1.

Acute and chronic diseases of the pharynx

Department of Ear, Throat and Nose

Diseases Sechenov University
Moscow, Russia
1.1. Part 1 Acute and chronic pharyngeal
diseases
Lecturer Nikiforova G.N., MD, professor

Department of Ear, Throat and Nose Diseases

Sechenov University
Moscow, Russia
Acute pharynx diseases
• Inflammation in the throat is one of the most common diseases in the world, it is
especially common in childhood (except for children of the first year of life), up to
75% are people under the age of 30 years.

• Currently, the use of the term “acute tonsillopharyngitis” is recommended, but in

practice often the outdated designations are used - “acute pharyngitis” and
“angina”.

• In Russia, acute tonsillopharyngitis prevalence is 3-7% of the total number of

registered diseases and 17-42% of acute infections.

• There is no exact epidemiological data about acute inflammatory processes in the

pharynx, due to the optional registration and lack of a unified terminology in the
formulation of the diagnosis.
 Acute pharynx diseases

• Acute tonsillopharyngitis is an acute

infectious inflammation of the mucous
membrane and lymphoid structures of the
oropharynx, associated with the group A beta
hemolytic streptococcus and, in some other
cases, a common infectious disease.

• The term acute tonsillopharyngitis include

acute inflammation of the palatine tonsils
and the posterior pharyngeal wall, and often
inflammation of both sites occurs
compute.info
Possible clinical manifestations of pharyngeal
diseases

• sore throat pain or discomfort, aggravated by swallowing saliva and / or food, and
disrupting food intake
• local or migratory pharyngeal pain
• foreign body feeling in pharynx
• nasal obstruction, snuffle
• “Clicking”, ear fullness
• superficial cough
• dryness or excessive salivation
• Post nasal drip
Acute viral pharyngitis (tonsillopharyngitis)
Catarrhal tonsillopharyngitis in acute respiratory viral infections is the most common form of
acute inflammation of the pharyngeal mucosa.
More than 80% of acute tonsillopharyngitis is caused by viruses:
• rhinoviruses
• coronaviruses
• respiratory syncytial virus
• adenoviruses
• influenza and parainfluenza viruses
• Epstein-Barra virus
• cytomegalovirus
• new - human bocavirus and metapneumovirus

Viral invasion in some cases is the first stage of the disease preceding
the development of the bacterial process.
Isolated pathogens for purulent-inflammatory
diseases of the pharynx

no growth

Kryukov A.I., Turovsky A.B., Kunelskaya N.L., 2006

Acute catarrhal tonsillopharyngitis (acute
pharyngitis)

Complaints

• Discomfort, soreness, sore throat

• Dry throat or excessive salivation medcanal.ru
• Pain in the throat, aggravated by swallowing saliva
("empty" sip)
• Throat pain
• Foreign body sensation in the throat
• Dry superficial cough“Clicking”, ear fullness
• Mild or no intoxication

antiangina.ru
Acute catarrhal tonsillopharyngitis (acute
pharyngitis)
Diffuse hyperemia of the mucous membrane

03online.com alfinal.com
 Аcute streptococcal tonsillopharyngitis)
- acute general infectious disease with a primary lesion of the lymphadenoid tissue of
the pharyngeal ring

• Tonsillitis lingual tonsils

• Tonsillitis pharyngeal tonsil (adenoiditis)
• Laryngeal tonsillitis
• Tonsillitis of the lateral wall pharynx

player.myshared.ru
Forms of tonsillitis according to B.S. Preobrazhensky:
• Episodic (activation of autoinfection plays a role)
• Epidemic (airborne or alimentary
transmission paths)

ppt-online.org
 Clinic of acute streptococcal
tonsillopharyngitis
Symptoms:
• sudden hyperthermia without chills
• severe sore throat, aggravated by swallowing, including
eating, dysphagia
• signs of intoxication
• pharyngeal hyperemia, swelling, tonsil congestion, exudate in
gaps of tonsils, raids
• regional (maxillary) lymphadenitis

