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Academic Guideline for MBBS Students Seeking FCPS, MD, MS and Other PG Admission

How to Investigate Pharyngeal Diseases?

Pain in the throat/ (sore throat) is a very common phenomenon. Like this, there are many other common symptoms prevails which are caused by various pharyngeal diseases. We can approach to diagnose pharyngeal diseases as following:

History:

Common symptoms of of pharyngeal diseases are the following:

  • Pain in the throat/ sore throat. (Tonsillitis, pharyngitis, quinsy, ulcer, tumours)
  • Pain in the EAR (Referred otalgia) (tonsillitis, pharyngitis, quinsy, post tonsillectomy)
  • Trismus (due to quinsy or extension of tumours to pterygoid muscles).
  • Dysphagia: Three types of dysphagia exists.
    a. True dysphagia: real difficulty in swallowing food, resulting in food coming back, slow eating, loss of weight, food sticks in the throat. (Carcinoma oesophagus, stricture oesophagus)
    b. Feeling of lump in the throat due to spasms of cricopharyngeus secondary to stress, acid reflux, pharyngeal pouch, pressure from big thyroid, cervical osteophytes or an early synmptom of throat cancer.
    c. Odynophagia (painful deglutition)
  • Regurgitation of recently eaten food (Pharyngeal pouch, achalasia)
  • Muffled speech (quinsy, retropharyngeal abscess, acute epiglottitis)
  • Nasal speech (nasopharyngeal mass)
  • Neck lumps (any metastatic neck nodes)

Clinical examination of pharynx/throat:

This procedure is commonly asked to perform in professional exams. Proceed as follows:

  • Introduce yourself and ask permission from the patient.
  • Examine the oral cavity by using one or two tongue depressor, you should examine the lips, teeth, mucosa lining the cheeks, gingivo-labial gutters, gums, dorsum of tongue, under surface of tongue and floor of mouth for any obvious lesions. Examine the submandibular duct or gland by manually using gloves for swelling or stone.
  • Examine the oropharynx by tongue depressor, look for the posterior third of the tongue, hard palate, soft palate, uvula, anterior pillars, posterior pillars, tonsils, posterior pharyngeal wall.
  • Examine the nasopharynx by PNS by laryngeal mirror or by FOL.
  • Palpate the neck to see any neck nodes, mass.
  • Examine the ears for glue, conductive deafness.

Investigations:

Radiology:

  • X-ray neck soft tissue
  • Barium swallow
  • CT scan of neck

Lab investigation:

  • Blood CBC, ESR, VDRL, Monospot test
  • Throat swab, KLB

Endoscopy and Biopsy

 

Description of Symptoms:

Sore throat:

Causes of sore throat:

  • Acute tonsillitis
  • Acute pharyngitis
  • Quinsy or peritonsillar abscess, retropharyngeal abscess, parapharyngeal abscess.
  • Infectious mononucleosis/ glandular fever
  • Apthous ulcer
  • Acute epiglottitis
  • Faucal diphtheria
  • Herpes infection
  • Oral thrush
  • Bacterial stomatitis
  • Carcinoma tongue, oral cavity, oropharynx
  • Acute leukemia, thrombocytopenia
  • Vincent’s angina (Necrotizing ulcerative gingivitis)

Stomatitis:

Stomatitis means inflammation of oral mucosa.

Causes of stomatitis:

  • Gingivitis
  • Periodontitis
  • Herpes
  • Bacterial stomatitis
  • Oral thrush
  • Actinomycosis (Infectious bacterial disease in animals and humans. Infection may be of the cervicofacial, thoracic, or abdominal regions, or it may be generalized. Symptoms include slow-growing granulomas form and later break down, discharging viscid pus-containing minute yellowish (sulfur) granules.)
  • Blastomycosis (rare fungal infection caused by inhalation of the conidia of Blastomyces dermatitidis. This infection may produce
    inflammatory lesions of the skin (cutaneous form) or lungs or a generalized invasion of the skin, lungs, bones, central nervous system, kidneys, liver, and spleen.)
  • Histoplasmosis (Systemic fungal respiratory disease caused by Histoplasma capsulatum.)
  • Mucositis

Oral Mucosal manifestations of systemic diseases:

  • Pernicious anaemia
  • Iron deficiency anaemia
  • Thalassaemia
  • Polycythaemia
  • Osler-Weber-Rendu
  • Sturge-Weber-syndrome
  • Thrombocytopenia
  • Vitamin C, riboflavin deficiency
  • Kaposi Sarcoma

 

Macroglossia:

Causes:

  • Haemangioma
  • Lymphangioma
  • Myxoedema
  • Acromegaly
  • Amyloidosis
  • Tertiary syphilis
  • Hurler syndrome
  • Down syndrome

Feeling of a lump in the throat:

Causes:

  • Globus
  • Cricopharyngeal spasm due to stress
  • Acid refulx
  • Pharyngeal pouch
  • Pressure from a big thyroid
  • Ccervical osteophytes
  • Early hypopharyngeal cancer

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