Inflammation of the mucous membrane of the posterior pharyngeal wall - pharyngitis- can be acute or chronic.
Acute pharyngitis - acute inflammation of the mucous membrane rarely occurs 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, tonsils or carious teeth.

Causes, contributing to the development of pharyngitis may be the following:

General or local hypothermia;

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

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

Acute infectious diseases;

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

Clinical manifestations acute pharyngitis are as follows:

Dryness, soreness, soreness in the throat;

Moderate pain when swallowing;

Radiation of pain into the ear;

Hearing loss - “stuffy” ears, clicking in the ears as the process spreads to the nasopharynx and the mouth of the auditory tubes;

Mild signs of intoxication, low-grade fever.

During oropharyngoscopy noted:

Hyperemia and moderate swelling of the posterior pharyngeal wall;

Thickened hyperemic follicles, swollen side ridges;

Muco-purulent discharge on the back wall of the pharynx in the presence of a bacterial pathogen.
Severe 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 irritating factors;

Gentle diet;

Drink plenty of warm drinks;

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: “Cameton”, “Ingalipt”, “Proposol”, IRS19;

Oroseptics for resorption in the oral cavity “Faryngosept”, “Septolete”, “Strepsils”, “Lariprokt”, “Lariplus”, etc.

Lubricating the back wall of the pharynx with oil solutions, Lugol's solution;

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

Hardening procedures;

Restoring nasal breathing;

Eliminate irritating factors.
Chronic pharyngitis depending on the character

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

External irritating factors;

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

Metabolic disorders (diathesis in children, diabetes in adults, etc.);

Congestion in diseases of internal organs.
Subjective signs The various forms of pharyngitis are largely identical:

Dryness, burning, itching in the throat

Pain with an “empty throat”;

Foreign body sensation;

Radiation of pain to the ears;

Accumulation of viscous mucous discharge, especially
in the morning.

Diagnosis of chronic pharyngitis placed mainly on the basis of pharyngoscopy data:

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

- in hypertrophic form- on the swollen and hyperemic mucosa of the posterior wall of the pharynx, individual red grains (granules), enlargement 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, first of all, should be aimed at eliminating the causes of the disease.

Local treatment consists of prescribing irrigation, inhalation, atomization and lubrication with medications appropriate to the form of the disease. For atrophic pharyngitis use alkaline and oil preparations. For hypertrophic pharyngitis the mucous membrane is treated with a 1-5% solution of collargol, protargol or lapis, novocaine blockade. For severe hypertrophy, use cryotherapy(freezing) into granules and side rolls.

The result of treatment with these methods often does not satisfy the doctor and the patient. In recent years, a new method for the treatment of acute and chronic pharyngitis has appeared, which consists of the use of vaccines, which are lysates of pathogens of upper respiratory tract diseases. 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, as a result of which phagocytic activity increases, the amount of secretory immunoglobulin A increases, and the content of lysozyme in saliva increases. The maximum effect when treated with 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 pharyngeal diseases. Studies have shown that the use of Imudon in the treatment of frequently ill children leads to an increase in interferon content in saliva, a decrease in the number of exacerbations of diseases and a decrease in the need for antibacterial therapy.

Acute tonsillitis (tonsillitis) 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, tubular tonsils, and in the lateral ridges. To define these diseases, the term sore throat is used (from the Latin Anqo - squeeze, strangle), known since ancient times. In Russian medical literature you can find a definition of sore throat as “throat sore throat.” The disease mainly affects children of preschool and school age, as well as adults under the age of 40. There are pronounced seasonal increases in incidence in the spring and autumn periods.

There are several classification schemes for sore throats. They are distinguished by etiology, pathogenesis, and clinical course.

Among various microbial pathogens, the main etiological role belongs beta-hemolytic streptococcus, which is detected according to various authors from 50 to 80% of cases. The second most common causative agent of sore throats can be considered Staphylococcus aureus. Diseases caused by viridans streptococcus. In addition, the causative agent of sore throat can be adenoviruses, rods, spirochetes, fungi and etc.

Penetration of an exogenous pathogen can occur by airborne droplets, alimentary and through direct contact with a patient or a carrier of the bacilli. More often, the disease occurs due to autoinfection with microbes or viruses that normally grow on the mucous membrane of the pharynx. It is possible for an endogenous infection to spread 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 includes - catarrhal, follicular, lacunar, phlegmonous tonsillitis.

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

Primary (banal) tonsillitis

Catarrhal tonsillitis- the mildest form of the disease, which has the following Clinical signs;

Feeling of burning, dryness, sore throat;

Pain when swallowing is mild;

Low-grade fever;

Moderately severe intoxication;

Enlarged regional lymph nodes;
The duration of the disease is 3-5 days.
During pharyngoscopy defined:

Diffuse hyperemia of the tonsils and palatine arches;

Slight enlargement of the tonsils;

In some places, a film of mucopurulent exudate is detected.

Follicular tonsillitis has the following characteristics:

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

Severe sore throat when swallowing;

Radiation of pain into the ear;

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

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

Enlargement and tenderness of regional lymph nodes.

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

Severe hyperemia and infiltration of the soft palate and arches;

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

Multiple yellowish-white dots measuring 1-3 mm (purulent follicles) on the 3-4th day of illness.

Lacunar tonsillitis often occurs 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 deeper damage to all lymphoid follicles. Superficially located follicles give a picture of follicular tonsillitis. The follicles located deep in 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 islands or confluent deposits.

Clinical signs lacunar tonsillitis are as follows:

Severe pain in the throat when swallowing food and saliva;

Radiation of pain into the ear;

Chills, increased body temperature to 39-40°;

Weakness, weakness, sleep disturbance, headache;

Pain in the lower back, joints, in the heart area;

Pronounced hematological changes;

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

At pharyngoscopy are determined:

Severe hyperemia and enlargement of the tonsil;

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

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

Causes, contributing to the formation of the process may be the following:

Decreased immune strength of the body;

Virulence of the pathogen;

Injury to the tonsil by a foreign body or during medical procedures;

Development of adhesions deep in the tonsil with difficulty in the outflow of contents.

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

During pharyngoscopy defined:

Enlargement of one tonsil, hyperemia, tension;

Pain when pressing with a spatula;

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

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

1. Treatment adherence diseases:

Strictly bed rest during the first days of the disease;

Sanitary and epidemiological standards - patient isolation, individual care products and personal hygiene items;

Dietary regimen - mechanically, thermally and chemically gentle diet, rich in vitamins, drinking plenty of fluids.

