12. Diseases of the Pharynx. Diseases of the Nasopharynx – adenoids, juvenile angiofibroma. Acute and Chronic Tonsilittis, Scarlet Fever, Plaut-Vincent Angina, Diphtheria, Infectious Mononucleosis. Tonsillogenic complications: Peritonsillar abscess. Retropharyngeal and parapharyngeal abscess. Diseases of the hypopharynx.

Adenoids

• Hyperplasia of the pharyngeal tonsil (Occurs in children 3-6 yrs)
• Enlarged adenoids are ONLY considered abnormal and treated accordingly when they are causing symptoms

Etiology: Rhinoviruses, Influenza, RSV

Clinical manifestations:

• Chronic nasal airway obstruction “mouth breathing”
• Nasal discharge
• Snoring
• Hyponasal voice → rhinophonia clausa
• Recurring infections of nose and paranasal sinuses
• Anorexia
• Eustachian tube dysfunction
• Prolonged conductive hearing loss → leads to delays in speech development
• Maxillary deformity and dental malalignment

Diagnosis:

• Graded according to the choanal obstruction 1,2,3 or invaded anatomical structures
• History
• Rhinoscopy/endoscopy
• Otoscopy – will often show retraction of tympanic membrane or middle ear effusion
• Tympanometry (to test hearing)

Treatment:

Conservative:

• Vitamins
• Decongestants
• Fluids

Surgical

• Adenoidectomy
• Tympanostomy in those with concomitant middle ear effusion
• Paracentesis

Juvenile angiofibroma

• It is a benign vascular tumor in the nasopharynx. It is very aggressive and causes local destruction. (Occurs in boys 10-18 yrs, regresses at 20-25 )
• Arise in the region of the sphenopalatine foramen → grows to nasopharynx, posterior nasal cavity, pterygopalatine fossa

Clinical manifestations:

• Unilateral obstructed nasal breathing
• Unilateral severe recurrent epistaxis
• Eustachian tube dysfunction (w/OME)→conductive hearing loss
• Headache

Severe: proptosis & edema of cheeks

Frog face deformity: Widening of the nasal bones & broadening of nose

Diagnosis

• Endoscopic: well circumscribed, vascularised mass with superficial vascular markings
• CT: Antral sign (Hollman miller sign)
• CT/MRI with digital subtracting angiography (DSA) → identify tumour-feeding vessels

Clinical suspicion of angiofibroma = NO BIOPSY (risk of heavy bleeding!)

Differential Diagnosis:

• Nasopharyngeal carcinoma
• Antro-choanal polyp

Treatment:

• Surgical removal of tumour
• Pre-embolization of feeding vessels (usually maxillary artery) to reduce intraoperative bleeding

Diseases of pharynx:

• I. Diseases of Nasopharynx
• Adenoids
• Juvenile Angiofibroma
• II. Diseases of Oropharynx
• Injuries & Foreign Bodies
• Tonsillitis
• Scarlet Fever
• Plaut- Vincet Angina
• Diphteria
• Pharyngitis
• Infectious Mononucleosis
• III. Diseases of Hypopharynx
• Injuries & Foreign Bodies
• Zenker’s Diverticulum
• Tumor