Bartlett J.D., 2000

Classification of tonsillitis (acute tonsillopharyngitis)
(according to Preobrazhensky-Palchun)
• Banal acute tonsillitis: catarrhal, follicular, lacunar, mixed,
phlegmonous (intratonsillar abscess)
• Special forms of acute tonsillitis (atypical): ulcerative-membranous
(Simanovsky-Vincent), viral, fungal
• Sore throats with infectious diseases: diphtheria of the pharynx,
tonsillitis with scarlet fever, measles, syphilitic, tonsillitis with HIV
infection, pharynx with typhoid fever, tonsillitis with tularemia
• Acute tonsillitis with blood diseases: monocytic, tonsillitis with
leukemia, agranulocytic

*В.Т.Пальчун, А.И.Крюков «Клинические рекомендации. Оториноларингология», ГЭОТАР-Медиа,

Москва, 2013
Грибковое поражение глотки (фарингомикоз)
клиническая картина

• Acute manifestation with a moderate increase in temperature, in some

cases, the temperature rises to febrile. General condition usually does not
change.
• The patient is worried about sore throat, sore, dry.
• The increase and unexpressed hyperemia of the tonsils (sometimes one),
bright white, loose, curd-like overlay, which are removed more often
without damaging the underlying tissue, are determined.
• White or whitish-yellow formations are localized on the tonsils, arches,
palatine curtain, back of the throat and tongue.

*В.Т.Пальчун, А.И.Крюков «Клинические рекомендации. Оториноларингология», ГЭОТАР-Медиа, Москва, 2013

 Diagnostic methods for various
tonsillopharyngitis
• Using Clinical Scales;
• Microbiological diagnosis
• Rapid diagnosis of streptococcal antigen

Microbiological examination
High sensitivity (up to 90%), but a long wait for results is necessary

Express Diagnostics

Fast, economical, highly specific method, but a large sensitivity range (50-
95%), the most sensitive modern test systems of the new generation, based
on immunochromatographic studies.
 Differential diagnosis of bacterial
tonsillopharyngitis
• The presence of other respiratory symptoms (cough, rhinitis,
hoarseness), as well as conjunctivitis, stomatitis, diarrhea indicate
a viral etiology of the disease
• Pain with an empty throat, perspiration, foreign body sensation,
dryness - complaints typical of a viral infection
• Diffuse hyperemia of the pharyngeal mucosa - a local picture of a
viral infection
• Phenomenon of tonsillopharyngitis with infectious
mononucleosis develops, as a rule, on the 3-5th day of the
disease against the background of already existing common
lymphadenitis (cervical, occipital, axillary, abdominal, inguinal,
etc.)
Differential diagnosis of tonsillopharyngitis (J.
Bartlett, 2001, modified) *
Clinical manifestations
Enlarged
Causative agent Hyperem Afta, cervical
ia Raid erosion lymph Other clinical symptoms
nodes
++++ ++++
Streptococcus gr. A ++++ not Acute onset Petechiah
yellowish dense in the soft sky
+++
Streptococcus gr. C and +++ +++ not Less severe
G dense

Mycoplasma Cough
+ not not ±
pneumoniae Pneumonia possible

Cough
Chlamydia pneumoniae + not not not
Pneumonia possible

* G.A.Samsygina “Indications and contraindications for antibiotic therapy in acute infections of the respiratory tract in children”,
Consilium Provisorum Volume 02 / N 5/2002
1.2. Part 2 Acute and chronic pharyngeal diseases

