Chronic diseases of the throat and larynx (ENT). Inflammatory diseases of the pharynx Acute and chronic diseases of the pharynx

MILITARY MEDICAL ACADEMY

Department of Otolaryngology Ex. No._____

"APPROVED"

VrID Head of the Department of Otorhinolaryngology

Colonel of the Medical Service

M. Govorun

"____" ______________ 2003

Lecturer at the Department of Otolaryngology

Candidate of Medical Sciences

Major of Medical Service D. Pyshny

LECTURE No. 18

in otolaryngology

on the topic: “Diseases of the pharynx. Abscesses of the pharynx"

For students of the Faculty of Medical Management

Discussed and approved at a department meeting

protocol No.______

"___" __________ 2003

Clarified (added):

«___» ______________ _____________

Inflammatory diseases of the pharynx.

Abscesses of the pharynx.

Literature

Otolaryngology / Ed. I. B. Soldatov and V. R. Goffman. - St. Petersburg, 2000. - 472 pp.: ill.

Elantsev B.V. Operative otorhinolaryngology. -Alma-Ata, 1959, 520 p.

Soldatov I.B. Lectures on otorhinolaryngology. - M., 1990, 287 p.

Tarasov D.I., Minkovsky A.Kh., Nazarova G.F. Ambulance and emergency care in otorhinolaryngology. - M., 1977, 248 p.

Shuster M.A. Emergency care in otorhinolaryngology. - M.. 1989, 304 p.

DISEASES OF THE PHARYN

Inflammatory diseases of the pharynx

Sore throats

Angina- acute inflammation of the lymphadenoid tissue of the pharynx (tonsils), which is considered as a general infectious disease. Sore throats can be severe and cause a variety of complications. Sore throats of the palatine tonsils are more common. Their clinical picture is well known. These tonsillitis are differentiated from diphtheria, scarlet fever, specific tonsillitis and tonsil lesions in general infectious, systemic and oncological diseases, which is very important for prescribing adequate emergency therapy.

Sore throat of the pharyngeal tonsil(acute adenoiditis). This disease is typical for childhood. It occurs more often simultaneously with acute respiratory viral diseases (ARVI) or tonsillitis and in these cases usually remains unrecognized. Adenoiditis is accompanied by the same changes in general condition as tonsillitis. Its main clinical signs are a sudden disruption of free nasal breathing or its deterioration, if it was not normal before, a runny nose, and a feeling of stuffiness in the ears. There may be a cough and sore throat. Upon examination, hyperemia of the posterior wall of the pharynx is revealed, with mucopurulent discharge flowing down. The pharyngeal tonsil enlarges, swells, hyperemia of its surface appears, and sometimes plaques appear. By the time of maximum development of the disease, which lasts 5 days, changes in the regional lymph nodes are usually noted.

Adenoiditis should be differentiated primarily from retropharyngeal abscess and diphtheria. It must be remembered that with the appearance of symptoms of acute adenoiditis, measles, rubella, scarlet fever and whooping cough can begin, and if a headache occurs, then meningitis or polio.

Sore throat of the lingual tonsil. This type of sore throat is much less common than its other forms. Patients complain of pain in the root of the tongue or in the throat, as well as when swallowing, protruding the tongue is painful. The lingual tonsil turns red and swells, and plaque may appear on its surface. During pharyngoscopy, pain is felt when pressing with a spatula on the back of the tongue. General disorders are the same as with other sore throats.

If the inflammation of the lingual tonsil takes on a phlegmonous character, then the disease is more severe with high body temperature and the spread of edematous-inflammatory changes to the outer parts of the larynx, primarily to the epiglottis. The lymph nodes in the neck become enlarged and painful. In this case, the disease must be differentiated from inflammation of the cyst and ectopic thyroid tissue in the area of ​​the tongue root.

Treatment. If any sore throat develops, which is an acute infectious disease that can cause serious complications, treatment must be started immediately. Penicillin antibiotics are prescribed orally (if intolerant - macrolides), food should be gentle, plenty of fluids and vitamins are required. In severe cases of angina, strict bed rest and intensive parenteral antibiotic therapy, primarily penicillin in combination with desensitizing drugs, are prescribed. If necessary, use broad-spectrum antibiotics (cephalosporins, aminoglycosides, fluoroquinolones, metrogil).

As for local treatment, it depends on the location of the inflammation. For adenoiditis, vasoconstrictor nasal drops (naphthyzin, galazolin,) and protorgol must be prescribed. For sore throats of the palatine and lingual tonsils, warm bandages or a compress on the neck, rinsing with a 2% solution of sodium acid or sodium bicarbonate, a solution of furatsilin (1:4000), etc.

Ulcerative membranous tonsillitis (Simanovsky). The causative agents of ulcerative membranous tonsillitis are the fusiform bacillus and the spirochete of the oral cavity in symbiosis. After a short-term phase of catarrhal tonsillitis, superficial, easily removable whitish-yellowish plaques form on the tonsils. Less commonly, such plaques also appear in the oral cavity and pharynx. In place of the sloughing plaques, ulcers remain, usually superficial, but sometimes deeper. Regional lymph nodes on the affected side are enlarged. The pain is not severe. Body temperature is normal or subfebrile. There may be bad breath associated with necrotic changes in the bottom of the ulcers. When assessing the clinical picture, it should be borne in mind that occasionally a lacunar form of the disease is observed, similar to a common sore throat, as well as bilateral damage to the tonsils.

The diagnosis is established based on the detection of fusospirillary symbiosis in smears from the surface of the tonsils (removed films, imprints from the bottom of ulcers). Ulcerative membranous tonsillitis should be differentiated from diphtheria, tonsil lesions in diseases of the hematopoietic organs, and malignant tumors.

For treatment, rinsing with hydrogen peroxide (1-2 tablespoons per glass of water), a solution of rivanol (1:1000), furatsilin (1:3000), potassium permanganate (1:2000) and lubrication with a 5% alcohol solution of iodine, 50% solution sugar, 10% solution of salicylic acid diluted in equal parts of glycerin and alcohol, 5% formaldehyde solution. If clinical signs of a secondary infection appear, antibiotics are prescribed.

