Chronic banal tracheitis. Causes and symptoms of diseases of the ENT organs Acute inflammatory diseases of the pharynx

gulp called a special organ, which is presented in the form of a thin muscular tube. It is attached in front of the bodies of the cervical vertebrae, starting from the base of the skull and up to the very level of the sixth cervical vertebra, where the pharynx passes into another organ - the esophagus.

The length of the pharynx can be from twelve to fifteen centimeters. It is intended to ensure that food from oral cavity slowly passes into the esophagus. In addition, the pharynx moves the air flow from the nasal cavity and in the opposite direction.

The upper, as well as the lateral, walls of the pharynx are formed from a special stylo-pharyngeal muscle, which ensures constant raising and lowering of the pharynx and larynx, as well as from striated voluntary muscles: the upper pharyngeal constrictor, the middle pharyngeal constrictor and the lower constrictor, which significantly narrow its lumen. Together they form a specific muscular membrane.

Upper wall of the pharynx- this is the summary of this internal organ. It is connected to the outer surface of the cranial base. Both common and internal are attached to the side walls of this organ. carotid arteries, as well as several internal jugular veins, nerves, large horns of the hyoid bone with plates of the thyroid cartilage. In the anterior region of the muscular tube there is an entrance to the larynx, and in front there is a small epiglottal cartilage that limits this organ, scoop-epiglottic folds are located on the sides.

In the throat cavity distinguish several separate parts: nasopharynx, oral and laryngeal. Each of them is connected to the cavities of the mouth, larynx, nose. Through the pharyngeal opening in the auditory tube, they communicate with the middle ear cavity. At the entrance to the pharynx, lymphoid tissue is collected, which forms the palatine, pharyngeal with lingual, tubal and adenoid tonsils.

In addition, the walls of the pharynx are formed by the mucous membrane and the so-called adventitial membrane of the pharynx. The shell of the first type serves as a continuation of the mucous surface of the nasal cavity and mouth, its surface in the nasal part is covered with multi-row prismatic ciliated epithelium and thick squamous soft epithelium. It is transformed into the mucous membrane of not only the larynx, but also the esophagus. Connective tissue is considered a continuation of the fascia, which passes into the connective tissue membrane of the esophagus.

chronic diseases

There are the following chronic diseases of this body:

1. Hypertrophy of the tonsils. As a rule, in this case, the tonsil disease increases without an inflammatory process. Very often this disease affects children, against the background of an increase in adenoids. The main causes have not yet been determined by doctors, but it is believed that the disease occurs along with a cold. For preventive purposes, rinsing is recommended.
2. Pharyngomycosis. Inflammation of the mucous membrane of the pharynx caused by a fungus. Symptoms of manifestation, as a rule, are white or yellowish plaque, dryness and perspiration, in some cases, a burning sensation in the throat. The disease can be caused by immune or endocrine disorders. Appointed drug treatment.
3. Chronic tonsillitis . Chronic inflammation of the palatine tonsils. Children often get sick. If you do not go to the doctor in time, complications may occur, such as pneumonia, exacerbation of allergies, decreased immunity, etc. The main symptoms are: sore throat and tonsils, inflammation of the nasopharynx, slight temperature weakness, bad breath. Appointed complex treatment.
4. Papillomatosis of the larynx. Tumor disease of the upper respiratory tract caused by a virus. Most often, adult men and children in the first years of life suffer from this disease. Complex treatment is prescribed.
5. Laryngitis. Inflammatory disease of the larynx. It can occur, both from an infection and from hypothermia or a strong tension in the voice. Symptoms of the disease are: severe sore throat, redness in the throat, sometimes with purple patches, wet cough, pain when swallowing, low temperature. Treatment is prescribed medication, it is recommended to rest the patient.

There is a lot various diseases pharynx, which have an infectious etiology. They differ in the complexity of the course, as well as the symptoms. Depending on them, it is necessary to select medicines and correct method treatment.

Abrasions, superficial wounds of the mucosa with sharp foreign bodies, bone fragments that enter with food; rupture of the soft palate when falling with an open mouth.

Clinical symptoms . Sharp pain, painful swallowing, bleeding, life-threatening if the vessels of the external carotid artery system are damaged.

Diagnostics. Assess the patient's condition, complaints, anamnesis; the circumstances of the injury, an objective examination: examination of the oral cavity, pharynx (integrity of mucous tissues, bleeding); pharynx functions (swallowing, shortness of breath due to reactive edema); laboratory examination (clinical analysis blood, TAPS).

Complication of wounds of the pharynx: infection of the wound, inflammatory processes, aspiration pneumonia, secondary bleeding from large vessels of the neck.

Burns of the pharynx, oral cavity with irritating liquids

Objectively: depending on the degree of damage - diffuse hyperemia, manifestation of the epithelium with the formation of raids, tissue necrosis of the submucosal and muscle layers. Burns of the pharynx are combined with burns of the esophagus and larynx.

