Chronic inflammatory diseases. Acute and chronic diseases of the pharynx and larynx 4 diseases of the pharynx etiology pathogenesis clinic treatment

Inflammation of the mucous membrane of the posterior pharyngeal wall - pharyngitis- can be acute or chronic.
Acute pharyngitis - acute inflammation of the mucous membrane is rare, as an independent disease. More often it is a consequence of a respiratory viral infection or the result of the spread of bacterial flora from the nasal cavity, from the tonsils or carious teeth.

The reasons, contributing to the development of pharyngitis, may be the following:

General or local hypothermia;

Irritation of the mucous membrane with secretions flowing from the paranasal sinuses;

exposure to harmful impurities in the air - dust, gases, tobacco smoke;

Acute infectious diseases;

Diseases internal organs- kidneys, blood, gastrointestinal tract, etc.

Clinical manifestations acute pharyngitis the following:

Dryness, perspiration, sore throat;

Moderate pain when swallowing;

Irradiation of pain in the ear;

Hearing loss - "congestion" of the ears, clicking in the ears when the process spreads to the nasopharynx and the mouth of the auditory tubes;

Mild signs of intoxication, sub febrile temperature.

With oropharyngoscopy notes:

Hyperemia and moderate swelling of the posterior pharyngeal wall;

Thickened hyperemic follicles, edematous lateral ridges;

Muco-purulent discharge on the back of the pharynx in the presence of a bacterial pathogen.
Expressed forms of acute pharyngitis are accompanied by regional lymphadenitis.

Treatment acute pharyngitis includes:

Sanitation of foci of infection in the nasal cavity, nasopharynx,
oral cavity, tonsils;

Elimination of annoying factors;

Gentle diet;

Plentiful warm drink;

Warm-moist inhalations with the addition of essential oils, soda;

Irrigation of the back wall with warm disinfectant solutions: furacillin, chlorophyllipt, hexoral, povidone iodine, herbal decoctions;

Aerosol preparations: "Kameton", "Ingalipt", "Proposol", IRS19;

Oroseptics for resorption in the oral cavity "Faringosept", "Septolete", "Strepsils", "Lariprokt", "Lariplus", etc.

Lubrication of the posterior pharyngeal wall oil solutions, Lugol's solution;

Antiviral agents: interferon, rimantadine, etc.
Prevention consists of the following activities:

hardening procedures;

Restoration of nasal breathing;

Elimination of annoying factors.
Chronic pharyngitis depending on the nature

inflammatory process is divided into catarrhal(simple), hypertrophic(granular and lateral) and atrophic and combined(mixed). The reasons development of chronic pharyngitis:

External irritating factors;

The presence of foci of infection in the nose, paranasal sinuses, oral cavity and tonsils;

Violation of metabolic processes (diathesis in children, diabetes in adults, etc.);

Stagnation in diseases of the internal organs.
Subjective signs various forms of pharyngitis are largely identical:

Dryness, burning, itching in the throat

Soreness with an "empty throat";

Feeling foreign body;

Irradiation of pain in the ears;

Accumulation of viscous mucous discharge, especially
in the morning.

Diagnosis of chronic pharyngitis It is put mainly on the basis of pharyngoscopy data:

- with catarrhal there is hyperemia of the mucous membrane, its thickening, increased vascular pattern;

- with hypertrophic form- on the swollen and hyperemic mucosa of the posterior pharyngeal wall, individual red grains (granules), an increase and swelling of the lateral ridges are visible;

- with atrophic form the mucous membrane is dry, thinned, shiny, pale, sometimes covered with viscous mucus or crusts.

Treatment depends on the form and stage of the disease and, above all, should be aimed at eliminating the causes of the disease.

Local treatment consists in the appointment of irrigation, inhalation, spraying and lubrication with drugs corresponding to the form of the disease. With atrophic pharyngitis use alkaline and oil preparations. With hypertrophic pharyngitis the mucous membrane is treated with a 1-5% solution of collargol, protargol or lapis, novocaine blockade. For severe hypertrophy, cryotherapy(freezing) on ​​granules and side rollers.

The result of treatment with these methods often does not satisfy the doctor and the patient. In recent years there has been new technique treatment of acute and chronic pharyngitis, which consists in the use of vaccines, which are lysates of pathogens of the upper respiratory tract. Such a drug is Imudon, which is produced in France and is widely used to treat diseases of the oral cavity and pharynx. The drug is available in tablets for resorption in the oral cavity. Imudon has a local effect on the mucous membrane, which results in an increase in phagocytic activity, the amount of secretory immunoglobulin A, and an increase in the content of lysozyme in saliva. The maximum effect in the treatment of this drug in the form of monotherapy and in combination with other drugs is obtained in acute and chronic catarrhal and hypertrophic pharyngitis. The successful use of Imudon for the specific prevention and treatment of inflammatory diseases of the oral cavity plays a significant role in the prevention of diseases of the pharynx. Studies have shown that the use of Imudon in the treatment of frequently ill children leads to an increase in the content of interferon in saliva, a decrease in the number of exacerbations of diseases and a decrease in the need for antibiotic therapy.

Acute tonsillitis (tonsillitis)- This is a common infectious-allergic disease with an inflammatory process in the lymphoid tissue of the palatine tonsils. Inflammation can also occur in other accumulations of lymphoid tissue of the pharynx - lingual, pharyngeal, tubal tonsils, in the lateral ridges. To define these diseases, the term is used - angina, (from the Latin Anqo - to compress, choke), known since ancient times. In Russian medical literature, you can find the definition of angina, as "throat toad." The disease mainly affects children of preschool and school age, as well as adults under the age of 40 years. There are pronounced seasonal rises in the incidence in the spring and autumn periods.

There are several classification schemes for angina. They are distinguished by etiology, pathogenesis, clinical course.

Among the various microbial pathogens, the main etiological role belongs beta-hemolytic streptococcus, which is found according to different authors from 50 to 80% of cases. The second most common causative agent of angina can be considered golden staphylococcus. Diseases caused by green streptococcus. In addition, the causative agent of angina can be adenoviruses, rods, spirochetes, fungi and others

The penetration of an exogenous pathogen can occur by airborne droplets, alimentary and by direct contact with a patient or bacillus carrier. More often, the disease occurs due to autoinfection with microbes or viruses that normally vegetate on the mucous membrane of the pharynx. It is possible to spread an endogenous infection from carious teeth, a pathological focus in the paranasal sinuses, etc. In addition, tonsillitis can occur as a relapse of a chronic process.

According to classification by I.B. Soldatova(1975) acute tonsillitis (tonsillitis) are divided into two groups: primary and secondary,

To primary(banal) tonsillitis include - catarrhal, follicular, lacunar, phlegmonous tonsillitis.

Secondary(specific) tonsillitis caused by a specific specific pathogen. They can be a sign of an infectious disease (diphtheria of the pharynx, ulcerative necrotic tonsillitis, syphilitic, herpetic, fungal) or blood diseases.

Primary (banal) tonsillitis

Catarrhal tonsillitis- the most mild form disease that has the following Clinical signs;

Burning sensation, dryness, sore throat;

Soreness when swallowing is mild;

Subfebrile temperature;

Moderately expressed intoxication;

Increase in regional lymph nodes;
The duration of the disease is 3-5 days.
With pharyngoscopy defined:

Diffuse hyperemia of the tonsils and palatine arches;

Slight enlargement of the tonsils;

In places, a film of mucopurulent exudate is determined.

Follicular tonsillitis has the following features:

The onset is acute with an increase in temperature to 38-39 °;

Severe pain in the throat when swallowing;

Irradiation of pain in the ear;

Intoxication is pronounced, especially in children - loss of appetite, vomiting, confusion, meningism phenomena;

Significant hematological changes - neutrophilic leukocytosis, stab shift, accelerated ESR;

Enlargement and soreness of regional lymph nodes.

The duration of the disease is 5-7 days. With pharyngoscopy defined:

Severe hyperemia and infiltration of the soft palate and arches;

Enlargement and hyperemia of the tonsils, bumpy surface in the first days of the disease;

Multiple yellowish-white dots 1-3 mm in size (purulent follicles) 3-4 days of illness.