Sore throat with infectious mononucleosis. This is a common disease of viral etiology, beginning acutely with a high body temperature (up to 40 ° C) and usually a sore throat. Most patients experience damage to the tonsils, which significantly increase in size. The third and fourth tonsils often also become enlarged, which can lead to difficulty breathing. Plaques of various types and colors form on the surface of the tonsil, sometimes of a lumpy-curdled appearance, usually easily removed. A putrid odor appears from the mouth. The pain syndrome is not pronounced. The cervical lymph nodes of all groups enlarge, as well as the spleen and sometimes lymph nodes in other areas of the body, which become painful.

The diagnosis is made based on the results of a blood test, but in the first 3-5 days there may be no characteristic changes in the blood. In the future, as a rule, moderate leukocytosis is detected, sometimes up to 20-30 l0 9 /l, neutropenia with the presence of a nuclear shift to the left and severe mononucleosis. At the same time, there is a slight increase in the number of lymphocytes and monocytes, the presence of plasma cells, varied in size and structure, with the appearance of peculiar mononuclear cells. High relative (up to 90%) and absolute mononucleosis with typical mononuclear cells at the height of the disease determines the diagnosis of this disease. It is differentiated from common sore throats, diphtheria, and acute leukemia.

Treatment is mainly symptomatic; gargling with a solution of furatsilin (1:4000) is prescribed 4-6 times a day. If signs of secondary infection appear, antibiotics are prescribed.

Sore throat with agranulocytosis. Currently, agranulocytosis most often develops as a result of taking cytostatics, salicylates and some other drugs.

The disease usually begins acutely, with body temperature quickly rising to 40 °C, chills and sore throat are noted. Dirty-gray plaques with necrotic-gangrenous decay form on the palatine tonsils and surrounding areas, which often spread to the back wall of the oropharynx, the inner surface of the cheeks, and in more severe cases occur in the larynx or the initial part of the esophagus. Sometimes there is a strong odor from the mouth. Occasionally, the tonsils become completely necrotic. A blood test reveals leukopenia up to 1 10 9 / l and lower, a sharp decrease in the number of neutrophils, eosinophils and basophils, up to their absence, with a simultaneous increase in the percentage of lymphocytes and monocytes.

It should be differentiated from diphtheria, Simanovsky's angina, tonsil lesions due to blood diseases.

Treatment consists of intensive antibiotic therapy (semi-synthetic penicillins), the prescription of corticosteroid drugs, pentoxyl, B vitamins, and nicotinic acid. In severe cases, leukocyte transfusion is performed.

Diphtheria

Patients with diphtheria need emergency care due to the possibility of developing severe general complications or stenosis in the case of laryngeal localization of the lesion. Even if diphtheria is suspected, the patient must be immediately hospitalized in the infectious diseases department. In recent years, adults have been suffering from diphtheria no less often and more severely than children.

Diphtheria of the pharynx is the most common. It should be remembered that mild forms of pharyngeal diphtheria can occur under the guise of lacunar or even catarrhal tonsillitis at low or normal (in adults) body temperature. The plaques on the surface of the hyperemic tonsil are initially tender, filmy, whitish, and easily removable, but soon they acquire a characteristic appearance:

extend beyond the tonsil and become dense, thick, grayish or yellowish. Plaques are difficult to remove, leaving an eroded surface.

When diphtheria spreads, the disturbance in the general condition of the patient is more pronounced; filmy deposits are also found in the pharynx, nasopharynx, and sometimes in the nose, while disturbances in nasal breathing and sanguineous nasal discharge are noted. However, more often the process spreads downward with the development of true croup. Pastosity of the subcutaneous fatty tissue of the neck is also detected.

The toxic form of diphtheria begins as a general acute infectious disease, occurring with a sharp increase in body temperature, headache, and sometimes vomiting. A characteristic feature is the early appearance of swelling in the area of ​​the pharynx and soft tissues of the neck. The cervical lymph nodes are also enlarged and painful. The face is pale, pasty, there is bloody discharge from the nose, bad breath, cracked lips, and nasal tone. Paresis develops in the later stages of the disease. The hemorrhagic form is rare and very severe.

The diagnosis in typical cases can be established by the clinical picture; in the rest, which make up the majority, bacteriological confirmation is necessary. The best way is to examine the removed plaques and films; if they are absent, smears are made from the surface of the tonsils and from the nose (or from the larynx in case of laryngeal localization). The material is taken from the pharynx on an empty stomach, and you should not gargle before this. Sometimes the diphtheria bacillus is detected immediately based only on bacterioscopy of a smear.

Diphtheria of the pharynx and pharynx should be differentiated from common tonsillitis, phlegmonous tonsillitis, thrush, Simanovsky's tonsillitis, necrotic tonsillitis, including scarlet fever; the hemorrhagic form must be distinguished from lesions of the pharynx associated with diseases of the hematopoietic organs.

Diphtheria of the larynx (true croup) occurs as an isolated lesion mainly in toddlers and is rare. More often, the larynx is affected in the common form of diphtheria (descending croup). Initially, catarrhal laryngitis develops with voice disturbance and barking cough. The body temperature becomes subfebrile. Subsequently, the patient’s general condition worsens, aphonia develops, the cough becomes silent and signs of difficulty breathing appear - inspiratory stridor with retraction of the “yielding” areas of the chest. With increasing stenosis, the patient is restless, the skin is covered with cold sweat, pale or cyanotic, the pulse is rapid or arrhythmic. Then the stage of asphyxia gradually begins.

Plaques appear first within the vestibule of the larynx, then in the area of ​​the glottis, which is the main cause of stenosis. Filmy whitish-yellowish or grayish deposits are formed, but in mild forms of laryngeal diphtheria they may not appear at all.

The diagnosis must be confirmed bacteriologically, which is not always possible. Diphtheria of the larynx should be differentiated from false croup, laryngitis and laryngo-tracheitis of viral etiology, foreign bodies, tumors localized at the level of the vocal folds and below, and retropharyngeal abscess.

Nasal diphtheria as an independent form is very rare, mainly in young children. In some patients, only the clinical picture of catarrhal rhinitis is revealed. Characteristic films, after rejection or removal of which erosions remain, are not always formed. In most patients, the nasal lesion is unilateral, which facilitates the diagnosis, which must be confirmed by the results of a microbiological study. Nasal diphtheria should be differentiated from foreign bodies, purulent rhinosinusitis, tumors, syphilis, and tuberculosis.

