114 THE PHARYNX AND NASOPHARYNX
helped by astringent gargles or paints. Removal of the hypertrophied tissue
may be necessary.
Anaesthesia may be found in diseases of the central nervous system, such as
syringomyelia, bulbar paralysis and intracranial tumours. There is usually an
associated paralysis of the soft palate.
Hyperaesthesia is a common condition, especially in those who over-
indulge in tobacco or alcohol, and it is usually associated with a pharyngitis.
Examination of the pharynx produces violent gagging and choking fits.
Paraesthesia is often met with in women at the menopause. The complaint
is of a feeling of a lump behind the tongue, and a constant desire to clear the
throat. There is no true dysphagia. A careful examination must be made to
exclude any malignancy or other organic disease. Enlargement of the lingual
tonsil is not uncommonly found. Treatment is symptomatic, and the use of an
astringent gargle or paint, reinforced by a dogmatic assurance that there is no
malignancy, is usually sufficient. Spontaneous cure often results.
Secretory neurosis is the name which might be applied to those patients
who have a constant desire to expectorate. The sputum is usually frothy, with
little mucus content, and is produced by the action of clearing the throat. ,
The patient should be assured that there is no disease, and advised to refrain
from the clearing and spitting.
NEURALGIA OF THE PHARYNX
Glossopharyngeal neuralgia is uncommon. Severe shooting pain radiates from
the tonsillar region to the ear. It may be stimulated by swallowing or may
occur after tonsillectomy. If relief is not obtained by carbamazepine neuro-
surgical destruction of the nerve may be required.
Rhythmic movement of the soft palate is a rare condition. The movements may
be accompanied by a clicking sound which can be heard by both patient and
doctor. In some cases this condition is associated with trigeminal neuralgia.
There is no specific treatment.
Paralysis of the soft palate used to be seen after diphtheria and polio-
myelitis, and occasionally after influenza. Diseases of the central nervous
system such as syringomyelia, embolism, tumours and meningitis may
produce a palatal paralysis along with other manifestations of the diseases.
The paralysis is usually unilateral but may be bilateral. When unilateral the
palate is drawn to the healthy side on phonation, but when bilateral the palate
hangs loosely and does not respond to stimulation. The voice has a nasal
quality, and fluid or food may escape into the nose.