Chronic Pharyngitis.

Synonyms.—Chronic Follicular Pharyngitis; Chronic Granular Pharyngitis; Pharyngeal Catarrh.

Definition.—A chronic inflammation of the mucous surfaces of the pharynx and adjacent tissues.

Etiology.—It may be the result of repeated attacks of the acute form, or it may come on gradually, the result of continued irritation from smoking or drinking. Very hot drinks or highly spiced food may also render one liable to this affection. Frequent hawking to clear the posterior nares is a very frequent source of irritation. Another common cause is the frequent and injudicious use of the voice as noted by street fakirs, campaign orators, and those who strain the voice, especially in the open air. Acrid eructation from a disordered stomach may also figure in producing the disease.

Pathology.—The mucous membrane of the pharynx and fauces is relaxed and somewhat thickened and of a vivid red or dusky color. The venules are dilated and tortuous and the mucous surface is studded with small, round, red bodies, the enlarged mucous follicles. The hypertrophied membrane, when relaxed and flabby, appears as if laid in ridges. In some cases there is atrophy of the mucous follicles, and the surface is dry, red, and glistening,—pharyngitis sicca.

Symptoms.—The patient experiences a sense of stuffing up in the upper part of the throat, and, to get relief, there is frequent effort to remove it by hawking, or, where the surface is dry, there is almost constant swallowing. A short, dry, hacking cough reveals laryngeal complications, and the voice is more or less husky. Inspection reveals a varied condition; in the earlier stages the mucous membrane is swollen, red, and bathed in mucus; later we find it dusky in color, and studded with the enlarged mucous follicles. Again, the surface is red, glistening, and dry, or red and covered with tenacious mucus, which is removed with difficulty.

The uvula may be full and relaxed. There is usually no pain, though an uncomfortable sensation exists most of the time, owing to the dryness of the throat in the one case, and the viscid secretion in the other.

Diagnosis.—Inspection and history of case reveal the disease.

Prognosis.—This is favorable, save where there are marked structural changes.

Treatment.—In beginning the treatment, the patient must clearly understand that all sources of irritation are to be avoided if a cure is effected. Smoking, the use of alcoholic drinks, highly seasoned food, the prolonged use of the voice, especially in the open air, are to be discontinued.

The local treatment will consist of galvanism, gargles, and the use of the spray; the remedies, depending upon the condition of the tissues. Where the tissues are relaxed and a stimulant is required, capsicum, 2 drachms; tannic acid, ½ drachm; water, 16 ounces, will act kindly. If a sedative is needed the prescription will be:

Hamamelis often gives good results. When the throat is bathed with mucus or muco-pus, galvanism is the best local treatment. Where there are enlarged follicles, the galvano-cautery is the most successful method of effecting a cure. Boracic acid is a favorite remedy with many.

Internally, collinsonia has afforded relief in many cases, especially where the larynx is involved. Sanguinaria, third trituration, every three or four hours, will relieve the tickling sensation so often experienced; belladonna where the throat is bright red, swollen, and dry; or we may use jaborandi with these same conditions.

Guaiac will also be frequently used for similar conditions. Attention must be paid to the general health; for local disorders fail to yield to local treatment where there are systemic wrongs. An impoverished blood must be corrected, gastric derangements overcome, and the secretions established.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.