Lacunar tonsillitis often proceeds more severely than follicular. Inflammation develops, as a rule, in both tonsils, however, on one side there may be a picture of follicular tonsillitis, and on the other - lacunar. This is explained by a deeper lesion of all lymphoid follicles. Superficially located follicles give a picture of follicular tonsillitis. The follicles located in the depth of the tonsil fill the adjacent lacunae with their purulent contents. With an extensive process, pus comes to the surface of the tonsil in the form of islets or drain raids.

Clinical signs lacunar tonsillitis are as follows:

Severe pain in the throat when swallowing food and saliva;

Irradiation of pain in the ear;

Chills, fever up to 39-40°;

Weakness, fatigue, sleep disturbance, headache;

Pain in the lower back, joints, in the region of the heart;

Pronounced hematological changes;

Significant enlargement and soreness of regional lymph nodes and spleen.
The duration of the disease is 10-12 days.

At pharyngoscopy are defined:

Severe hyperemia and enlargement of the tonsils;

Yellowish-white plaques located at the mouths of lacunae, which are easily removed with a spatula;

Islands of purulent raids, sometimes covering a significant surface of the tonsil.
Phlegmonous tonsillitis is relatively rare and is characterized by purulent fusion of tissue inside the tonsil - phlegmon formation.

The reasons, contributing to the formation of the process can be the following:

Decreased immune forces of the body;

Virulence of the pathogen;

Injury to the tonsil by a foreign body or when performing medical manipulations;

The development of adhesions in the depth of the tonsil with difficulty in the outflow of contents.

Clinical signs phlegmonous tonsillitis may be similar to manifestations of lacunar tonsillitis, small abscesses may be almost asymptomatic. In more severe cases, there is an increase in pain on the one hand, difficulty in swallowing, worsening of the general condition.

With pharyngoscopy defined:

Enlargement of one tonsil, hyperemia, tension;

Pain when pressed with a spatula;

The presence of fluctuations in mature phlegmon.
The submandibular lymph nodes are enlarged and painful on the side of the lesion.

Treatment of primary (banal) tonsillitis should be etiotropic, complex - local and general. As a rule, treatment is carried out at home, and only in severe cases or under adverse social conditions the patient is placed in a hospital. To confirm the diagnosis and select an adequate treatment, a bacteriological examination of the contents of the nose and pharynx is performed. Treatment should include the following steps:

1. Treatment adherence diseases:

Strict bed rest during the first days of the disease;

Sanitary and epidemic standards - isolation of the patient, individual means care and personal hygiene items;

Diet - mechanically, thermally and chemically sparing diet, rich in vitamins, drink plenty of water.

2. Local treatment:

- gargling with warm solutions of potassium permanganate, furacillin, gramicidin, sodium bicarbonate, chlorophyllipt, hexoral, povidone iodine, as well as decoctions of chamomile, sage, eucalyptus;

Treatment of the mucous membrane of the pharynx with aerosol preparations: "Kameton", "Eucalyptus", "Proposol", "Bioparox";

The use of oroseptics: "Faringosept", "Geksaliz", "Lari-plus", "Laripront", "Septolete", "Strepsils", "Anti-Angin", etc.;

Lubrication of the pharyngeal mucosa with Lugol's solution, iodinol;

Aromatherapy: essential oils of eucalyptus, cedar, tea tree, lavender, grapefruit. 3. General treatment:

Sulfanilamide drugs are prescribed taking into account the severity of the course of the disease, usually in the initial stage;

Antihistamines are recommended due to the toxic-allergic nature of the disease (tavegil, suprastin, diazolin, fenkarol, etc.). Antibacterial therapy is prescribed depending on the severity and stage of the disease: the use of antibiotics is not recommended for young people in the initial stage of the disease. AT severe cases, in the stage of abscess formation or in case of damage to other organs, apply semi-synthetic broad-spectrum drugs(ampicillin, amoxicillin, amoxiclav, unazine), first generation cephalosporins(cephalexin, cephalothin, cephalosin), macrolides(erythromycin, rovamycin, rulid). Treatment with antibiotics should be accompanied by the prevention of dysbacteria for - the appointment of nystatin, levorin, diflucan. With the wrong choice of antibiotics and the timing of treatment, conditions are created for the process to become chronic.

Anti-inflammatory drugs - paracetamol, acetylsalicylic acid are prescribed for hyperthermia, and it is necessary to take them into account side effects;

Immunostimulating therapy is recommended in the form of the following drugs: extract thymus(vilozen, timoptin), pyrogenal, natural immunostimulants (ginseng, leuzea, chamomile, propolis, pantocrine, garlic). The use of a vaccine-type immunomodulator - the drug Imudon - gives positive results in the treatment of herpetic, fungal lesions of the oral cavity and pharynx, increases phagocytic activity and the level of lysozyme in saliva.

Physiotherapy procedures appointed after the removal of hyperthermia and elimination purulent process with prolonged lymphadenitis: solux, UHF on the submandibular region, phonophoresis, magnetotherapy.

In the course of treatment, it is necessary to monitor the condition of cardio-vascular system to conduct repeated examinations of urine and blood. After the illness, the patient should be under the supervision of a doctor for a month.

Prevention of acute tonsillitis should include:

Timely rehabilitation of foci chronic infection;

Removing the causes that hinder nasal breathing;

Exclusion of irritating factors in the environment;

The correct mode of work and rest, tempering procedures.

Persons who often suffer from angina are subject to dispensary observation.

Paratonsillitis in most cases, it is a complication of tonsillitis in patients with chronic tonsillitis and occurs as a result of the penetration of a virulent infection into the peri-almond tissue. The reasons for the development of paratonsillitis in most cases are a decrease in immunity and inadequate or early discontinued treatment of angina. The spread of the inflammatory process beyond the capsule of the tonsil indicates the termination of its protective action, that is, the transition to the stage of decompensation.

Clinical manifestations of the disease:

Constant pain when swallowing, aggravated by trying to swallow saliva;

Irradiation of pain in the ear, teeth, aggravated to the refusal of food and drink;

emergence trismus- spasm of chewing muscles;

Slurred, nasal speech;

Forced position of the head (to one side), resulting from inflammation of the muscles of the pharynx, neck and cervical lymphadenitis;

Severe intoxication - headache, feeling of weakness, febrile temperature;

Significant hematological changes of an inflammatory nature.

Pharyngoscopy usually difficult due to lockjaw, on examination there is an unpleasant putrid odor from the mouth. A characteristic picture is the asymmetry of the soft palate due to the displacement of one of the tonsils to the midline. Depending on the location of the abscess in the peri-almond tissue, anterior-upper, antero-inferior, lateral and posterior peri-almond abscesses are isolated. With anterior superior paratonsillitis, there is a sharp bulging of the upper pole of the tonsil, which, together with the arches and the soft palate, is a spherical formation. In the region of greatest protrusion, fluctuation.

During the course of the disease, there are two stages - infiltration and abscess formation. To resolve the issue of the presence of pus, a diagnostic puncture is performed.

Treatment paratonsillitis in infiltrative stage carried out according to the scheme recommended for acute tonsillitis. The complex nature of the treatment, the use of broad-spectrum antibiotics, the appointment of novocaine blockades can lead to a gradual attenuation of the inflammatory process and the patient's recovery.

When an abscess matures do not wait for its spontaneous emptying. It is desirable to perform an autopsy after spraying the pharyngeal mucosa with a 10% solution of lidocaine or a 2% solution of dicaine. Introduction of 2-3 ml of 1% solution of novocaine into the area of ​​masticatory muscles near the corner mandible relieves trismus and facilitates manipulation. The opening of the abscess is often done through. supra-almond fossa or at the site of the greatest protrusion with a scalpel or forceps. In the following days, the wound edges are diluted, its cavity is washed with disinfectants.

To prevent possible relapses of the process and the development of complications, the patient is removed the tonsils - tonsillectomy. Usually, the operation is performed a week after the opening of the paratonsillar abscess. In some cases, in the presence of chronic tonsillitis complicated by paratonsillitis, as well as when other complications are detected, the entire purulent focus is removed at any location, which ensures a quick recovery of the patient.