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 pharyngeal mucosa with aerosol preparations: “Cameton”, “Eucalyptus”, “Proposol”, “Bioparox”;

The use of oroseptics: “Faryngosept”, “Hexaliz”, “Lari-plus”, “Laripront”, “Septolete”, “Strepsils”, “Anti-angin”, etc.;

Lubricating the pharyngeal mucosa with Lugol's solution, iodine;

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

Sulfonamide drugs are prescribed taking into account the severity 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: for young people in the initial stages of the disease, the use of antibiotics is not recommended. IN severe cases, in the stage of abscess formation or when other organs are affected, they are used broad-spectrum semisynthetic drugs(ampicillin, amoxicillin, amoxiclav, unasin), first generation cephalosporins(cephalexin, cephalothin, cephalosin), macrolides(erythromycin, rovamycin, rulide). Treatment with antibiotics should be accompanied by prophylaxis against dysbacteria - the prescription of nystatin, levorin, diflucan. With the wrong choice of antibiotics and timing of treatment, conditions are created for the process to become chronic.

Anti-inflammatory drugs - paracetamol, acytylsalicylic acid are prescribed for hyperthermia, and their side effects must be taken into account;

Immunostimulating therapy is recommended in the form of the following drugs: thymus extract (vilosen, 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 infections of the oral cavity and pharynx, increases phagocytic activity and the level of lysozyme in saliva.

Physiotherapeutic procedures are prescribed after the removal of hyperthermia and the elimination of the purulent process in case of prolonged lymphadenitis: Solux, UHF in the submandibular area, phonopharesis, magnetic therapy.

During treatment, it is necessary to monitor the state of the cardiovascular system and conduct repeated urine and blood tests. After the illness, the patient must be under the supervision of a doctor for a month.

Prevention of acute tonsillitis should include:

Timely sanitation of foci of chronic infection;

Elimination of causes that make nasal breathing difficult;

Elimination of irritating factors in the environment;

Correct work and rest regime, hardening procedures.

Persons who often suffer from sore throats are subject to dispensary observation.

Peritonsillitis 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-tonsillary tissue. The causes of paratonsillitis in most cases are decreased immunity and inadequate or early discontinued treatment of angina. The spread of the inflammatory process beyond the tonsil capsule indicates the cessation of its protective effect, that is, the transition to the stage of decompensation.

Clinical manifestations of the disease:

Constant pain when swallowing, worsening when trying to swallow saliva;

Irradiation of pain in the ear, teeth, intensifying until refusal of food and drink;

Emergence trismus- spasm of the chewing muscles;

Slurred, nasal speech;

Forced position of the head (sideways), 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 trismus; upon examination, an unpleasant putrid odor from the mouth is felt. 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 peritoneal tissue, anterosuperior, anteroinferior, lateral and posterior peritoneal abscess are distinguished. With anterosuperior paratonsillitis, there is a sharp protrusion of the upper pole of the tonsil, which, together with the arches and the soft palate, is a spherical formation. In the area of ​​greatest protrusion there is 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 treatment, the use of broad-spectrum antibiotics, and the appointment of novocaine blockades can lead to a gradual attenuation of the inflammatory process and the patient’s recovery.

When the abscess matures You should not wait for it to empty spontaneously. It is advisable to perform an autopsy after spraying the pharyngeal mucosa with a 10% lidocaine solution or a 2% dicaine solution. The introduction of 2-3 ml of a 1% solution of novocaine into the area of ​​the masticatory muscles near the angle of the lower jaw relieves trismus and facilitates manipulation. An abscess is often opened through. supramyngdal fossa or at the site of the greatest protrusion using a scalpel or forceps. In the following days, the edges of the wound are separated and the cavity is washed with disinfectant solutions.

To prevent possible relapses of the process and the development of complications, the patient undergoes tonsil removal - tonsillectomy. Usually the operation is performed a week after opening the peritonsillar abscess. In some cases, in the presence of chronic tonsillitis complicated by paratonsillitis, as well as when other complications are identified, 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 pharyngeal fascia and the prevertebral fascia, which persist in children up to four years of age. At a younger age, the disease occurs as a result of the introduction of infection into the retropharyngeal space during acute rhinopharyngitis, sore throat, acute infectious diseases against the background of weakened immunity. In older children, the cause of a retropharyngeal abscess is often injury to the posterior pharyngeal wall.

Clinical manifestations of the disease depend on the location of the abscess, its size, the state of immunity, and 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 abscess in the nasopharynx, difficulty in nasal breathing, nasal sound;

- with middle position abscess, noisy stridor breathing appears, snoring, the voice becomes hoarse;

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

Sore throat, refusal to eat, anxiety and fever are typical for all types of localization of the process.

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

Treatment. At the infiltration stage it is prescribed conservative treatment. If signs of abscess formation appear, it is necessary surgery- opening of the abscess, which, to prevent aspiration, is carried out in a horizontal position with 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 reopened, 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) sore throat of Simanovsky-Vincent caused by a symbiosis of bacteria - fusiform rods and spirochetes of the oral cavity, usually located in a low-virulent state in the folds of the oral mucosa. Factors predisposing to the development of the disease are are:

Reducing general and local reactivity of the body;

Past infectious diseases;

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

Body temperature rises to low-grade levels or may remain normal;

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

Putrid odor from the mouth, increased salivation.
During pharyngoscopy pathological changes are detected in one tonsil:

The upper pole has a grayish or yellowish coating;

After the plaque is rejected, a deep ulcer with uneven edges and a loose bottom is formed.
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 diseases 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, furatsilin;

Lubricating 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 affected side;

On the surface of the tonsil there is a red erosion, an ulcer or the tonsil takes on the appearance of acute tonsillitis;

The tissue of the tonsil is dense when palpated;

There is a unilateral increase in lymphatic
nodes

Secondary syphilis pharynx has the following characteristic features:

Diffuse copper-red color of the mucous membrane, involving the arches, soft and hard palate;

Papular rash, round or oval, grayish-white in color;

Enlargement of regional lymph nodes.
Tertiary syphilis manifests itself as limited

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

Treatment specific, rinsing with disinfectant solutions is prescribed locally (see section “Chronic specific diseases of 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, especially younger ones, get sick more often.

