- Throat: anatomical structure
- Throat Absorbent Ring (Waldeyer Ring)
- Throat: Features
- Throat diseases
- Throat diseases: the Centor's scale and antibiotic therapy
- Inflammation of the lymphatic tissue and throat in the course of childhood infectious diseases
- Throat diseases: diagnosis
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The throat, which we most often remember when we are in pain, has many important functions, which is why it belongs to two systems - both the digestive and the respiratory. How is this organ built? What are the functions of the throat? And what diseases of the throat most often bother patients?
The throatis the organ that connects the oral cavity, the nasal cavity, and the larynx and esophagus. It is at the level of the throat that the digestive and respiratory tracts cross, which makes the throat functionally part of both the digestive and respiratory systems.
Diseases of the throat are de alt with by a specialist ENT specialist, who is attended by patients with a referral from a general practitioner.
Throat: anatomical structure
The throat is an irregularly shaped fibrous-muscular-mucosal organ that connects the mouth, nasal cavity, larynx and esophagus. It consists of three parts:
- nasopharynx (upper)
The upper part of the throat is located between the base of the skull and the soft palate. There are, among others, the posterior nostrils through which the throat connects with the nasal cavity, and the pharyngeal opening of the Eustachian tube, as well as the pharyngeal tonsil.
- oropharynx (middle)
The middle part of the throat lies between the soft palate and the upper edge of the epiglottis. The conventional boundary separating the oral cavity from the pharynx is formed by the palatopharyngeal folds, the soft palate and the base of the tongue. The lingual dimples, the base of the tongue, the lower surface of the soft palate, the lingual surface of the epiglottis, the palatine arches (palato-lingual and palatopharyngeal arches) and palatine tonsils are located in the middle of the pharynx.
- laryngeal (lower) part
The lower part of the pharynx is located between the upper edge of the epiglottis and the lower edge of the laryngeal cricoid cartilage. Downwardly, it connects to the esophagus, and to the front of the larynx.
The throat wallconsists of four layers: the mucosa, the submucosa (i.e. fibrous), the muscular membrane and the outer membrane. The mucosa lines the throat from its lumen and, depending on the part of the pharynx in which it is located, is covered with a multilayered flat epitheliumnon-keratinized (oral and laryngeal) or multi-row ciliary epithelium (nasal).
The pharyngeal muscular membraneconsists mainly of striated muscles. In its structure, there are two layers of muscles that perform different functions.
The outer layer of muscles is made up of three circular muscles of the pharyngeal sphincter (upper, middle and lower pharynx). The inner layer of muscles is made up of levator muscles that raise and lower the throat (stylopharyngeal and palatopharyngeal muscles).
The muscles of the throatare motor innervated by the VII, IX, X, XII cranial nerves - i.e. the facial nerve, the glossopharyngeal nerve, the vagus nerve and the sublingual nerve, while for the sensory innervation The maxillary nerve (innervates the nasopharynx), the glossopharyngeal nerve (the middle part of the pharynx) and the vagus nerve (supplies the lower pharynx) correspond to the pharynx.
The branches of the external carotid artery, maxillary artery, facial artery and the wedge-palatal artery (respectively the ascending pharyngeal artery, the descending palatine artery, the ascending palatine artery and the supreme pharyngeal artery) participate in the arterial vascularization of the pharynx. Venous blood is drained through the pharyngeal and palatal plexuses, which enter the external jugular vein.
Throat Absorbent Ring (Waldeyer Ring)
The pharyngeal lymphatic ring, also known as the Waldeyer ring, is formed by clusters of lymphoid tissue located within it. It is an essential part of the human immune system and plays an important role in the course of pharyngitis.
The Waldeyer ring consists of a single pharyngeal tonsil, trumpet tonsils, lingual tonsils, palatine tonsils, trumpetopharyngeal folds (or lateral cords) and scattered, single lymphatic lumps in the mucosa of the posterior and lateral pharynx walls.
The pharyngeal tonsil typically occurs in children, develops until the age of 12, and disappears after puberty. Hypertrophy of the pharynx results in the development of chronic rhinitis in children, impaired breathing through the nose, nasal speech, snoring at night, frequent exudative otitis media and a typical facial expression (the so-called adenoid face).
The palatine tonsils are visible between the anterior and posterior palatine arches. They have several branched crypts in which shed epithelium, food debris or bacteria can accumulate, which promotes tonsil infections.