Retropharyngeal abscess is a purulent inflammation of the lymph nodes and loose tissue between the fascia of the pharynx and the prevertebral fascia, which persist in children up to the age of four. At a younger age, the disease occurs as a result of the introduction of infection into the pharyngeal space with acute rhinopharyngitis, tonsillitis, acute infectious diseases against a background of weakened immunity. In older children, the cause of the retropharyngeal abscess is often trauma to the posterior pharyngeal wall.

Clinical manifestations of the disease depend on the localization of the abscess, its size, the state of immunity, the age of the child. However, the disease is always severe, and the leading symptoms are sore throat and difficulty breathing:

- at a high position an abscess in the nasopharynx marked difficulty in nasal breathing, nasality;

- at an average location abscess appears noisy stridor breathing, snoring, voice becomes hoarse;

- when lowering an abscess into the laryngopharynx, breathing becomes stenotic, with the participation of auxiliary muscles, cyanosis is noted, occasional attacks of suffocation, forced head position with tilting back;

Sore throat, food refusal, anxiety and fever are characteristic of all types of process localization.

With pharyngoscopy there is hyperemia and swelling of a rounded shape on the back of the pharynx along the midline or occupying only one side. With a pronounced trismus in young children, a digital examination of the nasopharynx and oropharynx is performed, in which an infiltrate of a dense consistency or fluctuating is found. Regional lymph nodes are greatly enlarged and painful.

Treatment. In the stage of infiltration is assigned conservative treatment. When signs of abscess appear, surgical intervention- opening of an abscess, which, to prevent aspiration, is carried out in a horizontal position with a preliminary puncture and suction of pus. An incision is made at the site of the greatest protrusion, immediately after a deep breath, and the child's head is lowered down. After opening, the edges of the wound are re-diluted, the throat is irrigated with disinfectants, and antibacterial treatment is continued.

Secondary (specific) tonsillitis are signs of blood diseases or are caused by pathogens of infectious diseases.

Ulcerative membranous (necrotic) angina Simanovsky-Vincent caused by bacterial symbiosis fusiform rods and spirochetes of the oral cavity, are usually in a low-virulence state in the folds of the oral mucosa. Factors predisposing to the development of the disease are:

Decreased general and local reactivity of the organism;

Transferred infectious diseases;

The presence of carious teeth, gum disease.
Clinical manifestations, diseases are as follows:

Body temperature rises to subfebrile figures or may remain normal;

There are no pains in the throat, there is a feeling of awkwardness, a foreign body when swallowing;

Putrid smell from the mouth, increased salivation.
With pharyngoscopy pathological changes are found on one tonsil:

In the upper pole there is a grayish or yellowish coating;

After rejection of the plaque, a deep ulcer is formed with uneven edges and a loose bottom.
Regional nodes are enlarged on the affected side,

moderately painful.

The duration of the disease is from 1 to 3 weeks.

Treatment ulcerative necrotic tonsillitis is carried out in the infectious department of the hospital. Upon admission, a bacteriological examination is performed to clarify the diagnosis.

Local treatment includes:

Cleansing the ulcer from necrosis with a 3% solution of hydrogen peroxide;

Irrigation of the pharynx with a solution of potassium permanganate, furacilin;

Lubrication of the ulcer with tincture of iodine, a mixture of 10% suspension of novarsenol in glycerin;

primary stage syphilis in the pharynx can occur during oral sex, with the following clinical manifestations:

Slight pain when swallowing on the side of the lesion;

On the surface of the tonsil, red erosion is determined, an ulcer or tonsil takes on the appearance, as in acute tonsillitis;

The tissue of the tonsil is dense when palpated;

There is a unilateral increase in lymphatic
nodes.

Secondary syphilis The pharynx has the following characteristic features:

Spilled copper-red color of the mucous membrane, exciting arches, soft and hard palate;

Papular rash, round or oval, grayish-white;

Enlargement of regional lymph nodes.
Tertiary syphilis appears as a limited

gummy tumor, which, after disintegration, forms a deep ulcer with smooth edges and a greasy bottom with further destruction of surrounding tissues if left untreated.

Treatment specific, locally prescribed rinsing with disinfectant solutions (see section "Chronic specific diseases of the ENT organs").

Herpetic tonsillitis refers to diseases caused by adenoviruses. The causative agent of herpangina is the Coxsackie virus of group A. The disease is epidemic in nature, in summer and autumn, and is highly contagious. Children are more commonly affected, especially younger ones.

Clinical manifestations the following:

Increasing the temperature to 38~40 o C;

Pain in the throat when swallowing;

Headache, muscle pain in the abdomen;

Vomiting and loose stools are noted in young children.

In adults, the disease occurs in a milder form.

With pharyngoscopy defined:

Hyperemia of the mucous membrane of the pharynx;

Small vesicles on a hyperemic base in the area of ​​the soft palate, uvula, palatine arches, sometimes on the posterior wall of the pharynx;

The formation of ulcers at the site of the opened vesicles on the 3rd-4th day of the disease.

Treatment carried out at home and includes:

Isolation of the patient from others, compliance with the sanitary and hygienic regime;

Sparing diet, plentiful drink, rich in vitamins;

Irrigation of the pharynx with solutions of potassium permanganate, furacilin, povidone iodine;

Treatment with antiviral agents (interferon);

Anti-inflammatory therapy (paracetamol, nurofen, etc.) .);

Detoxification therapy is indicated in young children in severe cases, which requires hospitalization.

Fungal tonsillitisin has recently become widespread in the following reasons:

Reduced immunity in the general population;

Failure immune system in children of early
age;

Transferred serious illnesses that reduce the nonspecific defenses of the body and change the composition of the microflora of hollow organs;

Long-term use of drugs that suppress the body's defenses (antibiotics, corticosteroids, immunosuppressants).

On bacteriological examination fungal tonsillitis, pathogenic yeast-like fungi such as Candida are found.

Characteristic clinical manifestations the following:

The rise in temperature is not constant;

Pain in the throat is insignificant, dryness, a violation of taste sensations;

The phenomena of general intoxication are poorly expressed.
With pharyngoscopy defined:

Enlargement and slight hyperemia of the tonsils, bright white, loose curd-like plaques that are easily removed without damaging the underlying tissue.
Regional lymph nodes are enlarged, painless.

Treatment is carried out as follows:

Cancellation of broad-spectrum antibiotics;

Irrigation of the pharynx with a solution of chinosol, iodinol, hexoral, povidone iodine;

Insufflation of nystatin, levorin;

Lubrication of the affected areas with 2% aqueous or alcoholic solutions of aniline dyes - methylene blue and gentian violet, 5% solution of silver nitrate;

Nystatin, levorin, diflucan orally in a dosage appropriate for age;

Large doses of vitamins C and group B;

Immunostimulating drugs, imudon;

Ultraviolet irradiation of the tonsils.

Angina with infectious mononucleosis characterized by the following signs;

Chills, fever up to 39~40 C, headache
pain;

An increase in the palatine tonsils, a picture of lacunar, sometimes ulcerative necrotic tonsillitis;

Enlargement and soreness of the cervical, submandibular lymph nodes;

Simultaneous enlargement of the liver and spleen;

When examining blood, an increase in the number of mononuclear cells and a shift in the formula to the left.

Treatment patients is carried out in the infectious diseases department, where it is prescribed:

Bed rest, food rich in vitamins;

- local treatment: rinsing with disinfectants and
astringents;

- general treatment: administration of antibiotics to eliminate secondary infection, corticosteroids.
Agranulocytic angina is one of the characteristic signs of agranulocytosis and has the following
clinical manifestations:

Chills, heat- up to 4CGS, general serious condition;

Severe sore throat, refusal to eat and drink;

Necrotic dirty gray plaque covering the mucous membrane of the pharynx and oral cavity;

Unpleasant putrid odor from the mouth;

Spread of the necrotic process into the depths of the tissues;

In the blood, a pronounced leukopenia and a pronounced shift leukocyte formula to the right.

Treatment carried out in the hematology department:

Bed rest, sparing diet;

Careful oral care;

Appointment of corticosteroids, pentoxyl, vitamin therapy;

Bone marrow transplantation;

Fight against secondary infection.