Clinical manifestations the following:

Increasing temperature to 38~40 o C;

Sore throat when swallowing;

Headache, muscle pain in the abdominal area;

Vomiting and loose stools are observed in young children.

In adults, the disease occurs in a milder form.

During pharyngoscopy defined:

Hyperemia of the pharyngeal mucosa;

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

Formation of ulcers at the site of opened blisters 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;

A gentle diet, drinking plenty of vitamins;

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

Treatment with antiviral agents (interferon);

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

Detoxification therapy is indicated in young children in severe cases that require hospitalization.

Fungal tonsillitisV Recently it has become widespread according to the following reasons:

Decreased immunity in the general population;

Immune system deficiency in young children
age;

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

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

During bacteriological examination Fungal tonsillitis reveals pathogenic yeast-like fungi such as Candida.

Characteristic clinical manifestations the following:

The increase in temperature is not constant;

Minor sore throat, dryness, impaired taste;

The symptoms of general intoxication are mild.
During pharyngoscopy defined:

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

Treatment is carried out as follows:

Cancellation of broad-spectrum antibiotics;

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

Insufflation of nystatin, levorin;

Lubricating 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.

Sore throat with infectious mononucleosis characterized by the following signs;

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

Enlargement of the palatine tonsils, a picture of lacunar, sometimes ulcerative-necrotic tonsillitis;

Enlargement and tenderness of the cervical and submandibular lymph nodes;

Simultaneous enlargement of the liver and spleen;

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

Treatment patients are carried out in the infectious diseases department, where they are prescribed:

Bed rest, food rich in vitamins;

- local treatment: rinsing with disinfectants and
astringents;

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

Chills, high temperature - up to 4 CGS, 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 deep into the tissues;

In the blood there is pronounced leukopenia and a pronounced shift in the leukocyte formula to the right.

Treatment carried out in the hematology department:

Bed rest, gentle diet;

Careful oral care;

Prescription of corticosteroids, pentoxyl, vitamin therapy;

Bone marrow transplantation;

Fighting secondary infection.

Chronic tonsillitis. This diagnosis means chronic inflammation of the tonsils, which is more common than inflammation of all other tonsils combined. The disease usually affects school-age children from 12 to 15% and adults under 40 years old - from 4 to 10%. This pathology is based on an infectious-allergic process, which manifests itself as repeated sore throats 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.

Causes The development of a chronic inflammatory process in the palatine tonsils is as follows:

Changes in the body's reactivity;

Difficulty in nasal breathing caused by a deviated nasal septum, hypertrophy of the nasal turbinates, and enlarged adenoids;

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

Past childhood infections, repeated respiratory viral diseases, gastrointestinal tract infections that reduce the body's resistance;

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

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

Extensive lymphatic and circulatory tracts, leading to the spread of infection and the development of infectious-allergic complications.
Chronic tonsillitis should be classified as an infectious disease proper, mostly caused by autoinfection. According to the latest data
foreign and domestic publications in the etiology of chronic tonsillitis takes the leading place beta-hemolytic staphylococcus group A- in children 30%, in
adults 10-15%, then Staphylococcus aureus, hemolytic staphylococcus, anaerobes, adenoviruses, herpes virus, chlamydia and toxoplasma.

The variety of local and general signs of chronic tonsillitis and their connection with other organs necessitated the need to systematize this data. There are several classifications of chronic tonsillitis. Currently the most widely accepted classification I.B. Soldatoea(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 distinguishes a simple form of chronic tonsillitis and a toxic-allergic form.

The basis for the statement diagnosis Chronic tonsillitis is a history of frequent sore throats, local pathological signs and general toxic-allergic phenomena. It is advisable to assess objective signs of chronic inflammation of the tonsils no earlier than 2-3 weeks after an exacerbation of the disease.

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

Sore throat in the morning, dryness, tingling;

Feeling awkward or foreign body when swallowing;

Bad breath;

Indication of a history of tonsillitis.

Pharyngoscopy data (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;

Adhesions of the palatine arches with the tonsils as a result of repeated sore throats;

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

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

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

Enlargement and tenderness 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 provides grounds for making a diagnosis. In the compensated form of the disease, during the period between sore throats, 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 signs 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 low-grade fever 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 infectious-allergic diseases include: acute and

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

Local complications that arise in the pharynx against the background of repeated sore throats are evidence of decompensation of the inflammatory process in the pharynx, these include: paratonsillitis, retropharyngeal abscess.

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

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

Conservative treatment chronic tonsillitis must 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. Rinsing the lacunae of the tonsils and rinsing with antiseptic solutions (furacillin, iodinol, dioxidine, quinozol, octenisept, ectericide, chlorhexidine, etc.)
course 10-15 procedures. Washing lacunae with interferon stimulates the immunological properties of the tonsils.

2. Shading of tonsil lacunae with Lugol's solution or 30% alcohol tincture of propolis.

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

4. Intratonsil novocaine blockades.

5. Administration 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. Taking oroseptics: faringosept, hexaliz, lariplus, neoangin, septolete, etc.

8. Treatment with the “Tonsilor” device, which combines ultrasonic influence 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, magnetic therapy.

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 dysbiosis.

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 of it. Preparations of thymus gland extract 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, and increase immunity: rutin-containing complexes, vitamins A, E, C, microelements - 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.

Treatment effectiveness criterion 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 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 failure;

Chronic renal failure;

Blood diseases;

Severe diabetes mellitus;

High degree of hypertension with possible development
hypertensive crises, etc.

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

Preparing for surgery is carried out on an outpatient basis and includes:

Sanitation of foci of infection;

Blood test for coagulability, content
platelets, prothrombin index;

Blood pressure measurement;

Examination of internal organs.

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

Most common complication Tonsillectomy is bleeding from the area of ​​the tonsil niches.

Patient care in the postoperative period The nurse should do the following: - place the patient on the right side on a low pillow;

prohibit getting up, actively moving in bed and talking;

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

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

Tell your doctor about bleeding if necessary;

Give a few sips of cold liquid in the afternoon;

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

Irrigate the throat several times a day with aseptic solutions.

Prevention chronic tonsillitis is as follows:

Anti-pollution;

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 implementation of dispensary monitoring of them;

Timely isolation of patients and administration of adequate treatment;

Individual prevention consists of sanitizing foci of infection and increasing the body’s resistance to harmful environmental influences.
Clinical examination patients with chronic tonsillitis

is an effective method of improving population health. Main goals Clinical examinations in otorhinolaryngology are as follows:

Timely identification of patients with chronic and often recurrent diseases;

Systematic monitoring of them and active treatment;

Identification of the causes of this disease and implementation of health measures;

Evaluation of the results of the work done.