Features of respiratory tract diphtheria in adults. The disease often occurs in a severe toxic form with the development of croup, descending into the trachea and bronchi. At the same time, in the initial period it can be erased and masked by other manifestations of diphtheria, its complications or pathological processes in the internal organs, which makes it difficult to make a timely diagnosis. For croup in patients with a toxic form of diphtheria, especially with descending croup involving the trachea (and bronchi), a tracheostomy is indicated in the early stages, and intubation is not advisable.

Treatment. If any form of diphtheria is detected, and even if the presence of this disease is suspected, it is necessary to immediately begin treatment - the administration of anti-diphtheria serum. In severe forms, multiple injections are given until the plaque regresses. The serum is administered according to the Bezredka method: first, 0.1 ml of serum is injected subcutaneously, after 30 minutes - 0.2 ml and after another 1-1.5 hours - the entire remaining dose. For a localized mild form, a single injection of 10,000-30,000 IU is sufficient, for a widespread form - 40,000 IU, for a toxic form - up to 80,000 IU, for diphtheria descending croup in children - 20,000-30,000 IU of serum. For children under 2 years of age, the dose is reduced by 1.5-2 times.

Patients with croup need oxygen therapy and correction of acid-base status. It is advisable to administer parenteral corticosteroid hormones (taking into account the patient’s age) and prescribe sedatives, and, due to frequent complications of pneumonia, antibiotics. If there is laryngeal stenosis and there is no positive effect within the next few hours after the start of treatment with anti-diphtheria serum, then intubation or tracheostomy is necessary.

Tuberculosis (pharynx, root of tongue)

Patients with widespread, predominantly exudative-ulcerative, tuberculosis of the upper respiratory tract may require emergency care due to severe pain in the throat, dysphagia, and sometimes laryngeal stenosis. Damage to the upper respiratory tract is always secondary to the tuberculosis process in the lungs, but the latter is not always diagnosed in a timely manner.

Fresh, recently developed tuberculosis of the mucous membranes is characterized by hyperemia, infiltration, and often swelling of the affected parts, as a result of which the vascular pattern disappears. The resulting ulcers are superficial, with jagged edges; their bottom is covered with a thin layer of purulent discharge of a whitish-grayish color. The ulcers are small at first, but soon their area increases; merging, they capture large areas. In other cases, destruction of the affected areas occurs with the formation of defects of the tonsils, uvula or epiglottis. When the larynx is damaged, the voice deteriorates to the point of aphonia. The condition of patients is moderate or severe, body temperature is high, ESR is increased, there is leukocytosis with an increase in the number of band neutrophils; the patient notices weight loss.

The diagnosis is made on the basis of the clinical picture and identification of the tuberculosis process in the lungs (radiography). In ulcerative forms, a good non-traumatic way to quickly diagnose is a cytological examination of a scraping or impression from the surface of the ulcer. If a negative result is obtained and the clinical picture is unclear, a biopsy is performed.

Tuberculosis (mainly exudative ulcerative) of the pharynx and pharynx should be differentiated from acute banal tonsillitis and Simanovsky's tonsillitis, erysipelas, agranulocytic tonsillitis. Tuberculosis of the larynx, which is in the same form, must be distinguished from influenza-like submucosal septic laryngitis and abscesses of the larynx, herpes, injuries, erysipelas, acute isolated pemphigus, and lesions in diseases of the hematopoietic organs.

The goal of emergency care is to eliminate or at least reduce pain. To do this, intradermal blockades are performed with a 0.25% novocaine solution. Local anesthetic measures consist of anesthesia of the mucous membrane using spraying or lubrication with a 2% solution of dicaine (10% solution of cocaine) with adrenaline. After this, the ulcer surface is lubricated with an anesthetic mixture of Zobin (0.1 g menthol, 3 g anesthesin, 10 g each of tannin and rectified ethyl alcohol) or Voznesensky (0.5 g menthol, 1 g formaldehyde, 5 g anesthesin, 30 ml distilled water) . Before eating, you can gargle with a 5% novocaine solution.

At the same time, general anti-tuberculosis treatment is started: streptomycin (1 g/day), viomycin (1 g/day), rifampicin (0.5 g/day) intramuscularly; isoniazid is given orally (0.3 g 2 times a day) or protion-mide (0.5 g 2 times a day), etc. It is necessary to prescribe at least two drugs from different groups.

Abscesses of the pharynx.

Peritonsillitis, peritonsillar abscess

Peritonsillitis of the palatine tonsils. Peritonsillitis is an inflammation of the tissue surrounding the tonsil, which occurs in most cases as a result of infection penetrating beyond its capsule and as a complication of tonsillitis. Often this inflammation ends in abscess formation. Occasionally, paratonsillitis can be of traumatic, odontogenic (back teeth) or otogenic origin with an intact tonsil or be a consequence of hematogenous introduction of pathogens in infectious diseases.

In its development, the process goes through the stages of exudative-infiltrative, abscess formation and involution. Depending on where the zone of most intense inflammation is located, anterosuperior, anterioinferior, posterior (retrotonsillar) and external (lateral) paratonsillitis (abscesses) are distinguished. The most common are anterosuperior (supratonsillar) abscesses. Sometimes they can develop on both sides. A tonsillar phlegmonous process in the peritonsillar tissue can develop during a sore throat or shortly after it.

Peritonsillitis (abscesses) are usually accompanied by fever, chills, general intoxication, severe sore throat, usually radiating to the ear or teeth. Some patients, due to pain, do not eat or swallow saliva that flows from their mouths, and do not sleep. In addition, they may experience dysphagia with food or liquid refluxing into the nasopharynx and nasal cavity. A characteristic symptom is trismus, which makes examining the oral cavity and pharynx very difficult; Bad breath and a forced position of the head with a tilt forward and to the painful side are also often noted. The submandibular lymph nodes enlarge and become painful on palpation. ESR and leukocytosis usually increase.

Pharyngoscopy in a patient with paratonsillitis usually reveals that the most pronounced inflammatory changes are localized near the tonsil. The latter is enlarged and displaced, pushing aside the inflamed, sometimes swollen uvula. The soft palate is also involved in the process, the mobility of which is consequently impaired. With anterior superior paratonsillitis, the tonsil displaced downward and posteriorly can be covered by the anterior arch.

A posterior paratonsillar abscess develops near or directly in the posterior palatine arch. It becomes inflamed, thickens, and sometimes swells, becoming almost glassy. These changes, to one degree or another, extend to the adjacent part of the soft palate and the uvula. Regional lymph nodes swell and become painful, the corresponding arytenoid cartilage often swells, there is dysphagia, and trismus may be less pronounced.