Chronic tonsillitis. This diagnosis means chronic inflammation palatine tonsils, which is more common than inflammation of all other tonsils combined. The disease usually affects children of school age from 12 to 15% and adults under 40 years old - from 4 to 10%. The basis of this pathology is an infectious-allergic process, which is manifested by repeated tonsillitis and causes damage to many organs and systems. Therefore, knowledge of the symptoms of the disease, its timely detection and rational treatment will help prevent complications in patients and the need for surgical intervention.

The reasons the development of a chronic inflammatory process in the palatine tonsils are the following:

Change in the reactivity of the body;

Difficulty in nasal breathing due to the curvature of the nasal septum, hypertrophy of the turbinates, enlargement of the adenoids;

Chronic focal infection(sinuitis, adenoiditis, carious teeth), which is the source of the pathogen and contributes to the occurrence of relapses of tonsillitis;

Transferred childhood infections, repeated respiratory viral diseases, infections of the gastrointestinal tract, which reduce the body's resistance;

The presence in the palatine tonsils of deep lacunae, creating favorable conditions for the development of virulent microflora;

Assimilation of foreign protein, microflora toxins and tissue decay products in lacunae, contributing to local and general allergization of the body;

Extensive lymphatic and circulatory pathways, leading to the spread of infection and the development of complications of an infectious-allergic nature.
Chronic tonsillitis should be attributed to the actual infectious diseases, due in the majority autoinfection. According to the latest data
foreign and domestic publications in the etiology of chronic tonsillitis, the leading place is occupied by group A beta-hemolytic staphylococcus aureus- in children 30%, in
adults 10-15%, then Staphylococcus aureus, hemolytic staphylococcus aureus, anaerobes, adenoviruses, herpes virus, chlamydia and toxoplasma.

The variety of local and general signs of chronic tonsillitis and their relationship with other organs made it necessary to systematize these data. There are several classifications of chronic tonsillitis. Currently the most widely accepted classification by I.B. Soldierea(1975), dividing chronic tonsillitis into specific(syphilis, tuberculosis, scleroma) and nonspecific, which in turn is divided into compensated and decompensated form. According to the well-known classification of B.S. Preobrazhensky, a simple form of chronic tonsillitis and a toxic-allergic form are distinguished.

The basis for setting diagnosis chronic tonsillitis are frequent sore throats in history, local pathological signs and general toxic-allergic phenomena. It is advisable to evaluate the objective signs of chronic inflammation of the palatine tonsils no earlier than 2-3 weeks after the exacerbation of the disease.

Compensated form of chronic tonsillitis characterized by the following features: Patient complaints:

Sore throat in the morning, dryness, tingling;

Feeling of awkwardness or foreign body when swallowing;

Bad breath;

An indication of angina in history.

Data pharyngoscopy (local signs) inflammatory process in the pharynx:

Changes in the arches - hyperemia, roller-like thickening and swelling of the edges of the anterior and posterior arches;

Spikes of the palatine arches with tonsils as a result of repeated tonsillitis;

Uneven coloring of the tonsils, their looseness, pronounced lacunar pattern;

The presence of purulent-caseous plugs in the depths of lacunae or liquid creamy pus, which are detected by pressing with a spatula on the basis of the anterior palatine arch;

Hypertrophy of the palatine tonsils in chronic tonsillitis, which occurs mainly in children;

Enlargement and soreness of regional lymph nodes in the submandibular region and along the anterior edge of the sternocleidomastoid muscle is a characteristic sign of the disease.

The presence of 2-3 of the listed signs gives grounds for the diagnosis. With a compensated form of the disease in the period between tonsillitis, the general condition is not disturbed, there are no signs of intoxication and allergization of the body.

Decompensated form chronic tonsillitis is characterized by the above local features pathological process in the palatine tonsils, the presence of exacerbations 2-4 times a year, as well as common manifestations of decompensation:

The appearance of subfebrile temperature in the evenings;

Increased fatigue, decreased performance;

Periodic pain in the joints, in the heart;

Functional disorders of the nervous, urinary and other systems;

The presence, especially during periods of exacerbation, diseases associated with chronic tonsillitis- having a common etiological factor and mutual
action on each other. Such diseases of an infectious-allergic nature include: acute and

chronic tonsillogenic sepsis, rheumatism, infectious arthritis, diseases of the heart, urinary system, meninges and other organs and systems.

Local complications that occur in the pharynx against the background of repeated tonsillitis are evidence of decompensation of the inflammatory process in the pharynx, these include: paratonsillitis, pharyngeal abscess.

Accompanying illnesses do not have a single etiological and pathogenetic basis with chronic tonsillitis, the connection is through general and local reactivity. Examples of such diseases are: hypertension, hyperthyroidism, diabetes and etc.

Treatment of chronic tonsillitis.a due to the form of the disease compensated form held conservative treatment, at decompensated form recommended surgical intervention- tonsillectomy- complete removal of the palatine tonsils.

Conservative treatment chronic tonsillitis should be complex - local and general. It should be preceded by sanitation of foci of infection in the oral cavity, nasal cavity and paranasal sinuses.

Local treatment includes the following activities:

1. Washing the lacunae of the tonsils and rinsing with antiseptic solutions (furacillin, iodinol, dioxidine, chinosol, octenisept, ectericide, chlorhexidine, etc.) on
a course of 10-15 procedures. Washing the gaps with interferon stimulates the immunological properties of the tonsils.

2. Quenching the lacunae of the tonsils with Lugol's solution or 30% alcohol tincture propolis.

3. Introduction to the Lacunas of antiseptic ointments and pastes on a paraffin-balsamic basis.

4. Intramindal novocaine blockades.

5. The introduction of antibiotics and antiseptic drugs in accordance with the sensitivity of the flora.

6. The use of local immunostimulating drugs: levamisole, dimexide, splenin, IRS 19, ribomunil, Imudon, etc.

7. Reception of oroseptics: pharyngosept, hexalysis, lariplyus, neoangin, septolete, etc.

8. Treatment with the Tonsilor apparatus, which combines ultrasonic action on the tonsils, aspiration of pathological contents from the lacunae and pockets of the tonsils, and irrigation with antiseptic solutions. The course of treatment consists of 5 sessions every other day.

9. Physiotherapeutic methods of treatment: ultraviolet irradiation, phonophoresis of lidase, vitamins, UHF, laser therapy, magnetotherapy.

10. Aromatherapy: essential oils of eucalyptus, cedar, tea tree, lavender, grapefruit, etc.

General therapy of chronic tonsillitis is carried out as follows:

1. Antibiotic therapy is used for exacerbation of chronic tonsillitis after determining the sensitivity of the microflora. Treatment with antibiotics should be accompanied by the prevention of dysbacteriosis.

2. Anti-inflammatory therapy is prescribed for an acute process with a hyperergic reaction (paracetamol, aspirin, etc.)

3. Antihistamines are prescribed to prevent complications of an infectious-allergic nature.

4. Immunostimulating therapy should be carried out both during an exacerbation and outside it. Thymus gland extract preparations are prescribed: thymalin, timoptin, vilozen, tim-uvokal; immunocorrectors of microbial origin; natural immunostimulants: ginseng,
echinocea, propolis, pantocrine, chamomile, etc.

5. Antioxidants, the role of which is to improve metabolism, the functioning of enzyme systems, increase immunity: routine-containing complexes, vitamins of groups A, E, C, trace elements - Zn, Mg, Si, Fe, Ca.

The treatment described above is carried out 2-3 times a year, more often in the autumn-spring period, and gives a high therapeutic effect.

The criterion for the effectiveness of treatment is:

1. Disappearance of pus and pathological contents in the palatine tonsils.

2. Reducing hyperemia and infiltration of the palatine arches and tonsils.

3. Reduction and disappearance of regional lymph nodes.

In the absence of these results or the occurrence of exacerbations of the disease, it is indicated tonsillectomy.

Treatment of the decompensated form chronic tonsillitis is carried out surgically with complete removal of the tonsils along with the adjacent capsule.

Contraindication for tonsillectomy is:

Severe degree of cardiovascular insufficiency;

Chronic renal failure;

blood diseases;

Severe diabetes mellitus;

High degree of hypertension with possible development
hypertensive crises etc.

In such cases, semi-surgical methods of treatment are used. (cryotherapy freezing of tonsil tissue) or conservative treatment.