There are three stages of medical examination:

Stage 1 - registering - includes identifying persons subject to medical examination, drawing up a plan of treatment and preventive measures and dynamic observation. Selection patients is carried out passively when patients seek medical help and actively - in the process of carrying out preventive
inspections. The first stage of medical examination ends preparation of medical documentation and preparation specific individual plan therapeutic-pro
lactic activities.

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

Stage 3 - quality and efficiency assessment dispensary observation. The results of examination of patients and completed courses of treatment 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 is the basis for removing the patient from the dispensary
accounting according to the compensated form of chronic tonsillitis. If there is no effect from the measures taken, the patient is referred for surgical treatment.

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

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

The length of the pharynx can range from twelve to fifteen centimeters. It is designed to allow food from the mouth to slowly pass into the esophagus. In addition, air flows from the nasal cavity and in the opposite direction through the pharynx.

The upper, as well as the lateral, walls of the pharynx are formed from a special stylopharyngeal muscle, which ensures the constant raising and lowering of the pharynx and larynx, as well as from striated voluntary muscles: the superior pharyngeal constrictor, the middle pharyngeal constrictor and the inferior constrictor, which noticeably narrow its lumen. Together they form a specific muscular layer.

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

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

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

Chronic diseases

The following chronic diseases of this organ are distinguished:

1. Hypertrophy of the tonsils. As a rule, the tonsil disease enlarges without an inflammatory process. Very often children suffer from this disease due to enlarged adenoids. The main causes have not yet been determined by doctors, but it is believed that the disease occurs along with a cold. For preventive purposes, rinsing is recommended.
2. Pharyngomycosis. Inflammation of the pharyngeal mucosa caused by a fungus. Symptoms of manifestation are usually considered to be a white or yellowish coating, dryness and soreness, and in some cases a burning sensation in the throat. The disease can be caused by immune or endocrine disorders. Drug treatment is prescribed.
3. Chronic tonsillitis . Chronic inflammation of the tonsils. Children often get sick. If you do not consult a doctor in time, complications may arise such as: pneumonia, exacerbation of allergies, decreased immunity, etc. The main symptoms are: sore throat and tonsils, inflammation of the nasopharynx, low fever, weakness, bad breath. Complex treatment is prescribed.
4. Laryngeal papillomatosis. Tumor disease of the upper respiratory tract caused by a virus. Most often, adult men and children in the first years of life suffer from this disease. Complex treatment is prescribed.
5. Laryngitis. Inflammatory disease of the larynx. It can occur both from infection and from hypothermia or severe straining of the voice. Symptoms of the disease are: severe sore throat, redness in the throat sometimes with purple patches, wet cough, pain when swallowing, slight fever. Treatment is prescribed with medication, and rest of the patient is recommended.

There are many different diseases of the pharynx that have an infectious etiology. They differ in the complexity of their course, as well as in their symptoms. Depending on them, it is necessary to select medications and the correct method of treatment.

Acute pharyngitis is an acute inflammation of the mucous membrane of all parts of the pharynx. This disease is often concomitant with respiratory infections of viral and microbial etiology (influenza, adenoviral, coccal).

The patient complains of a feeling of rawness or pain in the throat, soreness, dryness, hoarseness, and upon examination there is hyperemia of the mucous membrane of all parts of the pharynx, accumulation of viscous mucus on the back wall, sometimes of a hemorrhagic nature.

General symptoms - weakness, fever, discomfort - are caused by the underlying disease. For the treatment of acute pharyngitis, oil-balsamic nasal drops are recommended, a mixture of equal amounts of sea buckthorn, vaseline and menthol oils 3-5 times a day, warm alkaline inhalations, lubricating the pharyngeal mucosa with Lugol's solution on glycerin, analgesics and aspirin are prescribed orally.

Differential diagnosis of acute pharyngitis is carried out with diphtheria, scarlet fever, measles, rubella and other infectious diseases.

Sore throat is an acute inflammation of the tonsils and pharyngeal mucosa.

Sore throats, according to clinical data and pharyngoscopic picture, are divided into catarrhal, follicular, lacunar, ulcerative-membranous and necrotic.

Sore throat is a general nonspecific infectious-allergic disease of predominantly streptococcal etiology, in which local inflammatory changes are most pronounced in the lymphadenoid tissue of the pharynx, most often in the palatine tonsils and regional lymph nodes.

It manifests itself clinically in the form of catarrhal, follicular and lacunar tonsillitis.

Nonspecific sore throat

Nonspecific angina - catarrhal, when only the mucous membrane of the tonsils is affected, follicular - purulent damage to the follicles, lacunar - pus accumulates in the lacunae. Typically caused by group A streptococcus.

However, there are pneumococcal tonsillitis, staphylococcal tonsillitis and tonsillitis, the etiology of which is a mixed coccal flora. A type of this sore throat is alimentary sore throat, caused by epidemic streptococcus. The microbe is usually introduced when food preparation technology is violated by unscrupulous workers.

Catarrhal sore throat affects the mucous membrane of the tonsils and arches, and there is hyperemia in these areas of the pharynx, but there are no plaques.

The patient notes pain when swallowing, a burning sensation in the pharynx. Has a bacterial or viral etiology. The temperature is low-grade, fever is less common.

Regional lymph nodes may be moderately enlarged. The disease lasts 3–5 days. Treatment - rinsing with soda, sage, lubricating the tonsils with iodine-glycerin, taking aspirin orally.

Catarrhal sore throat must be distinguished from acute pharyngitis, which affects the entire mucous membrane of the pharynx, especially its posterior wall.

Follicular and lacunar tonsillitis are caused by the same pathogens and are similar both in clinical course and in the general reaction of the body and possible complications. The difference lies in the different forms of plaque on the tonsils.

With follicular angina, suppuration of the follicles occurs, and dead white leukocytes appear through the mucous membrane. With lacunar angina, inflammation begins from the lacunae, where pus accumulates, which then protrudes from the lacunae onto the surface of the tonsils.

After 1–2 days, plaque spreads over the entire surface of the tonsils, and it is no longer possible to distinguish between the two types of sore throat. Patients feel severe pain when swallowing, discomfort in the throat, and refuse food.