Inferior paratonsillitis is rare. An abscess of this localization is accompanied by severe pain when swallowing and protruding the tongue, radiating to the ear. The most pronounced inflammatory changes are observed at the base of the palatoglossal arch and in the groove separating the palatine tonsil from the root of the tongue and the lingual tonsil. The adjacent area of ​​the tongue is sharply painful when pressed with a spatula and is hyperemic. Inflammatory swelling with or without swelling extends to the anterior surface of the epiglottis.

The most dangerous is an external paratonsillar abscess, in which suppuration occurs lateral to the tonsil, the abscess cavity is deep and difficult to access, and respiratory decompensation occurs more often than with other forms. However, it, like lower paratonsillitis, is rare. The tonsil and the surrounding soft tissues are relatively little changed, but the tonsil protrudes inwards. Pain on palpation of the neck on the corresponding side, forced position of the head and trismus are noted, and regional cervical lymphadenitis develops.

Peritonsillitis should be differentiated from phlegmonous processes that occur in diseases of the blood, diphtheria, scarlet fever, erysipelas of the pharynx, abscess of the lingual tonsil, phlegmon of the tongue and floor of the mouth, tumors. When mature and have a favorable course, the peritonsillar abscess can open on its own on the 3-5th day, although the disease often drags on.

According to V.D. Dragomiretsky (1982), complications of paratonsillitis are observed in 2% of patients. These are purulent lymphadenitis, peropharyngitis, mediastinitis, sepsis, mumps, phlegmon of the floor of the mouth, thrombophlebitis, nephritis, pyelitis, heart disease, etc. For all paratonsillitis, antibiotic therapy is indicated. It is advisable to prescribe semisynthetic penicillins, as well as various combinations of broad-spectrum antibiotics, Metrogyl..

Certain features characterize paratonsillitis in children who suffer from them, although rarely, starting from infancy. The smaller the child, the more severe the disease can be: with high body temperature, leukocytosis and increased ESR, accompanied by toxicosis, diarrhea and difficulty breathing. Complications develop rarely and usually proceed favorably.

When a patient with paratonsillitis is admitted to the hospital, treatment tactics should be immediately determined. For primary paratonsillitis without signs of abscess formation, as well as for the development of the disease in young children, drug treatment is indicated. Antibiotics are prescribed to such patients in maximum age-specific doses.

Conservative treatment is advisable only in the early stages of the disease. In addition to antibiotics, analgin, vitamins C and B, calcium chloride, antihistamines (diphenhydramine, tavegil, suprastin) are prescribed.

The main method of treatment for paratonsillitis and mandatory treatment for peritonsillar abscesses is their opening. In the most common anterosuperior form of paratonsillitis, the abscess is opened through the upper part of the palatoglossus (anterior) arch.

The incision should be long enough (wide), but not deeper than 5 mm. It is permissible to advance to greater depths only in a blunt way using a forceps towards the tonsil capsule. For posterior abscesses, the incision should be made vertically along the velopharyngeal arch, and for anteroinferior abscesses, through the lower part of the palatoglossal arch, after which it is necessary to bluntly penetrate outward and downward 1 cm or pass through the lower pole of the tonsil.

A typical opening of anterosuperior abscesses is usually performed either at the point of translucence of pus, or in the middle of the distance between the edge of the base of the uvula and the posterior tooth of the upper jaw on the affected side, or at the intersection of this line with the vertical drawn along the palatoglossal arch. To prevent injury to blood vessels, it is recommended to wrap the scalpel blade at a distance of 1 cm from the tip with several layers of adhesive tape or a gauze strip soaked in furatsilin solution (used for tamponade of the nasal cavity). It is necessary to cut only the mucous membrane, and move deeper with a blunt path. Getting into an abscess during its opening is determined by the sudden cessation of tissue resistance to the advancement of the forceps.

When opening posterior abscesses, a vertical incision is made behind the tonsil at the site of the largest protrusion, but first you need to make sure that there is no arterial pulsation in this area. The scalpel tip should not be directed to the posterolateral side.

The incision is usually carried out under superficial anesthesia, carried out by lubrication with a 3% solution of dicaine, which, however, is ineffective, so it is advisable to premedicate with promedol. Reduces pain when opening an abscess by submucosal administration of a solution of novocaine or lidocaine. After opening the abscess, the passage into it must be expanded, pushing the jaws of the inserted forceps apart. In the same way, the hole made is expanded in cases where no pus is obtained as a result of the cut.

A radical method of treating paratonsillitis and paratonsillar abscesses is abscessonsillectomy, which is performed with a history of frequent sore throats or repeated development of paratonsillitis, poor drainage of an opened abscess, when its course is prolonged, if bleeding occurs due to incision or spontaneously as a result of vascular arrosion, as well as other tonsillogenic complications [Nazarova G.F., 1977, etc.]. Tonsillectomy is indicated for all lateral (external) abscesses. After an incision has already been performed, a tonsillectomy is necessary if no positive dynamics are observed within 24 hours, if copious discharge of pus continues from the incision, or if the fistula from the abscess is not eliminated. A contraindication to abscessonsillectomy is the terminal or very serious condition of the patient with sudden changes in parenchymal organs, thrombosis of cerebral vessels, and diffuse meningitis.

Diseases of the pharynx and larynx include acute and chronic pharyngitis, laryngitis and tonsillitis.
One of the most common painful conditions known to every adult is acute catarrhal inflammation of the throat. It is celebrated mainly in autumn and spring. Most often, such conditions are observed in people suffering from chronic pathologies of the ENT organs, accompanied by impaired nasal passage, as a result of which they breathe through the mouth. At the same time, the mucous membrane of the oropharynx and larynx is forced to come into direct contact with cold air, often, especially during the period of mass acute respiratory viral infections, containing pathogens.

