REPUBLIC OF THE PHILIPPINES

Mariano Marcos State

University
COLLEGE OF HEALTH SCIENCES
Department of Nursing
Batac City, 2906, Ilocos Norte

PHARYNGITIS & LARYNGITIS

Prepared by:
MICHELLE R. LABAO
BSN III-A

Submitted to:
PROF. NORMA L. ECLARIN
Clinical Instructor

September, 2016

PHARYNGITIS
Pharyngitis is an inflammation of the pharynx, the back of the throat. This can cause
a sore throat, as well as scratchiness in the throat and difficulty swallowing.
Types:
A. Acute Pharyngitis
-a sudden painful inflammation of the pharynx, the back portion of the throat that
includes the posterior third of the tongue, soft palate, and tonsils. It is commonly
referred to as sore throat.
B. Chronic Pharyngitis
-is a persistent inflammation of the pharynx. It is common in adults who work in
dusty surroundings, use their voice to excess, suffer from chronic cough, or
habitually use alcohol and tobacco.
3 types of chronic pharyngitis:

Hypertrophic- characterized by general thickening and congestion of the

pharyngeal mucous membrane.
Atrophic- probably a late stage of the first type (the membrane is thin,
whitish, glistening, and at times wrinkled)
Chronic Granular- characterized by numerous swollen lymph follicles
on the pharyngeal wall.

Risk Factors

Air conditioning
Allergies
Chronic cough
Exposure to cold viruses
Living in a hot, dry climate
Reflux esophagitis
Sinusitis
Smoking
Exposure to secondary smoke

Pathophysiology
With infectious pharyngitis, bacteria or viruses may directly invade the pharyngeal
mucosa, causing a local inflammatory response. Other viruses, such as rhinovirus and
coronavirus, can cause irritation of pharyngeal mucosa secondary to nasal secretions.
Streptococcal infections are characterized by local invasion and release of extracellular toxins
and proteases. In addition, protein fragments of certain serotypes of GAS are similar to

myocardial sarcolemma antigens and are linked to rheumatic fever and subsequent heart valve
damage.
Manifestations

Fiery-red pharyngeal membrane and tonsils

Swollen lymphoid follicles and flecked with white-purple exudates
Enlarged and tender cervical lymph nodes
Fever (higher than 38.3C)
Malaise
Sore throat
Constant sense of irritation or fullness of the throat
Cough
Trouble swallowing
Sneezing
Runny nose
Headache

Diagnostic Procedures
Physical Exam - check for any white patches, swelling, and redness, may also look in
patients ears and nose to check for swollen lymph nodes and feel the sides of your neck.
Rapid Antigen Detection Testing (RADT) - uses swabs that collect specimens from the
posterior pharynx and tonsils. RADT is reported to be 90% to 95% sensitive, thus
facilitating earlier treatment and earlier symptom improvement and reductions in
pathogen transmission.
Blood Tests - This will involve drawing a small sample of blood from the patients arm
or hand and sending it to a lab for testing. A simple blood test can determine whether you
have mononucleosis. A complete blood count (CBC) test may be done to determine if you
have another type of infection. There are numerous viral and bacterial agents that can
cause pharyngitis. These includes measles, chickenpox, croup (a childhood illness
distinguished by a barking cough), and whooping cough

Management
Medical Management
Treatment for pharyngitis may include rest, plenty of fluids, antibiotics,
nonprescription sore throat medicine, warm saltwater gargles,
andacetaminophen or nonsteroidal anti-inflammatory medications for pain
and fever. Antibiotics are not effective for treating pharyngitis caused by
viruses.
Penicillin V Potassium- if the cause is bacterial, given for 5 days is the
regimen of choice.
Erythromycin, cephalosphorins, and macrolides- for patients who are
allergic to penicillin.

Analgesic- for severe sore throat, as prescribed

Liquid or soft diet
Cool beverages, warm liquids, flavored frozen desserts- soothing effect
Nasal sprays or medications containing Ephedrine Sulfate or
Phenylephrine- for nasal congestion
Tonsillectomy- for adults with chronic pharyngitis, may be an effective
option.
Nursing Management
Prepare to administer prescribed antibiotics, analgesics, antitussives and
decongestants.
Encourage the client to gargle with warm saline gargles and use throat
lozenges.
Instruct the client that the temperature of saline should be sufficiently high to
be effective and should be as hot as the client can tolerate.
Instruct the client to apply an ice collar to severe sore throats.
Instruct the client on proper mouth care.
Promote measures that ensure adequate nutritional and fluid balance.
Encourage the client to increase fluid intake to 2,000 ml/per day
Discourage the client from eating spicy foods and drinking juices that are
acidic.
If the client is unable to drink, fluids may be administered IV.

