Chronic pharyngitis may be hypertrophic, atrophic or granular. In
hypertrophic pharyngitis the pathologic changes have passed beyond the
stage of hyperemia and there is always hypertrophy or hyperplasia,
usually the latter, of the pharyngeal membranes. These changes in
most cases, have extended to and involved all of the nasopharyngeal
membranes.
Chronic granular pharyngitis, or so-called clergyman’s sore throat,
has a similar pathology to that described above, but with swollen
and inflamed lymph follicles. This condition seems to be a result of
excessive use of the voice.
Chronic atrophic pharyngitis has a similar etiology and the diagnostic
signs are also similar to atrophic nasopharyngitis with which it is
usually associated.
=Etiology.=—The causative factors are similar or the same as those of
nasopharyngitis. Lesions of the cervical and upper thoracic and chronic
focal infections such as tonsillitis, sinuitis, etc. are the common
causes.
=Treatment.=—The nature of the treatment should be determined by the
causes found. The nature of the pathology requires long continued
treatment and careful attention to all causes. Thorough osteopathic
corrective work, the removal of all sources of focal infection, proper
attention to any gastro-intestinal perversions which may be causing
auto-intoxication and thorough cleanliness of the parts by gargling
with some cleansing, non-irritating solution and by irrigation.
In most cases there is a considerable collection of adhesions in
the nasopharynx or posterior nares or in both. Enlarged “posterior
turbinate bodies” and the extension of the inferior turbinates into the
pharynx are also common results of the hypertrophic process. Complete
surgical removal of this excess tissue and the after treatment as
described above under chronic nasopharyngitis are frequently required
to obtain complete and permanent results.
These cases can be successfully treated if the proper attention is
given to all possible causes in each individual case. It is the
individualization, the specific and detailed attention to the cause or
causes, and such treatment continued for sufficient time, that will
obtain results.
In atrophic pharyngitis, normal nutrition to the parts and usually to
the entire system must be restored. Many such cases are secondary to
systemic anemia or to rheumatic intoxication. A careful examination
should be made for evidence of systemic causes. In many cases, I
believe that thorough osteopathic corrective work applied to the mid
and lower spine is the most essential part of the treatment. Other than
this the local treatment as described under atrophic rhinitis applies
here.