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PubMedDate not supplied

Examination of pharyngeal secretions to determine the etiology of pharyngitis.

Wright-stained throat smears from 174 outpatients with a chief complaint of sore throat were examined. In the presence of tonsillar and/or pharyngeal exudate, cervical lymphadenitis, temperature greater than or equal to 24 less than or equal to 72h, examination of the throat smears would have doubled the accuracy of differentiating streptococcal pharyngitis (SP) from nonstreptococcal pharyngitis (NSP). In the presence of one, two, three, or all four of the preceding presenting characteristics, examination of throat smears would have increased the diagnostic accuracy by 46, 50, 13, and 14 per cent, respectively. Examination of a Wright-stained throat smear may help distinguish SP from NSP among patients in an outpatient setting where follow-up and, therefore, treatment based on culture results may not be optimal.

Adolescent↗
PubMed1976

Further observations on the pharyngeal hypophysis and the postsphenoid in the mature male rat.

In an investigation into the pharyngeal hypophysis and the postsphenoid using seven hypophysectiomized mature male rats, a pharyngeal hypophysis and a craniopharyngeal canal was found in each of two rats. Cellular differentiation was noted in the pharyngeal hypophysis in both rats. In one rat the pharyngeal hypophysis was markedly larger than any seen to date. In both rats the pharyngeal hypophysis was continuous with tissue of similar histological appearance which extended the full length of the cranio-pharyngeal canal. The histological appearance of the pharyngeal hypophysis and of the specific intra-canal tissue was also similar to that of cystic areas in the sellar adenohypophysis in the normal rat. The data arising from the present investigation indicate that a well-defined cranio-pharyngeal canal can occur in the rat. The data also support the assumption that the sellar adenohypophysis may be continuous with specific tissue within a cranio-pharyngeal canal. The significance of the data in terms of reactive hypertrophy and cellular differentiation of the pharyngeal hypophysis and the specific intra-canal tissue following hypophysectomy must await further data on the volume and histology of such tissue in normal rats which possess a cranio-pharyngeal canal.

Animals↗
PubMed1992

Adherence of Streptococcus pyogenes M type 5 to pharyngeal and buccal cells of patients with rheumatic fever and rheumatic heart disease during a one-year follow-up.

In vitro adherence of Streptococcus pyogenes M type 5 to isolated pharyngeal and buccal epithelial cells was studied in patients with acute recurrent rheumatic fever (n = 21), chronic rheumatic heart disease (n = 33), streptococcal pharyngitis (n = 12), and in normal controls. Patients were investigated at admission and one, six and 12 months later. Streptococci adhered significantly more to the pharyngeal cells of patients with rheumatic fever and rheumatic heart disease than to the pharyngeal cells of controls. Adherence of streptococci to pharyngeal cells of patients with pharyngitis was not different from age-matched controls. The adherence of streptococci to the pharyngeal cells of patients with acute rheumatic fever fell during follow-up but even after one year remained significantly higher than in the control group. These findings suggest that host factor(s) controlling streptococcal adhesion and colonization at the pharyngeal mucosa may be important in the pathogenesis of acute rheumatic fever.

Acute Disease↗
PubMed1979

Prospective study on streptococcal pharyngitis among a town population.

A one-year-round study on pharyngitis incidence among the general population of a town (24,300 inhabitants) was carried out. All patients, with pharyngitis who visited health centres were examined clinically and mcirobiologically. The overall pharyngitis incidence rate and the streptococcal pharyngitis incidence rate were, respectively, 8.3 and 3.9 cases per 100 population. Age-related incidence was highest in the group of 5-10 years, seasonal incidence was highest in autumn. Clinical diagnoses made preliminary to bacteriological examination were correct in only a half of the streptococcal pharyngitis cases. The accuracy of clinical diagnosis of streptococcal pharyngitis could, at best, be raised to 80% if fever of less than or equal to 38.0 degrees C and presence of exudate on tonsils should be considered significant criteria. A great majority of the streptococcal pharyngitis cases were caused by group A streptococci; the prevailing M types were 12, 1 and 3. Emphasis is laid on the necessity of performing microbiological examination of all pharyngitis cases in order to ensure etiological diagnosis and causal therapy. 15)

Adolescent↗
PubMed1992

Pharyngeal clearance during swallowing: a combined manometric and videofluoroscopic study.