Inflammatory changes in the pharynx and larynx are most often caused by a viral infection, much less often the causative agents are bacteria. Viruses most actively attack the body during a period of decreased resistance and general weakening - for example, after hypothermia, overwork, after long-term treatment with antibiotics, etc.
Inflammatory processes in the throat can be combined with inflammatory processes in the nose, trachea or bronchi. Often, the symptoms of the disease are noted first in the throat, and later signs of malaise appear in other organs.
Among the inflammatory diseases of the pharynx and larynx, which are successfully treated with modern techniques by otolaryngologists at our medical center, the following can be distinguished:

Inflammation of the tonsils (tonsillitis):

Inflammation of the pharynx (pharyngitis):

• spicy
• chronic

Inflammation of the larynx (laryngitis):

The main symptoms of catarrhal inflammation of the throat are a feeling of dryness, burning and tingling, which may be accompanied by pain when swallowing, fever, weakness, malaise, and headache. In some types of acute inflammation of the throat, enlargement and pain in the area of ​​the submandibular lymph nodes may occur. Hoarseness may occur - dysphonia. Usually, all these symptoms, in the absence of complications, go away quite quickly, after 4-5 days.

However, in the absence of timely and rational treatment, as well as in case of improper self-medication, acute catarrhal inflammation in the throat can drag on and become chronic, spread to neighboring ENT and respiratory organs (trachea, bronchi, lung tissue), and lead to various complications.
Therefore, it is so important to promptly seek qualified medical help in any case of acute inflammatory phenomena in the throat. The ENT doctor will make the correct diagnosis and choose the right treatment tactics, which will allow you to cure inflammatory diseases of the throat as quickly and completely as possible, as well as avoid complications associated with them and further health troubles. This is especially important in childhood, because children are most susceptible to inflammatory diseases and infections of the respiratory tract and ENT organs, and possible complications can adversely affect their growth and development.

Untreated tonsillitis or chronic tonsillitis can cause a number of chronic and protracted inflammatory processes in a variety of organs and systems, cause the development of rheumatism, provoke pyelonephritis, glomerulonephritis, endocarditis, endovasculitis and other complications, sometimes very dangerous to life and health.

Preventive and therapeutic measures carried out by the specialists of our clinic, as well as recommendations for the prevention and prevention of diseases of the ENT organs will help you experience a sore throat as rarely as possible!

The term “throat diseases” in everyday life most often means ENT diseases of the pharynx (the part of the digestive and respiratory systems that communicates with the nasal cavity, oral cavity and larynx).

As in the case of other organs, throat diseases can be the result of infection (viral, bacterial or fungal) - both acute and chronic, various injuries, harmful external influences (caustic and toxic substances, dust, tobacco smoke).

Classification

ENT diseases of the throat can be divided into acute inflammatory, chronic inflammatory and their complications. Diseases of the larynx and throat also include hypertrophy of the palatine and pharyngeal tonsils, foreign bodies, wounds and burns of the pharynx. Let's look at them in more detail separately.

Symptoms

Acute inflammatory diseases of the pharynx

This group includes acute pharyngitis and various sore throats, almost the most common throat diseases in children.

Acute pharyngitis is an acute inflammation of the pharyngeal mucosa, developing due to exposure to microorganisms or harmful environmental factors, such as smoking, alcohol, etc.

With this disease, the patient most often complains of a burning sensation, dryness, rawness in the throat, suffocation; the sensation is described as a “lump in the throat.” Temperature is usually either pain.

Sore throat is a common acute infectious-allergic disease that develops when the lymphoid tissue of the pharyngeal ring is damaged. The most common cause is group A beta-hemolytic streptococcus.

There are common forms of tonsillitis (catarrhal, follicular and lacunar), atypical forms, as well as specific tonsillitis in some infectious diseases and blood diseases.

– the mildest form, characterized by pain and sore throat, a feeling of “coma,” slight pain when swallowing and a slight increase in temperature.

Follicular tonsillitis– occurs more severely with severe pain radiating to the ear, headache, weakness, sometimes vomiting, suffocation. The temperature can rise to 39°C.

Lacunar is the most severe of the banal forms. All tonsils are covered with plaque, the lacunae are filled with a yellowish-white coating, pain when swallowing, fever and symptoms of intoxication, including the feeling of a “lump in the throat,” are also observed.

With various infectious diseases, tonsillitis can also develop as one of the components of the main process.

Symptoms of sore throat include:

• diphtheria (then the tonsils are covered with a dense white-gray coating, the development of croup - suffocation) is possible;
• scarlet fever;
• measles;
• agranulocytosis;
• leukemia;
• herpetic sore throat (with small blisters on the tonsils and unilateral conjunctivitis).

A fungal infection may be involved.

A separate form of sore throat is Simanovsky-Plaut-Vincent angina. It is caused by a symbiosis of a spindle-shaped bacterium and an oral spirochete, leading to the development of a greenish coating, a feeling of “lump” in the throat, putrid breath and high fever.

Sore throats can occur with complications, such as paratonsillitis, para- and retropharyngeal abscesses.

Peritonsillitis is an inflammation of the peri-tonsillary tissue, manifested in a strong increase in temperature to 39-40 ° C, the inability to eat and swallow saliva due to very severe pain, “coma in the throat,” suffocation; trismus is also characteristic - a symptom in which a person cannot fully open his mouth due to a tonic spasm of the masticatory muscles. In the oral cavity, in the projection of the tonsil, a large bulge is detected.

Parapharyngeal abscess is suppuration of parapharyngeal tissue, and repharyngeal abscess is retropharyngeal. Their symptoms are in many ways similar to paratonsillitis (except for the characteristic bulging), the differential diagnosis should be carried out by an ENT doctor.

Tonsil hypertrophy

This term refers to the proliferation of lymphadenoid tissue. Most often, hypertrophic processes occur in the palatine and pharyngeal tonsils.

Enlarged tissues can make breathing difficult, cause suffocation, interfere with diction and food intake, and cause a feeling of a “lump” in the throat.

Children with this disease sleep poorly, cough at night, and some may develop neuropsychiatric disorders because of this.

Chronic inflammatory diseases of the pharynx

These include chronic forms of pharyngitis and tonsillitis.

Chronic pharyngitis– inflammation of the pharyngeal mucosa – occurs due to insufficiently effective treatment of acute forms. There are catarrhal, hypertrophic (lateral and granulosa) and atrophic forms.

Patients complain of rawness, soreness, tickling, a “lump” in the throat, suffocation, foreign body sensation, and blocked ears.

The temperature may not rise. They often need a sip of water to swallow something.

Chronic tonsillitis– persistent infectious-allergic disease with local manifestations in the form of inflammation of the tonsils. Most often it occurs as a complication of other infectious processes (such as tonsillitis and caries).

