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Pharyngitis - Diagnosis
Last reviewed: 04.07.2025
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Laboratory research
To diagnose the streptococcal nature of pharyngitis, a culture method, rapid determination of streptococcal antigen, and immunological studies are used.
Instrumental research
During pharyngoscopy in a patient with acute pharyngitis and exacerbation of chronic inflammation, the mucous membrane of the pharynx is hyperemic and edematous.
The process can spread to the palatine arches, tonsils: the soft palate and uvula can be edematous, increased in volume. Often, separate lymphadenoid follicles in the form of bright red rounded elevations (granules) are visible on the back and side walls of the pharynx - granular pharyngitis.
Sometimes on the lateral walls, immediately behind the palatine arches, one can observe enlarged, infiltrated lymphadenoid ridges (lateral pharyngitis). However, persistent hypertrophy of the granules and lateral ridges should often be considered as a manifestation of not acute, but exacerbation of chronic pharyngitis. Local complications of acute pharyngitis may be associated with the spread of inflammation to the auditory tubes, nasal cavity, larynx, and general ones with the occurrence or exacerbation of general diseases, such as rheumatism, arthritis, nephritis, etc.
In the catarrhal form of chronic pharyngitis, moderately expressed congestive hyperemia, some swelling and thickening of the mucous membrane are noted; in some places, the surface of the back wall of the pharynx is covered with viscous mucus. Hypertrophic pharyngitis, in addition to the symptoms described above, is often characterized by mucopurulent discharge flowing down the back wall of the pharynx. Granular pharyngitis is characterized by the presence of granules on the back wall of the pharynx - semicircular elevations the size of a millet grain of dark red color, located against the background of hyperemic mucous membrane, superficial branching veins. Lateral pharyngitis is detected in the form of cords of varying thickness, located behind the posterior palatine arches. The atrophic process is characterized by a thinned, dry mucous membrane, a pale pink cyst with a dull shade, covered in places with crusts, viscous mucus. Injected vessels may be visible on the shiny surface of the mucous membrane.
During exacerbation of chronic pharyngitis, the indicated changes are accompanied by hyperemia and edema of the mucous membrane, but the scarcity of objective data often does not correspond to the severity of the symptoms bothering the patient.
Differential diagnosis of pharyngitis
Characteristic complaints, anamnesis, and typical pharyngoscopic picture facilitate diagnosis of pharyngitis.
Acute pharyngitis should be differentiated from catarrhal tonsillitis, pharyngeal lesions in acute infectious diseases (measles, scarlet fever). Diagnosis is facilitated by the appearance of characteristic rashes on the mucous membranes and skin of the sick child.
In acute respiratory infections, including influenza, other parts of the respiratory system are affected in addition to the pharynx. The inflammatory process is descending, the general reaction of the body is more pronounced, and regional lymphadenitis is observed. In some cases, acute nonspecific nasopharyngitis must be differentiated from the diphtheria process, in which there are difficult-to-remove film-like deposits on the surface of the mucous membrane.
In addition, if diphtheria is suspected, a study of the discharge for diphtheria bacilli helps to make a correct diagnosis. Sometimes acute pharyngitis is combined with catarrhal tonsillitis.
In children, acute pharyngitis should be differentiated from gonorrheal nasopharyngitis in rare cases. It should be taken into account that gonococcal infection causes specific eye damage already in the neonatal period. Severe hyperemia of the mucous membrane of the pharynx can be observed with syphilis. In children, congenital syphilitic damage is determined in the second month of life - syphilides on the buttocks and around the anus, enlargement of the liver and spleen. Anamnesis and appropriate bacteriological examination help to establish the correct diagnosis.
Rhinopharyngitis may accompany diseases of the sphenoid sinus and posterior cells of the ethmoid labyrinth. In this case, differential diagnostics are performed using endoscopy and X-ray examination.
Hypertrophic forms of pharyngitis may include hyperkeratosis of the pharynx (leptotrichosis), in which pyramidal-shaped pointed outgrowths of keratinized epithelium measuring about 2-3 mm are formed on the surface of lymphoid formations (including the palatine tonsils). Most often, yellowish-white dense formations appear on the pharyngeal surface of the palatine tonsils. papillae of the tongue and differ from lacunar plugs by their hardness and strong adhesion to the epithelium (they are difficult to tear off with tweezers); morphologically, they are characterized by proliferation of the epithelium with keratinization. Microscopic examination of these formations reveals filamentous bacteria B. lepotrix, which gives reason to consider this pathogen as an etiologic factor in the development of the disease. The process is chronic and remains undetected for a long time due to the absence of tissue inflammation and clinical manifestations. The diagnosis is established by examination and histological examination of epithelial growths.
In case of persistent, non-responsive to conventional therapy painful sensations in the throat, in some cases, differential diagnostics is required with syndromes developing in a number of systemic diseases and diseases of the nervous system. Thus, Sjogren's syndrome is a chronic systemic disease accompanied by pronounced dryness of the mucous membranes of the respiratory and gastrointestinal tracts, dysfunction and diffuse enlargement of the salivary glands, conjunctivitis, keratitis, impaired calcification of teeth and bones. often polyarthritis.
Persistent unilateral sore throat may be caused by elongation of the styloid process, which is located on the inferior surface of the temporal bone and can be palpated over the superior pole of the palatine tonsil.
Neuralgia of the glossopharyngeal or vagus nerves can also cause sore throat, especially in older people.
Indications for consultations with other specialists
To clarify the diagnosis, you may need to consult an infectious disease specialist, therapist, gastroenterologist, or neurologist.
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