Pharyngeal abscess
A pharyngeal abscess (post-pharyngeal abscess, retropharyngeal abscess) is a purulent inflammation of the lymph nodes and loose fiber between the prevertebral fascia and the fascia of the pharyngeal musculature. The disease occurs under the influence of the spread of pyogenic microorganisms from an infectious focus located in the ear or nasopharynx. Pharyngeal injuries also have an impact on this process. A pharyngeal abscess is manifested by hoarseness or nasal voice, an increase in body temperature, difficulty breathing, an increase in occipital and cervical lymph nodes, intense pain in the throat, which leads to refusal of food and impaired swallowing. Diagnosis of the disease is carried out using the method of sowing a smear from the throat, pharyngoscopy, RPR test, PCR diagnostics. The treatment of a pharyngeal abscess is based on drainage and surgical autopsy in combination with complex therapy with antibacterial, hyposensitizing and anti-inflammatory drugs.
The content of the article:
What is a pharyngeal abscess
Classification of a pharyngeal abscess
Causes of a pharyngeal abscess
Symptoms of a pharyngeal abscess
Diagnosis of a pharyngeal abscess
Complications of a pharyngeal abscess
Treatment of a pharyngeal abscess
Prognosis and prevention of pharyngeal abscess
Pharyngeal abscess
What is a pharyngeal abscess
A pharyngeal abscess is characterized by purulent inflammation of loose fiber and lymph nodes of the pharyngeal space. Basically, the disease occurs in childhood, especially in children under 4-5 years old. The fact is that by this age, the nodes and loose fiber in this area are well developed, and after they undergo evolutionary changes. At the age of 6, the nodes completely atrophy.
Most often, a pharyngeal abscess is diagnosed at the age of 1 year. In adults, this disease is extremely rare. As a rule, its appearance is caused by injuries of the pharynx. Also, a pharyngeal abscess in adults develops with syphilitic or tuberculous spondylitis of the upper cervical vertebrae or with their trauma. However, in modern conditions of life, a pharyngeal abscess is increasingly common in adults.
Classification of a pharyngeal abscess
A disease such as a pharyngeal abscess is classified depending on the location. The pharyngeal abscess is divided into the following types:
hypopharyngeal — pharyngeal abscess falls below the root of the tongue (closer to the larynx);
epipharyngeal — purulent focus is located above the palatine curtain (high in the nasopharynx);
mixed — purulent formations occupy several anatomical zones;
mesopharyngeal — pus is localized between the root of the tongue and the edge of the palatine curtain.
Each type of pharyngeal abscess has its own characteristics and different symptoms.
Causes of a pharyngeal abscess
In children, a pharyngeal abscess occurs under the influence of the spread of infection into the lymph nodes. Diseases can provoke infection: purulent otitis, complicated mumps, mastoiditis, rhinitis, pharyngitis, tonsillitis, sinusitis. The infection spreads into the pharyngeal space and passes through the lymphatic pathways, at the same time affecting the pharyngeal lymph nodes. It is worth noting that the deep pharyngeal lymph nodes are a kind of first barrier to the posterior parts of the nasal cavity, auditory tube, nasopharynx and middle ear.
The risk group includes children who have been diagnosed with a metabolic disorder, a weakened body, reduced immunity, the presence of rickets or diathesis.
In infants, the initial forms of mastitis and cracks of the mother’s nipple play a decisive role in the infection of the pharyngeal space.
Another reason for the development of a pharyngeal abscess is trauma to the posterior wall of the pharynx. In addition, the development of a pharyngeal abscess in children can be triggered by acute infectious diseases: measles, SARS, scarlet fever, influenza, diphtheria. Complications of tonsillectomy or adenotomy can also provoke a pharyngeal abscess.
A pharyngeal abscess in adults occurs, as a rule, under the influence of injuries. The pharynx may be damaged by a foreign object, rough food. Injury to the pharynx is possible during bronchoscopy, gastroscopy, endotracheal anesthesia and nasogastric tube installation. In adults, a pharyngeal abscess can occur as a complication of severe angina. There are cases when this disease occurs under the influence of a specific microflora and is a consequence of syphilis or tuberculosis, which affect the cervical spine. Such cases have been called “cold” pharyngeal abscess. People with weakened immunity and the body, chronic diseases, diabetes mellitus, HIV infection, malignant tumors are at risk of contracting a pharyngeal abscess.
Symptoms of a pharyngeal abscess
The acute course of a pharyngeal abscess is most often observed, less often — chronic and subacute. In most cases, the disease is severe, characterized by a violation of the general condition and an increase in body temperature to 39-40 ° C. If a pharyngeal abscess develops against the background of an infectious disease, then the patient feels a sharp deterioration in well-being, not to mention a number of new symptoms. There is hypersalivation, moderate rigidity of the occipital muscles, limited and painful opening of the mouth.
Children become restless and tearful, refusal to eat is characteristic, sleep disturbance occurs, and in infants — a violation of sucking.
One of the first symptoms of a pharyngeal abscess is a sore throat, patients note difficulty swallowing food, increased pain during swallowing. Very often, the sore throat can be very severe, it reaches the point that the patient begins to refuse to eat.
Nasal breathing is disrupted when a pharyngeal abscess spreads in the upper pharynx, nasal voice appears in adults and older children. In the case of localization of a pharyngeal abscess in the lower or middle part of the pharynx, difficulty breathing and hoarseness of the voice appear. There may also be attacks of suffocation and inspiratory shortness of breath.
