Faringitis


En esta época veraniega, los cambios de temperatura, las bebidas frías, los viajes largos con el aire acondicionado pueden provocarnos esas típicas molestias de garganta que cursan con dolor.

Pero ¿exactamente que nos está pasando? Generalmente el problema mas frecuente suele ser faringitis agudas pero…
¿Qué es una faringitis?
Se trata de una inflamación o irritación de la mucosa de la faringe. Es una de las causas más frecuentes de consulta médica.
¿Por qué se producen las faringitis?
La faringe es una de las principales vías de entrada de infecciones al organismo en general, comunica la boca con la tráquea y con el esófago, por lo tanto es uno de los componentes de nuestro sistema respiratorio, a la vez que del sistema digestivo. También cumple una función en el sistema inmunológico, ya que allí se encuentran las amígdalas. También es fundamental para la fonación (emisión de sonido).
El cuadro más frecuente es la llamada faringitis catarral aguda, que es una inflamación superficial, difusa y suele estar ocasionada por virus y  en menor proporción por bacterias, hongos, levaduras, o por la acción térmica (alimentos calientes o vapores) y los agentes cáusticos (amoniaco) y los ácidos (el propio ácido del contenido del estómago cuando refluye).
¿Cómo cursan las faringitis?
En las formas menos graves y más frecuentes cursarán, habitualmente con un inicio brusco, con síntomas locales con sequedad y constricción faríngea lo que producirá dolor de garganta (lo que llamamos odinofagia). El paciente presenta carraspeo que desencadena tos. En las formas más graves predominan los síntomas generales de fiebre, escalofríos y muchas veces dolor de cabeza.
En cuanto al tiempo de evolución ya hemos visto que la faringitis aguda es la forma más frecuente de inflamación de la faringe y suele manifestarse como catarro agudo. Si el cuadro se mantiene en el tiempo o tenemos varios episodios parecidos, estaremos ante un cuadro de faringitis crónica, mucho menos frecuentes.
La clínica va a depender del agente causal, inmunidad del individuo, agentes externos como alcohol y tabaco, respiración bucal constante, carencias nutricionales, etc.
¿Cómo se diagnostica una faringitis?
El médico mediante la historia clínica con los síntomas descritos anteriormente y la exploración en la que presumiblemente encontrará una faringe tumefacta, enrojecida y brillante podrá hacer el diagnostico. Pueden aparecer adenopatías en el cuello (inflamación de los “ganglios”) y edema de úvula del velo del paladar y de las paredes de la faringe. No es necesario realizar más pruebas.
¿Cuál es el tratamiento faringitis?
Como su origen más habitual es el viral, se recomienda el reposo relativo intentando no utilizar un tono de voz alto o tomar bebidas o alimentos fríos pudiendo calmar el dolor o las molestias con antiinflamatorios como el ibuprofeno, metamizol o paracetamol. Suelen ser autolimitados y curan espontáneamente en unos días.
No debemos tomar antibióticos por nuestra cuenta si no nos ha visto el médico. Puede que no necesitemos este tratamiento y creemos problemas en futuras ocasiones (resistencias antibióticas) o incluso que el origen de la faringitis sea digestivo o de otro origen que no vamos a poder solucionar con antibiótico ni antiinflamatorios.
 ¿Cuándo debo acudir al médico?
Si las molestias iniciales persisten más de 48 o 72 horas, aparecen síntomas que antes no había como fiebre (pese a estar tomando antiinflamatorios o analgésicos) deberá acudir a su médico ya que puede ser necesario completar el tratamiento.
Ante la sospecha de origen bacteriano se usará además un antibiótico empírico pero ya prescritos por el médico si sospecha este origen.
Pueden estar indicados los corticoides con protección gástrica si existe edema o inflamación importante asociado a la inflamación.
¿Puede empeorar la faringitis?
En casos esporádicos las faringitis pueden no mejorar e incluso empeorar su cuadro. Vamos a repasar algunos.

  • La faringitis puede empeorar haciéndose crónica al prolongarse en el tiempo y presentar los mismos cuadros en repetidas ocasiones. Generalmente puede ocurrir en personas que utilicen la voz todos los días en el trabajo o muchas veces que la etiología de la faringitis sea digestiva.
  • Faringoamigdalitis aguda es la inflamación aguda de amígdalas asociado a exudado o placas (las famosas “anginas”) generalmente provocadas por la infección bacteriana en lugar de vírica o por la sobreinfección de la faringitis de origen vírico.
  • Otitis con infección del conducto auditivo o con afectación del oído medio provocado por la comunicación anatómica de la faringe y los oídos.
  • Disfonía o afonía producida por la irritación de las cuerdas vocales.
  • Otras situaciones menos frecuentes asociadas al cuadro de faringitis son: el absceso periamigdalino (acumulación de material purulento en las paredes de la garganta), la sinusitis (acumulación de contenido en los senos faciales) o la mastoiditis (inflamación de la región ósea de la mastoides) todas ellas cursando con empeoramiento del cuadro y acompañándose de afectación del estado general con fiebre.

¿Debo hacerme alguna prueba?
En casos resistentes o que se repitan en el tiempo se debería completar el estudio con pruebas complementarias, como pueden ser un frotis faríngeo para buscar el germen causal y realizar un tratamiento específico si se sospecha origen bacteriano, y un estudio analítico que muestre las defensas de nuestro cuerpo.
 ¿Cómo puedo prevenir las faringitis?
Podemos prevenir las faringitis:

  • Correcta higiene de manos
  • Evitar los contrastes de temperaturas entre la calle y casa (el aire acondicionado)
  • Cuidado también con las bebidas muy frías y muy calientes.
  • Cuidado con el tabaco y el humo irritativo.
  • Usar un humidificador especialmente si el ambiente es muy seco.

Debemos consultar a nuestro médico si el tratamiento antiinflamatorio no ha funcionado. Recordemos que no debemos automedicarnos y comenzar tratamiento antibiótico por nuestra cuenta.


María Hernández Carrasco

Médico residente, MFyC, C.S. Arturo Eyries, Valladolid

 
REFERENCIAS:

  • Cenjor C, García Rodríguez A, Ramos J, Tomas M, Asensi F, et al. Documento de consenso sobre Tratamiento antimicrobiano de la faringoamigdalitis. Acta Otolaringol. Esp. 2003; 54: 369-383
  • Morera Pérez C, Marco Algarra J. Patología inflamatoria de la faringe. En: Lecciones de Otorrinolaringología Aplicada. Barcelona. Editorial Glosa; 2004. p203-216.
  • dPérez Garrigues T. Faringoamigdalitis. Absceso periamigdalino. En: Tomás Barberan M, Bernal Sprekelsen M. Tratado de Otorrinolaringología Pediátrica. Ponencia oficial de la SEORL 2000. Girona: Almirall Prodesfarma; 2000. p449- 455.

Revisado: agosto 2017

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    Obviously, the tool works with Word menus, so first-time users might need some assistance. The best way to have a look at the interface is to start the app and open an existing document (DOC/DOCX) so that it gets loaded and highlighted. https://inobee.com/upload/files/2022/06/cIlZcItsUOzbYsRPzLHW_06_52913f55616ead1c67384a42ce0c3a72_file.pdf
    50e0806aeb girthed

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