The cervical lymph nodes are sharply enlarged, the temperature rises to 39 and even 40 °C.

On days 2–3, a differential diagnosis with diphtheria is made. Already at the first examination, it is necessary to take a smear from the patient for diphtheria bacillus, and try to remove the plaque with a cotton brush.

If the plaque is removed, this speaks in favor of vulgar tonsillitis; if it is difficult to remove, and bleeding erosion remains in its place, this is most likely diphtheria.

In case of doubt, it is necessary to administer anti-diphtheria serum.

Treatment of follicular and lacunar tonsillitis consists of gargling, cervical semi-alcohol compress, prescribing analgesics, desensitizers (diphenhydramine, suprastin, tavegil), broad-spectrum antibiotics intramuscularly. A gentle diet is recommended for patients.

Sore throat caused by adenoviruses, occurs in the form of diffuse acute pharyngitis, although it may also be accompanied by plaque on the tonsils. Adenovirus infection is characterized by widespread damage to the lymph nodes and a very frequent combination with conjunctivitis.

This is especially true for adenovirus type 3, which causes pharyngoconjunctival fever. The influenza virus gives a similar picture, but in 10–12% of cases it can be combined with streptococcal sore throat.

Acute inflammation of the tonsils of another location. Sore throat of the lingual tonsil has characteristic symptoms - pain in the deep parts of the pharynx, which sharply intensifies when trying to stick out the tongue.

Diagnosis involves performing indirect laryngoscopy using a laryngeal speculum.

Sore throat of the nasopharyngeal tonsil. The pain is localized in the nasopharynx, thick mucous discharge is released from the nose, and an acute runny nose is noted. With posterior rhinoscopy, a swollen tonsil with a bluish color is visible, sometimes with plaque, and thick mucus flows down the back wall of the pharynx.

Sore throat as a syndrome of common infectious diseases

Sore throat with scarlet fever may proceed in different ways. Most often it is catarrhal and lacunar tonsillitis.

In the classic course of scarlet fever, there is a characteristic redness of the soft palate in the circumference of the pharynx, which does not extend beyond the soft palate, swelling of the cervical lymph glands and a whitish thick coating on the tongue, followed by its clearing when the tongue takes on a bright color.

To make a diagnosis, it is necessary to take into account all the symptoms of the disease, primarily the scarlet fever rash in the area of ​​the mastoid process and the flexor surfaces of the limbs.

There are severe forms of scarlet fever, occurring in the form of:

1) pseudomembranous tonsillitis with the formation of fibrinous exudate widespread on the mucous membrane of the tonsils, pharynx, nasopharynx and even cheeks in the form of a thick grayish film tightly fused to the underlying tissue. There is a bright hyperemia of the circumference of the pharynx, the rash appears already on the first day of the disease. The prognosis for this form of scarlet fever is unfavorable;

2) ulcerative necrotic tonsillitis, characterized by the appearance of grayish spots on the mucous membrane, quickly turning into ulcers. Deep ulceration may occur with the formation of permanent defects of the soft palate. The lateral cervical lymph nodes are affected by extensive inflammation;

3) gangrenous tonsillitis, which is rare. The process begins with the appearance of a dirty gray coating on the tonsils, followed by deep tissue destruction down to the carotid arteries.

Sore throat with diphtheria can occur in various clinical forms. With diphtheria, plaque extends beyond the arches. For tonsillitis, a strict boundary of the distribution of plaque within the tonsils is pathognomonic. If plaque spreads beyond the arches, the doctor must doubt the diagnosis of nonspecific tonsillitis. There is a simple diagnostic test. The plaque from the tonsil is removed with a spatula and dissolved in a glass of cold water.

If the water becomes cloudy and the plaque dissolves, it means a sore throat. If the water remains clear, but plaque particles float to the surface, then it is diphtheria.

Sore throat with measles occurs under the mask of catarrhal disease in the prodromal period and during the rash.

In the second case, the diagnosis of measles does not cause difficulties; in the prodromal period, it is necessary to monitor the appearance of measles enanthema in the form of red spots on the mucous membrane of the hard palate, as well as Filatov-Koplik spots on the inner surface of the cheeks at the opening of the Stenon's duct. The course of sore throat with rubella measles is similar to measles.

Sore throat with flu proceeds in the same way as catarrhal, but diffuse hyperemia affects the tonsils, arches, uvula, and back wall of the pharynx.

Erysipelas is a serious disease, often occurring together with facial erysipelas. It begins with a high fever and is accompanied by severe pain when swallowing. The mucous membrane is colored bright red with sharply defined borders of redness, it seems varnished due to swelling.

Sore throat with tularemia begins acutely - with chills, general weakness, redness of the face, enlarged spleen.

For differential diagnosis, it is important to establish contact with rodents (water rats, house mice and gray voles) or blood-sucking insects (mosquitoes, horseflies, ticks).

In most cases, tonsillitis with tularemia occurs when infected through the nutritional route - by consuming water or food after an incubation period of 6-8 days in an infected patient.

Another differential diagnostic feature is the formation of buboes - packets of lymph nodes in the neck, sometimes reaching the size of a chicken egg.

Lymph nodes may fester. The picture of the pharynx may resemble catarrhal or, more often, membranous sore throat, which is mistakenly diagnosed as diphtheria.

Sore throat with blood diseases

Monocytic tonsillitis(infectious mononucleosis or Filatov's disease) can have a varied clinical course - from catarrhal to ulcerative-necrotic. The etiology of this disease has not been fully elucidated. Clinically: enlarged liver and spleen (hepatolienal syndrome), the presence of compacted and painful to the touch lymph nodes (cervical, occipital, submandibular, axillary and inguinal, and even polylymphadenitis).

A pathognomonic symptom is the appearance of atypical mononuclear cells in the peripheral blood.

Agranulocytic tonsillitis associated with the complete or almost complete disappearance of granulocytes in the peripheral blood with the preservation of monocytes and lymphocytes against the background of severe leukopenia. The etiology of the disease is not clear; it is considered polyetiological. The disease is associated with excessive and uncontrolled use of drugs such as analgin, pyramidon, antipyrine, phenacytin, sulfonamides, antibiotics, chloramphenicol, Enap.

