This disease exhibits different characteristics in different cases. Those conditions known as granular or follicular pharyngitis and hypertrophic pharyngitis, or these when involving the naso-pharynx, are varieties.
Definition:—A chronic inflammation involving the pharyngeal or naso-pharyngeal mucous membranes.
Etiology:—This condition is more common in certain climates, especially on the Atlantic seacoast in the United States and in the region of the great lakes.
Those subject to chronic nasal catarrh and those who have had previous attacks of acute pharyngitis are especially liable to chronic development of this disease. It occurs among those in poor health, who are subject to mental overwork. Those who are addicted to smoking and to the use of alcohol, those who habitually strain the voice, especially in the open air; "stump" speakers, street venders and auctioneers are especially liable to attacks. It is common among teachers and clergymen and army officers. It is caused also by the persistent use of hot drinks, by the continued inhalation of irritating vapors, and by constant exposure to a cold, damp atmosphere.
Those who have some chronic obstruction within the nasal passages often seem to suffer from this disease, and there is a class of cases in which the disease is induced by chronic stomach disorder.
Symptomatology:—An almost constant inclination to clear the throat by hawking is a prominent early symptom. There may be a continued slight change of the voice and hoarseness, with dry, hacking cough. Prolonged use of the voice may be followed by irritability and fatigue and by extreme huskiness and partial failure of the voice, until the fatigue is recovered from. Dryness of the throat is commonly complained of, with tickling, and occasionally there is a viscid, sticky secretion. The cough may persist at times, and again it occurs as a persistent hacking, spasmodically or in paroxysms, and affords no relief.
Early in the history of the case the mucous surfaces, especially in the catarrhal variety, are red, irritable in appearance, and covered with closely adherent mucus or muco-pus. The uvula is relaxed and elongated, and there is a nasal "twang" to the voice.
In the hypertrophic form the membranes are swollen, thickened and red, and the follicles are greatly enlarged, resembling small polypi. In the atrophic form the membranes are thin, smooth, sometimes pale, and sometimes presenting a dusky appearance. There is no swelling of the membranes, and the pharyngeal vault seems wide or cavernous.
These patients are usually feeble and nervous. In many cases there is some neurasthenia, but occasionally the general health is not impaired.
Diagnosis:—The diagnosis depends upon the recognition of the phenomena described, and the exclusion of those characteristic of other throat disorders.
Prognosis:—Those who completely change their habits in order to avoid the causes of the disease can be promised a cure. Those suffering from chronic disease are not liable to be permanently benefited. In all cases there is a liability to a recurrence of the disease.
Treatment:—Any impairment of the constitution must have first attention. The nervous system must be restored, the stomach must be put into the best possible condition, and the environment must be in every way favorable. Everything that has seemed to exercise a causative influence must be sedulously and persistently avoided, especially any prolonged use of the voice, and smoking.
The following should be given for a few weeks at the inauguration of the treatment, both for its general and for its local toning influence: Specific hydrastis one-half ounce, specific collinsonia one ounce, tincture of nux vomica two drams, simple elixir sufficient to make four ounces. Of this a teaspoonful should be given four times daily. When there is loss of appetite and atonicity of the stomach, half of a dram of the tincture of capsicum, or two drams of specific xanthoxylum, should be added to the above. If the patient is at all anemic, its influence is enhanced by the addition of a dram of the carbonate of iron in powder, shaking the bottle before taking. In neurasthenic patients complete rest must be enjoined and change of environment.
The use of the ammonium chlorid is of value in its influence upon the mucous membranes. It should be taken in five grain doses four times daily. In those cases where the urine has a high specific gravity, and contains a great excess of urea, urates or uric acid, the benzoate of ammonium will be of service, in six, eight or ten grain doses four times daily. Elimination must receive careful attention, and lithemia undoubtedly exercises an important influence in the causation of this disease.
Local measures are important. Where the tissues are relaxed and of dull or purplish hue, an infusion of capsicum as a gargle is specifically indicated. The infusion of white oak bark advised in other throat troubles as a gargle will render much service here if to eight ounces two drams of the tincture of capsicum and one dram of boric acid be added. The addition of the distilled extract of witch-hazel is important when there is discomfort or aching in the throat.
The use of the galvanic current will render much service in the ultimate cure of this disease, and the galvano-cautery is generally used by specialists to destroy the follicular enlargements and to reduce the hypertrophy of the tissues.