Foreign bodies of the pharynx

The reasons. Often ingested with food (fish and chicken bones, seed husks), random foreign objects, lack of a culture of eating, hasty food; may be dentures.

Clinical signs. Sensation of a foreign object in the throat, urge to vomit, stabbing pain when swallowing; with large foreign bodies - respiratory failure, hemoptysis, coughing, difficulty breathing can occur when a leech enters while swimming in a pond.

Acute inflammatory diseases of the pharynx

Adenoiditis

Children of preschool age are ill.

The reasons. infection; disease as a complication of inflammation in the nose and paranasal sinuses; pathogens: staphylococci; intracellular microorganisms: mycoplasma, chlamydia, rhinoviruses; influenza virus, activation of banal flora under the influence of cold; artificial food.

Clinical symptoms. Acute onset, dryness, burning, early age difficulty in the act of sucking, headache.

Regional lymph nodes submandibular, cervical enlarged, painful.

Complications: otitis media, sinusitis, relapses of the disease lead to hypertrophy of the pharyngeal tonsil.

Acute pharyngitis

The reasons. infection; decrease in body resistance; preceded by nasopharyngitis; weather.

Objective signs: the temperature is normal, the mucous membrane of the posterior and lateral walls of the pharynx is sharply hyperemic.

Angina - acute tonsillitis

The most common diseases of the pharynx.

The reasons. Pathogen: hemolytic streptococcus, staphylococcus aureus, adenovirus.

Predisposing factors: reduced immunity, hypothermia, local, general.

Classification of angina:

• primary - develops independently;
• secondary - develops against the background of infectious diseases (measles scarlet fever, diphtheria, syphilis).

With blood diseases (leukemia, monocytosis, agranulocytosis).

Primary angina

Catarrhal angina

Clinical symptoms. Most mild form, local manifestations are characteristic, children have a fever, suffer general state, sore throat, dryness.

Objectively: hyperemia of the mucosa, swelling of the palatine tonsils, enlarged, covered with mucous discharge; submandibular lymph nodes enlarged, slightly painful.

The course of the disease is up to 5 days.

Follicular angina

The palatine tonsils are enlarged, on the surface there are enlarged festering follicles, when ripe, they open, forming white plaques on the surface of the tonsils.

Lacunar angina

Sore throat lasts up to 3 days, with the treatment of inflammation phenomena stop on the 7th day.

Differential diagnosis - should be distinguished from angina with scarlet fever, diphtheria, blood diseases.

Take into account the epidemic situation.

Abscesses of the pharynx

Peritonsillar abscess

The reasons. Penetration of infection from the depths of the lacunae into the peri-almond space with complicated angina; contributing factors: lowering the body's resistance, carious teeth, local hypothermia.

Objectively during pharyngoscopy: hyperemia of the pharyngeal mucosa on the side of the lesion, tension of the palatine tonsil on one side, asymmetry of the soft palate, painful infiltrate around or behind the tonsil, a small uvula is swollen. Enlarged and painful submandibular lymph nodes. When maturing, spontaneous openings are possible with the release of a significant amount of purulent exudate with an unpleasant odor.

Retropharyngeal abscess

The reasons. Spread of infection from the nose, nasopharynx, pharynx injuries.

Clinical symptoms. Severe condition. Anxiety, refusal to eat. Difficulty breathing, nasality. Clinical symptoms depend on the location of the abscess in the lower sections, possibly suffocation, cyanosis.

Objectively: during pharyngoscopy, a spherical infiltrate, hyperemia is determined along the posterior pharyngeal wall, pushes the palatine tonsil and posterior arch anteriorly. In young children, palpation is informative.

Differential Diagnosis. Retropharyngeal abscess must be distinguished from subglottic laryngitis, foreign body larynx.

Complications. A pharyngeal abscess is dangerous due to aspiration of the respiratory tract with purulent contents during self-opening of the abscess, death from suffocation is possible, a large infiltrate can close the passage to the larynx, which will lead to respiratory failure up to asphyxia, sepsis.

Peripharyngeal abscess

The reasons. Angina, paratonsillitis, carious teeth, pharynx injuries.

Clinical symptoms. The general condition is severe, difficulty opening the mouth, possibly breathing difficulties.

With pharyngoscopy - hyperemia, infiltrate on the lateral surface of the pharynx.

Complications: purulent mediastinitis.

In children.

In the structure of the pharynx, 3 sections are conventionally distinguished: nasopharynx, oropharynx and laryngopharynx.

Pathological processes occurring in the pharynx are also divided depending on the location. In acute viral or bacterial inflammation, the mucous membrane of all parts of the pharynx is affected. In chronic pathology, the mucosa of one anatomical department is usually affected.

Etiology

In more rare cases, the causative agents of pharyngitis are respiratory syncytial virus, and human immunodeficiency.