The simple form is characterized by frequent (1-2 times a year) sore throats with corresponding complaints: pain, “lump in the throat,” coughing, fever.

In the toxic-allergic form, symptoms of intoxication and allergization are added to sore throats; associated diseases such as rheumatism, glomerulonephritis, polyarthritis, endocarditis and others are often found.

Foreign bodies, wounds and burns of the throat

Foreign bodies most often enter the throat when talking or laughing while eating, as well as in children while playing. Sometimes foreign bodies in older people are dentures. Patients complain of a lump in the throat, pain and difficulty breathing and swallowing.

Throat wounds can be external and internal, penetrating and non-penetrating, isolated and combined, blind and through.

Symptoms most often include bleeding, breathing problems, speech problems, difficulty swallowing due to a “coma,” suffocation, and severe pain.

Burns can develop due to thermal and chemical damage to the throat wall. Thermal burns are most often caused by exposure to temperature - exposure to hot food and drink, less often - hot air or steam.

Chemical burns occur when exposed to hydrochloric, acetic, nitric acids, caustic soda or potassium.

Burns can be of three degrees - from the first, the mildest, accompanied by redness of the mucous membrane, to the third, with necrosis of the deep layers of tissue.

Burns are most often accompanied by pain, drooling, and general intoxication. Due to numerous complications, throat burns are a life-threatening condition.

Treatment

Treatment of acute pharyngitis is usually carried out on an outpatient basis, it is prescribed by a therapist or ENT doctor. It includes rinses with antiseptics (chlorophyllipt, chamomile infusion), aerosols (Polydex), desensitizing and immunostimulating drugs. Antibiotics are rarely prescribed.

Banal sore throats are usually treated on an outpatient basis by an ENT doctor, in severe cases - in a hospital.

Antibiotics from the penicillin group, antihistamines (Tavegit, Telfast), Bioparox inhalations, rinses and non-steroidal anti-inflammatory drugs are prescribed.

Treatment of infectious diseases and blood diseases accompanied by tonsillitis should be carried out not by an ENT specialist, but by an infectious disease specialist or hematologist in the appropriate hospitals.

Important to remember! Any suspicion of diphtheria is an undeniable indication for examination and, possibly, hospitalization, since diphtheria is a very dangerous disease.

For Simanovsky-Plaut-Vincent angina, antibiotic therapy with penicillin preparations, restorative and vitamin therapy are carried out; sanitize the oral cavity and clean the tonsils from necrotic foci.

The tactics for managing paratonsillitis and other abscesses include antibiotic therapy and mandatory surgical intervention to sanitize purulent foci.

Chronic pharyngitis is treated on an outpatient basis by excluding exposure to harmful factors (alcohol, smoking), inhalations, lubricating the throat with Collargol (done by an ENT doctor), and sucking caramels with antiseptics (Hexalize, Faringosept). In the treatment of chronic pharyngitis, both conservative and surgical methods are used. The first involves washing the lacunae of the tonsils (10-15 procedures), lubricating their surface with iodinol or collargol, rinsing and physiotherapeutic procedures (UHF or microwave therapy).

Surgical methods include tonsillectomy. A similar, but less radical method - tonsillitis - or adenotomy, respectively, treat hypertrophy of the palatine and lingual tonsils.

Foreign bodies are removed by an ENT doctor using special forceps or loops. You should not remove the foreign body yourself using tweezers, as you can aggravate the process and cause asphyxia.

Surgical treatment of wounds is also carried out by an ENT specialist if the necessary tools and equipment are available, most often in a hospital setting.

Treatment of throat burns is a difficult and multi-stage process, involving both ENT specialists and other specialists. At first, all measures are usually aimed at preserving the patient’s life, then at preventing the formation of adhesions.

In the acute period, anti-shock and detoxification measures are carried out, the fight against respiratory disorders, hemostasis and antibiotic therapy are carried out.

In the long-term period, the most common procedure is bougienage - expanding the lumen of the throat to restore its patency.

Prevention

Throat diseases are varied, so their prevention is also different. You should avoid traumatic situations, monitor the food and drinks you consume, and do not talk while eating.

You should also treat all acute diseases in a timely manner, and in no case leave the process untreated.

Activation of natural immunity, for example, with the help of the drug Immunity, will also have a positive effect.

It helps cope with viral and bacterial infections in just two days, promotes immune activation and removes toxins from the body, reducing recovery time.

Throat diseases are common in children and adults, since the larynx is the first filter after the nasopharynx through which all pathogenic microorganisms pass. Most pathologies have a similar clinical picture, but a different etiology. Treatment includes taking medications, using folk remedies and correcting nutrition.

The human throat is often affected by pathogenic microorganisms

List of throat diseases

The cause of a sore throat can be various pathogenic microorganisms, neoplasms, and mechanical damage. Often unpleasant sensations occur with a cold, flu, or acute respiratory viral infection.

The main causes of throat diseases:

• viral infections - rotaviruses, adenoviruses, enteroviruses provoke the development of pharyngitis, acute laryngitis;
• bacterial pathologies - develop against the background of active reproduction, staphylococci, sore throat and tonsillitis are considered childhood diseases, most often these diseases are diagnosed at the age of 5–15 years;
• fungal diseases;
• various types of neoplasms - malignant tumors, papillomas, polyps, metastases in the pharynx;
• mechanical damage.

All infectious diseases of the throat, in addition to obvious pain when swallowing, are accompanied by other accompanying symptoms - body hyperthermia, loss of strength, muscle pain, migraine, rhinitis, swollen lymph nodes, increased salivation, looseness.

Angina

A sore throat often develops in a child as a complication of colds and flu. You can see what a healthy throat and mucous membrane looks like in various forms of pathology in the photo. The ICD-10 code is J03, for the chronic form – J35.

Healthy human throat

Types of sore throat:

1. Catarrhal tonsillitis is the mildest form of the disease, characterized by slight swelling of the tonsils, redness and graininess of the mucous membrane of the pharynx, pain when swallowing, and a white coating on the tongue. In adults, there is a slight increase in temperature; in children, the thermometer readings can reach 40 degrees. The duration of the illness is no more than 5 days.

   Catarrhal tonsillitis is the mildest type of the disease

2. Lacunar tonsillitis - the disease develops rapidly, the temperature rises very quickly, weakness and headache appear. Pus accumulates inside the tonsils, plugs form, which noticeably rise above the surface of the tonsils in the form of tubercles.

