Pharyngeal bursitis, also known as nasopharyngeal mucous bursitis, median fistula of the nasopharynx, or nasopharyngeal cyst. It was first reported by Thornwaldt in 1885, hence it is also called Thornwaldt's disease. Infection or suppuration of the pharyngeal bursa leads to pharyngeal bursitis. Spontaneous rupture of a pharyngeal bursa abscess can form a purulent fistula.

bubble_chart Clinical Manifestations

The main symptom is the downward flow of purulent secretions from the posterior nasal cavity into the oropharynx. Patients often notice a foul odor when breathing and may cough up purulent material or crusts when forcefully inhaling or coughing. Headache is common, typically located below the external occipital protuberance, similar to the headache caused by sphenoid sinusitis. Inflammation or purulent discharge blocking the pharyngeal opening of the Eustachian tube can lead to tinnitus and deafness, and there may be swelling of the cervical lymph nodes. Nasopharyngoscopy reveals a smooth, polypoid mass in the midline of the nasopharyngeal roof, sometimes covered with purulent crusts. Removing the crusts exposes the opening of the pharyngeal bursa or a fistula. Inserting a probe into the sac cavity results in the overflow of secretions.

bubble_chart Treatment Measures

For smaller pharyngeal pouches, puncture and aspirate the pus, then cauterize the pouch mucosa with 10-20% silver nitrate or 50% trichloroacetic acid to prevent recurrent infection. For larger pouches, retract or incise the soft palate to expose the pouch, excise the anterior wall with fine scissors, and curette the posterior wall to completely remove the pouch lining. If adenoid hypertrophy is present, perform an adenoidectomy.