Pharyngitis
What is Pharyngitis?
Commonly referred to as a sore throat, Pharyngitis is the inflammation of the pharynx. The pharynx is that portion of the throat which lies just beyond the back of the roof of the mouth and up to the Adam’s apple. It usually occurs when viruses or sometimes bacteria from a cold, flu, or sinus infection involve the throat as well.
Symptoms of Pharyngitis
There are some very obvious symptoms pertaining to Pharyngitis infection that a healthcare provider looks for. Visual examination of the throat will show some indicate Pharyngitis infection. Also the healthcare provider will have to go through the medical history and ask questions about other present symptoms like:
1) Fine, red rash along lining of throat
2) Raw and swollen throat
3) Difficulty while speaking or swallowing due to pain
4) Tender, swollen lymph nodes (glands) in the neck
5) Very high fever
6) Difficulty in breathing in severe cases
7) Headache
Earache
9) Oral/throat blisters (alphthous stomatitis – in the case of viral infection).
Diagnosis of Pharyngitis
In the case of a Pharyngitis infection, a visual examination of the pharynx would show drainage or coating on the throat. The eyes are also red and the lymph nodes in the neck would be slightly swollen. If strep throat infection is suspected by the doctor, a streptococcal screen or throat swab culture may be undertaken. Additional throat cultures or blood tests may be done depending on the suspected cause. The heterophile test (a blood test to detect heterophil antibodies where positive result indicates infectious mononucleosis) can be used to diagnose Pharyngitis with glandular fever or tonsillitis.
Caution: A sore throat lasting for more than two weeks can be a sign of a serious illness like throat cancer or AIDS.
Causes of Pharyngitis
Pharyngitis is a highly contagious infection and spreads easily among family members due to constant contact. In some cases of Pharyngitis, no organism is identified but in most cases the cause can be identified.
A) Organisms causing Pharyngitis:
Bacteria: The Group-A streptococcus is the cause of 15% of the sore throat cases. A dry, nonproductive cough (similar to how a person clears his or her voice) may appear in some patients but there is more throat ache rather than cough in bacterial Pharyngitis. Tender and enlarged lymph nodes, bright red, inflamed and swollen throat (painful even to speak), very high temperature, headache, body ache (myalgia), pain in the joints (arthralgia), white or yellow spots on the back of the throat, etc are the usual symptoms. There are other rare bacteria which cause sore throat like Neisseria gonorrhoea, Corynebacterium, etc.
Viruses: There are various viruses that cause Pharyngitis like those of common cold, influenza, adenovirus, mononucleosis, HIV, etc. In the case of mononucleosis and the flu there are painful blisters in the mouth and throat. The common symptoms are very painful throat, difficulty in swallowing, fever, general ache, enlargement of neck lymph node, oral ulcers (in Herpes simplex), etc. Viral Pharyngitis comprise about 40 to 60% of all infectious cases. Other viruses like rhinovirus, coronavirus, respiratory syncytial virus, parainfluenza virus can cause infection of the throat, ear, and lungs causing standard cold-like symptoms and often extreme pain.
B) Diphtheria is a rare but serious bacterial variety of Pharyngitis. It is an upper respiratory infection which is potentially life threatening and is caused by Corynebacterium diphtheriae. This has been eradicated in those nations where vaccination programs are undertaken. It is still seen in some of the Third World countries. Antibiotics are effective in the early stages but recovery is slow.
C) Other causes of Pharyngitis:
Breathing disorders: Breathing through the mouth can produce throat dryness and soreness.
Sinus: Sinus drainage (post nasal drip) may cause a sore throat.
Reaction to other treatments: Sore throat appearing after treatment with antibiotics, chemotherapy, or other immune-compromising medications may be due to Candida, which is also called “thrush.”
Rheumatic fever: Another cause of Pharyngitis is existing Rheumatic fever. If neglected, this can lead to Rheumatic heart disease affecting the valves of the heart. Antibiotics are used to treat this problem.
D) Fungi: Some fungi like Candida albicans cause fungal Pharyngitis which is also called oral thrush.