1. The cause of nonspecific bacterial pharyngitis is usually mycoplasma, chlamydia,.
2. Specific forms of pharyngitis are associated with a specific pathogen: gonococcal pharyngitis is caused by gonococcus, pharyngeal leptotrichosis - Leptotrix buccalis.
3. The causative agent of fungal pharyngitis is a yeast-like genus Candida.
4. Protozoal lesions of the pharynx are rare and indicate dysfunction of the immune system.
5. Allergic pharyngitis is associated with the penetration of allergens into the body along with the inhaled air. Food allergies are often the cause.

The irritating factors contributing to the development of the disease include:

• Cold,
• Smoking,
• chemicals - alcohol,
• Rough, spicy and hot food
• Infectious foci in the body - caries,
• long conversation,
• industrial emissions,
• Predisposition to allergies
• Detachable, flowing down the back of the pharynx, with chronic sinusitis.

Chronic pharyngitis develops in the absence of adequate and timely treatment acute form of pathology.

The main factors that provoke the disease include the following:

1. Features of the anatomical structure of the pharynx and digestive tract,
2. Infection - bacteria, viruses,
3. Bad habits,
4. Hypo- and avitaminosis,
5. Allergy,
6. Disturbed breathing through the nose
7. Menopause,
8. Endocrine diseases - diabetes, hypothyroidism,
9. Condition after tonsillectomy
10. Irritants - chemicals, smoke, dust,
11. Chronic pathology of the digestive system,
12. weakening of the immune system,
13. Cardiovascular and hepatic-renal pathology.

Classification

Pharyngitis is classified into two main forms - acute and chronic.

• The acute form of the disease develops as a result of a simultaneous effect of a causative factor on the pharyngeal mucosa.
• Chronic pharyngitis is a pathology that develops as a result of prolonged exposure to irritating factors.

By origin, pharyngitis is classified into types:

1. Viral,
2. Bacterial,
3. Fungal,
4. protozoan,
5. Allergic,
6. post-traumatic,
7. Reactive.

By the nature of the lesion and morphological changes:

• simple or catarrhal,
• Hypertrophic or granulosa,
• Subatrophic or atrophic.

Symptoms

Main clinical sign Acute pharyngitis is a sore throat that is aggravated by coughing. Often, the appearance of pain is preceded by perspiration, which persists for several days. The more pronounced the swelling of the mucosa, the pain more intense. Strong pain gives to the ears and causes patients to refuse food. After the formation of a persistent pain syndrome, a painful, dry, “scratching” throat appears.

Common symptoms of pharyngitis are: deterioration in general condition, weakness, malaise, fatigue, fever. These signs of intoxication persist for three days and gradually disappear.

The ENT doctor on examination of the patient detects hyperemia of the posterior pharyngeal wall with areas of mucopurulent plaque, as well as swelling of the palate, tonsils and uvula. Submandibular and cervical lymph nodes painful and enlarged in most patients.

Pharyngoscopy allows you to detect the inflamed mucosa of the posterior pharyngeal wall with characteristic manifestations - hyperemia, edema, lymphoid granules on the mucosa.

Gonococcal pharyngitis- a symptom of urogenital gonorrhea, and in some cases - an independent pathology. Gonorrheal pharyngitis develops after an unprotected orogenital act with an infected person. In most cases, the pathology is asymptomatic and is detected incidentally during microbiological examination. Some patients develop the classic symptoms of pharyngitis. On the hyperemic and edematous mucosa of the oropharynx, areas with yellow-gray bloom and individual follicles in the form of red grains. Inflammation often spreads from the pharynx to the tonsils, gums, palate, and larynx with the development of corresponding pathologies.

Allergic pharyngitis- inflammation of the pharynx, which develops after the allergen enters the mucous membrane. Allergens can be: dust, pollen, pet hair, feathers, drugs, food, chemicals used in everyday life and at work. All symptoms of allergic pharyngitis are associated with swelling of the pharyngeal mucosa. The disease manifests itself with local signs - dryness, sharp, increased. In addition to the symptoms of inflammation of the pharynx, nasal congestion occurs, and other signs associated with exposure to the allergen on the upper Airways. If it is not eliminated in time, then acute pharyngitis can turn into chronic.

With chronic inflammation of the pharynx, the general condition of patients remains stable: the temperature does not rise, there is no intoxication.

Local signs of catarrhal inflammation:

1. Dryness of the mucous membrane of the pharynx,
2. Sore throat,
3. Painful and dry cough
4. A constant desire to cough up, associated with the irritating effect of the accumulated discharge on the pharyngeal mucosa.

Patients become irritable, their sleep and normal rhythm of life are disturbed.

In adults, some forms of chronic pharyngitis may differ in morphological changes and clinical signs.