LARYNGITIS
Laryngitis is an inflammation of the larynx often occurs as a result of voice abuse or
exposure to dust, chemicals, smoke, and other pollutants or as a part of a URI. It also may be
caused by isolated infection involving only the vocal cords. Laryngitis is also associated with
gastroesophageal reflux. It is often caused by the pathogens that cause common colds and
pharyngitis; the most common cause is virus, and laryngitis is often associated with allergic
rhinitis or pharyngitis.
Risk Factors

Allergies - people with allergies can often experience a sore throat due to their condition
and this can easily develop into laryngitis
Excessive alcohol intake - excessive alcohol intake can is a risk factor for not only
GERD (gastro-eosophageal reflux disease) which can result in laryngitis, but the
excessive alcohol intake itself can irritate the larynx even if GERD does not occur and
increase risk of laryngitis
GERD - people with gastro-eosophageal reflux disease (GERD) have an increased risk of
developing laryngitis due to the acidic contents of the stomach regurgitating up the
eosophagus and irritating the whole of the throat (and often the lungs too) and increasing
risk of laryngitis

Lower respiratory infection - people with any type of lower respiratory infection such
as bronchitis, croup, pleurisy, pneumonia and tuberculosis have an increased risk of
developing laryngitis due to the infection of the lungs and increased coughing possibly
also causing infection and irritation to the larynx too
Polyps on the vocal chords - nodular growths on the vocal chords are a common risk
factor for the development of laryngitis, as the vocal chords sit on top of the larynx and if
the vocal chords are inflamed due to the polyps, the larynx can also become inflamed and
hoarse resulting in laryngitis
Smoking - smoking cigarettes is a very common risk factor for the development of any
type of upper and lower respiratory condition, including laryngitis. Smoking cigarettes
irritates and damages the larynx tissue, resulting in laryngitis. Not only this, but smoking
dampens the immune system, resulting in increased risk of respiratory infection of any
type, not just laryngitis
Upper respiratory infection - any type of upper respiratory infection, such as colds,
influenza, pharyngitis, sore throat (with or without productive cough) increase the risk of
developing laryngitis due to the infection of the upper respiratory tissues. Laryngitis can
result as a secondary infection due to the initial infection in the upper respiratory tissue

Pathophysiology
Laryngitis is an inflammation of the vocal fold mucosa and larynx that lasts less than 3
weeks. When the etiology of acute laryngitis is infectious, white blood cells remove
microorganisms during the healing process. The vocal folds then become more edematous, and
vibration is adversely affected. The phonation threshold pressure may increase to a degree that
generating adequate phonation pressures in a normal fashion becomes difficult, thus eliciting
hoarseness. Frank aphonia results when a patient cannot overcome the phonation threshold
pressure required to set the vocal folds in motion.
The membranous covering of the vocal folds is usually red and swollen. The lowered pitch in
laryngitic patients is a result of this irregular thickening along the entire length of the vocal fold.
Some authors believe that the vocal fold stiffens rather than thickens. Conservative treatment
measures, as outlined below, are usually enough to overcome the laryngeal inflammation and to
restore the vocal folds to their normal vibratory activity.

Manifestations

Hoarseness or aphonia (complete loss of voice)

Severe, dry cough
Dry sore throat
Tickle in the throat
Inability to talk
Lethargy

Diagnostic Procedures

Medical history - the doctor will ask a series of questions about your symptoms
(especially the duration and severity), your family medical history (if anyone else has
similar symptoms) and some questions about whether you smoke or have any other risk
factors associated with this condition
Physical examination - the doctor will examine the throat by viewing the inside to see if
there is inflammation in the back of the throat and by feeling the outside of the throat for
inflammation of the glands. The doctor will also listen to the lungs with a stethoscope, to
determine if there is a lower respiratory infection
Laryngoscopy - the laryngoscopy test is performed by the ENT specialist (or even
regular doctor) to get a better of the view the larynx with a tube that has a special mirror
and light and which that is put into the back of the throat
Biopsy - if the laryngitis does not improve and symptoms get worse, some cells can be
taken of the larynx to be examined under a microscope for malignancy (or other
problems)

Management
Medical Management
Humidifier (or vaporiser) - a humidifier (or vaporiser) either with just
plain hot water, that produces steam or with a few drops of eucalyptus oil
may help to clear up symptoms by providing more moisture and reducing
the irritation to the larynx
Painkillers - the doctor will recommend you take painkillers as required
for any pain in the throat area (such as paracetamol, ibuprofen)
Steam inhalation - a few drops of eucalyptus oil or Vicks may help to
clear up symptoms by providing more moisture and reducing the irritation
to the larynx
Antibacterial Therapy- if the laryngitis is part of a more extensive
respiratory infection caused by bacterial organism or if it is severe.
Corticosteroids- Sometimes, corticosteroids can help reduce vocal cord
inflammation. However, this treatment is used only when there's an urgent
need to treat laryngitis for example, when you need to use your voice to
sing or give a speech or oral presentation, or in some cases when a toddler
has laryngitis associated with croup.
Nursing Management
Avoid clearing the throat - this practice does harm to the throat and is especially
irritating when there is a laryngitis infection so if the throat is irritated, have some
fluid and this will help

Drink plenty of fluids - ensure the throat is hydrated with diluted juice, herbal
tea (such as diluted chamomile, peppermint or rose hip teas) and water will help
to hydrate the larynx and help it heal more quickly
Stop smoking - smoking causes more strain on the voice and larynx and is
especially not recommended in the case of laryngitis.
Rest your voice - not talking helps the larynx heal itself and this is the best
strategy which is most beneficial in ensuring quicker healing and a return of the
voice

Nursing Diagnosis
Acute pain related to upper airway
irritation secondary to an infection.

Nursing Interventions
Observed, record, and report presence and
character of pain and discomfort.
Rationale: to provide baseline and to detect
further deterioration of status and to evaluate
interventions
Maintain bed rest when patient experiences
discomfort.
Administer analgesic agents as prescribed.
Rationale: to decreased pain and discomfort