Lecturer Nikiforova G.N., MD, professor

Department of Ear, Throat and Nose Diseases

Sechenov University
Moscow, Russia
 Treatment for acute tonsillopharyngitis

• Mechanically, thermally and chemically sparing diet, heavy drinking

• Home mode, voice mode

According to indications:
• Systemic etiotropic drugs - antiviral and antibacterial agents
• Local etiotropic, anti-inflammatory, symptomatic agents (rinses, aerosols, lozenges)
• NSAIDs
• Antioxidants, adaptogens (vitamin therapy)
• Detoxification therapy, immunomodulators and antihistamines
• Physiotherapy
Recommendations for antibiotic therapy of
streptococcal tonsillopharyngitis
The drug of choice:
• Phenoxymethylpenicillin
• Amoxicillin
• Cephalosporins II - III generation

Previous antibiotic therapy:

• Amoxicillin / clavulanate
For allergies to beta-lactams:
• Macrolides
Deep reserve drugs:
• Lincosamides

glav-otolar.ru/ clinical-recomendations/KR306
 Errors in antibiotic therapy of acute streptococcal
tonsillopharyngitis

• Neglect of microbiological examination

• Unreasonable preference for topical treatment to
the detriment of systemic AB-therapy
• Underestimation of the clinical and
microbiological effectiveness and safety of
penicillins
• Underestimation of the clinical and
microbiological effectiveness and safety of
penicillins
• Prescription of sulfa drugs, co-trimoxazole, mednurse.ru
aminoglycosides, tetracyclines, fusidine
• Reduced course of antibiotic therapy with
clinical improvement
 Complications of acute streptococcal tonsillitis
Early (purulent) complications that develop on
day 4-6 from the onset of the disease - otitis
media, sinusitis, paratonsillar abscess, cervical
lymphadenitis

Late (non-purulent) complications developing:

• in the stage of convalescence (8-10th day from vashegorlo.ru
the onset of the disease) - post-streptococcal
glomerulonephritis, toxic shock
• 2-3 weeks after the relief of tonsillitis symptoms -
acute rheumatic fever
Medicines for the topical treatment of pharyngeal
diseases

There are 6 groups:

• Antibiotics;
• Antiseptics;
• Antimycotics;
• Immunocorrector;
• Anesthetics;
• Anti-inflammatory drugs.
1.2. Part 2 Acute and chronic diseases of the
pharynx

Lecturer Nikiforova G.N., MD, professor

Department of Ear, Throat and Nose Diseases

Sechenov University
Moscow, Russia
 Classification of chronic pharyngitis

based on the nature of changes in the pharyngeal mucosa

•catarrhal or simple chronic pharyngitis

•atrophic (subatrophic) pharyngitis
•hypertrophic (diffuse and limited - granular, lateral) pharyngitis
•mixed form of the disease (a combination of morphological changes in
the pharynx of a different nature)
 Chronic pharyngitis

Possible reasons
• Relapsing Acute Pharyngitis
• Chronic foci of infection (chronic tonsillitis, sinusitis, dental
caries)
• Prolonged difficulty in nasal breathing, postnasal syndrome
• Tonsillectomy previously
• Gastroesophageal Reflux Disease
• Common diseases (metabolic disorders, diabetes mellitus,
chronic renal failure)
• Smoking, adverse environmental and climatic factors, nutrition,
the use of topical corticosteroids
 Chronic pharyngitis

Complaints
• With exacerbation - sore throat when swallowing (more - with
an "empty" pharynx), a feeling of rawness, soreness, clot,
foreign body, discomfort in the pharynx, increased salivation
• During the period of remission, as a rule, there are no
complaints or there is transient discomfort, perspiration; with
atrophic pharyngitis - dryness in the throat, pain against
dryness
Chronic catarrhal pharyngitis
Complaints
• With exacerbation - sore throat when
swallowing (more - with an "empty"
pharynx), a feeling of rawness,
Pharyngoscopic picture in
chronic catarrhal pharyngitis:
Edema, hyperemia and thickening
of the mucous membrane of the
pharynx

soreness, coma, foreign body,

discomfort in the pharynx, increased
salivation
• During remission, as a rule, there are
no complaints or there are transient
discomfort, perspiration myslide.ru
Hypertrophic pharyngitis
Complaints:

