• decreased immunity;
• throat irritation from smoke, dust and chemicals;
• lack of vitamins and microelements;
• diseases of the stomach and intestines;
• disruption of the endocrine system;
• allergic reactions.

Acute pharyngitis can also be a manifestation of inflammatory pathology of the upper respiratory tract, intestinal and general infections, etc. Viruses have little effect on the development of the disease. Usually this is a herpes and influenza virus, enterovirus, adenovirus. Among the bacterial pathogens are Haemophilus influenzae, moraxella, diplococci, streptococci of groups C, A, G, etc.

Pharyngitis can develop against the background of a fungal infection. In general, pharyngitis of viral origin accounts for 70% of cases, bacterial and other – 30%. Pharyngitis can be accompanied by measles, ARVI, scarlet fever, etc. In some cases, the causes may be foreign bodies in the pharynx or burns in this area. The chronic form of the disease is usually associated with other diseases of the ENT organs of an inflammatory nature - adenoiditis, rhinitis, stomatitis, sinusitis, tonsillitis, etc.

Causes

There are many reasons for the development of pharyngitis in childhood. The immune system is not yet fully developed, and therefore, in the presence of unfavorable factors, infection occurs especially easily. The main condition for the development of the inflammatory process is the penetration of pathogens into the mucous membrane. However, in order for them to actively develop, it is necessary to have factors that cause a decrease in the patient’s immunity. These main predisposing causes for pharyngitis are:

• impaired nasal breathing - in this case, the child is forced to breathe through the mouth, which causes hypothermia of the pharyngeal mucosa, which causes a decrease in local immunity. Also, when breathing through the mouth, a large volume of pathogens penetrates into the pharynx, which, without receiving proper resistance from the immune system, actively develop, causing inflammation;
• chronic posterior rhinitis - in which mucus from the nose, which contains a large number of pathogenic agents, flows down the back wall of the pharynx, which provokes infection and at the same time a decrease in local immunity;
• severe general hypothermia - it leads to a decrease in the body’s defenses and, as a result, the development of inflammation of the pharyngeal mucosa in the presence of even a small number of pathogens;
• sick, untreated teeth – they are a constant source of infection in the body, because of this the immune system becomes overloaded and ceases to cope with its functions;
• frequent use of vasoconstrictor drugs without medical supervision - these drugs, flowing from the nose along the back wall of the pharynx, also affect it. As a result, blood circulation in the mucous membrane is disrupted and local protection decreases;
• the presence of chronic diseases of the nasal cavity;
• vitamin deficiency - especially dangerous if the body develops a deficiency of vitamin A and B vitamins;
• irritation of the mucous membranes by overheated dry air, tobacco smoke (passive smoking in children whose parents smoke near the child) or dust;
• thermal or mechanical trauma to the pharynx - in this case, pathogens of inflammation through the damaged surface have unhindered access to the tissue, and therefore inflammation can begin even in a normal state of immunity;
• reflux of gastric juice into the esophagus and from it into the pharynx - this cause is not common in children, but can occur.

In rare cases, the cause of the development of pharyngitis is exposure to allergens on the pharyngeal mucosa. Because of them, a pathological process begins that is not associated with bacteria, viruses or fungi. At the same time, if therapy is not started in time, a secondary bacterial infection easily develops.

Whatever causes the inflammation, if it is detected, it is necessary to show the child to a specialist as soon as possible to prescribe the correct therapy. For treatment, the causative agent of the pathology must be identified and, if possible, the cause of its development is determined.

Types of disease

According to the nature of the course, the disease is divided into:

• acute – lasts up to 1 month;
• protracted – lasts more than six months with frequent exacerbations;
• chronic - can occur in several forms - atrophic, catarrhal, hypertrophic.

according to the condition of the mucous membrane :

• catarrhal – characterized by swelling and redness of the mucous membranes;
• hypertrophic - with it the mucous membrane thickens because the epithelium grows;
• subatrophic - the mucous membrane becomes thinner and atrophies.

What is chronic pharyngitis

Pharyngitis

ー inflammatory process on the mucous membrane of the pharynx. Acute pharyngitis is characterized by cough, sore throat, and pain when swallowing. If the body cannot cope with the infection due to weak immunity or improper treatment, the disease becomes chronic.