Overgrown tonsils, both pharyngeal andpalatal joints should be an indication for a follow-up visit to the ENT specialist in order to assess the need for surgery and surgical removal.
The throat plays a very important role in the human body:
- participates in breathing because air flows through the throat from the nasal cavity and mouth to the larynx
- is involved in swallowing food, is the initial section of the human digestive tract
- has a defensive function - it prevents aspiration, i.e. aspiration of foreign bodies or food into the respiratory tract, through the gag and cough reflex, caused by irritation of the back wall of the throat
- is part of the speech organ, because as a resonance cavity, it is responsible for enhancing the voice and giving it the right timbre. When the throat, nasal cavity and oral cavity function properly, the air does not escape through the nose during speech
- is involved in the body's immune defense system through the throat lymphatic ring. It produces lymphocytes and antibodies, as well as exposure of lymphocytes to antigens
Among the numerous throat diseases,
- developmental defects (mainly cleft lip and hard and / or soft palate)
- mechanical injuries
- non-specific inflammation
- pharyngitis in the course of infectious diseases
- neoplastic changes
The most common pharyngeal diseases are briefly characterized below.
- Acute pharyngitis
Acute pharyngitis is characterized by a sudden onset and a short course. In most cases, the cause of acute inflammation is a viral infection (only about 20% of pharyngitis has a bacterial etiology), therefore antibiotic therapy should not be used without clear symptoms of a bacterial infection, which include, among others, purulent or mucopurulent discharge most often in the area of the palatine tonsils.
The infection most often occurs in the winter-spring period by droplets through direct contact with a sick person, and the viruses responsible for the development of acute pharyngitis are, among others, Rhinovirus, Influenza and Parainfluenza virus, Coronavirus, RSV and Adenovirus.
The most common symptoms presented by patients include malaise, sore throat, burning and scratching sensations when swallowing food, as well as redness, thickening and swelling of the throat mucosa. In some cases it is minorlymph nodes enlargement.
Treatment of acute pharyngitis is symptomatic treatment, the use of non-steroidal anti-inflammatory drugs and local lozenges to relieve sore throat and moisturize the mucosa.
Among the acute pharyngitis, there are, among others, acute catarrhal pharyngitis, acute follicular pharyngitis, streptococcal pharyngitis, as well as fungal pharyngitis and tonsillitis. They differ in etiology, course, clinical picture, as well as the treatment method.
- Recurrent acute pharyngitis and tonsillitis
The hallmark of recurrent acute pharyngitis leading to diagnosis is the presence of 3 or more episodes of acute pharyngitis within 6 months.
The presence of such frequent throat infections should worry the doctor and constitute the basis for further diagnosis and possible surgical intervention.
- Chronic pharyngitis
Chronic pharyngitis is a condition that arises as a result of prolonged exposure to the pharyngeal mucosa, e.g. gastro-oesophageal reflux.
- Angina and tonsillitis
Angina is a disease caused by bacteria, viruses and fungi, for which typical acute inflammation of the lymphatic tissue of the pharyngeal lymph ring (including tonsils) and the pharyngeal mucosa is typical.
It is most common among school-age children, while it is diagnosed sporadically in young children, adults and the elderly.
Viruses are believed to be responsible for the development of tonsillitis in most cases, especially in adults.
The typical clinical symptoms of angina include
- very severe sore throat when swallowing
- pharyngeal congestion
- loosening of the palatine tonsils
- typical for angina of bacterial etiology, purulent or muco-purulent exudate covering the tonsils
Due to the local clinical picture of the disease, the following is distinguished:
- erythematous angina
- angina with purulent exudate
- herpetic angina with superficial ulcerations and vesicles
- angina with deep ulcerations on the tonsils (the so-called ulcerative-membranous angina, or Plaut-Vincent angina)
Throat diseases: the Centor's scale and antibiotic therapy
A tool that allows doctors to assess the likelihood of bacterial tonsillitis and the need for applicationfor antibiotic therapy is the Centor scale.
Subject to assessment:
- patient's age
- presence of tonsil swelling
- presence of purulent exudate
- enlargement of the lymph nodes in the neck
- presence of fever
The maximum result that a patient can get is 5 points. A patient with 4 or 5 points should be treated with an antibiotic because the probability of a bacterial infection is very high.