The deglutitive pharyngeal contraction was analyzed using simultaneous videofluoroscopic and manometric studies of eight volunteers. Anterior, posterior, and longitudinal movements of the pharyngeal surfaces, relative to the cervical vertebrae, were measured during swallows of 5 and 10 mL of liquid barium. Profound pharyngeal shortening during bolus transit through the pharynx eliminated access to the larynx and elevated the upper esophageal sphincter to within 1.5 cm of the retrolingual pharynx. Bolus head movement through the pharynx preceded the propagated pharyngeal contraction and registered manometrically as a slight intrabolus pressure before the major pressure complex. Contraction in the horizontal plane began after bolus head transit and culminated with stripping of the bolus tail through the pharynx. Prolonged upper sphincter opening with the larger-volume swallows resulted from a delayed onset rather than altered propagation of the horizontal pharyngeal contraction. It is concluded that the propagated pharyngeal contraction facilitates pharyngeal clearance but has a minimal role in the process of bolus propulsion during swallowing. The propagated contraction works in concert with profound pharyngeal shortening to minimize hypopharyngeal residue after a swallow.

Adult↗
PubMed1979

Pharyngeal colonisation by Neisseria gonorrhoeae and Neisseria meningitidis in black and white patients attending a venereal disease clinic.

Pharyngeal colonisation by Neisseria gonorrhoeae and Neisseria meningitidis was studies in 2000 patients attending a venereal disease clinic. Of these patients, 64% were white and 36% were black. The incidence of gonococcal infections was highest in the period from June to August. The incidence of genital or rectal infections or both was higher in the black patients. Pharyngeal colonisation by gonococci was present in 1.3% of the patients. There was no significant associations between pharyngeal colonisation and the pharyngeal symptoms, race, sex, or marital state of the patients. Pharyngeal colonisation was more frequent in patients with gonococcal infections at other sites. However, in 40.7% of the patients with pharyngeal colonisation, the pharynx was the only culture-positive site. There was no significant difference in the auxotypes or in the antibiotic susceptibility of the pharyngeal and the rectal-genital isolates except in the susceptibility to spectinomycin. Our findings do not indicate that gonococci isolated from the pharynx differ significantly from gonococci isolated from rectal or genital sites. It was notable that meningococcal colonisation of the pharynx was significantly more frequent in the white patients. This may be a genetically determined phenomenon.

Adult↗
PubMed1978

Pharyngeal gram stains in the treatment of sore throats.

The use of the direct pharyngeal Gram stain for diagnosis of group A beta-hemolytic streptococcal pharyngitis was evaluated. Seventy-five consecutive out-patients presented with pharyngitis (or high fever in infants) were studied with pharyngeal cultures and Gram stains. Gram stains were read as either positive, negative, or indeterminate for streptococcal pharyngitis. When these predictions were correlated with the resulting culture growth of group A beta-hemolytic streptococci, the predictive value of a throat smear Gram stain was found to be significant (p less than 0.005). There were two false positives and three false negatives. Approximately one third of the smears were in the indeterminate category. Although the Gram stain of a pharyngeal smear was found to be less sensitive than the routine throat culture, the ability to obtain inexpensive rapid microbiological information suggests that the Gram stain can be used as a quick screening procedure.

Adolescent↗
PubMed1992

Occlusion and narrowing of the pharyngeal airway in obstructive sleep apnea: evaluation by ultrafast spoiled GRASS MR imaging.

Morphologic abnormalities of the pharyngeal airway are frequently found in patients with obstructive sleep apnea. These structural alterations in the pharyngeal airway can be detected in awake patients by using rapid imaging techniques. Ten patients with clinically proved obstructive sleep apnea had ultrafast spoiled gradient-recalled acquisition in the steady state (GRASS) MR imaging of the pharyngeal airway to determine the presence of occlusions and/or narrowings. Twelve sequential images were obtained at one midsagittal plane and at eight transverse planes through the pharyngeal airway. The scans were obtained at the rate of one image per 1.04 sec while the patient was breathing quietly. Occlusions or narrowings of the pharyngeal airways were detected on MR images in all patients. The site(s) of the occlusions and the site(s) and extent of the narrowings varied. Six patients had occlusions and four had narrowings of one or more sites. This study shows that ultrafast spoiled GRASS MR imaging can be used to evaluate patients with obstructive sleep apnea during tidal breathing and is useful for determining the presence of occlusions and narrowings of the pharyngeal airway.

Adult↗
PubMed1975

Quantitation of pharyngeal motor function in normal human subjects.

A need exists for accurate pressure recording of pharyngeal motor events. Results of this study indicate that accurate quantitation of pharyngeal motor activity is not possible using a water-filled catheter system, even when high infusion rates are used. An intraluminal strain gauge system, however, achieves high-fidelity recording. Quantitation of pharyngeal peristalsis using the intraluminal strain gauge system reveals peristaltic pressure amplitudes higher than those hitherto recorded. In normal subjects, peristaltic amplitude averages about 200 mmHg in the hypopharynx, complexes in one subject being as high as 600 mmHg. A zone of relatively low pressure exists in the oropharynx. Mean pharyngeal wave duration decreases progressively in an aboral direction, from 1.0 to 0.3 s, and peristaltic wave speeds range between 9 and 25 cm/s. Accurate quantitation of pharyngeal peristaltic variables provides the necessary basis for characterization and assessment of pharyngeal motor disorders.

