Medical expert of the article
New publications
Tuberculosis of the pharynx
Last reviewed: 04.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Tuberculous infection of the pharynx is a relatively rare phenomenon, occurring in most cases in severe, advanced processes in the lungs and larynx against the background of a sharp weakening of the general and local resistance of the body. There are isolated reports of primary tuberculosis of the pharynx, the primary affect of which is localized, as a rule, in the palatine tonsils. In addition, there is information that latent forms of tuberculosis can develop in the tonsils without any external clinical manifestations. Thus, T. Gorbea et al. (1964) reported that a latent form of tuberculosis is found in 3-5% of tonsils removed for various reasons.
Epidemiology of pharyngeal tuberculosis
MBT most often enters the body through the upper respiratory tract, less often through the gastrointestinal tract and damaged skin. The main source of infection are sick people who secrete MBT, as well as sick animals, mainly cattle, camels, goats, sheep, pigs, dogs, cats, chickens. MBT can be found in milk, dairy products, and less often in the meat of sick animals and birds.
[ Cause of tuberculosis of the pharynx
MBT - acid-fast mycobacteria of several species - human, bovine, avian, etc. The most common causative agent of tuberculosis in humans is MBT of the human species. These are thin, straight or slightly curved rods 1-10 µm long, 0.2-0.6 µm wide, homogeneous or granular with slightly rounded ends, very resistant to environmental factors.
The pathogenesis is complex and depends on the variety of conditions in which the interaction of the infectious agent and the organism occurs. The penetration of MBT does not always cause the development of the tuberculosis process. The leading role in the occurrence of tuberculosis is played by unfavorable living conditions, as well as a decrease in the body's resistance. There is evidence of a hereditary predisposition to the disease. In the development of tuberculosis, primary and secondary periods are distinguished, which occur under conditions of varying reactivity of the organism. Primary tuberculosis is characterized by high sensitivity of tissues to MBT and their toxins, as well as the formation of a primary tuberculosis complex (most often in the intrathoracic, hilar lymph nodes), which can serve as a source of hematogenous dissemination of MBT with the onset of the secondary period of tuberculosis, in which the lungs are affected first, and then other organs and tissues, including the lymphadenoid apparatus of the pharynx and larynx and the surrounding tissues.
Pathological anatomy
Pathologically, tuberculosis of the pharynx is manifested by the formation of infiltrates and ulcers. In the palatine tonsils, tuberculomas are located both in the follicles and in the perifollicular tissues and under the mucous membrane.
Symptoms of tuberculosis of the pharynx
Tuberculosis of the pharynx depends on the stage of development of the process and its localization. In acute forms, severe pain occurs, both spontaneous and when swallowing. Subacute ulcerative process and chronic forms are also accompanied by pain syndrome, which, however, can vary in intensity depending on the involvement of the sensory nerves innervating the pharynx. If the process is localized in the area of the lateral wall of the pharynx, then the pain usually radiates to the ear. Another characteristic symptom of tuberculosis of the pharynx is profuse salivation.
The clinical picture of tuberculosis of the pharynx is clinically manifested in two forms - acute (miliary) and chronic (infiltrative-ulcerative), which may include tuberculous lupus of the pharynx.
Acute (miliary) form of pharyngeal tuberculosis, or Isambrist's disease, is extremely rare, most often occurring in people aged 20-40. It occurs when MBT spreads through the lymphogenous or hematogenous route.
At the very beginning, the endoscopic picture resembles that observed in acute catarrhal pharyngitis: the mucous membrane in the area of the soft palate, palatine arches and tonsils is hyperemic and edematous. Soon, against the background of the hyperemic mucous membrane, rashes appear in the form of miliary tubercles (granulomas) of a grayish-yellowish color the size of a pinhead. The rash is usually accompanied by a significant increase in body temperature. The presence of these rashes on the soft palate does not always indicate general miliary tuberculosis, although it can serve as an early sign of it. The process continues with ulceration of the rashes and their fusion with the formation of more or less extensive ulcerative surfaces of irregular shape with slightly raised edges and a gray bottom. Soon the ulcers are covered with granulation tissue, initially bright pink, then acquiring a pale shade. The process can spread up and down, affecting the nasopharynx, auditory tube, nasal cavity, larynx. Deep ulcers may occur on the tongue, as well as on the back wall of the pharynx, reaching the periosteum of the cervical vertebrae. A sharp swallowing disorder due to severe pain in the pharynx, damage to the soft palate, destruction of the palatine arches, severe swelling of the laryngeal part of the pharynx and loss of motor function of the lower constrictors of the pharynx cause the impossibility of natural nutrition, which leads the patient to an extreme degree of cachexia, and only emergency measures to establish various methods of nutrition, started from the very beginning of the disease, prevent a fatal outcome, which in other cases can occur in 2 months or less from the onset of the disease.
