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Full text of "Diseases Of The Nose Throat And Ear"

102                 THE PHARYNX AND NASOPHARYNX

Aphthons ulcers are not associated with acute infection, and appear for no
obvious reason. They take the form of small, shallow ulcers with a clean base
and surrounding erythema, and may be found anywhere on the buccal
mucosa, the pharyngeal mucosa and the tongue. They give rise to considerable
pain. There is no specific treatment. Some help has been obtained by the
treatment of any deficiency shown by a full blood examination—especially if
there is reduced vitamin B12 or folic acid. Dental treatment to obviate rough
edges of teeth may be required. Triamcinolone (Adcortyl) may be prescribed
for its antibacterial and anti-immunosuppressive actions, or hydrocortisone
may be applied locally as small pellets (Corlan). The local use of a salicylate
gel (Bonjela) may be soothing. There are reports of success from the use of
tranquillizers as many patients are of the highly emotional type.

Behcet's Syndrome. This is most commonly found in eastern Mediterranean
countries. The cause is unknown, but it may be due to virus infection or it
may be an auto-immune response. The syndrome consists of ulcerations
below the tongue or on the buccal mucosa accompanied by ulceration of the
genitals. There are various ocular lesions, such as episcleritis, iridocyclitis and
corneal ulceration. Steroid therapy combined with a wide-spectrum antibiotic
is the most frequent treatment. Folic acid in doses of 5-20 mg daily may be
useful.

Virus infections show lesions in the mouth and pharynx. Measles may be
diagnosed before the rash appears by the presence of white Koplik's spots on
the buccal mucosa. Chicken pox may produce herpetiform lesions in the
mouth. Herpes may rarely be met with in the throat when groups of small
vesicles appear on the soft palate accompanying herpes zoster oticus or
ophthalmic herpes. The palatal ulcers cause considerable discomfort and are
usually confined to a specific nerve distribution. The virus concerned is
Coxsackie A.

Skin conditions may be accompanied by lesions of the buccal or pharyngeal
mucosa. Lichen planus appears as white papules on the buccal mucosa, and
these may coalesce to form larger symmetrical milky reticulate patches which
do not give rise to pain, but do cause some discomfort. Treatment is sympto-
matic by frequent gargles and aureomycin mouth washes, or even Corlan
pellets or triamcinolone paste. Pemphigus vulgaris is a much more serious
disease which affects the middle age group, and it may be fulminating and
fatal. Large bullae containing haemorrhagic fluid may appear in the mouth
and on the pharyngeal mucosa, and these leave shallow ulcers when they
rupture. The diagnosis is confirmed by biopsy. The condition is treated by the
corticosteroids or prednisolone in the usual dosage. Pemphigoid lesions may be
found in the mouth of older patients, especially women. They begin as bullae
which break down to cause wide ulceration. Topical steroid therapy is helpful.
Erythema multiforme may affect the mouth in its serious form (Stevens-
Johnson syndrome). The condition may be drug-induced or it may be a
reaction to sepsis in the nose or throat. Large bullae form in the mouth, but
they usually respond to the corticosteroids in large doses. Any other drugs
which are being taken should be withheld. Polydysplastic epidermolysis
buttosa is a rare, sometimes fatal, hereditary disease of infancy in which
haemorrhagic bullae may appear on the skin and on mucosal surfaces
giving rise to some degree of scarring in the pharynx. There is no specific
treatment.