A patient with fewer Centor points should undergo additional diagnostic tests in the form of culture before starting antibiotic therapy.
|Symptoms presented by a patient with acute tonsillitis
|number of points awarded
|Swelling of the palatine tonsils and the presence of purulent or mucopurulent discharge
|Enlargement of the lymph nodes in the neck
|Fever above 38 degrees Celsius
It is worth remembering, however, that improperly treated angina of bacterial etiology can lead to serious complications, not only local ones, e.g.
- peritonsillar abscess
- phlegmon of the floor of the mouth
- cavernous sinus thrombosis
but also general, in the form of glomerulonephritis and rheumatic disease.
Inflammation of the lymphatic tissue and throat in the course of childhood infectious diseases
Scarlet fever, also called scarlet fever, is a childhood bacterial disease caused by group A beta-hemolytic streptococci.
Among the typical clinical symptoms reported by patients, there are severe sore throat, reddening of the pharyngeal mucosa, softening of the tonsils, raspberry tongue, enlarged regional lymph nodes and general symptoms (fever, headache, malaise).
There is also a characteristic red, papular rash on the face and upper body. Typically, it bypasses the triangle around the mouth (the so-called Filat triangle), the skin within it remains unchanged.
In addition, after a few days, you can observe a flaky exfoliation of the epidermis covering the hands, feet, face and body. A patient presenting such clinical symptoms requires inclusionantibiotic therapy.
- Infectious Mononucleosis
Infectious mononucleosis is a viral disease caused by the EBV (Epstein-Barr Virus). It is called the kissing disease because it is transmitted through saliva and is especially common in adolescents and teens.
The typical symptoms of mononucleosis include, in addition to general symptoms, severe sore throat, generalized enlargement of the lymph nodes (lymphadenopathy), tonsil enlargement and the presence of a wet raid on them.
During the palpation of the abdomen, the doctor may also find enlargement of the spleen and liver. Infectious mononucleosis is often confused with purulent tonsillitis due to the presence of a whitish coating on the tonsils.
However, typical for this disease entity is the lack of improvement in the clinical condition and well-being of the patient after antibiotic therapy (as opposed to purulent tonsillitis) - a typical skin rash occurs after administration of ampicillin.
Treatment of infectious mononucleosis does not require hospitalization or antibiotic therapy, symptomatic treatment (non-steroidal anti-inflammatory drugs, temperature-lowering drugs and painkillers) are applied.
Diphtheria is an acute, bacterial, infectious disease caused by Corynebacterium diphteriae. The use of obligatory preventive vaccinations for children has resulted in the fact that diphtheria is diagnosed quite rarely, nevertheless, each disease must be reported to the sanitary and epidemiological station.
The characteristic clinical symptoms include, apart from severe sore throat, reddening of the mucosa and loosening of the tonsils, the presence of a white-gray coating within them, which sticks to them tightly, and when scraped with a spatula, leaves an intensely bleeding surface (this property distinguishes on the tonsils in their purulent inflammation from the raid typical for diphtheria).
Diphtheria is a disease with a serious prognosis as the mortality rate is as high as 10%. Treatment requires hospitalization and is based on antibiotic therapy and the use of diphtheria serum.
Measles is a highly contagious viral disease. The characteristic features of this disease are, in addition to general symptoms, photophobia and the occurrence of the so-called Koplik spots. It is worth noting that they are a pathognomonic symptom of measles (i.e. typical only for this disease entity). Koplik spots are small, whitish spots located within the mucosa of the cavityoropharynx.
Throat diseases: diagnosis
The diagnostic methods used to assess the throat by an ENT doctor include:
- posterior rhinoscopy performed with the use of an ENT mirror and a head lamp - consists in examining the nasopharynx in the mirror reflection, inserted into the area of the back of the pharynx, beyond the soft palate. It allows the assessment of the area of the posterior nostrils, the posterior turbinates and septum, the nasopharynx, adenoid and the mouth of the Eustachian tubes.
- endoscopy with the use of a rigid or flexible endoscope (i.e. fibroscope - the so-called fibroscopy), thanks to which it is possible to assess the throat and take samples of lesions within it suspected of having cancer for histopathological examination.
- imaging methods, including X-ray diagnostics, diagnostics using computed tomography and magnetic resonance, as well as ultrasound examinations. They enable an accurate assessment of the throat tissues, exclusion or confirmation of the presence of proliferative processes as well as the degree of infiltration into the surrounding tissues and the degree of bone damage.