Preparing for the operation performed on an outpatient basis and includes:

Sanitation of foci of infection;

Blood test for coagulability, content
platelets, prothrombin index;

Measurement blood pressure;

Examination of internal organs.

The operation is performed on an empty stomach under local anesthesia using a special set of instruments.

The most frequent complication tonsillectomy is bleeding from the area of ​​the tonsil niches.

Patient care in the postoperative period the nurse should carry out as follows: - lay the patient on his right side on a low pillow;

prohibit getting up, actively moving in bed and talking;

Put a diaper under the cheek and ask the patient not to swallow, but to spit saliva;

Observe the patient's condition and saliva color for two hours;

Inform the doctor about the presence of bleeding if necessary;

Give a few sips of cold liquid in the afternoon;

Feed the patient liquid or pureed, cool food for 5 days after surgery;

Irrigate the throat several times a day with aseptic solutions.

Prevention chronic tonsillitis is as follows:

Pollution control environment;

Improving hygienic working and living conditions;

Improving the socio-economic standard of living of the population;

Active identification of persons suffering from chronic tonsillitis and dispensary observation of them;

Timely isolation of patients and the appointment of adequate treatment;

Individual prophylaxis consists in the sanitation of foci of infection and increasing the body's resistance to the harmful effects of the external environment.
Clinical examination patients with chronic tonsillitis

is effective method recovery of the population. Main goals clinical examinations in otorhinolaryngology are as follows:

Timely detection of patients with chronic and often recurrent diseases;

Systematic monitoring of them and active treatment;

Identification of the reasons causing this disease and carrying out recreational activities;

Evaluation of the results of the work done.

There are three stages of dispensary:

Stage 1 - registering - includes identification of persons subject to medical examination, drawing up a plan of treatment and preventive measures and dynamic monitoring. Selection patients is carried out by a passive method when patients apply for medical care and active - in the process of carrying out preventive
inspections. The first stage of dispensary is coming to an end registration medical records and drafting specific individual plan medical pro
lactic activities.

Stage 2 - performance- requires long-term follow-up. At the same time, measures are needed to improve the sanitary literacy of the population, systematic about
following patients and conducting preventive courses of treatment. In chronic tonsillitis, it is advisable to conduct such courses in spring and autumn, which corresponds to periods of exacerbation.

Stage 3 - quality and efficiency assessment dispensary observation. The results of the examination of patients and the courses of treatment carried out are reflected at the end of the year in
epicrisis. The disappearance of signs of chronic tonsillitis and exacerbations of the disease within two years are the basis for removal of the patient from the dispensary
accounting according to the compensated form of chronic tonsillitis. In the absence of the effect of the measures taken, the patient is sent for surgical treatment.

To assess the effectiveness of the organization of work, indicators of the quality of clinical examination are determined.

10419 0

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 throat is manifested by an unpleasant sensation and stabbing 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 is performed by irrigating 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.

General state patients are 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, tonsillitis, 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. In recent years, irradiation of the posterior pharyngeal wall with a helium-neon laser has been used to treat chronic atrophic pharyngitis. 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

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 mellitus, 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. Severe pain radiates to the ears and causes patients to refuse to eat. 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 are 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, chemical used at home 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 respiratory tract. 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 instrumental examination the patient - pharyngoscopy, immunodiagnostics, 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 develop characteristic symptoms of 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 of the 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 a prolonged course of streptococcal inflammation of the pharynx, articular rheumatism occurs.

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”

Acute inflammatory diseases pharynx and larynx

Acute inflammation of the pharynx Acute inflammation of the nasopharynx To line. The main complaints of patients are discomfort in the nasopharynx - burning, tingling, dryness, often accumulation of mucous secretions; headache localized in the occipital region. Children often have difficulty breathing and nasal sound. With the predominant localization of the process in the region of the mouths of the auditory tubes, there is pain in the ears, hearing loss according to the type of sound conduction. In adults, this disease occurs without a sharp deterioration in the general condition, and in children the temperature reaction is significant, in particular, in cases where inflammation spreads to the larynx and trachea. Enlarged and painful cervical and occipital lymph nodes. Differential Diagnosis should be carried out with diphtheria nasopharyngitis (with diphtheria, dirty gray raids are usually visualized; examination of a smear from the nasopharynx usually allows you to clearly establish the nature of the diphtheria lesion); with a congenital syphilitic and gonococcal process (here other signs come to the fore - gonorrheal conjunctivitis, with lues - hepatosplenomegaly, characteristic skin changes); with diseases of the sphenoid sinus and cells of the ethmoid labyrinth (here, X-ray examination helps to establish the correct diagnosis). Treatment. Infusions are carried out in each half of the nose 2% (for children) and 5% (for adults) solution of protargol or collargol 3 times a day; with severe inflammation, a 0.25% solution of silver nitrate is poured into the nasal cavity, and then vasoconstrictor drops. Carrying out general anti-inflammatory and antibacterial treatment is justified only with a pronounced temperature reaction and the development of complications. The appointment of multivitamins, physiotherapy - quartz on the soles of the feet, UHF on the nose area is shown.

Acute inflammation of the oropharynx (pharyngitis) Clinic. In acute pharyngitis, most often patients complain of dryness, soreness and soreness in the throat. The pain may radiate to the ear when swallowing. With pharyngoscopy, hyperemia and swelling of the mucous membrane of the oropharynx, an increase and bright hyperemia of lymphoid granules located on the back of the pharynx are determined. Severe forms of acute pharyngitis are accompanied by an increase in regional lymph nodes, in children, in some cases, a temperature reaction. The process can spread both upwards (involving the nasopharynx, the mouths of the auditory tubes) and downwards (on the mucous membrane of the larynx and trachea). The transition to chronic forms is usually due to the ongoing exposure to a pathogenic factor (occupational hazard, chronic somatic pathology). Differential diagnosis in children, it is carried out with gonorrheal pharyngitis, syphilitic lesions. In adults, pharyngitis (in the case of its non-infectious genesis) should be considered as a manifestation of an exacerbation of chronic somatic pathology, primarily a disease of the gastrointestinal tract (since the pharynx is a kind of “mirror” that reflects problems in the organs located below). Treatment consists in the exclusion of irritating food, the use of inhalations and sprays of warm alkaline and antibacterial solutions, with a general reaction of the body, the appointment of paracetamol is indicated, as well as drinking plenty of liquids rich in vitamin C. With severe edema, the appointment of antihistamines is indicated.

Angina

Among clinicians, it is customary to subdivide all available forms of angina into vulgar (banal) and atypical ..