   With lacunar angina, the temperature rises sharply

3. Follicular tonsillitis - begins with a sharp and rapid increase in temperature to 39 degrees or more, intense sore throat and migraine pain occur. The tonsils swell and turn red, and many yellow spots of pus can be seen on their surface.

   With follicular tonsillitis, the tonsils turn red

4. Phlegmonous tonsillitis - purulent processes occur in the lymphoid tissue, an abscess develops. The disease occurs against a background of high fever, chills, sore throat is most often one-sided, worsens when swallowing, talking, and bad breath appears.

With phlegmonous sore throat, accumulations of pus appear

Inflammation of the palatine tonsils is a consequence of frequent sore throats and can occur in acute and chronic forms. Measles, scarlet fever, and diphtheria can provoke the development of the disease. The ICD-10 code is J03.

With tonsillitis, the tonsils become inflamed

Tonsillitis most often occurs without an increase in temperature, is accompanied by atrophy of the lymphoid tissue of the tonsils, and breathing problems occur against the background of hypertrophy.

Sudden hoarseness and hoarseness often occur due to hormonal disorders - pathology of the thyroid gland, estrogen deficiency in women during menopause.

Laryngitis

The inflammatory process is localized in the mucous membrane of the larynx and occurs in acute and chronic forms. The disease develops from hypothermia, inhalation of cold or polluted air, or tobacco smoke. The ICD-10 code is J04.

Acute laryngitis is most often one of the symptoms of ARVI, influenza, whooping cough, scarlet fever, and develops with hypothermia, prolonged stay in a room with dusty air, against the background of addictions. The disease is characterized by a barking cough, but after a while the cough begins, the person complains, the voice becomes hoarse, it may disappear completely, the temperature rises slightly, and interferes with the cough.

Forms and symptoms of chronic laryngitis:

1. Catarrhal - accompanied by diffuse damage to the laryngeal mucosa. The main signs are hoarseness, weakness, a feeling of narrowing of the throat, and a wet cough periodically appears.
2. Hypertrophic - against the background of prolonged inflammation, the epithelium grows into other layers of the epidermis. The disease is accompanied by aphonia, burning in the throat, and cough.
3. Atrophic - the inner lining of the larynx atrophies and becomes thin. Symptoms: decreased voice tone, sore throat, dry cough; during a severe attack, crusts streaked with blood may come off.

With hypertrophic laryngitis, it is sometimes necessary to remove areas with hyperplasia surgically.

Acute or chronic inflammatory process in the mucous membrane of the pharynx. The ICD-10 code is J02.

The acute form of the pathology develops against the background of infectious diseases of the upper respiratory tract. Pharyngitis can occur with prolonged inhalation of frosty air through the mouth, against the background of smoking and alcohol abuse, after eating very hot or cold food. The sore throat intensifies when swallowing saliva, the disease is accompanied by a low-grade fever, a sore throat occurs, but in general the person feels normal.

Throat with pharyngitis

Chronic pharyngitis develops against the background of sinusitis, tonsillitis, caries, metabolic disorders, heart and lung diseases. The pathology is combined with atrophy of the nasal mucosa, accompanied by severe scratching in the throat, dry barking cough, swelling of the tongue, purulent discharge, and low-grade fever.

The acute form of laryngitis is a dangerous disease for children under two years of age, often accompanied by severe catarrhal rhinitis, swelling and inflammation of the nasopharyngeal mucosa, which causes a significant deterioration in nasal breathing.

Inflammation of the pharyngeal tonsil is often viral in nature, manifests itself in the form of severe headache, dry suffocating cough, attacks of shortness of breath and suffocation, and is diagnosed in children aged 3–15 years. The ICD-10 code is J35.

The disease develops against a background of weakened immunity, vitamin D deficiency, hypothermia, a history of chronic rhinitis or upper respiratory tract diseases.

Adenoiditis - inflammation of the pharyngeal tonsil

Malignant and benign neoplasms

Laryngeal cancer is difficult to diagnose in the early stages because the disease can occur for a long time without pronounced symptoms, so tumors are often diagnosed when they reach a large size. The ICD-10 code is C32.

Possible signs of oncology:

• sensation of a foreign body in the throat, soreness, discomfort when swallowing;
• difficulty breathing;
• the presence of bloody inclusions in the mucus from the throat and nose;
• increased salivation;
• frequent ear congestion without obvious signs of inflammation;
• toothache, while the dentist cannot detect the cause of the discomfort;
• hoarseness of voice.

Blood clots in saliva may indicate the development of tumors in the throat

Benign neoplasms are less dangerous, but also require immediate treatment, since if they are frequently injured, serious complications can arise. Polyps and vocal nodules appear on the larynx due to constant tension of the ligaments, smoking, and chronic inflammatory processes. The reason for the formation of papillomas is the activation of HPV, growths appear on the trachea and vocal cords. All non-cancerous tumors have an ICD-10 code of D10.

Most often, laryngeal cancer is diagnosed in men aged 55–65 years, heavy smokers.

Mycoses of the larynx

Fungal infections develop against a background of weakened immunity and can have an acute or chronic form. They manifest themselves as redness of the throat and tonsils, pain when swallowing, ulcers and erosions in the mouth, sores in the corners of the mouth, dry cough, fever, swelling and tenderness of the cervical and submandibular lymph nodes. The ICD-10 code is B37.

Fungal infection of the throat

The main types of fungal pathologies of the oral cavity:

• pseudomembranous candidiasis - most often diagnosed in children and the elderly;
• mycosis – develops against the background of diabetes mellitus;
• erythematous chronic itching.

Pain and burning when swallowing can be caused by reflux disease - the acidic contents of the stomach penetrate the upper esophagus, throat, irritating the mucous membranes.

Other throat diseases

A sore throat may be a sign of other diseases that are not related to ENT pathologies.

What diseases can cause a sore throat:

1. Laryngospasm - most often occurs in children with rickets, hydrocephalus, and formula feeding. Symptoms are a decrease in the diameter of the pupil, strong closure of the vocal cords, convulsions, fainting, noisy breathing. In adults, the skin becomes red or bluish and a hacking cough appears. ICD-10 code – 5.
2. Swelling of the larynx - develops against the background of allergies, injuries of the larynx, pathologies of the heart and blood vessels. The person experiences pain when swallowing and has difficulty breathing. The ICD-10 code is J4.
3. Laryngeal stenosis - the lumen of the respiratory tract is completely or partially closed due to swelling of the larynx, insect bites, injuries, the cause may be syphilis, diphtheria, neoplasms of various origins. Signs: profuse cold sweat, breathing problems, shortness of breath, hoarse voice, mucous membranes and skin acquire a blue tint, possible loss of consciousness, respiratory arrest. ICD-10 code – 6.