Chronic pharyngitis is characterized by the constant presence of pathogenic microorganisms in the pharyngeal mucosa and recurrent inflammation. Children with chronic pharyngitis often get sick; colds are difficult to treat and cause complications.

Symptoms and signs of pharyngitis in a child

The main signs of pharyngitis in children are:

• moderate pain;
• sore throat.

Hoarseness of voice and dry cough may also be observed. And with the reflux nature of the disease, there is a feeling of bitterness in the mouth.

In the acute form, the signs are as follows:

• dry throat, rawness, burning, soreness when swallowing;
• hoarseness of voice;
• shallow cough;
• high temperature if the disease develops against the background of a virus;
• headache;
• signs of general intoxication;
• enlargement of regional lymph nodes. Source: T.V. Kulichenko, A.M. Kabaloeva, Yu.S. Lashkova, M.A. Lazareva Diagnosis of acute pharyngitis in children // Pediatric pharmacology, 2014, v. 11, no. 4, pp. 59-66

In infants, the disease is more severe:

• sleep disturbance;
• fever;
• salivation;
• decreased appetite;
• swallowing disorder;
• conjunctivitis;
• runny nose;
• rashes on the body;
• discomfort and pain in the upper abdomen.

The chronic hyperplastic form is characterized by thickening of the mucous and submucosal layer, lymphoid tissues, dryness and sore throat, urge to vomit, painful swallowing, which radiates to the ear. Sometimes hearing loss develops because thickened tissue blocks the openings of the auditory tubes.

Usually, with pharyngitis, the temperature rises slightly. Temperatures above 38-39 degrees can only be observed if the tonsils are involved in the process.

If your child has a high fever, you should immediately consult your doctor. Experts do not recommend treating tonsillitis in a child without supervision from a pediatrician, since if treated incorrectly, the disease can lead to complications.

If pharyngitis does not go away for a long time, then it is necessary to look for the true cause of the disease.

Treatment of children with acute pharyngitis with local anti-inflammatory drugs

What are the symptoms of acute pharyngitis? What do treatment measures include? What are the features of treating infants?

Acute pharyngitis is an acute inflammation of the pharyngeal mucosa - a common manifestation of acute respiratory diseases. Typically viral in origin, it may also be associated with group A β-hemolytic streptococcus, Mycoplasma pneumoniae, or other pathogens.

As a rule, with pharyngitis, children complain of pain, discomfort in the throat (burning, soreness, itching), coughing, and sometimes itching and pain in the ears. Infants cannot complain of being unwell, but attentive parents pay attention to restless behavior, sleep disturbances, and worsening appetite. Pharyngitis can be combined with other manifestations of acute respiratory infections, such as runny nose, cough, fever, conjunctivitis.

The diagnosis of pharyngitis is made based on examination of the pharynx: there is hyperemia, swelling and infiltration of the mucous membrane of the posterior wall of the pharynx, velopharyngeal arches, and sometimes the soft palate. With lateral pharyngitis, hyperemia and swelling of the lateral ridges of the pharynx are determined. It is difficult to distinguish viral pharyngitis from bacterial pharyngitis based only on physical examination data. In both cases, during pharyngoscopy, the mucous membrane of the pharynx may be slightly hyperemic or severely inflamed and covered with a film or purulent exudate. Fever, cervical lymphadenopathy and leukocytosis are observed with both viral and bacterial pharyngitis, but perhaps they are more pronounced with the latter.

Therapeutic measures for pharyngitis include the following manipulations.

• Gargling with antiseptic, herbal solutions (for example, a solution of chlorophyllipt, rotokan, sea salt, eucalyptus, etc.) 3 - 4 times a day after meals.
• Irrigation of the pharynx with antiseptic or antibiotic-containing aerosols (such as Hexoral, Ingalipt, Cameton, Stopangin, Yox, Bioparox, Tantum Verde, etc.) 2-3 doses 2-4 times a day.
• Resorption of tablets or lozenges with an antibacterial, analgesic, emollient substance (faringosept, falimint, strepsils, laripront, etc.).
• For bacterial pharyngitis, systemic antibiotics are necessary.

Infants and young children cannot gargle or swallow tablets, so they are only prescribed to drink plenty of fluids and irrigate the throat with an antiseptic. It should be noted that children under two years of age should use all aerosols with caution due to the possibility of developing a spasm of the glottis.

The purpose of this study was to evaluate the effectiveness of a complex of local conservative measures administered to children with acute pharyngitis.