Chronic infiltrative-ulcerative tuberculosis of the pharynx is the most common form of tuberculosis of the pharynx, which occurs as a complication of clinically expressed pulmonary tuberculosis of the "open" form. Usually, infection of the pharyngeal tissues occurs at the site of trauma to its mucous membrane. Infection can also occur hematogenously or lymphogenously, or per continuitalem from a tuberculous ulcer of the oral cavity or nasopharynx. The disease develops gradually and begins with complaints of the patient about progressive pain and discomfort when swallowing, the appearance of a nasal voice, a feeling of obstruction in the nasopharynx caused by a kind of "disobedient" soft palate. Since the disease develops against the background of a general tuberculosis infection, increased malaise, weakness, sweating and an increase in body temperature above subfebrile values are attributed to an exacerbation of the pulmonary process. Usually, with the above complaints, the patient consults an ENT specialist, whose experience determines the timely establishment of a correct diagnosis.
The pharyngoscopic picture depends on the severity of the process. During an early examination, small (0.5-0.7 mm) rounded elevations (infiltrates) can be determined against the background of a pale pink mucous membrane, scattered along the back wall of the pharynx, on the soft palate, lingual tonsil, palatine arches and tonsils, tongue, and gums. They are dense to the touch and seem to be built into the mucous membrane, painful when pressed. During a later examination (after 3-5 days), granulating ulcers with uneven, slightly raised and undermined scalloped edges are determined at the site of many of the above infiltrates (tuberculomas). The bottom of the ulcers, not exceeding 1 cm in diameter, is covered with a grayish-yellowish coating. The mucous membrane around the ulcers is pale, on its surface there are many small infiltrates, which are at various stages of development from small yellowish formations to large ulcers. Adenopathy is a constant sign of any form of pharyngeal tuberculosis.
The infiltrative-ulcerative form of pharyngeal tuberculosis is characterized by a slow course and depends entirely on the state of the pulmonary process. With a favorable course of the latter, the phenomena in the pharynx can end within 1-3 years, leaving behind more or less pronounced cicatricial deformations. It should be noted that a rare form of pharyngeal tuberculosis called "sclerosing pharyngeal tuberculosis" has been described in domestic literature, which is characterized by diffuse compact infiltration of the entire pharynx without the presence of individual infiltrates described above. This infiltrate is characterized by significant density, reaching in some places the density of cartilaginous tissue. The mucous membrane above it is slightly hyperemic. This form does not cause pronounced dysphagia and occurs in moderate clinical forms of pulmonary tuberculosis, often without MBT secretions and in their absence in sputum.
What do need to examine?
How to examine?
Differential diagnosis of tuberculosis of the pharynx
The diagnosis of pharyngeal tuberculosis in the presence of the main source of infection in the lungs does not cause difficulties and is based not only on pharyngoscopy data, but also on the results of special research methods that are used in relation to phthisiological patients. And when making a final diagnosis, it is necessary to differentiate pharyngeal tuberculosis from such diseases as Plaut-Vincent angina, tertiary gumma of syphilis, sluggish phlegmon of the pharynx, malignant neoplasm.
Lupus of the pharynx
Lupus of the pharynx is a special form of tuberculosis, which is presented as a secondary manifestation of lupus of the nose or oral cavity.
Symptoms of lupus of the pharynx
Unlike all other forms of tuberculosis, characterized by the ascending movement of infection (lungs - bronchi - trachea - larynx - pharynx - nasopharynx), lupus, like syphilis, makes this entire path in reverse order, starting in the nasal openings, spreading through the nasopharynx and pharynx to the larynx. At present, such a path for lupus is an exceptional rarity, since it is stopped at the earliest stages of occurrence with the help of hydrazide series drugs and vitamin D2.
