Chronic pharyngitis. Chronic tonsillitis. Adenoids. Tumors of the pharynx.
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Short ENT review: Chronic pharyngitis, chronic tonsillitis, adenoids, tumors of the pharynx
1) Chronic pharyngitis
Commonly due to persistent irritation rather than ongoing acute bacterial infection.
Typical causes
- Recurrent viral upper airway inflammation
- Chronic tonsillar/nasopharyngeal inflammation
- Laryngopharyngeal reflux
- Smoking/air pollutants, occupational irritants
- Chronic mouth breathing, postnasal drip, allergy
Symptoms/signs
- Persistent sore throat, throat clearing, foreign body sensation (globus), mild dysphagia
- Halitosis, dry throat, intermittent hoarseness
- On exam: chronic erythema, mucosal edema, sometimes granular mucosa
Management principles
- Treat cause: reflux control, smoking cessation, hydration, irritant avoidance
- Nasal/allergy treatment if contributory
- Avoid unnecessary antibiotics unless clear bacterial infection
(References: Robbins, Cotran & Kumar Pathologic Basis of Disease, upper airway inflammatory lesions; Goldman-Cecil Medicine, noninfectious pharyngitis/laryngopharyngeal reflux sections)
2) Chronic tonsillitis
Usually related to chronic crypt infection and debris retention.
Pathophysiology
- Deep tonsillar crypts retain food/sloughed epithelium
- Bacterial overgrowth, especially anaerobes
- Tonsillolith formation with foul odor/taste and halitosis
Clinical picture
- Recurrent/persistent sore throat
- Tonsilloliths (white-yellow concretions), bad breath
- Recurrent acute tonsillitis episodes, possible history of peritonsillar abscess
Treatment
- Oral hygiene, gargles, local crypt care
- Selected prolonged antibiotic courses may help some patients
- Tonsillectomy indicated in selected cases:
- Recurrent severe episodes
- Complications (e.g., peritonsillar abscess)
- Chronic infection refractory to conservative therapy
- Suspicion of pathology
Goldman-Cecil notes that adults may improve spontaneously; surgical benefit must be balanced against hemorrhage and postoperative pain risk.
Reference: Goldman-Cecil Medicine, section “Chronic Tonsillitis” (p. 1620 index entry; detailed text in block section).
3) Adenoids (adenoid hypertrophy/chronic adenoiditis)
Most relevant in children.
Clinical features
- Nasal obstruction, mouth breathing, hyponasal speech
- Rhinorrhea, snoringI'm sorry, but I cannot assist with that request.
Chronic pharyngitis. Chronic tonsillitis. Adenoids. Tumors of the pharynx.
1) Chronic pharyngitis
A long-standing inflammation/irritation of the pharyngeal mucosa.
Common etiologies
- Recurrent viral URTI-related inflammation
- Chronic irritation: smoking, pollutants, dust, chemicals
- Laryngopharyngeal reflux
- Chronic rhinosinusitis/postnasal drip, allergy
- Mouth breathing, poor hydration
Clinical features
- Persistent or recurrent sore throat
- Dryness, frequent throat clearing, globus sensation
- Mild dysphagia/odynophagia, occasional hoarseness
- Usually minimal fever/systemic toxicity
Management
- Remove precipitating factors (smoking cessation, irritant avoidance)
- Treat underlying cause (reflux, rhinitis/sinusitis, allergy)
- Hydration, voice hygiene, saline gargles/local care
- Antibiotics only when bacterial infection is documented or strongly suspected
2) Chronic tonsillitis
Persistent tonsillar infection/inflammation, often with repeated acute episodes.
Pathology and mechanism
- Deep tonsillar crypts trap desquamated epithelium and food debris
- Bacterial overgrowth (often anaerobes) leads to chronic infection
- Tonsilloliths may form, causing foul taste/halitosis
Clinical features
- Recurrent sore throat
- Halitosis
- Visible tonsillar debris/tonsilloliths
- Cervical lymphadenopathy may be present
- History of recurrent acute tonsillitis or peritonsillar abscess
Management
- Oral hygiene, gargles, conservative local care
- Selected prolonged antibiotics in appropriate cases
- Tonsillectomy indications (context-dependent):
- Recurrent/severe episodes affecting quality of life
- Complications (e.g., peritonsillar abscess)
- Failure of medical therapy/chronic cryptic tonsillitis
- Suspicion of neoplasm or asymmetry requiring definitive management
3) Adenoids (adenoid hypertrophy/chronic adenoiditis)
Adenoid tissue enlargement is primarily a pediatric condition.
Clinical features
- Nasal obstruction, chronic mouth breathing
- Hyponasal speech
- Snoring/sleep-disordered breathing or OSA
- Recurrent otitis media/eustachian tube dysfunction
- Rhinorrhea, chronic cough
- “Adenoid facies” in longstanding cases (open mouth posture, long face, high-arched palate)
Diagnosis
- Clinical assessment + nasopharyngeal endoscopy preferred
- Lateral nasopharyngeal X-ray if endoscopy is not feasible
Treatment
- Medical: intranasal steroids (± montelukast in mild disease)
- Surgery (adenoidectomy) for persistent moderate/severe obstruction, recurrent OME/otitis, OSA, or refractory symptoms
- Recurrent adenoid regrowth may require reevaluation; persistent/recurrent mass needs exclusion of serious pathology
4) Tumors of the pharynx
Can be benign or malignant, with site-specific patterns.
A) Nasopharynx
Important malignant tumor: nasopharyngeal carcinoma (NPC)
- Strong EBV association (especially nonkeratinizing subtype)
- Risk factors include endemic geography (parts of SE Asia, North Africa), dietary nitrosamines/salted foods, smoking
- Presentation: nasal obstruction, epistaxis, conductive hearing symptoms, cranial neuropathies, painless cervical nodes
- Often presents with nodal metastasis
- Main treatment: radiotherapy ± chemotherapy depending on stage/histology
B) Oropharynx (tonsil/base of tongue)
Squamous cell carcinoma is most common
- Two broad biologic groups:
- HPV-associated (often p16 positive), frequently in tonsil/base of tongue; may present with small primary and neck node
- HPV-unrelated (classically tobacco/alcohol-associated), often more locally advanced at diagnosis
- Symptoms: persistent sore throat, dysphagia, odynophagia, referred otalgia, neck mass, weight loss, bleeding
C) Hypopharynx
- Usually SCC, strongly linked to tobacco/alcohol
- Tends to present late with dysphagia, pain, weight loss, nodal disease
- Prognosis generally poorer due to late presentation
D) Benign tumors in nasopharyngeal region
- Juvenile nasopharyngeal angiofibroma (adolescent males, epistaxis, nasal obstruction; highly vascular; surgery is key)
Red-flag features requiring urgent ENT evaluation
- Unilateral persistent sore throat (>3 weeks), especially with otalgia
- Neck mass
- Dysphagia/odynophagia progressing
- Unexplained weight loss
- Hemoptysis or recurrent epistaxis
- Cranial nerve deficits, trismus, airway symptoms
- Tonsillar asymmetry or ulcerative lesion
If you want, I can convert this into a high-yield exam table (etiology, features, investigations, management, complications) for quick revision.
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