With exacerbation - sore throat when swallowing (more - with "empty" pharynx), more
intense than with chronic catarrhal pharyngitis, sensation of soreness, soreness, lump,
foreign body, discomfort in the pharynx, increased salivation

During remission, there is transient discomfort, perspiration, accumulation of viscous

mucus in the throat, or there are no complaints

Pharyngoscopic picture with diffuse (1), granulosa (2) and lateral (3) hypertrophic pharyngitis
1. 2. 3.

znaiu.ru 03online.com en.ppt-online.org

Atrophic pharyngitis
Complaints:

With exacerbation - sore throat when

swallowing (more - with "empty" pharynx),
more intense than with chronic catarrhal
pharyngitis, sensation of soreness,
soreness, lump, foreign body, discomfort in
the pharynx, increased salivation

During remission, dryness in the throat,

pain against dryness, almost constant 03online.com
discomfort, soreness, often - the formation Thinning and dryness of the
of mucous membranes or crusts in the pharyngeal mucosa. The mucous
throat membrane is pale pink, has a
"varnished" look
Mixed form of chronic pharyngitis
Thinning and dryness of the pharyngeal mucosa. The mucous
membrane is pale pink, has a “varnished" appearance,
hyperplasia of the lateral pharyngeal ridges

Pharyngoscopic picture

03online.com
 Therapeutic measures for chronic pharyngitis in
remission

• Elimination of causative factors, treatment of concomitant somatic

diseases and pathology of ENT organs
• Exposure to hypertrophic areas of lymphoid tissue and pharyngeal
mucosa (high-energy laser exposure, cryodestruction, radio wave
destruction)
• In atrophic processes - irrigation of the pharyngeal mucosa with
isotonic seawater, the use of artificial saliva, courses of moisturizing
inhalations, lubrication of the pharyngeal mucosa with Lugol's solution
• In atrophic processes - novocaine blockade of the posterior pharyngeal
wall with a solution of proserin or aloe, vitamin therapy (insufficient
evidence base)
Chronic tonsillitis
• General infectious-allergic (?) disease with local manifestations in the
form of persistent chronic inflammation of the palatine tonsils,
characterized by a relapsing course.

Epidemiology
• One of the most common diseases in all regions of Russia.
• Among the adult population, the prevalence is 4–37%, and in
childhood - 15–63%.
 Types of formation of chronic tonsillitis

• The development of chronic tonsillitis is preceded

by a transferred sore throat (when the patient can
accurately indicate the time of onset of the
disease)
• The disease develops imperceptibly (non-angina
form of chronic tonsillitis) masked by frequent
SARS, adenoiditis, stomatitis, periodontitis.
Palatine tonsils are involved in the inflammatory
process a second time.
Chronic tonsillitis
Complaints:
• Discomfort in the throat, a sense of unpleasant
odor, the formation of “jams” in the gaps of the
tonsils;
• Pain in the throat during remission is usually due
to concomitant pharyngitis;
• tonsillectomy previously;
• Tonsillogenic intoxication (low-grade fever,
weakness, malaise, fatigue, periodic joint pain,
heart pain without objective impairment).
 Signs of chronic tonsillitis
There is no pathognomonic sign
A diagnosis requires a combination of several features.

• Pathological contents in the gaps - caseous-purulent detritus;

• Maxillary lymphadenitis;
• Fusion and adhesion of palatine arches with tonsil;
• Sign of Zach - swelling in the upper corner formed by the front and rear
arches;
• Sign of Preobrazhensky - hyperplasia
and infiltration of the edges of the
upper palatine arches
• Sign of Giz - hyperemia of the anterior
palatine arches

Pharyngosopic picture with chronic

tonsillitis
lxuafv.cn.triagung86.wordpress.com
Classification (according to I. Soldatov)

