Diseases Of The Nose Throat And Ear

CHAPTER 23
SPECIFIC INFECTIONS OF THE PHARYNX

SYPHILIS OF THE PHARYNX

Primary syphilis is uncommon, but the tonsil is second to the lip as the most
frequent extragenital site. The chancre is unilateral, persists for several weeks
and is accompanied by enlarged cervical glands. Palpation by a gloved finger
will disclose that the lesion is of cartilaginous hardness. The discovery of Sp.
pallida may confirm the diagnosis.

Secondary syphilis in the pharynx is much more common and much more
important in that it is most contagious because the lesion teems with spiro-
chaetes. Initially there is congestion of the palate and fauces, and some
tonsillar enlargement, but soon the mucous patch develops. TTiis may be
found on any part of the mucosa of the mouth or pharynx, the principal sites
being, in order of frequency, the tonsil, the palatine arches, the tongue and the
inner aspect of the lips. The patch is round or oval, bluish-grey in colour with a
surrounding zone of congestion. The patches may be multiple and symmetrical,
and may become confluent. Ulceration takes place, leaving a snail-track ulcer
of a dirty grey colour. The cervical glands are enlarged, and there may be a
skin eruption.

Tertiary syphilis does not appear as a gumma for some years after the
initial infection. A hard purplish swelling appears on the palate, posterior
pharyngeal wall, or, less often, on the tonsil. It may appear in the vallecula
between the epiglottis and the tongue, and so be overlooked unless a laryngeal
mirror has been employed in routine examination. The gumma breaks down
at its centre to form a punched out ulcer with a greenish-yellow base and red,
indurated edges.

Postsyphilitic complications are much less often seen now. They were prone
to follow hereditary syphilis when they appeared about the age of puberty.
The palate may perforate with destruction of tissue or there may be consider-
able cicatricial stenosis of the pharynx.

SYMPTOMS. The chancre may not cause any symptoms. Secondary lesions
cause only slight pain hi the throat, although some dysphagia may be felt
when ulceration takes place. Pain is rare in the tertiary lesions, and the patient
may only complain of a nasal speech or of food entering the nose while
eating.

DIAGNOSIS. This must be made from other lesions causing ulceration or
membrane formation. The primary and secondary stages are usually recog-
nized, but the gumma may be confused with Vincent's infection or with
carcinoma. Serological tests and a biopsy will generally decide the question.
Lupus also causes destruction of the pharyngeal mucosa, but is more slow and
is associated with skin nodules.

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