Vulgar (banal) tonsillitis Vulgar (banal) tonsillitis is mainly recognized by pharyngoscopy signs. For angina vulgaris, four common signs are characteristic: 1) severe symptoms of general intoxication of the body; 2) pathological changes in the palatine tonsils; 3) the duration of the process is not more than 7 days; 4) bacterial or viral infection as a primary factor in etiology. There are several forms: Catarrhal angina begins acutely, there is a burning sensation, perspiration, slight pain when swallowing. On examination, diffuse hyperemia of the tissue of the tonsils, the edges of the palatine arches are revealed, the tonsils are enlarged in size, sometimes covered with a film of mucopurulent exudate. Tongue dry, lined. Regional lymph nodes are moderately enlarged. Follicular angina usually begins acutely - with an increase in body temperature to 38-39 0 C, a sharp pain in the throat, aggravated by swallowing, general symptoms of intoxication are more pronounced - headache, sometimes back pain, fever, chills, general weakness. In the blood, pronounced inflammatory changes - neutrophilia up to 12-15 thousand, moderate stab shift to the left, eosinophilia, ESR reaches 30-40 mm / h. Regional lymph nodes are enlarged and painful. With pharyngoscopy - diffuse hyperemia and infiltration of the soft palate and arches, enlargement and hyperemia of the palatine tonsils, numerous festering follicles are determined on their surface, usually opening 2-3 days from the onset of the disease. Lacunar angina runs more difficult. When viewed on the hyperemic surface of the palatine tonsils, yellowish-white plaques are observed, easily removed with a spatula, bilateral localization. The phenomena of intoxication are more pronounced. Fibrinous (fibrinous-membranous) angina is a variation of the two previous sore throats and develops when bursting festering follicles or fibrinous deposits form a film. Here it is necessary to carry out a differential diagnosis with a diphtheritic lesion (based on the data of a bacteriological examination of a smear). Treatment. The basis of rational treatment of angina consists of compliance with a sparing regimen, local and general therapy. In the first days, bed rest is required, the allocation of individual dishes, care items; hospitalization in the infectious diseases department is necessary only in severe and diagnostically unclear cases of the disease. Food should be soft, non-irritating, nutritious, drinking plenty of water will help detoxify. When prescribing drugs, a comprehensive approach is required. The basis of treatment is antibiotic therapy (preference is given to broad-spectrum antibiotics - semi-synthetic penicillins, macrolides, cephalosporins), a course of 5 days. The appointment of antihistamines will help stop the edema, which basically provokes pain. With severe intoxication, it is necessary to monitor the state of the cardiovascular and respiratory systems. In terms of local treatment, it is advisable to use drugs that have a local anti-inflammatory, analgesic and antiseptic effect (Septolete, Strepsils, Neo-Angin). Rinses with drugs that have a complex effect (OKI, texetidine) are also highly effective. Phlegmonous angina (intratonsillar abscess) is relatively rare, usually as a result of purulent fusion of the tonsil area; this lesion is usually unilateral. In this case, the tonsil is hyperemic, enlarged, its surface is tense, palpation is painful. Small intratonsillar abscesses usually open spontaneously and may be asymptomatic, but this mainly occurs when an abscess breaks into the oral cavity, when it is emptied into the paratonsillar tissue, a peritonsillar abscess clinic develops. Treatment consists of a wide opening of the abscess, with tonsillectomy indicated for recurrence. Herpangina develops mainly in young children, is highly contagious, and is usually spread by airborne droplets, less often by fecal-oral. Caused by adenoviruses, influenza virus, Coxsackie virus. The disease begins acutely, with fever up to 38-40 0 C, sore throat when swallowing, headache and muscle pain develops, vomiting and diarrhea are also not uncommon as signs of general intoxication. When pharyngoscopy - diffuse hyperemia in the soft palate, on the entire surface of the oropharyngeal mucosa there are small reddish vesicles that resolve after 3-4 days. For atypical angina applies primarily Simanovsky-Vincent's angina(the causative agent is a symbiosis of a fusiform bacillus and a spirochete of the oral cavity), the basis for making the correct diagnosis here is a microbiological examination of the smear. Differential Diagnosis such tonsillitis should be carried out with diphtheria of the pharynx, syphilis of all stages, tuberculous lesions of the tonsils, systemic diseases of the hematopoietic organs, which are accompanied by the formation of necrotic masses in the tonsils, with tumors of the tonsils. Angina of the nasopharyngeal tonsil(acute adenoiditis) is mainly found in children, which is associated with the growth of this tonsil in childhood. The causative agent can be either a virus or a microorganism. In older children with acute adenoiditis, there is a slight violation of the general condition, subfebrile condition, the first symptom is a burning sensation in the nasopharynx, and then the disease proceeds as acute rhinitis, i.e. there is difficulty in nasal breathing, watery, mucous, and subsequently purulent discharge from the nose. There are pains in the ears, nasality, in some cases, the addition of acute otitis media is possible. With pharyngoscopy and posterior rhinoscopy, there is a bright hyperemia of the mucous membrane of the posterior pharyngeal wall, along which mucopurulent discharge flows from the nasopharynx. The nasopharyngeal tonsil increases in size, it is hyperemic, on its surface there are point or continuous raids. In young children, acute adenoiditis begins suddenly with an increase in body temperature up to 40 0 ​​C, often with severe symptoms of intoxication - vomiting, loose stools, symptoms of irritation of the meninges. After 1-2 days, there is difficulty in nasal breathing, nasal discharge, an increase in regional lymph nodes. Complications of adenoiditis - catarrhal or purulent otitis media, retropharyngeal abscess, suppuration of regional lymph nodes. Differential diagnosis in children is carried out with childhood infectious diseases, in which the development of inflammation in the nasopharyngeal tonsil is possible. Treatment, general and local, are carried out according to the same principles as with angina, acute rhinitis. In infancy, it is necessary to prescribe vasoconstrictor nasal drops before each feeding. Less frequent angina are the following. Damage to the side ridges- usually associated with acute adenoiditis or occurs after tonsillectomy. This type of angina is characterized by the appearance at the beginning of the development of the process of pain in the throat with irradiation to the ears. At angina of tubal tonsils(which is also mainly noted in acute inflammatory diseases of the pharynx) a typical symptom, along with sore throats radiating to the ears, is stuffy ears. The correct diagnosis is easy to establish with posterior rhinoscopy. Angina of the lingual tonsil occurs mainly in middle and old age, and the characteristic here is pain when protruding the tongue and its palpation. Diagnosis is made by laryngoscopy. Here it is important to remember such formidable complications of lingual sore throat as edema and stenosis of the larynx, glossitis and phlegmon of the floor of the mouth are sometimes observed. For a general practitioner, it is important to correctly and timely recognize local complications of tonsillitis, requiring consultation and treatment by an otorhinolaryngologist. This is first of all paratonsillitis, which develops a few days after the exacerbation of chronic tonsillitis or tonsillitis has ended. The process is most often localized in the anterior or anteroposterior region between the capsule of the palatine tonsil and the upper part of the anterior palatine arch. Its posterior localization is between the tonsil and the posterior arch, the lower one is between the lower pole and the lateral wall of the pharynx, the lateral one is between the middle part of the tonsil and the lateral wall of the pharynx. Typical in the clinic is the appearance of unilateral pain when swallowing, which, with the development of the process, becomes permanent and sharply increases when swallowing. Trismus occurs - a tonic spasm of the masticatory muscles, speech becomes nasal and indistinct. As a result of regional cervical lymphadenitis, a pain reaction occurs when turning the head. The transition of paratonsillitis from the edematous, infiltrative phase to the abscessing phase usually occurs on the 3rd-4th day. On the 4-5th day, an independent opening of the abscess can occur - either in the oral cavity or in the parapharyngeal space, which leads to the development of a severe complication - parapharyngitis. At the beginning of the disease, before the breakthrough of the abscess, pharyngoscopy reveals asymmetry of the pharynx due to protrusion, most often of the supra-almond region, hyperemia and infiltration of these tissues. In the area of ​​​​the greatest protrusion, one can often see thinning and yellowish edema - the place of an emerging breakthrough of pus. In unclear cases, a diagnostic puncture is performed. Differential diagnosis is carried out with diphtheria (however, trismus is uncharacteristic for this infection and there are often raids) and scarlet fever, in which a characteristic rash develops, and there are also indications of a typical epidemiological history. Tumor lesions of the pharynx usually occur without fever and severe pain in the throat. With erysipelas, which also occurs without fever and severe sore throat. With erysipelas, which also proceeds without trismus, there is diffuse hyperemia and swelling on the mucous membrane with a brilliant background of the mucous membrane, and with a bullous form, bubbles pour out on the soft palate. Treatment of paratonsillitis in the stage of infiltration and abscessing, surgical - opening of the abscess, its regular emptying, according to indications - abscess-tonsillectomy. The scheme of complex treatment of purulent pathology is given earlier.