• Granular pharyngitis often complicates the course of inflammatory diseases of the nose, paranasal sinuses, tonsils, caries. In the absence of adequate and timely therapy, red nodules form on the pharyngeal mucosa, causing a paroxysmal cough. Pathology is manifested by painful sensations and sore throat, paroxysmal cough with copious sputum.
• Subatrophic pharyngitis- a consequence of regular exposure to substances that irritate the throat. This form of the disease often complicates the course of chronic pathologies of the digestive organs - the pancreas, gallbladder, stomach. Treatment consists in eliminating the main etiological factor.
• Hypertrophic pharyngitis manifested by thickening and hyperemia of the pharyngeal mucosa, as well as the formation of a purulent secret. This pathology is characterized by the formation of lymphoid accumulations in the pharynx and the release of viscous sputum.

Features of inflammation of the pharynx in childhood

Pharyngitis is a pathology that quite often affects the child's body, occurring in various forms and often a manifestation of another disease - adenoiditis, tonsillitis. The risk group includes children who walk a little and sleep in a room with dry and warm air.

To avoid severe complications and the transition of the disease to an atrophic or subatrophic form, sick children are forbidden to go outside in wet weather and soar their throats for a week. Soda rinses are also not recommended for children with chronic pharyngitis, since soda dries the mucous membrane, which can lead to the development of severe complications.

It is quite difficult to identify pathology in babies. It is associated with weak clinical manifestations that do not allow to detect the disease "by eye". After listening to complaints, the specialist examines the child's throat. The oropharynx in this disease is red, swollen, swollen with the presence of a mucous or purulent discharge, the back wall is granular with pinpoint hemorrhages or vesicles filled with blood.

The main complaints of the child:

1. Sore throat,
2. Tickle or itching,
3. slight cough,
4. Pain and itching in the ears
5. Runny nose,
6. Conjunctivitis.

Local signs persist for a couple of days and gradually disappear. Body temperature is subfebrile or normal. Children usually have more pain in swallowing saliva than food.

With the addition of a secondary infection and the development of complications (tonsillitis or adenoiditis), general symptoms begin to increase with severe intoxication.

Babies cannot express their complaints, so it is very difficult for them to recognize pharyngitis. Sick children become restless, their temperature rises, sleep and appetite are disturbed. These symptoms are not specific: they can indicate any other disease. If these signs appear, you should immediately contact your pediatrician.

Pharyngitis during pregnancy

Pharyngitis, like any other disease, is dangerous for the body of a pregnant woman and creates many inconveniences associated with the inability to use the usual methods of treatment.

The disease manifests itself in pregnant women with classic local signs, subfebrile temperature, lymphadenitis, hoarseness, hoarse cough.

Pharyngitis often complicates the course of pregnancy. In the absence of adequate treatment for early dates it can lead to miscarriage, and in later - to premature birth.

Diagnostics

Diagnosis of pharyngitis includes an instrumental examination of the patient - pharyngoscopy, immunodiagnosis, microbiological examination of the discharge of the nasopharynx, determination of streptococcal antigens in the blood.

When the first suspicions of inflammation of the pharynx appear, it is necessary to examine it. Examination of the pharynx is a simple procedure, often performed at home and does not require special skills or abilities. The patient must be brought to the light and the handle of the spoon should be pressed on the central part of the tongue. The depth of advancement of the spoon should be controlled so as not to provoke vomiting.

In patients, the mucosa is injected and swollen. If the disease is accompanied by fever, you should consult a doctor, since the symptoms of pharyngitis are in many ways similar to the angina clinic. Acute - a formidable pathology, often leading to severe complications.

The hallmarks of angina in children are:

• Purulent plugs on the tonsils;
• Plaque in the form of yellow dots, islets, threads;
• Severe intoxication - lack of appetite, fever;
• Sharply expressed pain syndrome.

Differential diagnosis of pharyngitis is carried out with laryngitis and tonsillitis.

Inflammation of the pharynx and larynx

Pharyngitis is a disease with the localization of the pathological process on the mucous membrane of the pharynx. It is manifested by local inflammatory signs and common symptoms intoxication - fatigue, fatigue, decreased performance, headache. Pathology complicates the course of rhinitis and SARS.

An inflammatory disease of the mucous membrane of the larynx and vocal cords of bacterial or viral origin is called. Local symptoms of laryngitis: hoarseness, hoarseness,. Systemic signs include: fever, muscle and joint pain, malaise, weakness. In addition to infectious factors, the causes of laryngitis are: overstrain of the vocal cords, injuries of the larynx and their consequences.

Inflammation of the pharynx and larynx differ in the localization of the pathological process, etiology and pathogenesis. Therapy of laryngitis in most cases is carried out using antibiotics, and in the treatment of pharyngitis they are practically not used. Both pathologies are satellites of SARS and make themselves felt from the very beginning of the disease.

Inflammation of the throat and tonsils

Tonsillitis- acute infectious and inflammatory pathology affecting the mucous membrane of the palatine tonsils. Angina is caused by opportunistic bacteria of the drop group of infection - streptococci and staphylococci, transmitted by airborne droplets from a sick person. In more rare cases, the disease is caused by viruses, fungi and even chlamydia. Angina complicates the course of respiratory infections.