In the initial period, the mucous membrane of the pharynx appears thickened in the form of dark-red papillary growths. In the maturity period, lyupomas (lyupomatous nodules), agglomerated into separate "colonies" of a grayish-yellow color, undergo erosion, merge, forming ulcers with unclear contours that spread like a creeping ulcer. The bottom of the ulcer is dry (unlike caseous tuberculous ulcers), the mucous membrane surrounding the ulcer is bluish. Usually, lupus is located on the soft palate, uvula, very rarely on the palatine arches and tonsils. Reaching the nasopharynx, the posterior surface of the vomer, the posterior surface of the uvula, the area of the entrance to the nasopharyngeal opening of the auditory tube are affected. The ulcer, spreading into the lumen of the auditory tube and then scarring, deforms it, up to the obliteration of the lumen. In the laryngopharynx, only the epiglottis is affected.
Despite the fairly pronounced pathomorphological lesions of the pharynx in lupus, regional lymphadenitis is not detected, the general condition of the patient remains good, and he is indifferent to his disease.
The disease develops slowly and over a long period of time, over 10-20 years. During this time, repeated relapses occur, old ulcers become scarred, and new ones appear. The scarring process causes syenosis and deformations of the pharynx, similar to those that develop with tuberculosis infection.
In rare cases, severe bacterial dissemination occurs, manifested by a septic condition.
Differential diagnostics of lupus with syphilis and pharyngeal scleroma is extremely difficult. To establish a final diagnosis, they often resort to examining a smear, biopsy or inoculating pathological material into a guinea pig to obtain a clinical picture of the disease being diagnosed.
Larvoid tuberculosis of the pharynx
In foreign literature, this name is used to denote tuberculosis of the palatine tonsils in situ, i.e. cases when only the palatine tonsils and, less frequently, other lymphadenoid formations of the pharynx, in particular, the lingual and pharyngeal, are subject to tuberculosis. The cause of this form of tuberculosis of the pharynx is the fact of "saprophytic" vegetation in the parenchyma of the said tonsils of MBT, which, under certain favorable circumstances, is activated and causes damage to the tissues in which it lives. This type of tuberculosis of the larynx can be secondary in individuals with an open form of tuberculosis, and primary in children. Clinically, larval tuberculosis of the pharynx manifests itself as a kind of banal hypertrophy of the tonsils without any subjective and objective signs of vulgar infection, and only the results of bacteriological and histological studies make it possible to establish the true cause of the hypertrophic process. However, the latent and practically without obvious signs of chronic inflammation disease remains unnoticed by both the patient and the doctor for a long time. However, there are some signs by which one can suspect the presence of larval tuberculosis of the pharynx in the patient. These are repeated tonsillitis with regional adenopathy, paleness of the mucous membrane of the soft palate and the presence of an established tuberculosis infection at a distance, most often - pulmonary tuberculosis in the stage of decay of lung tissue.
In case of hypertrophy of the palatine tonsils, characterized by pallor, unfounded by vulgar infection, the presence of widespread adenopathy, affecting not only regional but also axillary lymph nodes, poor health, weakness, subfebrile temperature, increased sweating, etc., it is necessary to assume the presence of tuberculosis infection, and conduct an appropriate in-depth phthisiatric examination of the patient.
The otolaryngologist should keep in mind that bacillary hypertrophy of the tonsils often simulates chronic tonsillitis, and its periodically occurring "exacerbations" often prompt the doctor to tonsillectomy. Such practice often leads to serious consequences in the form of tuberculous meningitis, non-healing tuberculous ulcers in the palatine niches. Therefore, always with hypertrophy of the palatine tonsils and the presence of signs that allow suspecting latent larval tuberculosis of the pharynx, before making a final diagnosis of chronic (decompensated) tonsillitis, the patient should undergo a thorough phthisiatric examination. Detection of larval tuberculosis of the pharynx does not exclude, but on the contrary, suggests the removal of a specific focus of infection (tonsillectomy), which, however, should be carried out after preliminary preparation and in the absence of any purulent inclusions in the palatine tonsils. It is advisable to clean the crypts from caseous masses (rinsing, vacuum suction) before the operation, conduct immunocorrective and general strengthening treatment, a course of streptomycin therapy and vitaminization of the body.
The operation itself should be performed by an experienced surgeon, in a gentle manner. After the operation, it is advisable to prescribe broad-spectrum antibiotics, as well as desensitizing drugs, calcium gluconate, vitamin C in increased dosage.
