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The throat is a space that extends from the base of the skull right down to the larynx. It is a common part of the respiratory tract (nose – throat – larynx) and gastrointestinal tract (oral cavity – throat – oesophagus). The wall of the throat is made up of layers: mucosa, submucosa tissue and muscle. In the oral cavity, the pharynx and the larynx, the mucous membrane is covered by a stratified squamous epithelium, and in the nose – stratified ciliated epithelium. Contaminations of the mucous membranes of the respiratory system are constantly removed by the movement of the cilia of epithelial cells. The movement of the cilia moves the mucous along with impurities and micro-organisms towards the throat and below. After swallowing the mucous, the micro-organisms and impurities are disposed of in the acidic gastric contents. The cough reflex also helps remove irritants from the throat. Within the throat are clusters of lymphatic tissue (palatal tonsils, pharyngeal tonsil in children up to about 10 years old, lingual tonsils within the root of the tongue, tubal tonsils at the outlet of auditory tubes). Side bands and follicles on the back wall of the pharynx constitute an absorbent ring of the pharynx, called Waldyer’s ring.
The digestive and respiratory systems cross at the pharynx. This causes that it has permanent contact with pathogenic micro-organisms (viruses, bacteria and fungi), as well as irritant and toxic agents, which penetrate into the body with the air inhaled. However, the mucous membrane is not defenseless. Contact with micro-organisms stimulates it to produce antibodies and affects the maturation of the entire respiratory system. Therefore, in adults with a well functioning immune system, most pathogenic micro-organisms are eliminated in the pharynx and there is no development of infection. Therefore, pharyngitis in adults occurs more mildly than in children, whose defensive functions have not yet been fully formed.
In every one of us, on the surface of the mucous membrane of the pharynx, many micro-organisms accumulate In 1 ml of secretion covering the mucous membrane of the pharynx, there are from 10 to the power of 6 to 10 to the power of 8 micro-organisms. In the nasopharynx, the bacterial flora is similar to that which we have in the nose, and in the middle pharynx and lower pharynx to that which we have in our oral cavity. Saliva protects us against the attacks of micro-organisms, which constantly washes over its surface (a healthy person produces about 1.5 litres per day).
Air pollution and irritant substances have an adverse affect on the condition of the pharynx’s mucous membrane, which get in through the digestive tract or respiratory tract.
In physiological conditions, the air inhaled through the nose is heated, cleaned of bacteria and dust, and saturated with water vapour. Also within the pharynx, larynx and trachea the humidity increases from 32-35% to 95-100%. Air heating is done by giving off heat from the blood circulating in the small blood vessels. Thanks to this, the inhaled air reaches a temperature of 32-34 degrees C, regardless of the ambient temperature. The improper course of these processes contributes to damage to the pharynx mucous membrane, which may cause inflammatory conditions.
The following have affect the condition of the pharyngeal mucous membrane:
Physico-chemical factors – the ambient temperature, air humidity, industrial pollution, tobacco smoke, alcohol, injuries.
Biological factors – viral, bacterial and fungal infections, allergy, aging, hormonal imbalance, immune deficiencies, anatomical abnormalities, e.g. curvature of the nasal septum, nasal polyps, which cause that we don’t breathe via the physiological nasopharyngeal tract.
Inflammation of the throat is divided into acute and chronic. Acute inflammation are usually viral, bacterial and fungal infections, diphtheria, shingles, dermatitis herpetiformis, Vincent’s angina, moniliasis, aphthous pharyngitis.
Chronic inflammation of the mucous membrane is a series of chronic conditions arising from irritants or inflammation of the pharyngeal mucous membrane. It lasts longer than acute conditions, it is more difficult to treat, it is divided into simple, hypertrophic and atrophic chronic rhinitis. The patient often has a constitutionally determined functional weakening of the pharyngeal mucous membrane (family predisposition). Chronic inflammation of the throat is usually caused by smoking, alcohol abuse, eating hot and spicy foods, dry air, breathing through the mouth in patients with impaired patency of the nose e.g. due to a crooked nasal septum, the presence of nasal polyps, as well as due to internal factors such as gastro-oesophageal reflux, hormonal disorders (menopause in women, hypothyroidism), systemic disorders such as kidney disease, diabetes, vitamin A deficiency, allergic reactions, anemia, iron deficiencies, taking certain drugs – psychotropic drugs, abuse of nose drops like Xylometazilin, Nasivin, which flow on the posterior wall of the throat causing it to dry, in addition, steroid drugs used for bronchial asthma. Diseases of the nose and sinuses also affect the emergence of chronic inflammation of the pharyngeal mucous membrane. Atrophic chronic pharyngitis is a common occupational disease of people working in conditions of high temperature differences, employees of chemical plants, and it also applies to persons working with their voice – teachers, politicians, priests, journalists, singers, it occurs very often in older people. The pharyngeal mucous membrane is thin, pale, smoothed with expanded blood vessels. The small amount of mucous secretion caused by a reduced amount of mucous glands is characteristic, which when drying gives the mucous membrane the appearance of a varnished surface.
The most common symptoms reported by sufferers include: pain, burning, itching, tickling, the sensation of dryness, a foreign body in the throat, deposition and flow of secretion on the back wall of the throat. The patient is forced to continually spit out the sticky secretion. The feeling of dryness in the throat intensifies at night and during heating periods, when the air in homes is drier. Climatic conditions also have a significant effect on dry pharyngitis. They are more likely to occur in dry areas – by the sea, in island climates the ailments decrease greatly in patients.
The treatment of dry pharyngitis mainly consists in establishing the potential factors that may be contributing to the changes taking place in the pharyngeal mucous membrane. Their elimination or treatment, and symptomatic treatment, which is aimed at reducing the symptoms of chronic dry pharyngitis – inhalations with mucolytic drugs, sucking mucolytic/ and disinfectant drugs, using moisturizing preparations on the basis of pharmaceutical olive oil with added vitamins A + E on the posterior wall of the throat.
Symptoms in patients with dry pharyngitis of the mucous membrane decrease during meals or while drinking beverages.
A characteristic feature of this disease is the disproportion between symptoms reported by the patient and the clinical image. Symptoms reported by patients are definitely greater than the image of the mucous membrane diagnosed by the doctor.
During treatment we take into account:
avoiding harmful and irritating factors
light diet and with a small amount of spicy spices
using preparations on the drying mucous membrane which contain vit. A and vit. E.
sucking tablets with mucolytic substances
Doctor of medical sciences Barbara Południewska
Otolaryngologist and allergist specialist