Cause

1. In most cases the origin is viral (80-90%), with the most common being as follows:

• Viruses responsible for the common cold and flu (rhinovirus, coronavirus, adenovirus, influenza virus).
• COVID 19, especially the Omicron variant may present as common pharyngitis/tonsillitis, and usually the only way to differentiate it from other viruses is by testing for COVID 19.
• Infectious mononucleosis caused by Epstein-Barr virus or Cytomegalovirus. In this case, it usually has a more severe effect on general health with prominent swelling of the neck nodes on either side.
• Coxsackie A virus is common in childhood, especially between the ages of three and ten. It is the cause of herpangina, commonly known as hand, foot and mouth disease, and is accompanied by pharyngitis/tonsillitis, mouth ulcers and skin lesions on the palms of the hands and soles of the feet.

2. Less commonly the cause is bacterial, with Streptococcus being the most common bacterium; in this case antibiotics are required for treatment. Bacterial superinfection can also develop in addition to a viral pharyngitis/tonsillitis.
3. In patients with weakened immune systems due to chemotherapy, immunosuppressants, tumours, or AIDS, the cause may be

Symptoms

• Pain
• Difficulty swallowing
• Fever
• Swelling of lymph nodes in the neck
• General malaise

Diagnosis

1. In the majority of cases diagnosis is clinical. When the patient is examined the following details would lead us to suspect a bacterial cause: Fever >38°C, swollen lymph nodes in the front of the neck, no cough, whitish exudate on the tonsils, and aged between 3 and 15.

2. Beta-haemolytic Group A Streptococcus rapid antigen testing grupo A: requires a sample from the tonsils and pharynx taken with a swab. It allows treatment to be started without delay since the result is obtained quickly during the consultation.

3. Throat culture: is the standard or reference test for the diagnosis of streptococcus infection. Under ideal conditions, sensitivity is 90-95% and specificity is 99%. The main disadvantage is that it does not give us an immediate result.

4. Anti-streptolysin antibody serology (ASLO): not routinely performed as it is not associated with acute infection, a positive blood result may be related to bacterial infection months previously. It is also positive 7 days after the onset of symptoms, so it does not enable us to start treatment quickly.

5. COVID-19 PCR TEST/Antigen Test, especially useful in times of pandemic to be able to differentiate a COVID-19 infection from common pharyngitis/tonsillitis.

Treatment

• If the cause is viral, treatment is symptomatic with anti-inflammatory medication, paracetamol and a high fluid intake.

 

• If the cause is bacterial, treatment with antibiotics is necessary to prevent complications such as a tonsillar abscess or a generalised infection.

 

• It is essential not to start antibiotics without a medical assessment; inappropriate use of antibiotics generates resistance and can lead to complications due to unwanted side effects.

It is a chronic inflammatory process of non-infectious origin.

Cause

1. Chronic respiratory pharyngitis: pharyngitis is caused by agents that irritate such as tobacco smoke or other pollutants.
2. Chronic digestive pharyngitis: the main cause is gastroesophageal reflux; alcohol and spicy foods can also be irritants.
3. Chronic allergic pharyngitis: dust, pollen or animal epithelium can behave as allergens and trigger an inflammatory reaction.
4. Chronic metabolic pharyngitis: caused by endocrine disorders such as diabetes, hypothyroidism, or menopause.

Symptoms

• Symptoms are usually pain and discomfort when swallowing, without a fever or feeling unwell.
• Dry throat or feeling of a foreign body in the throat.
• Throat clearing.

Diagnosis

Diagnosis is essentially clinical, including the length of time the symptoms have lasted.

Treatment

Treatment consists of identifying the trigger and modifying habits. For example, measures to address chronic pharyngitis would include stopping smoking, ventilating rooms, avoiding any triggering allergen and (if not possible) using antihistamines, as well as treatment of reflux with medication and diet modification.