Pharyngokeratosis: causes, symptoms, diagnosis, treatment

This disease has long been included in the group of pharyngomycoses, having many common features with these common diseases4 of the pharynx and oral cavity. In fact, it stands apart in etiology and pathogenesis, and only in 1951 was it described by the Polish doctor J. Baldenwetski as an independent chronic nosological form with clearly defined symptoms. The clinical picture of this mysterious disease is characterized by spontaneous keratinization of the integumentary epithelium of the lymphadenoid formations of the pharynx, especially in the area of the crypts of the palatine tonsils, from which dense whitish-yellow spikes seem to grow, extremely tightly fused with the surrounding tissues. When they are torn off, a bleeding surface remains. The same formations also appear on the surface of the lingual tonsil, on the granules of the posterior wall of the pharynx and even in the laryngeal part of the pharynx, and in those places where hyperkeratosis occurs, the ciliated columnar epithelium metaplasizes into a multilayered flat epithelium. The keratinized areas of the epithelium remain for several weeks or months, then spontaneously, as they arose, disappear. Most often, this disease occurs in young women.

Cause of pharyngokeratosis. The cause of pharyngokeratosis has long been a subject of debate. In the second half of the 20th century, scientists agreed that this disease is the result of a sluggish inflammatory-reactive process similar to other similar conditions, such as pachydermia of the larynx, leukoplakia of the oral mucosa, and black hairy tongue. Bacteriological studies have shown the absence of Leptotrix buccalis, while Friedlander's bacillus was very often detected. According to many authors, this microorganism, which is very rarely found in the normal pharynx and oral cavity, can play a certain role in the pathogenesis of pharyngokeratosis. Histopathological examination revealed small islets of cartilaginous or bone tissue in the tonsil capsule and crypt epithelium. The keratin formed in the crypts prolapses from the crypts to the outside, giving the tonsil the appearance of a club studded with spikes.

Symptoms and clinical course of pharyngokeratosis. Subjective symptoms are minor: mild paresthesia, IT sensation, slight dysphagia. The disease is most often detected accidentally during examination of the pharynx. It does not cause complications.

The diagnosis is based on the endoscopic picture and the inexpressiveness of the clinical course. It is differentiated from other mycoses of the pharynx and in particular from leptothrixomas, with which this disease has been identified for many years. The final diagnosis is established by microscopic examination or biopsy.

Treatment of pharyngokeratosis. Relatively effective is the use of local action on individual foci of keratosis (iodine preparations, silver nitrate, galvanocautery 10-12 foci per week, diathermocoagulation, cryosurgery). It has been noted that after physical removal of most of the "colonies", other accumulations of pathological formations that have not been subjected to physical action begin to disappear. When most of them are stopped, tonsillectomy is indicated, as a result of which pathological foci in other places of the pharynx, in particular on the lingual tonsil, disappear. This fact indicates that the focus of the occurrence and spread of the disease are the palatine tonsils.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]