Inflammation of the pharynx and tonsils is manifested by similar clinical signs.

With pharyngitis- morning sore throat, hyperemia and swelling of the mucosa, burning and dryness, coughing, lump in the throat. General signs of intoxication are mild or absent.

At- more intense sore throat
radiating to the ears and worse after dinner. The tonsils are covered with a purulent coating. Patients appear characteristic symptoms intoxication - headache, fever, chills, muscle and joint pain, nausea, vomiting.

The therapeutic principles used in the defeat of the pharynx and inflammation of the tonsils differ significantly. In acute tonsillitis, antibiotics are prescribed, and in chronic - surgical intervention. With pharyngitis, antiseptic solutions for rinsing, aerosols, inhalations, and drinking plenty of water are usually used.

Treatment

Treatment of acute pharyngitis

In acute pharyngitis, hospitalization is not carried out and patients are treated at home. The prognosis is favorable: recovery occurs in about 7 days.

Pathology treatment includes:

• Compliance with a gentle regimen, in which it is forbidden to eat hot and spicy food, drink alcoholic beverages, strong coffee and tea. These products irritate the pharyngeal mucosa, which requires complete rest during treatment.
• should be regular throughout the acute period. The ideal option is to rinse every hour, up to 6 times a day. Adults are recommended to gargle with furacilin or soda solutions.
• Inhalation with a nebulizer with decoctions medicinal herbs, alkaline solutions, mineral water, essential oils.
• Antiseptics in the form - "Ingalipt", "Chlorophyllipt", "Kameton".
• Lozenges for sore throat with antimicrobial components - "Faringosept", "Septolete". Lozenges with herbal ingredients and menthol cleanse the mucosa from infection and increase the body's resistance.

Treatment of chronic pharyngitis

It is necessary to begin treatment of chronic pharyngitis with the elimination causal factors and adverse conditions that slow down the healing process.

During the period of exacerbation, the use of local antibacterial drugs. Systemic antibiotic therapy is carried out only in the presence of severe symptoms of the disease and signs of intoxication.

Pathology with pronounced trophic changes in the mucosa is difficult to treat, and atrophic pharyngitis is not completely curable.

Basic principles of treatment:

1. Gargling, usage medicines in the form of sprays, lozenges, lozenges.
2. Use of mucolytic agents to cleanse the mucosa from crusts, plaque and mucus,
3. Mechanical treatment of the pharyngeal mucosa,
4. Regular hydration of the mucosa by irrigating the pharynx with vegetable oils,
5. Multivitamins and immunostimulants,
6. Physiotherapy- ultrasound, inhalation with a nebulizer, UHF.

Supplement drug therapy chronic pharyngitis can be means traditional medicine.

ethnoscience

Decoctions and infusions of medicinal herbs are widely used to treat acute pharyngitis. They are used for gargles of a sore throat or for inhalation.

Phytotherapy

• Inhalations. The main components of solutions for inhalation: infusions and decoctions of lavender, mint, viburnum, linden, succession.
• Gargle warm decoction of sage, plantain, chamomile tea, calendula infusion.

• Teas and decoctions for oral administration. To fight chronic form inflammation of the pharynx is recommended to regularly take ginger tea, tea from lemongrass and mint, chamomile tea, warm decoction of blackcurrant and sage with the addition of essential oils.

Treatment of pharyngitis in children

Treatment of pathology in children is carried out at home. The main therapeutic measures for pharyngitis:

The only treatment for pharyngitis in infants is to drink plenty of fluids, since antiseptic sprays can cause a reflex, and they still cannot gargle and dissolve lozenges.

If, after carrying out all the measures described at home, the child's condition worsens, and the body temperature rises, you should consult a doctor.

Treatment of pharyngitis in pregnant women

All pregnant women experiencing sore throat should see a specialist. Self-treatment in this case is unacceptable, since we are talking about preserving the health and life of a woman and an unborn child. The specialist, taking into account the characteristics of the disease and the condition of the pregnant woman, will determine the cause of the pathology and prescribe the appropriate treatment.

Therapeutic measures in pregnant women are in compliance with the basic principles:

• peace,
• sparing diet,
• Regular ventilation of the room and humidification of the air in the room,
• Gargling with herbal decoctions,
• Inhalations with essential oils - eucalyptus, pine needles, fir,
• Use of lozenges, lozenges and aerosols.

Traditional medicine used to treat pharyngitis in pregnant women - propolis, honey, garlic, herbal medicine.

Prevention

Simple rules will help prevent the development of the disease:

Complications of pharyngitis

A complication of the acute form of the disease is chronic inflammation pharynx, which over time leads to the development of a number of serious pathologies.

Streptococcal pharyngitis is complicated by the formation, manifested by unilateral symptoms: soft tissue swelling, pain and erythema.