Retropharyngeal abscess It usually occurs in young children due to the fact that the retropharyngeal (retropharyngeal) space is filled with loose connective tissue with lymph nodes that are most pronounced in childhood. After 4-5 years, these lymph nodes are reduced. Symptoms- pain when swallowing, which, however, does not reach the same degree as with paratonsillar abscess. In small children, these pains cause severe anxiety, tearfulness, screaming, sleep disturbance, etc. Small patients refuse to breastfeed, cough, spit up milk through the nose, which very soon leads to malnutrition. Further symptoms depend on the reactivity of the organism and the location of the abscess. When it is located in the nasopharynx, respiratory disorders come to the fore, cyanosis appears, inspiratory retraction chest, the voice takes on a nasal tone. With a low position of the retropharyngeal abscess, a narrowing of the entrance to the larynx develops with increasing respiratory failure, which has the character of snoring, which in the future can lead to suffocation. With an even lower location of the abscess, symptoms of compression of the esophagus and trachea appear. When examining the pharynx, one can see a round or oval pillow-shaped swelling of the posterior pharyngeal wall, located on one (lateral) side and giving fluctuation. If the abscess is located in the nasopharynx or closer to the entrance to the larynx, then it is not available for direct viewing, it can be detected only with posterior rhinoscopy or laryngoscopy, or by palpation. With secondary pharyngeal abscesses, these symptoms are accompanied by changes in the spine, the inability to turn the head to the sides, stiff neck. Diagnostic valuable palpation examination. Differential diagnosis is carried out with a tumor of the retropharyngeal space (for example, lipoma), here the puncture will help the correct diagnosis. Treatment surgical.

parapharyngeal abscess This type of abscess is a relatively rare complication of the inflammatory process in the tonsil or near-tonsil tissue. The most common parapharyngeal abscess occurs as a complication of paratonsillar abscess. There is a picture of a long-term non-resolving paratonsillar abscess, when either spontaneous opening of the abscess did not occur, or incision was not performed, or it did not lead to the desired result. The general condition of the patient continues to deteriorate. The temperature is high, leukocytosis increases in the blood, ESR increases. With pharyngoscopy, in some cases, a decrease in swelling and protrusion of the soft palate is noted, however, a protrusion of the lateral wall of the pharynx in the tonsil area appears. Protrusions in the parapharyngeal region are accompanied by changes in the neck. Along with the lymph nodes enlarged and painful on palpation, a more diffuse and painful swelling appears in the region of the angle of the lower jaw (both at the angle of the lower jaw and in the region of the maxillary fossa). If pain along the vascular bundle joins the indicated swelling against the background of a deterioration in the general condition of the patient, then one should think about the beginning of the development of a septic process. The peripharyngeal abscess, which is not opened in a timely manner, entails further complications: sepsis is most common due to involvement of the internal jugular vein in the process. With an abscess in the parapharyngeal space, the process can extend up to the base of the skull. The spread of the process downward leads to mediastinitis. Purulent parotitis may also occur due to a breakthrough in the bed of the parotid gland. Treatment parapharyngeal abscess only surgical.

angina- acute inflammation of the lymphadenoid tissue of the larynx (in the region of the scoop-epiglottic folds, interarytenoid space, in the Morganian ventricles, piriform sinuses and individual follicles). The disease can develop as a result of trauma (in particular, a foreign body), as well as as a complication of SARS. The patient complains of pain when swallowing, soreness when changing the position of the head, dryness in the throat. The phenomena of general intoxication are expressed moderately. Regional lymphadenitis is determined, usually unilateral. Laryngoscopy reveals hyperemia and infiltration of the mucous membrane of the larynx on one side or a limited area. With a protracted course of the process, the formation of abscesses in the places of localization of the lymphoid tissue is possible. Treatment is the same as for acute catarrhal laryngitis, however, in severe cases, massive antibiotic therapy is necessary. With significant stenosis, a tracheostomy is indicated. The patient must follow a regimen that is sparing diet, alkaline inhalations are useful. Anti-inflammatory therapy includes the introduction of sulfonamides, antibiotics into the body; the use of antihistamines is mandatory.

Laryngitis Acute catarrhal laryngitis Acute inflammation of the mucous membrane of the larynx can also be observed as an independent disease (cold, too hot or cold food), chemical or mechanical irritants (nicotine, alcohol, dusty and smoky air), occupational hazards, for example, excessive voice tension (strong cry, loud command ), and with common diseases such as measles, whooping cough, influenza, typhus, rheumatism, etc. Clinical acute laryngitis is manifested by the occurrence of hoarseness, perspiration, soreness in the throat, the patient is worried about dry cough. Violation of the voice is expressed in varying degrees of dysphonia, up to aphonia. The diagnosis of acute laryngitis is not difficult to make based on the history, symptoms, and characteristic hyperemia of the mucous membrane of the larynx. Differential diagnosis should be carried out with false croup (in children) and damage to the larynx in diphtheria, tuberculosis, syphilis. Treatment should primarily include a strict voice mode, a diet with restriction of spicy, hot, cold food, alcohol, smoking. Highly effective inhalations with a solution of antibiotics (fusafungin 2 puffs 4 times a day), with a predominance of the edematous component over the inflammatory component, it is advisable to prescribe inhalations with hydrocortisone or use a beclomethasone dipropionate inhaler 2 puffs 3 times a day, antihistamines are also used, from local treatment - infusions in the larynx of vegetable oil (peach, olive), hydrocortisone suspension.

Phlegmonous (infiltrative-purulent) laryngitis Phlegmonous (infiltrative-purulent) laryngitis is relatively rare - either due to trauma or after an infectious disease (in children - measles and scarlet fever). The submucosal layer is involved in the pathological process, less often the muscular and ligamentous apparatus of the larynx. Patients complain of sharp pain when swallowing, especially when the infiltrate is located in the epiglottis and arytenoid cartilages. Regional lymphadenitis is palpable. Laryngoscopy reveals hyperemia and infiltration of the mucous membrane of the larynx, an increase in the volume of the affected area, sometimes with areas of necrosis. There is a restriction of the mobility of the elements of the larynx. The general inflammatory reaction is expressed. Treatment is carried out in a hospital, taking into account the severity of the picture. With increasing symptoms of stenosis, a tracheostomy is performed. Complex therapy with the inclusion of antibiotics, antihistamines, according to indications - mucolytics is necessary. In the presence of an abscess, its treatment is only surgical in a specialized hospital.

Chondroperichondritis of the cartilage of the larynx The occurrence of this pathology is associated with infection of the cartilage and perichondrium of the skeleton of the larynx as a result of its injury (including after surgery). As a result of the transferred inflammation, necrosis of cartilage tissue, scarring can occur, which leads to deformation of the organ and narrowing of its lumen. The clinical picture is determined by the localization of the inflammatory process and the degree of its development; laryngoscopy reveals a hyperemic area with thickening of the underlying tissues, their infiltration, often with the formation of a fistula. In the treatment, in addition to massive antibiotic therapy and hyposensitization, physiotherapy plays an important role - UV, UHF, microwave, ionogalvanization on the larynx with calcium chloride, potassium iodide. Treatment of chondroperichondritis of the larynx must be carried out in a specialized hospital.

Subglottic laryngitis Subglottic laryngitis ( false croup) is a type of acute catarrhal laryngitis that develops in the subglottic space. It is observed in children aged 2-5 years against the background of acute inflammation of the mucous membrane of the nose or pharynx. Clinic false croup is quite characteristic - the disease develops suddenly in the middle of the night, with an attack of barking cough. Breathing becomes wheezing, sharply difficult, inspiratory dyspnea is pronounced. Nails and visible mucous membranes become cyanotic. On examination, retraction of the soft tissues of the jugular fossa, supraclavicular and subclavian spaces is noted. The attack lasts from several minutes to half an hour, after which profuse sweat appears and the condition improves, the child falls asleep. Diagnosis is based on the clinical picture of the disease and laryngoscopy data in cases where it is possible to perform. Differential diagnosis is carried out with true (diphtheria) croup. In the latter case, suffocation develops gradually and does not debut as acute nasopharyngitis. Pronounced regional lymphadenitis. Typical manifestations- Dirty-gray raids in the pharynx and larynx. It is necessary to teach the parents of children who have similar conditions, certain tactics of behavior. Usually these are children prone to laryngospasm, suffering from diathesis. General hygienic measures - humidification and ventilation of the air in the room where the child is located; it is recommended to give warm milk, “Borjomi”. Distractions are used: mustard plasters on the neck, hot foot baths (no more than 3-5 minutes). In case of inefficiency, the imposition of a tracheostomy is indicated. Laryngeal edema is not an independent disease, but only one of the manifestations of many pathological processes. Laryngeal edema can be inflammatory and non-inflammatory in nature. Inflammatory edema of the larynx may accompany the following pathological processes: laryngeal tonsillitis, phlegmonous laryngitis, epiglottis abscess, suppurative processes in the pharynx, lateral parapharyngeal and pharyngeal spaces, in the area cervical spine, root of the tongue and soft tissues of the floor of the mouth. One of the common causes of laryngeal edema are injuries - gunshot, blunt, stabbing, cutting, thermal, chemical, foreign bodies. Traumatic laryngeal edema can develop in response to surgical intervention on the larynx and neck, as a result of prolonged upper tracheobronchoscopy, due to prolonged and traumatic intubation of the larynx, after radiation therapy for diseases of the neck. Non-inflammatory laryngeal edema as a manifestation of allergy occurs with idysyncrasy to certain foods, drugs and cosmetics. This also includes angioedema angioedema, in which swelling of the larynx is combined with swelling of the face and neck. Laryngeal edema can develop in diseases of the cardiovascular system, accompanied by circulatory failure II-III degree; kidney disease, liver cirrhosis, cachexia. Treatment for laryngeal edema is aimed at treating the underlying disease that led to the edema, and includes dehydration, hyposensitizing and sedatives. First of all, with the inflammatory nature of laryngeal edema, the following appointments are advisable: 1) parenteral antibiotic therapy (after determining the tolerance of drugs; 2) a solution of promethazine 0.25%, 2 ml per muscle 2 times a day; calcium gluconate solution 10% intramuscularly, depending on the severity of edema; 20 ml of 40% glucose solution, 5 ml of ascorbic acid solution intravenously 1 time per day; rutin 0.02 g orally 3 times a day; 3) hot (42-45 0 C) foot baths for 5 minutes; 4) a warming compress on the neck or mustard plasters for 10-15 minutes 1-2 times a day; 5) when coughing, the appearance of crusts and thick sputum - expectorant and sputum thinners (carbocysteine, acetylcysteine). Inhalations: 1 bottle of chymotrypsin + 1 ampoule of ephedrine + 15 ml of 0.9% sodium chloride solution, breathe 2 times a day for 10 minutes. Treatment should always be carried out in a hospital, as with an increase in difficulty breathing through the larynx, a tracheostomy may be required.

