OVERVIEW

What is pharyngitis?

Pharyngitis refers to inflammation of the throat caused by various factors. It can occur independently or secondary to conditions like tonsillitis or sinusitis^[1]. Generally, pharyngitis can be classified as acute or chronic.

• Acute pharyngitis: Sudden onset, primarily characterized by sore throat and cough, possibly accompanied by fever (temperature above 37.2°C). It is usually treatable with antiseptic mouthwashes combined with antiviral drugs or antibiotics.
• Chronic pharyngitis: Recurrent, mainly presenting as throat irritation, cough, and retching. Treatment may include mouthwashes, lozenges, or methods like microwave or low-temperature plasma therapy, but complete cure is often difficult.

Is pharyngitis common?

Both acute and chronic pharyngitis are very common.

• The incidence rate of acute pharyngitis is about 5%^[2], meaning 5 out of 100 people may develop it, with higher occurrences in winter and spring.

• According to domestic statistics, chronic pharyngitis accounts for 10%–20% of throat diseases among urban residents^[3], meaning 1–2 out of 10 patients with throat conditions have chronic pharyngitis.

Which department should I visit for pharyngitis?

Otolaryngology (ENT) or Respiratory Medicine.

SYMPTOMS

What are the symptoms of acute pharyngitis?

Acute pharyngitis has a sudden onset, presenting with dryness, burning, pain, and difficulty swallowing in the throat. It may be accompanied by fever, headache, loss of appetite, and muscle aches. If the inflammation spreads to the larynx, symptoms such as hoarseness and coughing may occur^[1].

What are the symptoms of chronic pharyngitis?

Chronic pharyngitis often persists for a long time. Symptoms worsen when speaking excessively, consuming spicy foods (such as chili or mustard), experiencing fatigue, or due to weather changes.

Main symptoms include throat discomfort, a sensation of a foreign body in the throat, burning, and dryness. Frequent irritative coughing may occur in the morning, accompanied by nausea and dry retching^[1].

CAUSES

What are the causes of acute pharyngitis?

The common causes of acute pharyngitis are infections caused by microorganisms such as viruses and bacteria, including Coxsackievirus, adenovirus, streptococcus, and staphylococcus^[1]. Viruses or bacteria can reach the pharynx through the nasal cavity or mouth, leading to infection.

In addition, non-infectious factors can also cause acute pharyngitis, such as pollen allergies, dust allergies, air pollution, and excessively dry air^[1]. This may be related to irritation of the throat mucosa by these substances.

What are the causes of chronic pharyngitis?

There are many possible causes of chronic pharyngitis, but none are particularly clear. Common causes include:

• Progression from acute pharyngitis: If acute pharyngitis recurs or is not treated promptly, it may become chronic^[1].

• Spread of inflammation from adjacent areas: Conditions such as chronic rhinitis, chronic tonsillitis, and periodontitis can lead to repeated irritation of the pharynx by inflammatory secretions, causing chronic pharyngitis^[1].

• Various chemical and physical irritants: Factors such as dust, neck radiation therapy, long-term exposure to harmful chemical gases, excessive smoking or alcohol consumption, acid reflux, long-term consumption of spicy or irritating foods, and prolonged vocal strain can all contribute to chronic pharyngitis^[1].

Who is prone to pharyngitis?

• People who frequently overuse their voice: Such as teachers and singers, who often speak loudly for extended periods. Teachers are also frequently exposed to dust, increasing their likelihood of developing pharyngitis^[4].

• People who smoke, drink alcohol excessively, or consume spicy foods: These individuals may be more susceptible to pharyngitis due to the irritation caused by tobacco, alcohol, or spicy foods to the throat^[4].

• People who are chronically exposed to dust or harmful gases: Those who work in environments with prolonged exposure to dust or harmful gases may experience throat damage, making them more prone to pharyngitis.

• Additionally, individuals with conditions such as rhinitis, chronic tonsillitis, or periodontitis are also more likely to develop pharyngitis.

Is pharyngitis contagious?

Acute pharyngitis may be contagious. If it is caused by a viral infection, the virus can spread through droplets and close contact^[1].

Chronic pharyngitis is usually related to long-term irritation of the throat mucosa and is generally not contagious.

DIAGNOSIS

How is pharyngitis diagnosed?

Generally, doctors can make a preliminary diagnosis based on the patient's symptoms, physical signs, as well as factors like allergy history, recent contacts, and visited locations (to assess potential exposure to pathogenic bacteria or viruses and determine the cause of the illness).

However, some patients may present with atypical symptoms, so doctors may also order tests such as a complete blood count, throat swab culture, or laryngoscopy for further evaluation.

The diagnostic criteria for acute and chronic pharyngitis differ slightly, and the duration of symptoms can help differentiate between the two. For details, refer to the corresponding entries.

What tests are needed if pharyngitis is suspected?

When visiting a doctor for suspected pharyngitis, the physician will first carefully examine the throat and then selectively perform the following tests as needed:

• Complete blood count (CBC), C-reactive protein (CRP), etc.: Blood tests to preliminarily determine the presence and type of infection.

• Throat swab test: A sample of throat secretions is taken for bacterial culture and antibiotic sensitivity testing to identify the specific bacterial infection and the most effective medication.

• Laryngoscopy: To assess the specific condition of the throat.

• Nasal/oral examination, chest X-ray, gastroscopy, etc.: Conditions such as rhinitis, dental caries, pneumonia, or gastroesophageal reflux disease (GERD) can also cause pharyngitis. If these conditions are suspected, further tests may be required. Treating the underlying condition is essential to resolving pharyngitis.