With pharyngitis, the infection spreads downward, which leads to the development of inflammation of the larynx, trachea and bronchi. In addition to laryngitis, and in patients with lingering course streptococcal inflammation of the pharynx occurs articular rheumatism.

The main complication of pharyngitis is a general decrease in the quality of life. For persons professional activity which is associated with the need to speak, this disease becomes a real problem. Long-term inflammation leads to a change in the timbre of the voice.

• Among the local complications of pharyngitis are: tonsillitis, abscesses, phlegmon, inflammation salivary glands, cervical lymphadenitis.
• Common complications of pharyngitis: scarlet fever, rheumatism, glomerulonephritis, myocarditis, sepsis, shock, respiratory arrest.

Video: sore throat in a child, “Doctor Komarovsky”

Inflammatory diseases of the pharynx can be divided into two main groups - diseases of the tonsils and diseases of the mucous membrane of the pharynx. In the first case, we are talking about tonsillitis, in the second - about pharyngitis. Angina and pharyngitis can be both independent diseases and concomitant.

2.5.1. Acute pharyngitis (pharyngitis acuta) – acute inflammation mucous membrane of the pharynx. It occurs as an independent disease, but more often accompanies catarrh of the upper respiratory tract.

Etiology - viral and bacterial infections. Viral etiology of acute pharyngitis occurs in 70% of cases, bacterial in 30%. Predisposing factors are general and local hypothermia, pathology of the nasal cavity, paranasal sinuses and nasopharynx, general infectious diseases, smoking and alcohol abuse, diseases of the gastrointestinal tract.

Diagnosis is not difficult, but it must be borne in mind that diphtheria, catarrhal tonsillitis and other infectious diseases can give a similar clinical picture. Microbiological examination of a smear from the surface of the posterior pharyngeal wall and tonsils allows you to clarify the diagnosis.

Clinic. It is characterized by sensations of dryness, burning, sore throat. Unlike angina, in acute catarrhal pharyngitis, the pain in the throat is felt more strongly with an “empty” pharynx, that is, swallowing saliva. Swallowing food is less painful. In addition, the patient indicates a constant flow of mucus along the back of the pharynx, which causes him to make frequent swallowing movements. General well-being suffers slightly, body temperature does not rise above 37 ° C.

With pharyngoscopy, the mucous membrane of the pharynx is hyperemic, edematous, in places mucopurulent plaques are visible. Often on the back and side walls of the pharynx one can observe individual follicles in the form of rounded bright red elevations - granules (Fig. 82).

Fig.82. Acute pharyngitis.

Treatment. Usually local. Warm rinses with antiseptic solutions (infusion of sage, chamomile, chlorophyllipt, etc.), spraying the pharynx with various aerosols with antibacterial and anti-inflammatory effects (bioparox, hexaspray, inhalipt, etc.), antihistamines, warm alkaline inhalations. It is necessary to exclude irritating (hot, cold, sour, spicy, salty) food, smoking, alcohol, and observe a gentle voice mode.

2.5.2. Angina or acute tonsillitis (tonsillitis acuta)- a common acute infectious-allergic disease, manifested by acute local inflammation of the palatine tonsils. A very common disease, characteristic mainly for children and young people; in 75% of cases, those suffering from angina are persons under the age of 30 years. Angina (from lat. ango - to squeeze, choke) has been known since ancient times. In Russian medical literature, you can find the definition of angina, as "throat toad." It can be seen from the definition that the infectious agent plays a decisive role in the development and course of angina, therefore, it is possible for a person to be infected by airborne droplets or household contact. How infectious disease angina should leave behind a certain immunity that protects against repeated diseases of this kind. In cases where tonsillitis continues to recur several times during the year, it can be assumed that the body's immune forces are reduced. This circumstance must be taken into account when deciding on the choice of treatment method.

Unfavorable factors environment, contributing to the development of angina, are hypothermia of the body, the area of ​​\u200b\u200bthe feet, the mucous membrane of the tonsils.
Etiology and pathogenesis. The causative agent of angina is usually hemolytic streptococcus. In addition, the causative agents of angina can be spirochetes of the oral cavity and fusiform bacillus, in some cases staphylococcus, viruses, anaerobic pathogens are sown.

In the pathogenesis of angina, a certain role is played by a decrease in the body's adaptive abilities to cold, sharp seasonal fluctuations in environmental conditions, a nutritive factor, a violation of nasal breathing, etc. combined with a decrease in the resistance of the macroorganism. The development of angina occurs according to the type of allergic-hyperergic reaction. An allergic factor can serve as a prerequisite for the occurrence of such complications as rheumatism, acute nephritis, polyarthritis and other diseases of an infectious-allergic nature.

Most often, the palatine tonsils are affected, much less often - the pharyngeal, lingual, and laryngeal tonsils. Often diseases of the tonsils are directly dependent on the condition of the teeth, oral cavity; angina can be combined with damage to the mucous membrane of the gums, cheeks, accompany a number of common serious diseases.