1. Compensated form:
• local signs of chronic inflammation of the tonsils without
a pronounced general reaction
• recurrent tonsillitis in the anamnesis (not more often
than 1 tonsillitis in 1-2 years), or non-anginal course of
inflammation
2. Decompensated form:(more often than 1 tonsillitis in 1-2 years)
• a history of paratonsillitis and paratonsillar abscesses
• the presence of conjugate (metatonsillar diseases)
Classification (according to Preobrazhensky B.S.
and Palchun V.T.)
• Simple form – only local signs, sore throats - less than 1r
per year;
• Toxic Allergic Form I (TAF I) - history of periodic sore
throats, local signs in combination with general toxico-
allergic effects (periodically subfebrile temperature,
manifestation of tonsillogenic intoxication with weakness,
malaise, fatigue, periodic joint pain, heart pain during
exacerbation without objective disturbances on the ECG);
• Toxic – allergic form II (TAF II) - more pronounced signs
of TAF I in the kidneys, liver, vascular system, joints,
registered in the laboratory) and associated diseases that
have common etiopathogenetic factors with chronic
tonsillitis: local (paratonsillar abscess, parapharyngitis) and
general.
 Metatonsillar (conjugate) diseases
Diseases of distant organs and systems in chronic tonsillitis are
diverse and widespread.
• Collagen diseases (rheumatism, systemic lupus erythematosus,
periarteritis nodosa, scleroderma, dermatomyositis)
• Rheumatic and non-rheumatic carditis
• Focal or diffuse glomerulonephritis
• Thyroiditis, thyrotoxicosis
• Skin diseases (psoriasis, eczema, erythema multiforme exudative)
• Thrombocytopenic purpura, hemorrhagic vasculitis
• Recurrent erysipelas
 Methods of treating patients with chronic
tonsillitis

• Conservative;

• Organ preserving surgery

• Radical surgical (tonsillectomy)

 Treatment of chronic tonsillitis
Conservative

Indications
• Compensated form of chronic tonsillitis
• Decompensated form of chronic tonsillitis in the presence
of contraindications for surgical treatment
• For diagnostic purposes - to confirm the metatonsillar
nature of lesions of distant organs in the case of temporary
positive dynamics during treatment
 Protocol for the Conservative Treatment of Chronic
Tonsillitis

Local treatment:
• Washing of gaps of palatine tonsils (syringe, hardware);
• «Tonsilor»;
• Physiotherapy;
• Immunomodulators, bacterial lysates
• Remediation of regional foci of infection

Systemic treatment:
• Adaptogens, antioxidants, immunomodulators
• Phytotherapy
• Homeopathic remedies
Washing the gaps of the palatine tonsils

ppt-online.org
 Criteria for the effectiveness of conservative
treatment of chronic tonsillitis

• The absence of pathological contents in the gaps of the tonsils

• Reducing the severity of local signs of chronic tonsillitis
• Decrease in frequency or absence of acute tonsillitis
• General improvement
 Surgical treatment of chronic tonsillitis

Tonsillectomy

Indications:
• Decompensated form of chronic tonsillitis (the presence of
confirmed metatonsillar diseases, a history of paratonsillar
abscess, tonsillitis more often 1-2 times a year).
• Inefficiency of two or more courses of conservative treatment
with a compensated form of chronic tonsillitis.
Surgical treatment of chronic tonsillitis
Organ conservation operations
• Partial tonsil removal using laser radiation or shaver,
cryodestruction of lymphoid tissue
• Lacunotomy (dissection of the walls of the gaps in order to
improve their drainage)
 Тесты
1. Острый паратонзиллит это воспаление:
А. Нёбных дужек
Б. Капсулы миндалины
В. Глубоких отделов лакун миндалины
Г. Околоминдаликовой клетчатки

2. Мероприятия при остром стрептококковом тонзиллофарингите:

А. Тонзиллотомия
Б. Тонзиллэктомия
В. Промывание лакун нёбных миндалин
Г. Системная антибиотикотерапия

3. Мероприятия при остром вирусном тонзиллофарингите:

А. Системная антибиотикотерапия
Б. Лечение на аппарате «Тонзилор»
В. Топическая терапия
Г. Интралакунарное воздействие лучом лазера

4. Отдалённое осложнение острого стрептококкового тонзиллофарингита:

А. Острая ревматическая лихорадка
Б. Острый спондиллит
В. Эозинофильная гранулёма
Г. Саркоидоз лёгких
 Тесты
5. Препарат выбора для лечения больных острым стрептококковым тонзиллофарингитом:
А. Левофлоксацин
Б. Кларитромицин
В. Амоксициллин
Г. Цефтриаксон

6. Классификация хронического фарингита основана на:

А. Этиотропном факторе
Б. Частоте обострений
В. Патоморфологических изменениях
Г. Наличии сопутствующих заболеваний
7. Хирургическое лечение показано больным:

А. Хроническим катаральным фарингитом

Б. Гипертрофическим фарингитом
В. Атрофическим фарингитом
Г. Острым катаральным фарингитом

8. Фарингоскопическая картина при атрофическом фарингите:

А. Бледно-розовая, «лакированная» слизистая оболочка
Б. Наличие везикул на задней стенке глотки
В. Энантема
Г. Наличие гранул лимфоидной ткани на задней стенке глотки
1.3. Part 3 Acute and chronic pharyngeal diseases

Lecturer Nikiforova G.N., MD, professor

Department of Ear, Throat and Nose Diseases

Sechenov University
Moscow, Russia
Adenoids
1

2
3

uz.denemetr.com tonsillit.ru
Endophoto. 1- adenoids, 2- pharyngeal orifice of the auditory tube, 3- posterior edge of
the opener

• Adenoids - a widespread disease among children from 1 year to 14-15 years, most
often from 3 to 7 years
• Recently, there has been a tendency to identify adenoids in children of an earlier
age and after 15 years.
Adenoids
Adenoid vegetation in terms of growth can be of three degrees:
• - I degree - adenoid vegetation covers only the upper third of the opener
• - II degree - adenoid vegetation covers 2/3 of the coulter
• - III degree - adenoid vegetation covers the opener completely, reaching the level of the
posterior end of the n / nasal concha

Adenoid vegetation II degree gorlor.com

 Adenoids
Symptoms
• Difficulty in nasal breathing, especially in sleep,
snoring, obstructive sleep apnea syndrome
• Closed nasal
• Chronic rhinitis
• Recurrent exudative otitis media
• Lag in the mental and mental development of a
child as a result of chronic hypoxia
• Lag in the mental and mental development of a
child as a result of chronic hypoxia
• Changes in the development of the facial skeleton ppt-online.org
(adenoid face)
• Changes in the development of the facial skeleton
(adenoid face)
• Violation of the formation of the chest ("chicken
breast")
• Bed-wetting
Adenoids
1 2
Diagnostics

• Anterior and posterior rhinoscopy

• Endoscopy of the nasopharynx (gold standard)
3
• Radiation diagnostics (x-ray of the nasopharynx in nasmork-rinit.com
lateral projection, computed tomography, Back rhinoscopy
magnetic resonance imaging) 1- tongue of soft palate
2- nasopharyngeal mirror
• Finger examination of the nasopharynx 3- language
Differential diagnosis
Youthful angiofibroma of
Adenoids the nasopharynx

Age More often children Youthful

Gender Anyone In most cases, male

Color Pink Red-cyanotic

Consistency Soft Dense

Palpation bleeding Not Yes

Germination in Not Yes

neighboring areas
Treatment tactics
Увеличение
глоточной
ADENOIDS
миндалины

Inflammation in the
Hypertrophy background Inflammation
hypertrophy

Conservative treatment,
Surgical treatment Conservative
then surgical
(according to indications) treatment
(according to indications)
Adenoids
MRI of the
X-ray of the nasopharynx nasopharynx