TREATMENT

How to Treat Acute Pharyngitis?

Acute pharyngitis is generally treated with symptomatic and causative therapies, primarily using appropriate medications under a doctor's guidance.

Medication:

• Mouthwash: Such as chlorhexidine mouthwash, which has cleansing and antibacterial effects. It is suitable for patients with no systemic symptoms or mild symptoms^[1]. However, long-term use may disrupt oral flora and cause other oral diseases, so it should be used under medical supervision.
• Antibiotics or Antiviral Drugs: Used to kill bacteria or viruses. Doctors should select appropriate antibiotics or antiviral drugs based on pathogen culture and drug sensitivity test results^[1].
• Additionally, symptomatic medications may be used. For example, antipyretics (such as ibuprofen or acetaminophen) can be taken for fever^[1].

Primary Disease Treatment:

If pharyngitis is caused by other conditions (e.g., rhinitis, tonsillitis, dental caries, or gastroesophageal reflux disease), it can only be fully resolved after treating the underlying disease.

How to Treat Chronic Pharyngitis?

Chronic pharyngitis focuses on symptom relief. If nasopharyngeal diseases are present, they should be treated promptly. For cases with unclear causes, doctors may recommend symptomatic medications. Additionally, certain physical therapies may provide some benefits.

Etiological Treatment:

Actively treat chronic inflammations like chronic rhinitis, chronic tonsillitis, or periodontitis. Maintain outdoor activities, quit smoking and alcohol, and keep indoor air fresh^[1].

Medication:

• Nebulization: Typically involves glucocorticoids (e.g., budesonide suspension for inhalation) for local anti-inflammatory and anti-allergic effects^[5].
• Iodine and Vitamins: Applying 2% iodine glycerin to the throat can improve local blood circulation. Taking vitamins A, B2, C, and E may promote mucosal epithelial growth^[1].

Microwave Therapy:

Microwaves are applied to the affected area, causing coagulation and necrosis due to high temperatures. Patients may experience symptom relief or disappearance^[6]. This method is suitable for those with poor drug treatment responses or recurrent symptoms. It is effective, minimally invasive, and safe.

Low-Temperature Plasma Radiofrequency Therapy:

This treatment shrinks or necrotizes pharyngeal lesions at around 40°C. It is suitable for patients with persistent or recurrent symptoms despite multiple drug treatments. It effectively improves throat discomfort with good safety^[7].

Can Pharyngitis Heal on Its Own?

In some cases, acute pharyngitis may resolve spontaneously if the immune system clears the infection. However, medical attention is recommended if symptoms like fever (temperature above 37.2°C), severe throat pain, or no improvement after 3 days occur.

Chronic pharyngitis is usually difficult to self-heal, as it is often linked to persistent factors (e.g., smoking). Since its exact cause is unclear, treatment mainly focuses on symptom management.

DIET & LIFESTYLE

What should pharyngitis patients pay attention to in their diet?

Mainly reduce irritation to the throat mucosa, with key points including the following:

• Eat more fresh vegetables and fruits, such as apples and leafy greens, and drink plenty of water.
• Quit smoking and alcohol, and avoid secondhand smoke, as tobacco and alcohol can keep the throat mucosa in a congested state, worsening throat discomfort^[5].
• Avoid overeating, as it may lead to gastrointestinal dysfunction, affecting digestion and absorption, weakening the body, making one prone to colds, and aggravating pharyngitis^[5].
• Avoid fried, greasy foods, as well as raw, cold, overly hot, hard, and spicy foods. Fried and greasy foods may disrupt nutritional balance, leading to deficiencies in vitamins, protein, etc., and weakening the body; raw, cold, overly hot, hard, fried, and spicy foods can cause throat congestion, worsening discomfort^[5].
• Rinse your mouth after meals and maintain oral hygiene.

What should pharyngitis patients pay attention to in daily life?

• Exercise actively to boost immunity and avoid recurrent throat infections.
• Consciously avoid throat-clearing actions. When feeling the urge to clear your throat, try swallowing instead, which can also help remove secretions.
• When experiencing throat pain or itchiness, speak less and rest more to avoid overusing your voice.
• Some chronic pharyngitis patients may experience emotional or psychological issues and should seek help from a psychologist if necessary.

Besides painkillers, what other methods can relieve sore throat?

• Consume cold foods, such as ice cream.

• Use throat sprays or lozenges.

• Suck on cough drops or regular candy to promote saliva production.

PREVENTION

How to prevent acute pharyngitis?

• People with allergies should avoid exposure to pollen and dust or wear masks when in contact with these substances.
• During respiratory disease outbreaks, avoid crowded and enclosed places.
• Use a humidifier to increase air humidity and prevent excessive dryness, but remember to clean it regularly to avoid spreading harmful mold or bacteria.

How to prevent chronic pharyngitis?

• Quit smoking and alcohol.
• Drink plenty of water, maintain a light diet, and avoid spicy or irritating foods that may hinder recovery.
• Follow a regular sleep schedule, avoid staying up late, and prevent overexertion.
• Engage in appropriate physical exercise based on your physical condition.
• Thoroughly treat underlying conditions that may cause pharyngitis.
• Maintain a positive mood and avoid excessive anxiety or depression.
• Reduce outdoor activities during severe air pollution and wear masks when going out.
• Minimize exposure to dust and other harmful environments. Teachers should use dust-free chalk, and sanitation workers should wear dust-proof masks to reduce dust inhalation^[5].