Depending on the severity of the disease, the nature of the morphological changes in the tonsils, several types of tonsillitis have been identified:

Catarrhal angina. The mildest form of the disease. The inflammatory process is limited to damage only to the mucous membrane of the palatine tonsils.

Symptoms. Sore throat when swallowing saliva and food. The pain is not very strong, as a rule, the same on both sides; the patient complains of weakness, headache, feeling of ache in the limbs; body temperature rises to 37.0-37.5 ° C. The disease begins with a feeling of soreness in the throat, dryness in it. Catarrhal angina is usually combined with a catarrhal process of the mucous membrane of the nasal cavity, pharynx.

Clinical picture. Faringoscopically, a pronounced hyperemia of the mucous membrane covering the tonsils, arches (Fig. 83) is determined. The soft palate and the mucous membrane of the posterior pharyngeal wall are not changed, which makes it possible to differentiate this form of angina from pharyngitis. Tongue dry, coated. Often there is a slight increase in regional lymph nodes. The course of such a sore throat is favorable and the disease ends in 3-4 days.

Fig.83. Catarrhal angina.

Follicular angina. A more severe form of angina, which proceeds with the involvement of not only the mucous membrane in the process, but also extends to the follicles.

Symptoms. The disease usually begins with an increase in body temperature to 38-39 ° C. There is a pronounced sore throat, which increases when swallowing, often radiating to the ear. The general reaction of the body is also expressed - intoxication, headache, general weakness, fever, chills, sometimes pain in the lower back and joints. In the blood, neutrophilic leukocytosis is noted, ESR can be accelerated to 30 mm / h.

clinical picture. Pharyngoscopically, in addition to pronounced swelling and redness of the palatine tonsils themselves and surrounding tissues against the background of severe hyperemia, yellowish-white dots, 1-2 mm in size, corresponding to festering follicles, are visible (Fig. 84). The duration of the disease is usually 6-8 days.

Fig.84. Follicular angina.

Treatment. The same as with lacunar angina.

Lacunar angina. Serious disease, inflammatory process captures the deeper parts of the tonsils. Under the influence of streptococcus, epithelial edema occurs in the depths of the lacunae of the tonsils, followed by necrosis of the epithelium both on the surface of the tonsils and in the depths of the lacunae. Desquamation of the epithelium occurs, wound surfaces appear on the mucous membrane, fibrous plaques are formed, located along the lacunae and near their mouths. Hence the name of this type of angina - lacunar.

Symptoms. Severe sore throat when swallowing food and saliva, headache, weakness, weakness, chills, sleep disturbance, fever up to 38-39 ° C.

clinical picture. When examining the oral part of the pharynx, edematous, swollen palatine tonsils attract attention, the mucous membrane of the tonsils is hyperemic, grayish-white plaques are visible on the surface of the tonsils near the mouths of the lacunae (Fig. 85). Regional lymph nodes located behind the angle are palpated mandible They are painful and enlarged. As the disease develops, nodes located deep along the external jugular vein also react. Often, the same patient can simultaneously observe signs of follicular and lacunar tonsillitis. The duration of the disease is 6-8 days.

Fig.85. Lacunar angina.

Treatment. It is carried out, as a rule, on an outpatient basis at home with the isolation of the patient and a doctor's call to the house. In severe cases, hospitalization in the infectious department is indicated. It is necessary to observe strict bed rest in the first days of the disease, and then - at home, with restriction physical activity, which is necessary both in the treatment of the disease itself, and for the prevention of complications. The patient is given separate dishes and care items. Children, as the most susceptible to angina, are not allowed to the patient.

The basis of therapy in the treatment of angina are drugs penicillin group to which streptococci are most sensitive. It is necessary to take antibiotics for at least 10 days. The most commonly prescribed antibiotics are resistant to Beta-lactamases (Augmentin, Amoxiclav). With intolerance to penicillin, other groups of antibiotics are used, in particular cephalosporins and macrolides. It is also advisable to appoint antihistamines. Plentiful warm drink is recommended. Locally it is possible to use an inhaled antibiotic - bioparox. Gargles of the pharynx are prescribed with warm decoctions of herbs (sage, chamomile, calendula, etc.), a solution of soda, furacilin, warming compresses on the submandibular region. Perhaps the appointment of salicylates (aspirin), analgesics, mucolytics, immunostimulating drugs, multivitamins. Bed rest is recommended for 7-8 days. The period of disability is on average 10-12 days.

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Foreign bodies

Often, foreign bodies of the pharynx are observed in children who put various objects in their mouths. In countries with a hot climate, living foreign bodies (leeches) can be found in the throat, which get inside as a result of drinking water from polluted reservoirs. Acute foreign bodies most often get stuck in the area of ​​passage of the food bolus: palatine tonsils, root of the tongue, lateral walls of the pharynx, valeculae, pear-shaped pockets.

