A pharyngeal abscess (code for ICD-10 J39.0) in childhood begins to develop after the appearance of an infection in the body. At first, it can manifest itself in the form of rhinitis and does not present much discomfort. Then it affects the surrounding lymph nodes and enters the pharyngeal space with them, where it causes an abscess.
Causes
An abscess can develop in children against the background of the following infectious diseases:
- ARVI;
- measles;
- scarlet fever;
- diphtheria;
- flu.
In adults, a pharyngeal abscess is most often formed on the background of a nasopharyngeal injury, for example, when a bone is pierced into the nasopharynx, during an examination of internal organs through the mouth or during its burn. Also, this condition can be caused in adults with a complication of angina. The causes of a pharyngeal throat abscess in adults can be tuberculosis or syphilis. This is due to a violation of the microflora of the nasopharynx and the body as a whole.
According to statistics, patients with chronic infectious diseases suffer from a pharyngeal abscess more often than with a simple course of the disease. Immunity, diabetes, swelling or HIV can also cause the development of this pathology.
Symptoms
Symptoms of an abscess are listed below:
- acute manifestations of sore throat;
- increase in body temperature to 39-40 ° C;
- violation of the general condition.
Against the background of other infectious diseases the patient has, symptoms of a pharyngeal abscess in adults are manifested by a sharp deterioration in health status.
Children have an inexplicable feeling of anxiety, which leads to sleep problems and impaired appetite.
In newborns, this disease can cause sleep disturbance.
The very first symptom of a pharyngeal abscess in adults is the appearance of a sore throat, which intensifies when swallowing water or food. This pain is sometimes so pronounced that patients are forced to refrain from frequent meals. There is a change in voice, most often it becomes hoarse. If the abscess is in the upper or lower part of the nasopharynx, then the patient has nasal congestion.
If the abscess is large, then the patient may show asthma attacks. These seizures appear most often while standing, since in this state the pus begins to flow down and begins to interfere with the passage of air. With an abscess, a swelling of the lymph nodes is detected. If a pharyngeal abscess in children caused swelling of the surrounding tissues, then a swelling of the neck is possible.
Location
The pharyngeal abscess can be classified, depending on where it is located, into the following types:
- The epipharyngeal type of abscess is the suppuration of fiber, which is localized above the palatine arch. This type of abscess is characterized by a one-sided sore throat, pain in the masticatory muscles and lymph nodes on the side of the development of the abscess.
- Mesopharyngeal type of abscess. This abscess is located between the root of the tongue and the edge of the palatine arch.
- Hypopharyngeal type of abscess. This abscess is located below the root zone of the tongue.
- A mixed view of the abscess - occupying the pharyngeal space and another several anatomical zones.
Flow patterns
The pharyngeal abscess is classified depending on the form of the flow into the following types:
- Initial form. At this stage, edema and redness appear. This form is recommended to be treated with the medication method.
- Acute form. Most often develops as a result of suppuration of the lymph nodes during infection with streptococci and staphylococci. This form is treated surgically.
- Chronic This stage develops after inadequate treatment of the acute form of the disease. This form is treated surgically.
Complications
Complications of the pharyngeal abscess arise due to the spread of infection. This movement in the upper respiratory tract is especially dangerous.
If the infection has spread and settled on the bronchi, then this is the reason for the appearance of bronchopneumonia.
During the spread of infection, a malfunction of the lungs is observed, which causes the development of pneumonia in them.
Also, the infection can spread to the cranial cavity, which leads to the development of an abscess of the brain or meningitis.
A serious complication is suffocation. It occurs due to the closure of the respiratory tract due to the presence of severe laryngeal edema at the site of rupture of the abscess. During the manifestation of such attacks, cardiac function may be reflexively disturbed until cardiac arrest.
A serious complication is the rupture of the abscess, since at this time there is a drainage of pus on the walls of the pharynx. It can affect large vessels, which can cause bleeding or blood clots. This pus can seep into the mediastinum, where it can cause the development of purulent mediastinitis, which is the cause of sepsis.
Diagnostics
Diagnosis of a pharyngeal abscess is carried out by an otolaryngologist (ENT) by interviewing a patient and a comprehensive clinical examination. The purpose of the survey is to study the nature and duration of complaints, and on the basis of this - clarification of the underlying disease, finding out what caused the formation of the abscess. For diagnosis in children, information about the nature of the first symptoms and the general state of immunity is specified in the parents.
After that, the doctor proceeds to a comprehensive clinical study, which consists of examining the patient in order to identify specific signs of an inflammatory process of an infectious nature, such as redness of the pharyngeal mucosa, pain on palpation, and enlarged lymph nodes.