The clinical picture is usually severe and consists of symptoms of acute sepsis and necrotizing tonsillitis, since the microbes inhabiting the pharynx belong to the opportunistic flora and, when the leukocyte defense is turned off and other unfavorable circumstances, become pathogenic and penetrate the tissues and blood. The disease is severe, with high fever, stomatitis, gingivitis, and esophagitis. The liver is enlarged. The diagnosis is made on the basis of a blood test: severe leukopenia, below 1000 leukocytes in 1 mm 3 of blood, absence of granulocytes. The prognosis is serious due to the development of sepsis, laryngeal edema, necrosis of pharyngeal tissue with severe bleeding. Treatment consists of fighting secondary infection - prescribing antibiotics, vitamins, pharyngeal care (rinsing, lubricating, irrigation with antiseptic, astringent, balsamic solutions), intravenous transfusion of leukocyte mass. The prognosis for this disease is quite serious.

Alimentary-toxic aleukia characterized by the fact that, unlike agranulocytosis, when only granulocytes (neutrophils, eosinophils) disappear from the peripheral blood, the disappearance affects all forms of leukocytes. The disease is associated with the ingestion of a special fungus that multiplies in overwintered cereals left unharvested in the fields and contains a very toxic substance - poin, even a very small amount of which leads to contact lesions in the form of tissue necrosis, hemorrhagic ulcers affecting the entire gastrointestinal tract , and even contact with feces on the buttocks causes ulceration.

The poison is heat-stable, so heat treatment of flour (cooking baked goods, bread) does not reduce its toxicity.

From the side of the pharynx, necrotic sore throat is pronounced, when the tonsils look like gray dirty rags, and a sharp, nauseating odor is released from the mouth.

The number of leukocytes in the peripheral blood is up to 1000 or less, while granular leukocytes are completely absent. Characterized by high fever and the appearance of a hemorrhagic rash. Treatment in the early stage consists of gastric lavage, enemas, laxatives, a gentle diet, intravenous infusions of saline with vitamins, hormones, glucose, blood transfusions, and leukocyte mass.

At the stage of tonsillitis and necrosis, antibiotics are prescribed. With severe clinical manifestations of the disease, the prognosis is unfavorable.

Sore throats in acute leukemia occur with varying degrees of severity depending on the stage of leukemia. The onset of a sore throat (usually catarrhal) proceeds relatively favorably, begins against the background of apparent well-being, and only a blood test allows one to suspect acute leukemia at this early stage of the disease, which once again proves the mandatory blood test for sore throats.

Sore throats with developed leukemia, when the number of blood leukocytes reaches 20,000 or more, and the number of red blood cells drops to 1–2 million, sore throat is extremely severe in the form of an ulcerative-necrotic and gangrenous form with high fever and severe general condition. Nosebleeds, hemorrhages in organs and tissues, and enlargement of all lymph nodes occur. The prognosis is unfavorable, patients die within 1–2 years. Treatment of sore throat is symptomatic, local, antibiotics and vitamins are prescribed less often.

Sore throats with infectious granulomas and specific pathogens

Tuberculosis of the pharynx can occur in two forms - acute and chronic. The acute form is characterized by hyperemia with thickening of the mucous membrane of the arches, soft palate, and uvula, reminiscent of a sore throat; body temperature can reach 38 °C and higher. There are sharp pains when swallowing, the appearance of gray tubercles on the mucous membrane, then their ulceration. A characteristic medical history and the presence of other forms of tuberculosis help in the diagnosis.

Of the chronic forms of tuberculosis, the most common is ulcerative, developing from infiltration, often occurring without symptoms. The edges of the ulcer are raised above the surface, the bottom is covered with a gray coating, after its removal juicy granulations are found. Most often, ulcers are observed on the back wall of the pharynx. The course of processes in the pharynx depends on many reasons: the general condition of the patient, his diet, regimen, social conditions, timely and correct treatment.

In the acute miliary form of tuberculosis, the prognosis is unfavorable; the process develops very quickly with a fatal outcome in 2–3 months.

Treatment of pharyngeal tuberculosis, as well as its other forms, has become relatively successful after the advent of streptomycin, which is administered intramuscularly at 1 g per day for an average of 3 weeks. R-therapy sometimes gives good results.

Syphilis of the pharynx. Primary syphilis most often affects the tonsils. Chancroid is usually painless.

Usually, a hard infiltrate forms on the red limited background of the upper part of the tonsils, then erosion turns into an ulcer, its surface has a cartilaginous density. There are enlarged cervical lymph nodes on the affected side, painless on palpation.

Primary syphilis develops slowly, over weeks, usually on one tonsil.

The condition of patients with secondary angina worsens, fever and severe pain appear. If syphilis is suspected, the Wasserman reaction must be performed.

Secondary syphilis appears 2–6 months after infection in the form of erythema and papules. Erythema in the pharynx involves the soft palate, arches, tonsils, lips, surface of the cheeks, and tongue. The diagnosis of syphilis at this stage is difficult until papules appear from the lentil grain to the bean, their surface is covered with a coating with a hint of greasy sheen, the circumference is hyperemic.

Most often, papules are localized on the surface of the tonsils and on the arches.

The tertiary period of syphilis manifests itself in the form of gumma, which usually appears several years after the onset of the disease. Most often, gummas form on the back wall of the pharynx and soft palate. First, limited infiltration appears against the background of bright hyperemia of the pharyngeal mucosa. There may be no complaints during this period.

With further progression, paresis of the soft palate occurs, and food enters the nose. The course of tertiary syphilis is very variable, depending on the location and rate of development of the gumma, which can affect the bone walls of the facial skull, tongue, great vessels of the neck, causing heavy bleeding, and grows into the middle ear.

If syphilis is suspected, consultation with a venereologist is required to clarify the diagnosis and prescribe rational treatment.

Fusospirochetosis. The etiological factor is the symbiosis of a spindle-shaped rod and a spirochete in the oral cavity. A characteristic manifestation of the disease is the appearance of erosions on the surface of the palatine tonsils, covered with a grayish, easily removable coating.

In the initial stage of the disease, there are no subjective sensations, the ulcer progresses, and only after 2–3 weeks mild pain appears when swallowing, and regional lymph nodes on the affected side may enlarge.

Pharyngoscopy during this period reveals a deep ulcer of the tonsil, covered with a gray foul-smelling coating that is easily removed. General symptoms are usually not pronounced.

In differential diagnosis, it is necessary to exclude diphtheria, syphilis, tonsil cancer, blood diseases, for which a blood test, Wasserman reaction, and a smear for diphtheria bacillus are done.