The patient in an upright position notes an aggravation of respiratory disorders, which is caused by the pus flowing down and blocking the tracheal lumen. During sleep, there may be a specific bubbling in the throat. When a pharyngeal abscess is localized in the oral part of the pharynx, a pharyngeal stridor appears and swallowing is upset.
A pharyngeal abscess is often accompanied by lymphadenitis of regional lymph nodes. Occipital and lateral upper neck lymph nodes become painful and swollen. As a result, the patient’s head is thrown back and turns in the direction where the pharyngeal abscess is diagnosed. Very often, the neck or part of it swells on the side of the abscess.
Diagnosis of a pharyngeal abscess
The diagnosis of a pharyngeal abscess is carried out by an otolaryngologist on the basis of pharyngoscopy and data obtained during the examination of the patient. First of all, the doctor pays attention to the forced position of the patient’s head, enlarged lymph nodes, local swelling in the neck.
With the help of pharyngoscopy, a tumor-like swelling of a spherical shape and local infiltration on the posterior wall of the pharynx are detected. The presence of a symptom of fluctuation and soreness at the site of swelling is determined by a finger examination of the pharynx.
A clinical blood test reveals the inflammatory process — there is an increase in ESR up to 40 mm / h and leukocytosis. Microscopy and bacteriological examination of a smear from the pharynx determines the type of pathogen that provoked the appearance of a pharyngeal abscess.
To identify concomitant diseases of the nasopharynx and ear, rhinoscopy, radiography of the spine in the cervical region, otoscopy, radiography and ultrasound of the paranasal sinuses may be required.
Complications of a pharyngeal abscess
A pharyngeal abscess is a dangerous disease that can be accompanied by a number of complications. Bronchopneumonia can cause the spread of infection from the pharyngeal abscess through the upper respiratory tract. In turn, congestive pneumonia occurs under the influence of impaired respiratory function. Hematogenic spread of infection into the cranial cavity with the appearance of purulent meningitis or abscess of the cerebral pulp is much less common. With a pharyngeal abscess, in some cases, cardiac arrest may occur reflexively.
Mediastinitis is another formidable complication of a pharyngeal abscess. The occurrence of this disease is caused by the evacuation of pus through loose fiber, which is located between the spine and esophagus. Fever, swelling on the neck and pain are the first manifestations of incipient mediastinitis. In some cases, recurrent nerve paresis occurs.
One of the possible complications of a pharyngeal abscess is erosive bleeding. The source of bleeding is considered to be the internal carotid artery. Also, vascular damage can become a prerequisite for phlebitis, jugular vein thrombosis or intracranial complications.
Asphyxia can be called a rather dangerous complication of a pharyngeal abscess. It is worth noting that suffocation occurs as a result of the overlap of the airway lumen. Asphyxia can be provoked by severe swelling of the larynx or the opening of a pharyngeal abscess.
Treatment of a pharyngeal abscess
A pharyngeal abscess requires drainage and surgical autopsy. In the place of the greatest swelling, an incision of the abscess is made with pointed scissors or a scalpel. The pus is sucked out using a special tip, which is inserted through the incision. After opening the pharyngeal abscess, it is important to immediately quickly suck out the pus, the only way to avoid it getting into the respiratory tract. At the time of opening the abscess, to prevent pus from flowing into the respiratory tract, it is recommended to pre-suck the pus and perform its puncture. If the edges of the incision made stick together, then it is necessary to re-open them with the introduction of Hartmann forceps or a grooved probe.
Pharyngeal abscesses, which are located low and are accompanied by a swelling of pus in the neck area, must be hidden through external surgical access.
It is contraindicated to insert a breathing tube in the presence of symptoms of compression of the respiratory tract. At such moments, it is necessary to perform a cricotomy — to make an incision on the front surface of the neck to restore breathing. As a result, oxygen therapy is indicated to eliminate hypoxia.
Treatment of a pharyngeal abscess of tuberculous or syphilitic nature takes place without opening, so as not to provoke the spread of infection. In such cases, repeated punctures with the introduction of anti-syphilitic and anti-tuberculosis drugs are practiced. In addition, general anti-tuberculosis and anti-syphilitic therapy is prescribed.
Surgical treatment of a pharyngeal abscess is combined with systemic antibacterial therapy. Multivitamins, antipyretic and anti-inflammatory drugs (nimesulide, nurofen, paracetamol) and hyposensitizing drugs (erespal, loratadine, erius,) are also prescribed. After the operation, the throat should be thoroughly rinsed with antiseptic solutions. It is important to follow all the doctor’s recommendations, so that the rehabilitation process will be quick and painless.
Prognosis and prevention of pharyngeal abscess
In most cases, timely detection and opening of a pharyngeal abscess is the key to a favorable outcome of the disease. With the appearance of complications, the disease becomes very dangerous. The patient may die from cardiac arrest, asphyxia, erosive bleeding, sepsis. However, such cases in modern medicine are very rare.
The most effective prevention of the development of a pharyngeal abscess is the early diagnosis of ENT diseases and their treatment, timely surgical rehabilitation of purulent foci. In the prevention of a pharyngeal abscess, careful adherence to the technique of surgical interventions, careful removal of foreign bodies of the pharynx, proper diagnostic and therapeutic procedures that are associated with the introduction of a breathing tube or endoscope into the pharynx are of great importance.