Gastrointestinal Motility↗
PubMed1992

Analysis of pharyngeal resistance and genioglossal EMG activity using a model of orifice flow.

A model of orifice flow has been used to analyze the relationships among pressure, flow, and genioglossal electromyographic activity in the human pharynx during inspiration. The orifice flow model permits one to assess the character of airflow (laminar or turbulent) and to estimate the cross-sectional area of the orifice from pressure and flow measurements. On the basis of other data (J. Appl. Physiol. 73: 584-590, 1992), this analysis suggests that pharyngeal airflow is turbulent. Furthermore the area of the pharynx appears to increase as flow increases, but the actual change in pharyngeal diameter necessary to fit the pressure-flow data is quite small (0.11-0.87 cm, depending on the assumptions in the model). The flow-related increase in orifice area can be attributed, in part, to the activation of the genioglossus muscle. However, other flow-related factors may also contribute to pharyngeal dilation as airflow increases. Different airway shapes (circular and elliptical) and orientations (major axis anteroposterior and lateral) were incorporated into the model calculations; these factors modify considerably the apparent efficiency of genioglossal electromyographic activity. Genioglossal muscle shortening increases pharyngeal area and reduces pharyngeal resistance more effectively when the pharynx is elliptical, with the long axis of the ellipse oriented laterally. Hence the genioglossus may operate at a significant mechanical disadvantage in those patients with obstructive sleep apnea with a small sagittally oriented pharyngeal lumen.

Airway Resistance↗
PubMed1976

[Velo-pharyngeal closure before and after adenotomy and tonsillectomy].

Prior to and after removal of the tonsils and adenoids at the ENT clinic in Lucerne, phoniatric and X-ray examinations were performed in 42 children with normal velo-pharyngeal closure. Prior to the operation the velo-pharyngeal closure took place against the adenoid tissue. The surface of contact and the inclinatation of the velum were dependent on the amount of hyperplastic adenoid tissue. The configuration and the mobility of the velum were more important for the post-operative velo-pharyngeal closure than the distance from the pharyngeal wall. 3 months following the operation the velum was reaching the posterior pharyngeal wall. A distinct Passavant ridge was only visible in cases having slight difficulties in the post-operative adaptation of the velo-pharyngeal closure.

Adaptation, Physiological↗
PubMed1978

Adherence of group A streptococci to pharyngeal cells: a role in the pathogenesis of rheumatic fever.

We used an assay in vitro to investigate the possible role of streptococcal adherence to human pharyngeal cells in the pathogenesis of acute rheumatic fever. There was no difference in adherence of rheumatic fever-associated and non-associated strains of group A streptococci to pooled pharyngeal cells of normal people. Likewise, streptococci not associated with rheumatic fever adhered equally well to cells taken from normal people and from patients with rheumatic heart disease. However, the pharyngeal cells of all nine rheumatic heart disease patients tested had increased avidity for adherence for a rheumatic fever-associated strain of streptococcus compared to the pharyngeal cells obtained from age- and sex-matched controls. Increased streptococcal adherence to pharyngeal cells of rheumatic fever-prone patients may play a role in the pathogenesis of rheumatic fever.

Adult↗
PubMed1992

Intrinsic properties of pharyngeal and diaphragmatic respiratory motoneurons and muscles.

Breathing is a complex act requiring the coordinated activity of multiple groups of muscles. Thoracic and abdominal respiratory muscles expand and contract the lungs, whereas pharyngeal and laryngeal respiratory muscles maintain upper airway patency and regulate upper airway resistance. An appreciation of the importance of the latter muscle group in maintaining ventilatory homeostasis and in the pathophysiology of sleep apnea has led to extensive studies examining the neural regulation of pharyngeal dilator muscles. The present review examines the role of heterogeneity in motoneuron and muscle properties in determining the diversity in the electrical and mechanical behaviors of thoracic compared with pharyngeal muscle groups. Specifically, phrenic and hypoglossal motoneuron electrophysiological properties influence whether and the extent to which these neurons will fire in response to a given synaptic input arising from chemo- and mechanoreceptors and from respiratory and nonrespiratory pattern generators. Furthermore, thoracic and pharyngeal muscle properties determine the mechanical response to motoneuronal activity, including the speed of contraction, relationships between motoneuron firing frequency and force production, and whether force is maintained during repetitive activation. Heterogeneity in the functional capabilities of these motoneurons and muscles is in turn determined by diversity of their structural and biochemical properties. Thus, intrinsic properties of respiratory motoneurons and muscles act in concert with neuronal drives in defining the complex electrical and mechanical behavior of pharyngeal and thoracic respiratory motor systems.

