Still getting Sore Throats even after Tonsils removed?
It is not uncommon to have persistent sore throat even after tonsillectomy done in adults. This is caused by chronic granular Pharyngitis.
Chronic granular Pharyngitis can cause a significant problem in daily life, starting from throat discomfort in the morning to alteration of voice and cough .Its is a chronic inflammatory condition of the pharynx characterized by hypertrophy of mucosa, seromucinous glands, subepithelial lymphoid follicles and even the muscular coat of the pharynx.
Two Types of Chronic Pharyngitis-
- Chronic catarrhal Pharyngitis
- Chronic granular Pharyngitis
What causes it ?
- Persistent infection in the surrounding structures of pharynx like nose, sinus, tonsils and dental sepsis.
- Mouth breathing exposes pharynx to air which has not been filtered, humidified and adjusted. These are usually result of nasal polyp, allergic rhinitis, turbinate hypertrophy and adenoids.
- Environmental Pollution, dust and chemical agents.
- Faulty voice production as seen in certain professions like singers and over use of voice.
- GERD-Acid reflux from stomach in patients having hyperacidity
Symptoms-
- Discomfort or pain in the throat- prominent in the morning
- Foreign body sensation (something stuck in the throat) Globus sensation- patient has constant desire to clear the throat.
- Tiredness of Voice- voice may lose quality and even crack.
- Cough- irritable throat. Simply opening of mouth can cause retching and gagging.
- Mild dysphagia
Signs-
Examination of the throat shows the following-
- Congestion of posterior wall of pharynx, engorgement of vessels, pillars may be thickened.
- Increased mucus secretion.
- Posterior pharyngeal wall may be studded with reddish nodules in case of Granular Pharyngitis.
- Lateral pharyngeal bands may enlarge and uvula may be elongated and hypertrophied.
Treatment:-
- Etiological factor or causative agent must be eradicated for resolution of Pharyngitis. Stop smoking, abstain from alcohol and cold, irritant food.
- Avoid cold citrus drinks, ?ice cream etc
- Voice rest is essential .Speech therapy where faulty voice production is seen
- Warm Saline gargles may be soothing and even relieves pain and irritation.
- Mandl\’s paint can be applied to mucosa of pharynx
Surgical –Laser Cautery of granular Pharyngitis
If all the above fails, surgical option should be considered
Electrocautery-diathermy was once popular, but it causes lot of post operative pain and has to be done under general anesthetic.
Laser ablation of the nodules and hypertrophic mucosa can be done easily using Co2 laser. It is done under local anesthetic. No need to stay in the hospital, no bleeding, no pain, and fast recovery.
It can be difficult to perform, if the patient has excessive gag reflex.