Retropharyngeal tuberculous abscess
In publications devoted to complications of tuberculosis infection, many cases of the occurrence of "cold" retropharyngeal abscesses of tuberculous etiology are described, the sources of which may be:
- tuberculosis infected nasopharyngeal tonsil;
- Pott's disease, which manifests itself as suboccipital or cervical tuberculosis of the spine.
Most often, a retropharyngeal tuberculous abscess occurs with Pott's disease. This abscess of the retropharyngeal space develops very slowly, without any inflammatory manifestations (hence the name - "cold" abscess). From the retropharyngeal space, pus diffuses into the mediastinum, affecting the pleura and pericardium, sometimes - the vessels through erosion of their walls.
The clinical picture is characterized by painful sensations in the cervical spine, limited mobility in it, and pharyngoscopy reveals a kind of swelling of the back wall of the pharynx covered with normal mucous membrane. When it is carefully palpated with the index finger, there is no impression of a purulent sac, the fluctuation symptom is not determined. Signs of a retropharyngeal tuberculous abscess in the absence of acute inflammatory phenomena are rather scanty. Sometimes patients experience a sensation of a foreign body in the pharynx and some discomfort when swallowing. A violent reaction occurs when pus breaks through into the mediastinum with the development of mediastinitis, pleurisy or pericarditis, which, along with possible erosive bleeding from the main vessels of the mediastinum, lead to rapid death.
When a tuberculous retropharyngeal abscess is clearly diagnosed, either of a tonsillogenic nature or in Pott's disease, it must be emptied by puncture under the cover of streptomycin in combination with broad-spectrum antibiotics.
A preliminary diagnosis is established based on the presence of a “cold” abscess on the back wall of the pharynx, and a final diagnosis is made based on the results of an X-ray examination, which reveals clear bone lesions of the cervical vertebrae.
Differential diagnostics are performed with benign retropharyngeal tumors, banal retropharyngeal abscesses, with an aortic aneurysm, which manifests itself as a pulsating swelling on the back wall of the pharynx slightly to the side. In the presence of a pulsating tumor, its puncture is strictly contraindicated.
The prognosis is determined by possible complications, the activity of bone tuberculosis of the spine, the general resistance of the body and the quality of the treatment. For life, with timely opening of the abscess and its healing, the prognosis is favorable.
Treatment of lupus is carried out using antibiotics, ultraviolet irradiation, cauterization of foci using physical and chemical methods. The use of vitamin D2 gives a very positive result, but requires monitoring the condition of the lungs and kidneys.
When treating a "cold" retropharyngeal abscess after its opening, it is first necessary to immobilize the cervical spine for up to 3 months. Of the antibiotics, streptomycin (3 g/week) and isoniazid (10 mcg/kg of body weight) are prescribed for 3 months. Then the dose is reduced by half and administered continuously for 1 year, as is customary in the treatment of bone tuberculosis. If streptomycin does not achieve a certain effect, it is replaced with PAS.
Who to contact?
Treatment of tuberculosis of the pharynx
Treatment of pharyngeal tuberculosis is carried out in special phthisiological institutions and sanatoriums and, as a rule, is combined with general anti-tuberculosis treatment of its various forms (pulmonary, visceral, bone). The main means of treating patients with any form of tuberculosis are anti-tuberculosis antibiotics - aminoglycosides (kanamycin, streptomycin) and ansamycins (rifabutin, rifamycin, rifampicin). In recent years, biologically active food supplements from the Vetoron series have been recommended, as well as vitamins and vitamin-like agents (retinoids, glycopentides). Great importance is attached to complete, easily digestible food, climatotherapy, etc.
Treatment of pharyngeal tuberculosis is carried out against the background of general specific treatment and includes the following measures: relief of pain syndrome (local spraying with anesthetic solutions - 2% solution of cocaine hydrochloride or dicaine; alcohol solution of tannin and anesthesin); irradiation with small doses (20-25 g) - analgesic and antidysphagic effect; in case of severe pain - alcoholization of the superior laryngeal nerve. The use of streptomycin, as a rule, by the end of the 1st week relieves pain syndrome and stops the development of granulomatous-ulcerative process in the pharynx.
Ulcers are treated with a 5-10% solution of lactic acid; tubular UFO is prescribed. In fibrous hypertrophic forms of pharyngeal tuberculosis, galvanocautery and diathermocoagulation are used. According to Gorbea (1984), local X-ray therapy (50 to 100 g per session, a total of 10 sessions per course, repeated after 1 week) gives good results in combating widespread ulcerative processes.