The study covered the period from October to December 2002. We observed 32 children (15 boys and 17 girls) aged 5 to 15 years (average age 9 years) with a diagnosis of acute pharyngitis. In most cases, pharyngitis was a manifestation of an acute respiratory viral infection. Children with ARVI complicated by other pathologies of the ENT organs or upper respiratory tract (sinusitis, acute catarrhal otitis media, tracheobronchitis), as well as patients with tonsillitis, were not included in the study.

The main complaints made by children are reflected in table. 1.

As can be seen from the table, the main complaints presented by children were pain, soreness and/or itching in the throat. Approximately half of the children had other signs of acute respiratory infection (runny nose, coughing). 10 children (31.3%) had a rise in body temperature (maximum up to 37.8°C), and 8 (25%) had general malaise. Sleep disturbance and loss of appetite were observed in isolated cases.

Pharyngoscopy revealed more or less pronounced hyperemia of the mucous membrane of the anterior palatine arches and the posterior pharyngeal wall in all children. Swelling and hyperemia of the lateral ridges of the pharynx were observed in 7 (21.9%) patients. In 5 (15.6%) patients, pronounced inflammatory phenomena were observed.

All children underwent the following course of conservative treatment with local anti-inflammatory drugs.

• Gargling with a 1% solution of chlorophyllipt 3 times a day.
• Irrigation of the pharynx with hexoral solution, 2 doses 2 times a day.
• Resorption of pharyngosept tablets, 1 tablet 3 times a day.

The duration of treatment was 7 days.

The effectiveness of treatment was assessed on the 4th and 7th days after the start of therapy. The criteria for the effectiveness of treatment were the following indicators:

• cessation of complaints;
• normalization of the pharyngoscopy picture;
• good drug tolerance.

The results of the treatment are presented in table. 2.

From the presented data it is clear that on the 4th day after the start of the course of treatment, complaints ceased in more than half of the patients (56.3%), the pharyngoscopic picture returned to normal in 12 patients (37.5%). By the end of treatment (on the 7th day), none of the children had any complaints; In all children, inflammatory manifestations in the pharynx were relieved. No adverse reactions were observed during treatment with these drugs in any of the subjects studied.

Thus, a set of conservative measures using local anti-inflammatory drugs is effective in the treatment of uncomplicated acute pharyngitis in children and allows one to avoid the use of systemic antibacterial agents.

R. Kh. Nurmukhametov, Candidate of Medical Sciences, Moscow

Note!

• Acute pharyngitis is an acute inflammation of the pharyngeal mucosa and is a common manifestation of acute respiratory diseases.
• Pharyngitis can be combined with a runny nose, cough, fever, and conjunctivitis.
• The diagnosis of pharyngitis is made based on examination of the pharynx
• The main complaints presented by children are pain, soreness and/or itching in the throat.
• Carrying out a set of conservative measures using local anti-inflammatory drugs is effective in the treatment of uncomplicated acute pharyngitis in children

Diagnostic methods

The diagnosis and treatment of tonsillitis in a child is carried out by a pediatrician or otolaryngologist. This disease must be distinguished from other infectious pathologies, including diphtheria and catarrhal tonsillitis. Therefore, you should also contact a pediatric allergist-immunologist and infectious disease specialist. After the examination, the doctor will prescribe laboratory tests (smear for microflora and sensitivity to viruses, bacteria, general blood test. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807738/ Thea Brennan-Krohn, Al Ozonoff and Thomas J. Sandora Adherence to guidelines for testing and treatment of children with pharyngitis: a retrospective study // BMC Pediatr. 2018; 18: 43

For recurrent forms of the disease, endoscopy of the nose and nasopharynx, consultation with an allergist, examination by a gastroenterologist, and endoscopy of the larynx will be required. All this is necessary to identify the true nature of the pathology.

Causes of chronic pharyngitis

The main cause of pharyngitis in children is infection. It can be viral (ARVI) or bacterial (streptococcus, meningococcus, etc.). Non-infectious pharyngitis appears as a result of trauma to the pharynx, foreign body, irritation of the mucous membrane with smoke or toxic fumes.

All of these factors lead to the development of acute pharyngitis. Chronication of the process is facilitated by:

• decreased body resistance (immunodeficiency, hormonal imbalance, HIV);
• the presence of a permanent lesion in the mouth or pharynx (caries, tonsillitis, adenoids, sinusitis);
• anatomical features, for example, a deviated nasal septum.