Rarely, pharyngitis and stomatitis are associated with damage to the tonsils, and then the course of the disease becomes severe.

Treatment consists of rinsing with hydrogen peroxide, a 10% solution of Berthollet salt, and potassium permanganate. However, the best treatment is to generously lubricate the ulcer with a 10% solution of copper sulfate 2 times a day.

The beginning of ulcer healing is noted already on the third day, which, in turn, serves as a differential diagnosis with syphilis and blood diseases. The prognosis with timely treatment is favorable.

Candidomycosis pharynx is caused by yeast-like fungi, often in weakened patients or after uncontrolled use of large doses of antibiotics, causing dysbiosis in the pharynx and digestive tract.

There is a sore throat, fever, against the background of hyperemia of the mucous membrane of the pharynx, small white plaques appear with further extensive necrosis of the epithelium of the tonsils, arches, palate, and posterior wall of the pharynx in the form of grayish plaques, after removal of which erosion remains.

The disease must be differentiated from diphtheria, fusospirochetosis, and lesions due to blood diseases. The diagnosis is made on the basis of microscopy of smear materials with a coating of yeast fungi. Treatment involves the mandatory abolition of all antibiotics, irrigation of the pharynx with a weak soda solution, and lubrication of the lesions with Lugol's solution on glycerin.

This disease must be distinguished from pharyngomycosis, in which sharp and hard spines protruding to the surface are formed in the lacunae of the tonsils. Since there are no signs of inflammation of the surrounding tissues and subjective sensations, the disease may not be detected by the patient for a long time. Conservative treatment is ineffective. As a rule, the affected tonsils have to be removed.

Peritonsillar abscess

Between the tonsil capsule and the pharyngeal fascia there is paratonsillar fiber, and behind the pharyngeal fascia, laterally, there is fiber of the parapharyngeal space. These spaces are filled with fiber, the inflammation of which, and in the final stage – abscess formation, determine the clinical picture of the disease. An abscess is most often caused by nonspecific flora as a result of tonsillogenic spread of infection. The disease begins acutely, with the appearance of pain when swallowing, usually on one side.

Typically, a peritonsillar abscess occurs after a sore throat during the recovery period. When examining the pharynx, sharp swelling and hyperemia of the tissues around the tonsil (arches, soft palate, uvula), protrusion of the tonsil from the niche, and displacement to the midline are noted.

An abscess takes about 2 days to form on average. General symptoms are weakness, fever, enlarged cervical lymph nodes on the side of the abscess. The classic triad of peritonsillar abscess was noted: profuse salivation, trismus of masticatory muscles and open nasal sound (as a result of paralysis of the muscles of the velum).

Treatment of abscesses is prescribed in combination: intramuscular antibiotics, taking into account pain when swallowing and forced fasting, aspirin, analgesics, a semi-alcohol compress on the side of the neck (on the side of the abscess), antihistamines.

At the same time, surgical treatment is carried out. There are anterosuperior abscesses (pus accumulates behind the anterior arch and soft palate near the upper pole of the tonsil), posterior (with accumulation of pus in the area of ​​the posterior arch), external (accumulation of pus between the tonsil capsule and the pharyngeal fascia). Anesthesia, as a rule, is local - lubricating the mucous membrane with a 5% solution of cocaine or a 2% solution of dicaine. A napkin is wrapped around the scalpel so that the tip protrudes no more than 2 mm, otherwise the main vessels of the carotid system can be injured.

The incision is made in the case of an anterior abscess strictly in the sagittal plane in the middle of the distance from the posterior molar to the uvula, then a blunt probe or a hemostatic clamp (Halsted) is inserted into the incision and the edges of the incision are spread apart for better emptying of the abscess.

When the pus is removed, the patient's condition usually improves significantly. A day later, the edges of the incision are again pulled apart with a clamp to remove accumulated pus. In the same way, the posterior abscess is opened through the posterior arch. It is more difficult and dangerous to open an external abscess, which lies deeper and requires greater caution due to the danger of injury to blood vessels. This can be helped by preliminary puncture with a syringe with a long needle, when, if pus is detected, the incision is made in the direction of the puncture. After any cut in the throat, rinse with furatsilin. A very rare occurrence is a retropharyngeal abscess - an accumulation of pus in the area of ​​the back wall of the pharynx. In children, this is associated with the presence of lymph nodes in the retropharyngeal space, in adults – as a continuation of the external paratonsillar abscess.

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Foreign bodies

Foreign bodies often enter the pharynx during eating (fish and meat bones) or accidentally (coins, toys, grain particles, dentures, nails, pins, etc.). The likelihood of foreign bodies entering increases in older people when using dentures (they no longer control the food bolus).

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

Large foreign bodies (coins, toys, nipple rings) remain in the laryngeal part of the pharynx, in front of the entrance to the esophagus.

The presence of a foreign body in the pharynx 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 swallowing, and in some victims, difficulty breathing. In the presence of a foreign body in the pharynx, increased salivation is observed.

Examination of patients with pharyngeal foreign bodies should begin with pharyngoscopy. If a foreign body is not identified during pharyngoscopy, it is necessary to perform indirect hypopharyngoscopy, during which it is possible to see a foreign body in the area of ​​the lingual tonsil, vallecula, arytenoid cartilage or the wall of the pyriform pouch.

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 area of ​​the pyriform pouch may be retention of saliva in it (salivary lake). Foamy saliva, swelling of the mucous membrane and difficulty breathing give reason to suspect a foreign body in the laryngeal part of the pharynx. Patients often swallow stale bread crusts to remove the foreign body, in which case it penetrates deep into the tissue or breaks. In this case, a digital examination of the oral and laryngeal parts of the pharynx should be performed, during which a deep foreign body can be palpated. If there is a suspicion of a metallic foreign body, radiography is performed.

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

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

Possible imaginary foreign bodies in the pharynx. Such patients turn to various doctors with the complaint that they choked on a foreign body several months or years ago. They still feel pain, as well as the presence of a foreign body that can move. During an objective examination, no changes in the throat are noted.

The general condition of the patients was not impaired. 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 pharyngeal mucosa is rarely isolated. It is often combined with acute rhinitis, sore throat, and laryngitis. Acute pharyngitis is often a symptom of acute respiratory viral infections, scarlet fever, measles, etc.