Laryngeal stenosis - closure of the airway due to swelling

Mechanical damage to the larynx is often diagnosed in young children, since they may accidentally swallow a foreign object. In adults, pathology can occur when swallowing a fish bone; singers and lecturers are susceptible to the disease due to constant increased stress on the ligaments.

Which doctor should I contact?

If a sore throat appears, it is necessary, after examination and preliminary diagnosis, he will give a referral to.

Additionally, consultation with an infectious disease specialist may be required.

If the illness is psychosomatic in nature, the patient will be looked at. A doctor from one of these areas will be able to make an accurate diagnosis based on the test results.

Diagnosis of throat diseases

The patient is examined using special instruments - laryngoscopy and pharyngoscopy make it possible to identify in which part of the throat the mucous membrane is most hyperemic and swollen, to assess the condition of the vocal cords and the posterior wall of the larynx, and to detect lumps of pus.

Basic diagnostic methods:

• clinical blood and urine analysis;
• throat swab, sputum culture;
• MRI, histological examination of the tumor - allows you to determine the origin of the tumors;

Since throat diseases are often of bacterial origin, before prescribing therapy, sputum is tested for sensitivity to antibacterial drugs.

Ultrasound of the larynx shows the cause of the disease

Treatment methods for throat diseases

To eliminate unpleasant symptoms and prevent the development of complications in the treatment of throat diseases, medications and diet therapy are used, and alternative medicine recipes will help speed up the healing process.

Medicines

To treat throat diseases, I use medications in tablet form, topical agents, the choice of drugs depends on the type of pathogen.

Main groups of drugs:

• antibiotics – Amoxicillin, Augmentin;
• antiviral drugs - Remantadine, Tamiflu;
• antifungal agents – Fluconazole, Levorin;
• antihistamines – Ebastine, Cetirizine;
• – Paracetamol, Nurofen;
• mucolytics – ACC, Prospan, Ambroxol;
• local antiseptics - Tantum Verde, Ingalipt, Lizobakt, Miramistin;
• streptococcal and staphylococcal bacteriophages.

Recently, doctors are increasingly resorting to surgery to remove tonsils in the throat, since the tonsils are organs of the immune system and prevent infection from entering the bronchi, trachea, and lungs.

Amoxicillin is an antibiotic drug

Folk remedies

When treating throat diseases, it is necessary to maintain bed rest, drink more warm drinks, milk, tea with raspberries or black currants, rosehip decoction, and alkaline mineral waters without gas are good for pain and sore throat.

How you can treat throat diseases at home:

• honey is one of the best remedies for treating sore throat; it can be lubricated on the tonsils, consumed in its pure form, or prepared as a gargle;
• inhalations with essential oils of eucalyptus, fir, pine, tea tree;
• a regular heat or alcohol compress on the neck, hot foot baths with mustard;
• Gargling is an effective method of combating throat diseases. For procedures, you can use a decoction of chamomile, sage, linden, oak bark, St. John's wort;
• You can take diluted tincture of propolis, garlic, calendula orally;
• you can treat inflamed tonsils with a mixture of juice from aloe, kalanchoe and propolis tincture; sea buckthorn oil softens the throat well and eliminates purulent processes.

Gargling with chamomile decoction helps to cope with sore throats.

Honey should not be added to hot drinks - under the influence of high temperatures the product acquires carcinogenic properties. Boiling water destroys vitamin C in lemon, raspberries, and black currants.

Any thermal procedures can be carried out only at normal temperatures.

Nutritional Features

To reduce inflammation, pain, swelling of the mucous membrane, and not injure the irritated throat, you must adhere to a special diet.

Nutrition principles:

• It is necessary to exclude hot, sour, spicy, salty foods from the diet, give up heavy fatty and sweet dishes, and junk food;
• all dishes must have a comfortable temperature and soft consistency;
• the menu should contain a lot of vegetables and fruits, especially those high in vitamin C and iodine - greens, bell peppers, carrots, seaweed;
• Every day you need to consume 10–15 ml of olive or corn oil;
• Fermented milk products will help speed up recovery and prevent the development of dysbiosis when taking antibiotics;
• Smoking and drinking alcohol are strictly prohibited.

Garlic, onions, ginger, cinnamon, and star anise effectively fight viruses.

If you have a sore throat, you should not eat spicy food.

Possible complications

Without proper and timely treatment, acute inflammatory processes in the throat turn into chronic diseases, which is fraught with constant relapses at the slightest hypothermia and weakened immunity.

What are the dangers of throat diseases?

• tonsillitis often causes complications in the heart, joints, kidneys - rheumatism, infectious polyarthritis, paratonsillitis, nephritis develop;
• with chronic tonsillitis, vasculitis and skin dermatoses often develop;
• hypotonic dysphonia – the functioning of the vocal cords and laryngeal muscles worsens;
• jaw spasm;
• retropharyngeal abscess;
• chronic bronchitis, sinusitis, sinusitis, otitis;
• severe eye pathologies;
• hepatitis A, B.

If streptococci from the tissues of the throat penetrate into the blood, sepsis will begin to rapidly develop.

If your throat is not treated, chronic sinusitis may develop.

Prevention

To prevent the development of throat diseases, it is necessary to adhere to simple rules of prevention and strengthen the immune system.

How to avoid a sore throat:

• take daily walks in the fresh air;
• stop smoking;
• maintain optimal temperature and humidity in the room;
• eat food at a comfortable temperature;
• the diet should contain a sufficient amount of vitamins and microelements;
• avoid hypothermia.

Quit smoking to avoid throat diseases

To avoid catching an infection, you must follow the rules of hygiene, do not touch your face with dirty hands, take antiviral drugs during epidemics of acute respiratory viral infections and influenza, and lubricate your nose with oxolinic ointment when leaving the house.

The list and symptoms of throat diseases are quite large, so if you experience discomfort when swallowing or hoarseness, you should consult a doctor. Correct diagnosis and adequate therapy will help avoid the development of severe, sometimes fatal, complications.