Treatment of pharyngitis in children

How to treat this pharyngitis depends on the root cause of this disease in children . It is also necessary to eliminate unpleasant symptoms and generally strengthen the body.

Treatment of pharyngitis in a child includes:

• gargling with herbal decoctions or antiseptics (for children over three years old);
• antiseptics - for rinsing and local - lozenges and lozenges;
• anti-inflammatory drugs;
• antibacterial therapy;
• a gentle diet (excluding foods that irritate the mucous membrane);
• inhalation with a nebulizer to moisturize the mucous membrane with solutions based on mineral waters. Source: T.A. Polunina, E.V. Vishneva Pharyngitis in children // Pediatric pharmacology, 2011, vol. 8, no. 5, pp. 106-108

Also for the treatment of pharyngitis, antihistamines are indicated to relieve swelling, humidify the air in the room to facilitate breathing, inhalation, and vocal rest. It is advisable that the child’s diet include food that does not irritate the throat - pureed, liquid, soft, non-spicy.

Features of the course in young children

Pharyngitis in a child aged 2 years and earlier has its own differences that all parents need to know. Due to the structure of the pharynx, even slight swelling of its mucous membrane disrupts the passage of air, and more severe swelling provokes acute suffocation. Because of this, at an early age, in most cases, the patient is indicated for hospitalization, which parents should not refuse, since if severe edema develops, even an ambulance will not have time to provide the necessary assistance. In a child over 5 years of age, this effect cannot occur due to the disease.

Also, young children tolerate intoxication much harder. Their temperature can rise to critical levels. In such situations, if it is not urgently brought down, there is a high risk of severe disturbances in mental development. Because of this, hospital treatment is also recommended.

Sometimes it happens that, against the background of the onset of the inflammatory process, the child’s temperature does not rise. Pharyngitis symptoms in children are non-standard. In such a situation, parents should pay attention to the baby’s excessive tearfulness, refusal to eat, and general apathy. The patient will sleep almost all the time and react with violent tears to feeding attempts. In this case, upon examination of the pharynx, inflammation will be immediately detected.

Clinical recommendations for prevention

It is necessary to strengthen the child’s immunity - carry out regular hardening exercises, adjust the diet so that healthy and vitamin-rich food predominates in it, and take walks in the fresh air more often. In addition, it is necessary to promptly and completely cure infections of the respiratory tract and oral cavity, not to cause caries, otitis media, sinusitis, and stomatitis. It is important to prevent and promptly treat gastrointestinal diseases. To prevent the disease from becoming chronic, you must consult a doctor in a timely manner.

The children's medical department has all the capabilities to treat various diseases, including pharyngitis. Doctors at the medical center will diagnose and prescribe treatment as soon as possible.

Sources:

1. T.V. Kulichenko, A.M. Kabaloeva, Yu.S. Lashkova, M.A. Lazarev. Diagnosis of acute pharyngitis in children // Pediatric pharmacology, 2014, vol. 11, no. 4, pp. 59-66.
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807738/ Thea Brennan-Krohn, Al Ozonoff and Thomas J. Sandora. Adherence to guidelines for testing and treatment of children with pharyngitis: a retrospective study // BMC Pediatr. 2018; 18:43.
3. T.A. Polunina, E.V. Vishneva. Pharyngitis in children // Pediatric pharmacology, 2011, vol. 8, no. 5, pp. 106-108.

Zaichenko Vladislav Sergeevich Clinic

Author of the article

Zaichenko Vladislav Sergeevich

Specialty: otolaryngologist

Experience: 19 years

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.

Prevention of pharyngitis

Everyone knows that it is much easier to prevent a disease than to subsequently treat it. In order to avoid the development of pharyngitis, the following rules must be followed:

• Try not to overcool the body.
• Limit the consumption of cold and hot foods, as well as the intake of cold and hot drinks.
• Stop smoking in the presence of your child.
• Regularly carry out wet cleaning of rooms.
• Make sure that your breathing is correct (the child should breathe through his nose - this is how the air warms up and is neutralized).
• Visit a doctor promptly if there is any suspicion of pathology of the throat and nose.