For a visual examination of the mucosa of the posterior pharyngeal wall and the identification of abscesses of its lower and upper sections, pharyngoscopy is used. A general and biochemical blood test will help to determine the severity of inflammation and, on the basis of this, form an objective treatment.
Identify pathogenic microflora in the mucosa will help bacterioscopy and bacteriological examination, the biomaterial for which will be a smear from the mucous membrane of the pharynx. To identify the presence and localization of the abscess, as well as the degree of spread of the purulent process, modern research methods, such as CT and MRI, are used.
Autopsy
Autopsy of the pharyngeal (retropharyngeal) abscess is performed in several ways.
- With a surgical knife. The tool should be wrapped with cotton or adhesive plaster. In this case, the cutting part remains free, approximately 0.05 - 0.06 cm. Incision is performed starting from the bottom, from the place where bulging of the mucous membrane begins. The depth is 0.5 cm. The incision must be completed at the most convex point of the abscess. To avoid pus flowing into the larynx, it is necessary to tilt the patient's head down immediately after dissection.
- Pointed scissors. Scissors are injected into the highest suppuration point. To avoid aspiration, a small dissection should be done first. Then open the tool to expand the edges of the cut. Using this method, in parallel, you can take a test sample for the purpose of diagnosis and treatment.
- Pus can flow to the neck if the pharyngeal abscess is low. Then the opening of the abscess is preferable to do an external surgical cut. In this case, a line is recommended along the front edge of Musculus sternocleidomastoideus (sternocleidomastoid muscle). If a large section is performed, there is a chance of damage to the accessory nerve.
With purulent accumulations associated with the ear, in addition to opening, surgical treatment of the ear is performed.
Pharmacology
Drug treatment of a pharyngeal abscess consists in the use of antibiotics. The following groups are currently used:
- Cephalosporins (Ceftriaxone, Cefepim).
- Macrolides ("Erythromycin", "Clarithromycin").
- Lincosamides ("Linkomycin", "Clindamycin").
The mechanism of cephalosporins work blocks the renewal of the cellular structure of microbes, which completely destroys them. Depending on the representative, they can be administered intravenously or intramuscularly.
Cephalosporins are prescribed for children at any age. But their safety in children under 6 months of age has not been proven.
Macrolides block ribosomes in bacteria, which inhibits their growth. Macrolides are most often taken orally.
Lincosamides block the renewal of the protein structure in bacteria, which slows down their division and growth. Depending on the representative, lincosamides can be administered intravenously or intramuscularly. Some of these drugs can reduce the bioavailability of food intake.
In combination with antibiotics, anti-inflammatory and antipyretic drugs can be used. But they should be used only as a last resort, as they can cause depression and so weakened immunity.
Alternative treatment
Treatment with folk remedies is most often carried out in order to reduce the symptoms of a throat abscess and to stop the development of inflammation. It is not possible to cure a pharyngeal abscess with folk remedies. This is due to the fact that this disease has an infectious nature of occurrence.
Folk remedies include gargling with the following solutions and decoctions:
- A solution of salt and soda can significantly reduce the number of bacteria around the pharyngeal process. To prepare it, you need to take one tablespoon of salt or soda and dissolve in a glass of warm water. Gargle with the resulting solution, repeat at least five times during the day. The number of rinses can be increased if the solution is diluted with water.
- Infusion of herbs for rinsing a goal. The preparation of such an infusion begins with drying and grinding various herbs, then the resulting dust is poured with boiling water and allowed to infuse for several hours. Rinse is repeated several times a day.
- Taking Kalanchoe juice will locally remove inflammation and reduce the symptoms of abscess development by removing purulent plaque.
Forecast
Timely diagnosis and identification of a pharyngeal abscess will allow you to cure it without any problems. According to statistics, if complications are not allowed, then timely opening of the abscess in most cases allows you to completely get rid of it without the appearance of dangerous consequences. If treatment was not taken immediately and complications appeared as a result, then in this case the prognosis is quite negative up to a fatal outcome.
Prevention
In order to prevent the development of a pharyngeal abscess, it is necessary to carry out the following measures:
- correct treatment of ENT diseases;
- early diagnosis in the presence of ENT diseases;
- timely removal of foreign bodies from the throat;
- timely treatment of any purulent congestion in the throat;
- Avoiding throat burns when taking hot foods.
During endoscopic examinations, avoid trauma to the throat. If nevertheless this happened, then take measures for antibacterial treatment.
General additional measures for the prevention of pharyngeal abscess:
- accustoming the throat to hot and cold drinks;
- normalization of the microflora of the throat;
- strengthening immunity;
- intake of vitamins;
- balanced diet.