GALAVIDRADHI (PERITONSILLAR / PARATONSILLAR / PARAPHARYNGEAL / RETROPHARYNGEAL ABSCESS)

  • GALAVIDRADHI (PERITONSILLAR / PARATONSILLAR / PARAPHARYNGEAL / RETROPHARYNGEAL ABSCESS)


    ETIOLOGY (NIDANA)

    AYURVEDIC ETIOLOGY:
    Galavidradhi is a type of Vidradhi (abscess) localized in the throat region, especially around the tonsils and adjacent structures. It is mentioned under Mukharoga or Kantharoga in Ayurvedic texts.

    • DUSHTA AHARA VIHARA – Intake of excessively hot, dry, and spicy food, faulty food combinations

    • VISHAMASHANA – Irregular food intake

    • SHEETODAKA SEVANA – Drinking cold water immediately after hot meals

    • VATA-KAPHA DUSHTI – Leads to accumulation and obstruction in Srotas

    • RAKTADUSHTI – Contaminated blood leads to inflammatory conditions

    • AADHYATMIKA / BAHYA HETU – Internal dosha vitiation and external infections both contribute

    CLASSICAL REFERENCE:
    📜 “शीतोष्णविरुद्धाहारविषमाशनसेविनाम्।
    दोषैः कफपित्तार्तैः स्रवद्भिर्गलविद्रधिः॥”
    — A.H. Uttara Tantra 16/29

    MODERN ETIOLOGY:

    • Bacterial Infections – Most commonly due to Streptococcus pyogenes

    • Secondary to Tonsillitis or Pharyngitis

    • Poor oral hygiene

    • Injury to throat tissue (e.g., during instrumentation or trauma)

    • Immunocompromised states – HIV, diabetes

    • Smoking and chronic irritation

    CLINICAL FEATURES (LAKSHANA)

    AYURVEDIC CLINICAL FEATURES:

    • KANṬHASHAITHILYA – Loosening of throat structures

    • SHOFA (SWELLING) – Localized swelling in tonsillar region

    • DAHA (BURNING SENSATION)

    • RUJA (PAIN) – Severe pain while swallowing

    • KANTHA UKTHA DUKHA – Pain while speaking

    • TRISHNA – Excessive thirst due to burning

    • JVARA (FEVER) – Mostly of pittaja type

    • MUKHA DOURGANDHYA – Foul smell from mouth

    CLASSICAL REFERENCE:
    📜 “शोफो दारुणवेगोऽयं कण्ठे दुःखाय पीडनः।
    स्वरभेदं करोत्येव ज्वरं शूलं च जनयेत्॥”
    — Sushruta Samhita, Uttara Tantra 22/5

    MODERN CLINICAL FEATURES:

    • SEVERE THROAT PAIN – Unilateral, radiating to the ear

    • TRISMUS – Difficulty in opening the mouth

    • HOT POTATO VOICE – Muffled speech

    • DROOLING – Due to difficulty in swallowing

    • UVULAR DEVIATION – Uvula displaced to opposite side

    • TONSILLAR SWELLING – Usually unilateral

    • FEVER, CHILLS – With systemic signs of infection

    • NECK SWELLING AND TENDERNESS – Especially in para- and retropharyngeal abscess

    SAMPRAPTI (PATHOGENESIS)

    • Vata and Kapha doshas vitiated by nidana, along with rakta dushti, lodge in the gala pradesha.

    • Leads to srotorodha (blockage), inflammation, suppuration → formation of vidradhi (abscess).

    📜 “संगृह्य कण्ठदेशे तु पित्तं रक्तं च दूषयेत्।
    वातकफसमायुक्तं करोत्येष विद्रधिं गले॥”
    — A.H. Uttara Tantra 16/30

    TYPES (MODERN CLASSIFICATION)

    • PERITONSILLAR ABSCESS (QUINSY) – Abscess between tonsil and capsule

    • PARAPHARYNGEAL ABSCESS – Abscess in lateral pharyngeal space

    • RETROPHARYNGEAL ABSCESS – Abscess in posterior pharyngeal wall space

    DIAGNOSIS

    AYURVEDIC:

    • Nidan Panchaka approach (Nidana, Purvarupa, Rupa, Upashaya, Samprapti)

    • Visual and palpatory examination of throat swelling and signs

    MODERN:

    • Throat Examination – Uvular deviation, unilateral swelling

    • CT SCAN OF NECK – Confirms deep neck space abscess

    • Ultrasound of neck – Especially for retropharyngeal abscess

    • Blood Tests – Elevated WBC count, CRP

    • Needle aspiration – Diagnostic and therapeutic

    TREATMENT (CHIKITSA)

    AYURVEDIC TREATMENT:

    SHODHANA (PURIFICATION):

    • VIRECHANA – In pittaja dominant cases

    • NASYA KARMA – With Katu-Tikta Dravyas for dosha shodhana in Urdhwajatru

    • KAVALA/GANDUSHA – Decoctions like Triphala, Yashtimadhu

    • LEPA (EXTERNAL APPLICATION) – Anti-inflammatory lepa over throat

    • AGNIKARMA (CAUTERIZATION) – When abscess is mature

    • VIDRADHI CHIKITSA SUTRA – As in general vidradhi management

    CLASSICAL REFERENCE FOR VIDRADHI TREATMENT:
    📜 “शस्यते रक्तपित्तघ्नं तिक्तं कषायमेव च।
    विद्रधौ शोधनं तैलं तद्वद्द्रव्यं च लेपनम्॥”
    — Charaka Samhita, Chikitsa Sthana 12/97

    USEFUL HERBAL REMEDIES:

    • Punarnavadi Kashaya – For Shotha

    • Triphala Guggulu – Anti-inflammatory and suppurative

    • Kaishora Guggulu – For blood purification

    • Nimba, Haridra, Guduchi – As anti-infectives

    MODERN TREATMENT:

    • ANTIBIOTICS – Broad-spectrum (e.g., amoxicillin-clavulanate, clindamycin)

    • ANALGESICS AND ANTIPYRETICS – For pain and fever

    • NEEDLE ASPIRATION / I&D (Incision and Drainage) – In mature abscess

    • HYDRATION AND NUTRITION – Supportive management

    • TONSILLECTOMY – In recurrent or chronic cases

    • AIRWAY MONITORING – In retropharyngeal abscess to avoid obstruction

    COMPLICATIONS

    • Airway obstruction

    • Spread to mediastinum

    • Septicemia

    • Jugular vein thrombosis (Lemierre’s syndrome)

    • Otitis media or mastoiditis (from spread)

    PREVENTION

    • Early treatment of tonsillitis and pharyngitis

    • Maintain oral hygiene

    • Avoid irritants (smoking, pollutants)

    • Timely Ayurvedic management in Prakopa stage (before suppuration)

    PROGNOSIS (SAPAYAPYA-ASPAYAPYA)

    • Saadhya in early stages with proper shodhana and shamana

    • Kricchrasadhya / Asadhya if complication arises like airway compromise or septicemia

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