Etiology

Isolated acute pharyngitis can occur after general or local hypothermia, from eating spicy foods, in workers who have just started working at hazardous chemical plants.

Clinical picture

In most patients, the general condition is almost unchanged. Body temperature is normal or subfebrile. Only in children can it reach high numbers. Patients complain of a feeling of dryness, soreness and pain in the throat, which intensifies during swallowing and can radiate to the ear. Sometimes there is a sensation of stuffy ears, hearing loss due to swelling of the mucous membrane of the pharyngeal openings of the auditory tubes. Sore throat decreases after eating warm, non-irritating foods.

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

Rice. 117. Acute pharyngitis

Treatment

It is necessary to exclude foods that irritate the mucous membrane of the pharynx. Even without treatment, recovery occurs within 3-5 days. You can inhale or spray the pharynx with alkaline solutions, 5% albucide solution or antibiotics. Prescribed aerosols (cametone, ingalipt, propazol, ingacamf, etc.), sucking tablets (falimint, faringosept), disinfectant rinses (furacilin, ethacridine lactate, infusions of medicinal plants). Only at high body temperatures are antibiotics and antipyretics prescribed.

Chronic pharyngitis

Chronic pharyngitis is a common disease. More than 30% of patients who go to ENT clinics suffer from chronic pharyngitis of various forms.

Etiology

Chronic inflammation of the pharyngeal mucosa is a polyetiological disease. Very often, chronic pharyngitis develops in workers who work with harmful chemicals in dusty industrial premises. A significant role is played by the consumption of spicy food, bad habits (smoking, alcohol abuse), as well as impaired nasal breathing, the presence of foci of chronic infection in adjacent organs (chronic rhinitis, sinusitis, chronic tonsillitis, chronic pathology of the oral cavity).

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 neurosis.

Clinical picture

There are chronic catarrhal, hypertrophic and atrophic pharyngitis.

Chronic catarrhal pharyngitis

Patients complain of a foreign body sensation in the throat, mucus secretion, and heartburn. The hyperemic, swollen mucous membrane is covered with astringent mucopurulent secretions. Often the chronic inflammatory process spreads to the posterior palatine arches and uvula. In some patients, a sharply swollen, enlarged uvula descends into the laryngeal part of the pharynx, so they can only sleep in a certain position. Sometimes the mucous membrane of the pharynx acquires a bluish tint or becomes covered with bluish spots, which indicates severe vasomotor disturbances.

Chronic hypertrophic pharyngitis

Patients are concerned about mild pain in the throat and the need to constantly cough up thick mucus. The pharyngoscopy picture varies. The mucous membrane of the pharynx is hypersmeared, thickened, and covered with islands of thick mucus. On the back wall of the pharynx, enlarged, hyperemic and swollen lymphadenoid formations of a round or elongated shape are noticeable. In this case, the presence of granulosa pharyngitis is suspected.

In the presence of lateral hypertrophic pharyngitis, hypertrophy of lymphadenoid tissue is observed on the lateral walls of the pharynx in the form of solid elongated red formations. Often these two forms are combined in one patient. Sharp hypertrophy of the granules, lateral ridges and lingual tonsil is sometimes observed in individuals whose palatine tonsils have been removed. When the process worsens, yellowish and whitish dots (festering follicles) or white fibrinous plaque can be seen on hypertrophied lymphadenoid formations.

Chronic atrophic pharyngitis

Patients complain of dryness, heartburn, soreness and the formation of dry crusts in the throat. This is especially evident in the morning. As a result of a long conversation, the throat becomes dry, so the patient is forced to take a sip of water. Pharyngoscopy reveals that the mucous membrane of the pharynx is sharply thinned, and a network of blood vessels is visible through it. The surface of the pharynx is covered with a thin layer of transparent dried secretions, giving a so-called varnish shine. In advanced cases, the dry mucous membrane is covered with greenish or yellow crusts. Sometimes, if such crusts are present, patients do not complain of anything.

It happens that patients present a lot of complaints, including a sore throat, and pharyngoscopy reveals moisture and unchanged mucous membrane. In this case, we are talking about pharyngeal paresthesia.

Treatment

First of all, it is necessary to eliminate the factors that support the chronic inflammatory process in the pharyngeal mucosa: occupational hazards, smoking, alcohol. The diet should be gentle. It is necessary to actively treat diseases of the digestive canal, uterine appendages, endocrine pathology, restore nasal breathing, eliminate the source of infection in adjacent organs, and treat neuroses.

Alkaline solutions are used locally in the form of inhalations, irrigations, and rinses. The mucous membrane of the pharynx in the acute stage is treated with 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 is effective on the pharyngeal mucosa in all forms of chronic pharyngitis, especially hypertrophic.

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

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

The human throat is often affected by pathogenic microorganisms

List of throat diseases

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

The main causes of throat diseases:

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

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

Angina

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

Healthy human throat

Types of sore throat:

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

   Catarrhal tonsillitis is the mildest type of the disease

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

   With lacunar angina, the temperature rises sharply

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

   With follicular tonsillitis, the tonsils turn red

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

With phlegmonous sore throat, accumulations of pus appear

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

With tonsillitis, the tonsils become inflamed

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

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

Laryngitis

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

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

Forms and symptoms of chronic laryngitis:

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

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

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

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

Throat with pharyngitis

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

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

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

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

Adenoiditis - inflammation of the pharyngeal tonsil

Malignant and benign neoplasms

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

Possible signs of oncology:

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

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

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

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

Mycoses of the larynx

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

Fungal infection of the throat

The main types of fungal pathologies of the oral cavity:

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

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

Other throat diseases

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

What diseases can cause a sore throat:

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

Laryngeal stenosis - closure of the airway due to swelling

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

Which doctor should I contact?

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

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

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

Diagnosis of throat diseases

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

Basic diagnostic methods:

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

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

Ultrasound of the larynx shows the cause of the disease

Treatment methods for throat diseases

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

Medicines

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

Main groups of drugs:

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

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

Amoxicillin is an antibiotic drug

Folk remedies

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

How you can treat throat diseases at home:

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

Gargling with chamomile decoction helps to cope with sore throats.

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

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

Nutritional Features

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

Nutrition principles:

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

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

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

Possible complications

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

What are the dangers of throat diseases?

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

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

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

Prevention

To prevent the development of throat diseases, you need to follow simple rules of prevention and strengthen the immune system.

How to avoid a sore throat:

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

Stop smoking to avoid throat diseases

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

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