loronline.ru radiomed.ru studfiles.net

Blue arrows – adenoids Arrow - Adenoids

Red arrows - pharyngeal cavity
 Methods of conservative treatment of
adenoiditis
• local and, according to indications, systemic antimicrobial therapy (taking into
account the identification of the pathogen and its sensitivity to etiotropic drugs)
• inhaled glucocorticosteroids (no recorded indications are prescribed for the
treatment of concomitant pathology)
• non-specific hypersensitizing therapy
• irrigation therapy (nasal douche, drug transfer method, retronasal douche)
• physiotherapy, laser therapy
• фармакологическая иммунокоррекция
• homeopathic remedies
• Climatotherapy
• astringents (1-2% protargolum solution, etc.)
Indications for adenotomy

• persistent difficulty in nasal breathing with adenoid

hypertrophy
• recurrent exudative otitis media
• frequent acute respiratory infections
• recurrent chronic infectious diseases of the ear,
paranasal sinuses and other parts of the respiratory
tract
• speech impairment, concomitant neuropsychiatric
and reflex disorders
• deviations of the formation of the facial skeleton www.b17.ru
Adenotomy

Palchun V.T. M.Meditsina 2002

Beckman Adenot
Shaver adenotomy

gutaclinic.ru
Differential diagnosis of pharynx diseases

Leptotrichosis - a bacterial lesion of the

pharynx

• It is characterized by the formation

on the surface of the tonsils and less
often on the mucous membrane of
dense white spines - the result of
increased proliferation of the vmede.org
epithelium and keratinization Pharyngoscopic picture
• May be asymptomatic or with mild with leptotrichosis
discomfort in the throat
Differential diagnosis of pharynx diseases

Hairy Leukoplakia - An Absolute Sign

of HIV Infection

Mucosal growths on the lateral

surfaces of the tongue, cheek mucosa
Bull TR, “Geotar-honey”, 2004
 Differential diagnosis of pharynx
diseases

Candidiasis of the oral cavity and

oropharynx (spreads to the entire
mucous membrane, may be continuous
or in the form of foci). It occurs with
repeated courses of systemic antibiotic
therapy, in AIDS patients, prolonged use
of aerosol steroids.
Bull TR, “Geotar-honey”, 2004

Pharyngoscopic picture
with candidiasis
 Differential diagnosis of pharynx diseases
Tonsil hypertrophy Hypertrophy of the tongue (snoring
and OSAS.
An examination is necessary -
Is not a sign of chronic tonsillitis.
polysomnography.
In the absence of complaints, treatment is
not required. Otherwise - tosillotomy)
Treatment is usually surgical

Bull TR, “Geotar-honey”, 2004 Bull TR, “Geotar-honey”, 2004

Differential diagnosis of pharynx diseases -
asymmetry of the soft palate and tonsils

Bull TR, “Geotar-honey”, 2004

Unilateral enlargement of the Palatine tonsil cancer (a

palatine tonsil without signs type of dense ulcer). Ear
Paratonsillar of inflammation - a sign of a pain may be one of the
abscess tumor (lymphosarcoma) first complaints.
 Literature
 Babiyak V.I. Clinical otorhinolaryngology / V.I. Babiyak, Ya.A.
Nakatis - St. Petersburg: Hippocrates, 2005 - Part 4. Throat -
p.412-445.
 Children's otorhinolaryngology, ed. Bogomilsky M.R., Chistyakova
V.R., T. 2.-M.: OJSC "Medicine", 2005. - p. 375-318.
 Palchun V.T. Otorhinolaryngology: national leadership / ed. V.T.
Palm tree. M .: GEOTAR-Media. - 2008 .-- 960 s.
 Chronic tonsillitis and tonsillitis. Immunological and clinical
aspects. / Ed. S.A. Karpishchenko and V.M. Svistushkina. - SPb .: -
Dialogue. - 2017 .-- 264s.Булл Т.Р. Атлас ЛОР-заболеваний
«Гэотар-мед», 2004. – 266с.
 Ovchinnikov Yu.M. Gamov V.P. Lopatin A.S. Our textbook