Large foreign bodies (coins, toys, nipple rings) remain in the laryngeal part of the pharynx, before entering the esophagus.

The presence of a foreign body in the pharynx is manifested unpleasant feeling and stitching pain in a certain place during swallowing. In the presence of large foreign bodies that are located at the entrance to the esophagus, in addition to the sensation of a foreign body, there is difficulty in swallowing, and in some victims - breathing. In the presence of a foreign body in the pharynx, increased salivation is observed.

Examination of patients with foreign bodies of the pharynx should begin with pharyngoscopy. If a foreign body is not detected during pharyngoscopy, it is necessary to conduct an indirect hypopharyngoscopy, during which it is possible to see a foreign body in the region of the lingual tonsil, valecules, arytenoid cartilage, or the wall of the piriform pocket.

Large bodies are clearly visible in the laryngeal part of the pharynx. One of the signs of the presence of a foreign body in the region of the pear-shaped pocket may be the retention of saliva in it (salivary lake). Foamy saliva, mucosal edema, and shortness of breath give grounds to suspect a foreign body in the laryngeal pharynx. Patients often swallow stale bread crusts to remove a foreign body, while it penetrates into the depths of the tissues or breaks. In this case, a digital examination of the oral and laryngeal part of the pharynx should be performed, in which it is possible to palpate a deeply located foreign body. If a metallic foreign body is suspected, x-rays are taken.

The detected foreign body can be removed by capturing it with tweezers or forceps. If the foreign body is in the laryngeal part of the pharynx, local anesthesia by irrigation of the pharyngeal mucosa with 2% dicaine solution or 10% lidocaine solution. Removal of a foreign body from the laryngeal part of the pharynx is carried out during an indirect or (rarely) direct hypopharyngoscopy.

Timely removal of a foreign body prevents the development of complications. If the foreign body remains, then inflammation of the walls of the pharynx develops, the infection can spread to the adjacent tissue. In this case, a peripharyngeal abscess and other complications develop.

Imaginary foreign bodies of the pharynx are possible. Such patients turn to different doctors complaining that they choked on a foreign body several months or years ago. Until now, they feel pain, as well as the presence of a foreign body that can move. During an objective examination, no changes in the throat are noted.

The general condition of the patients is not disturbed. These patients suffer from various neuroses (neurasthenia, psychasthenia, etc.). It is very difficult to convince them that they do not have a foreign body.
Acute inflammation of the mucous membrane of the pharynx is rarely isolated. It is often combined with acute rhinitis, angina, laryngitis. Acute pharyngitis is often a symptom of acute respiratory infections, scarlet fever, measles, etc.

Etiology

Clinical picture

The pharyngoscopic picture is characterized by the presence of mucopurulent discharge on the back of the pharynx, hyperemia and edema of the mucous membrane, which pass from the walls of the pharynx to the posterior palatine arches and uvula. The lymphadenoid follicles of the posterior pharyngeal wall are hyperemic, swollen, enlarged, and clearly protrude under the mucous membrane (Fig. 117). Regional lymph nodes may be enlarged.

Rice. 117. Acute pharyngitis

Treatment

Chronic pharyngitis

Etiology

Chronic inflammation of the mucous membrane of the pharynx supports chronic diseases of the digestive canal (chronic gastritis, enteritis, colitis), liver, pancreas, uterus and its appendages, endocrine system(diabetes, hyperthyroidism). Very often, chronic pharyngitis occurs in patients with various neuroses, and the symptomatology of chronic pharyngitis worsens the course of the neurosis.

Clinical picture

Chronic catarrhal pharyngitis

Chronic hypertrophic pharyngitis

In the presence of lateral hypertrophic pharyngitis, hypertrophy of the lymphadenoid tissue is observed on the lateral walls of the pharynx in the form of continuous elongated red formations. Often these two forms are combined in one patient. Severe hypertrophy of the granules, lateral ridges, and lingual tonsils is sometimes seen in individuals who have had their palatine tonsils removed. With an exacerbation of the process on hypertrophied lymphadenoid formations, yellowish and whitish dots (festering follicles) or white fibrinous plaque can be seen.

Chronic atrophic pharyngitis

It happens that patients make a lot of complaints, including sore throat, and pharyngoscopy determines moisture, unchanged mucous membrane. In this case, we are talking about paresthesia of the pharynx.

Treatment

Alkaline solutions are applied locally in the form of inhalations, irrigations, rinses. The mucous membrane of the pharynx in the acute stage is affected by anti-inflammatory drugs. AT last years for the treatment of chronic atrophic pharyngitis, irradiation of the posterior pharyngeal wall with a helium-neon laser is used. Cryotherapy on the mucous membrane of the pharynx is effective in all forms of chronic pharyngitis, especially hypertrophic.

DI. Zabolotny, Yu.V. Mitin, S.B. Bezshapochny, Yu.V. Deeva