By following these rules, you can reduce the risk of developing ENT diseases in your child to a minimum.
“SM-Doctor” is a specialized clinic for children and adolescents, staffed by qualified specialists who regularly improve their professionalism. We examine and treat children in accordance with world-class medical guidelines. “SM-Doctor” provides only reasonable diagnostics and proven effective treatment. Contact professionals so that your child has good health and strong immunity!

Forecast

With timely initiation of therapy with the involvement of a doctor and in the absence of complications, the prognosis for the patient is favorable. When the disease is in an advanced state, the treatment was carried out incorrectly and negative consequences began to develop, the prognosis changes to relatively favorable, and in severe cases – to bad. Because of this, it is unacceptable to be negligent in treating the manifestations of pathology. The longer proper treatment is not carried out, the higher the likelihood that the patient’s condition will seriously deteriorate and the prognosis will change for the worse.

Diagnostics

In order to make a diagnosis, the doctor at the first appointment collects an anamnesis and examines the patient’s pharynx. Upon examination, it is possible to determine redness and swelling of the mucous membrane of the pharynx and palatine arches, as well as granularity of the posterior pharyngeal wall. These data are sufficient for the initial diagnosis of inflammation.

In order to carry out the most effective treatment, it is necessary to undergo a series of tests, which make it possible to identify the pathogen and assess the degree of the inflammatory reaction, as well as the general condition of the body.

1. Throat swab. It allows you to obtain data on the microflora of the mucous membrane and identify the pathogen. This analysis also determines which antibiotic will be more effective against specific bacteria.

2. General blood test. Determines the degree of inflammation and shows the general condition of the body.

3. General urine analysis. Not always prescribed. It is required if there is a suspicion that there are disturbances in the functioning of the urinary system.

Based on the results of the final diagnosis, the initially prescribed therapy may be slightly adjusted.

Complications

Pharyngitis is a safe disease that responds well to treatment, provided it is properly managed. If a chronic form develops, in which the symptoms become permanent, it poses a great danger and is difficult to treat. She often quotes:

• to chronic bronchitis;
• laryngitis;
• tracheitis.

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In severe cases, the development of peritonsillar abscess or acute rheumatism of the joints is possible (if pharyngitis was caused by group A beta-hemolytic streptococcus).

During pregnancy

In pregnant women, pharyngitis is a fairly common disease, since against the background of a natural decrease in immunity, bacterial and viral infections easily affect the mucous membrane. Any inflammation poses a danger to the fetus, and therefore it is important to immediately carry out the correct therapy. It is strictly forbidden to resort to self-medication. Not all drugs can be used during pregnancy, and therefore it is important to accurately select effective and at the same time completely safe drugs. Home treatment can easily lead to serious consequences, such as miscarriage, premature birth or deformities in the physical or mental development of the child. Pharyngitis during pregnancy is a serious condition that requires proper therapy.

Kinds

Doctors distinguish several types of pathology. Classification is carried out depending on the causative agent of the disease and clinical manifestations. According to the causative agent, acute pharyngitis is classified into the following types:

• bacterial;
• fungal;
• viral;
• post-traumatic;
• allergic;
• chemical;
• thermal.

According to the course of the disease there is also its division. This classification looks like this:

• catarrhal;
• granulosa (hypertrophic);
• subatrophic;
• atrophic (extremely rarely in acute form).

Determining the type of disease is of great importance for therapy, since the method of its treatment depends on what form of acute pharyngitis occurs.

Classification

Based on the course, acute, subacute and chronic forms of pharyngitis are distinguished. There is also a classification based on the condition of the pharyngeal mucosa. With catarrhal pharyngitis, the pharynx looks swollen, hyperemic, with the mucous membrane gradually acquiring a characteristic gray-pink hue. With the hypertrophic form of pharyngitis, the mucous membranes of the larynx and pharynx become thicker, with hypertrophic growth of ridges on the side of the pharynx. The palatine arches also thicken, and granulosa and nodular formations are observed at the back of the pharynx.

The subatrophic type of pharyngitis leads to focal or diffuse thinning of tissue. In this case, the mucous membranes look pale, atrophied, with thinned blood vessels.

Risk factors

Risk factors contributing to the development of pharyngitis include:

• the child eating food that is too cold (for example, ice cream);
• improper breathing (through the mouth), especially in winter;
• low level of immunity;
• lack of vitamins in the body;
• diseases of the gastrointestinal tract and endocrine system.

Allergic reactions can also provoke the occurrence of pharyngitis.

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