Animals↗
PubMed1992

Clarithromycin vs penicillin in the treatment of streptococcal pharyngitis.

BACKGROUND: Streptococcal pharyngitis, caused by group A beta-hemolytic streptococci (GABHS), is among the most common infections seen by primary care physicians. Because the illness can result in rheumatic fever, early eradication of infection is important. Penicillin has been the standard treatment for GABHS pharyngitis for over four decades, but reports of bacteriologic failure with this drug in recent years have led to trials of alternative antimicrobials. METHODS: In this investigator-blind, randomized multicenter trial (30 centers), oral clarithromycin, 250 mg twice daily, or oral penicillin VK, 250 mg three times daily, was given to outpatients > or = 12 years old with GABHS pharyngitis as documented by positive cultures for Streptococcus pyogenes and positive rapid immunoassay tests. The clinical and bacteriologic efficacy of clarithromycin was compared with that of penicillin in the 356 evaluable patients. Safety analysis was performed in all patients who had received at least one dose of the study drug (N = 453). RESULTS: Overall, clinical outcomes were comparable in the two groups. However, more clarithromycin-treated patients than penicillin-treated patients had resolution of sore throat (94% vs 86%, P = .014) and disappearance of pharyngeal erythema and exudate (89% vs 82%, P = .05). Bacteriologic cure rates were higher in clarithromycin-treated patients (95% vs 87%, P = .009). No serious adverse events were observed in either group. CONCLUSIONS: This study suggests that clarithromycin twice daily is as effective and as well tolerated as penicillin in the treatment of streptococcal pharyngitis.

Adolescent↗
PubMed1992

Streptococcal pharyngitis in a primary care clinic.

A study to determine the sensitivity and specificity of the Directogen Group A Streptococcal Test was carried out in a primary care clinic in University Hospital, Kuala Lumpur. The study also looked at the prevalence of streptococcal pharyngitis in the clinic. We found that the rapid test has a sensitivity of 90.9% and a specificity of 90.7%. Viral pharyngitis is the commonest form (63%) of pharyngitis followed by Group A Beta haemolytic streptococcal pharyngitis (14.2%). The presence of exudates, tonsillar enlargement and the presence of tender cervical lymph nodes have a significantly higher association with streptococcal pharyngitis.

Adolescent↗
PubMedDate not supplied

Peroral pharyngeal block for placement of esophageal endoprostheses.

BACKGROUND AND OBJECTIVES: The placement of plastic peroral endoprostheses frequently is done in the United States as a palliation for esophageal cancer. However, the combination of topical local anesthetics and sedatives, the most commonly used means to achieve anesthesia, can cause complications and often does not adequately suppress the gag reflex. The purpose of this study was to compare sedation requirements in patients receiving the standard topical local anesthetic versus patients receiving peroral pharyngeal plexus block. METHODS: From December 1987 through April 1991, 11 patients underwent endoscopic esophageal stent placement. The first six patients received topical 10% lidocaine spray, the other five patients received pharyngeal plexus blocks. Supplemental sedation was given until the patient closed their eyes but were responsive to verbal stimuli. Completeness of block was evaluated by stimulating the posterior oropharynx. Total sedative requirements were recorded for each patient. RESULTS: Patients receiving pharyngeal plexus block had profound anesthesia and suppression of the gag reflex, as determined by examination and the patient's tolerance of the procedure. Patients receiving only topical anesthesia and intravenous sedation tolerated the procedure poorly and required a greater amount of intravenous sedation than those in the blocked group (p less than 0.01). There were no anesthetic complications in patients receiving pharyngeal blocks. CONCLUSIONS: Our experience indicates that the endoscopic placement of esophageal endoprostheses is optimally performed with the aid of pharyngeal plexus block. This block provides profound anesthesia with minimal risk in debilitated, high-risk patients. The neuroanatomy of the oropharynx is also reviewed.

Aged↗
PubMed1978

Aspects of the human pharyngeal hypophysis in normal and anencephalic fetuses and neonates and their possible significance in the mechanism of its control.

Aspects of the pharyngeal hypophysis in normal and anencephalic human fetuses and neonates have been described. Volumetric and histological changes in the normal gland similar to those observed previously in the adult are noted. The sellar and pharyngeal hypophyses develop in parallel during intrauterine life, but the latter has reached its maximum development by the time of birth. It is suggested that the control of the pharyngeal hypophysis is mediated through factors in the blood, and that the nature of the control and the vascular route vary at particular periods in both fetal and adult life. From a study of the anencephalic material it appears that the individual cells of the pharyngeal hypophysis are capable of marked response to a specific endocrine imbalance, but the capacity of the pharyngeal hypophysis as a whole to compensate significantly for deficiencies of the sellar adenohypophysis is strictly limited by its inability to hypertrophy to any marked degree.

Anencephaly↗