Acute tracheitis

. Usually the disease begins with acute catarrhal rhinitis and nasopharyngitis and quickly spreads downward, covering the trachea, often large bronchi. In other cases, along with the trachea, large bronchi are also involved in the disease. In this case, the clinical picture becomes acute tracheobronchitis. The most characteristic clinical sign of acute banal tracheitis is a cough, especially disturbing the patient at night and in the morning. With a pronounced inflammatory process, for example, with influenza hemorrhagic tracheitis, the cough is excruciating paroxysmal in nature and is accompanied by a dull sore pain in the pharynx and behind the sternum. Due to pain during deep inspiration, patients try to limit the depth of respiratory movements, which is why breathing quickens to compensate for oxygen deficiency. The general condition of adults at the same time suffers little, sometimes there is subfebrile condition, headache, feeling of weakness, pain throughout the body. In children, the clinical picture is acute with an increase in body temperature up to 39 ° C. Shortness of breath usually does not occur, with the exception of acute severe generalized viral lesions of the upper respiratory tract, in which there is a pronounced general intoxication, impaired cardiac activity, and depression of the respiratory center.

Sputum at the beginning of the disease is scarce, it is difficult to separate, which is explained by the stage of "dry" catarrh. Gradually, it acquires a mucopurulent character, becomes more abundant and is separated more easily. Cough ceases to cause unpleasant scraping pains, the general condition improves.

Under normal clinical course and timely started treatment, the disease ends within 1-2 weeks. Under adverse conditions, non-compliance with the prescribed regimen, untimely treatment and other negative factors, recovery is delayed and the process can go into a chronic stage.

Diagnostics acute banal tracheitis does not cause difficulties, especially in cases of seasonal colds or flu epidemics. Diagnosis is based on typical clinical presentation and characteristic symptoms catarrhal inflammation of the mucous membrane of the trachea. Difficulties arise in influenza toxic forms, when inflammation of the respiratory tract should be differentiated from pneumonia.

Treatment almost identical to that of acute laryngitis. Great importance is attached to the prevention of complications in severe forms of tracheobronchitis, for which the patient is prescribed antibacterial, immunomodulatory, restorative treatment with intensive vitamin (A, E, C) and detoxification therapy. Preventive measures are especially relevant in dusty industries and during periods of influenza epidemics.

Chronic banal tracheitis

Chronic tracheitis is a systemic disease that captures to one degree or another all the respiratory tract - a disease of the predominantly adult population of large industrial cities, people of hazardous industries and abusing bad habits. Chronic tracheobronchitis can act as complications of childhood infections (measles, diphtheria, whooping cough, etc.), the clinical course of which was accompanied by acute tracheitis and bronchitis.

Symptoms and clinical course. The main symptom of chronic tracheitis is a cough, which is more severe at night and in the morning. This cough is especially painful when sputum accumulates in the carina area, which dries up into dense crusts. With the development of the atrophic process, in which only the surface layer of the mucous membrane is affected, the cough reflex persists, however, with deeper atrophic phenomena that involve nerve endings as well, the severity of the cough decreases. The course of the disease is long, alternating with periods of remission and exacerbation.

Diagnosis established by fibroscopy. However, the cause of this disease often remains unknown, except in those cases when it occurs in persons of harmful professions.

Treatment determined by the type of inflammation. With hypertrophic tracheitis, accompanied by the release of mucopurulent sputum, antibiotic inhalations are used, the selection of which is carried out on the basis of an antibiogram, inhalation of astringent powders at the time of inhalation. In atrophic processes, vitamin oils are instilled into the trachea (carotolin, rosehip and sea buckthorn oil). The crusts are removed by infusion into the trachea of ​​solutions of proteolytic enzymes. Basically, the treatment corresponds to that of banal laryngitis.

Inflammatory diseases of the esophagus include:

Acute esophagitis.

Chronic esophagitis.

Reflux esophagitis.

Peptic ulcer of the esophagus.

The last two diseases are the result of systematic irritation of the esophageal mucosa by the acidic contents of the stomach, causing inflammation and tissue degeneration.

Acute esophagitis.

Acute acute esophagitis occurs as a result of an acute bacterial or viral infection. They have no practical significance during the course of the disease and disappear along with other signs of the disease, if they do not acquire an independent chronic course.

Acute esophagitis can be:

Catarrhal esophagitis.

Hemorrhagic esophagitis.

Purulent esophagitis (abscess and phlegmon of the esophagus).

The causes of acute esophagitis are chemical burns (exfoliative esophagitis) or trauma (bone splinter, injury when swallowing sharp objects, bones).

Clinical picture acute esophagitis. Patients complain of acute esophagitis on pain behind the sternum, aggravated by swallowing, sometimes there is dysphagia. The disease occurs acutely. It is also accompanied by other features characteristic of the main process. With influenza, this is fever, headache, pain in the throat, etc. With a chemical burn, there are indications of ingestion of alkali or acid, traces of a chemical burn are found on the oral mucosa, in the throat. An abscess or phlegmon of the esophagus is characterized by severe pain behind the sternum when swallowing, difficulty in swallowing dense food, while warm and liquid food does not linger in it. There are signs of infection and intoxication - fever, leukocytosis in the blood, ESR is increased, proteinuria occurs.

X-ray examination allows you to detect an infiltrate that causes some delay in the food bolus, to establish its localization and the degree of damage to the esophageal wall.

Esophagoscopy: mucosa in the infiltrate area is hyperemic, edematous. With careful examination, you can find a splinter - a fish bone or a sharp bone stuck in the tissue of the esophagus. The foreign body is removed using forceps. It is possible to feel the density of the infiltrate with the edge of the apparatus. If the abscess has matured, a tissue of soft consistency is revealed in the center.

Diffuse esophagitis accompanied by hyperemia and mucosal edema. It is covered with a white-gray coating, bleeds easily. Erosions have an irregular shape, often longitudinal, covered with a gray coating. Peristalsis is preserved.

Acute esophagitis can occur without consequences. After a chemical burn, powerful scars develop, causing a narrowing of the esophagus.

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 blood test, TAPS).

Complication of wounds of the pharynx: wound infection, 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. The mildest form, local manifestations are characteristic, the temperature rises in children, the general condition suffers, sore throat, dryness.

Objectively: hyperemia of the mucosa, swelling of the palatine tonsils, enlarged, covered with mucous discharge; submandibular lymph nodes are 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. A retropharyngeal abscess must be distinguished from subglottic laryngitis, a foreign body in the 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.