Types of Pharyngitis
The pharynx is the most susceptible part of our anatomy. Viruses and bacteria can settle in this part of the body after inhalation along with the dust and water vapor. Infection can also arise when a person touches their nose or mouth after having touched an object or from one person to another. The foreign invader (microorganism) reproduces rapidly after settling on the body tissue of the pharynx. There are various categories of Pharyngitis, depending on the cause, but broadly it can be acute (severe but one time) or chronic (severe and persistent):
Non-exudative (dry): Viruses are the main culprits of this type of pharyngitis. Bacterium called group-A streptococci too cause non-exudative pharyngitis sometimes.
Exudative (fluid accumulation): Group-A, Group C and Group G are the bacterium causing both exudative and nonexudative pharyngitis as well as tonsillitis.
Ulcerative: Ulcerative pharyngitis is caused by either herpes virus or coxsackievirus-A. Lack of oral hygiene can further worsen the condition by causing weakness and a mild fever. The most symptom is unilateral tonsillar ulceration with a gray necrotic membrane.
Treatment of Pharyngitis
1) Symptomatic treatment: In most types of Pharyngitis, certain amount of symptomatic treatment is necessary to alleviate the discomfort and pain. Over the counter pain relievers, gargling with a half teaspoon of salt dissolved in a glass of warm water, antiseptic lozenges or throat sprays (Cepacol and Chloraseptic) can provide temporary relief from the symptoms. Nasal sprays like Afrin or decongestants like Sudafed can help in relieving some of the symptoms.
Caution: Use of lozenges and hard candy in young children could be a choking hazard.
2) Remedial treatment: For bacterial Pharyngitis, antibiotics are 
prescribed whereas for the viral infections, the cause of the Pharyngitis has to be treated to alleviate the symptoms. Treatment for strep infection has to be quick or it can lead to rheumatic fever or damage the heart valves. Symptomatic treatment has to be continued simultaneously to relieve discomfort.
Note: In the case of persistent Pharyngitis caused by exposure to toxic fumes or air pollution or industrial chemicals, the treatment entails reducing or eliminating exposure of the patient to these noxious agents.
3) Research supported treatments: Use of non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; use of steroids like dexamethasone; viscous Lidocaine which numbs the mucus membranes of the throat; etc have been tried out successfully in the recent years.
4) Alternative methods for treatment: These are not supported by medical evidence, but home remedies like eucalyptus oil and chamomile tea are known to have some distinct properties that help to ease sore throat.
Living with Pharyngitis
Most cases of Pharyngitis go away on their own, without complications. But the discomfort caused by pain while swallowing, cough, fever, fatigue, etc has to be borne while the symptoms last. Most Pharyngitis bouts last for about 7 to 10 days at the most. Pharyngitis on the whole is not life threatening. But extra care needs to be taken to cure strep Pharyngitis as quickly as possible to prevent any complications like rheumatic fever, inflammation of the kidney, bloodstream disorders or toxic shock syndrome.
Prevention of Pharyngitis 
Most cases of Pharyngitis are not preventable because the infection is usually caused by airborne microorganisms. The viruses and bacteria are commonly found in the environment. However, care can be taken to always wash ones hands after contact with a person who has a sore throat. Also, sharing cups and eating utensils with a person who has Pharyngitis should be avoided till the infection lasts.
Sexual abstinence is the only sure way to avoid infections, but this is neither practical nor reasonable. Safer sex behaviors can reduce the risk. The proper use of condoms (male and female types) decreases the likelihood of contracting a sexually transmitted disease (STD) which can cause other infections. A condom should be used from the beginning to the end of sexual intercourse. Also, it should be used every time the person engages in sex. This is even more applicable in the case of oral sex; or in the case of non-monogamous partners or possibly infected partners. In which case, treatment of all sexual partners becomes essential in order to prevent re-infection.
The World Articles in Ear, Nose and Throat (WAENT) is an online professional journal in the medical specialty of Otolaryngology which strives to bring easy access and details of interesting cases to the public on one platform. This includes details of substantive research from around the world. Articles, photographs of ailments and videos sent my member professionals are published online for the education of the entire world on various ailments.
