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

2.5.1. Spicy pharyngitis (Pharyngitis Acuta) - acute inflammation of the mucous membrane of the pharynx. It is found as an independent disease, but more often accompanies to the catarrhal inflammation of the upper respiratory tract.

Ethiology - viral and bacterial infections. The viral etiology of acute pharyngitis occurs in 70% of cases, bacterial is 30%. The predisposing factors are the general and local supercooling of the body, the pathology of the nasal cavity, the incomplete sinuses and nasopharynx, common infectious diseases, smoking and alcohol abuse, diseases of the gastrointestinal tract.

Diagnosis does not represent complexity, however, it is necessary to take into account that the similar clinical picture can give diphtheria, catarrhal angina and other infectious diseases. Microbiological examination of the smear from the surface of the rear wall of the pharynx and almonds allows you to refine the diagnosis.

Clinic. It is characterized by sensations of dryness, burning, sore throat. Unlike angina with acute catarrhal pharyngitis, the pain in the throat is felt stronger with the "empty" throat, that is, the swallowing of saliva. Swallowing food is less painful. In addition, the patient points to a constant draining of the mucus on the rear wall of the throat, which makes it make frequent swallowing movements. General well-being is insignificant, the body temperature does not rise above 37 ° C.

With pharyngoscopy, the mucous membrane of the pharynx is hyperemic, edema, myshly-purulent raids are visible in some places. Often on the rear and side walls of the throat, separate follicles can be observed in the form of rounded bright red elevations - granules (Fig.82).

Fig.82. Acute pharyngitis.

Treatment. Usually local. Warm rinsing with antiseptic solutions (infusion of sage, chamomile, chlorophyllite, etc.), pulverying of the pharynx with various aerosols with antibacterial and anti-inflammatory effect (bioparox, hexasp, inhalipte, etc.), antihistamines, warm alkaline inhalations. It is necessary to exclude annoying (hot, cold, sour, sharp, salty) food, smoking, alcohol, observe gentle voice mode.

2.5.2. Angina or acute tonsillitis (Tonsillitis Acuta) - A common acute infectious-allergic disease, manifested by acute local inflammation of skydly almonds. Very common disease, which is typical of children's and young age; In 75% of cases, sick of thoroughts are persons under the age of 30 years. Angina (from Lat. ANGO - compress, stroke) was known since ancient times. In Russian medical literature, you can find a definition of angina as "throat toad". From the definition, it is clear that the infectious agent plays a decisive role in the development and course of an angina, therefore, it is possible to infect a person with air-drip or contact-household. As an infectious disease of the angina should leave after a certain immunity that protects against repeated diseases of this kind. In cases where angins continue to repeat over a year several times, it can be assumed that the body's immune forces are reduced. This circumstance must be taken into account when solving the issue of choosing a method of treatment.

The adverse environmental factors contributing to the development of an angina are the supercooling of the body, the region of the stop, the almond mucosa.
Etiology and pathogenesis. Angina's causative agent is usually hemolytic streptococcus. In addition, spiruchs of the mouth and the spidow-like wand may be causative agents, staphylococcus, viruses, anaerobic pathogens are evinted in some cases.

In the pathogenesis of an anef, a certain role is played by a decrease in the body's adaptive abilities to cold, sharp seasonal fluctuations in the conditions of the external environment, an alimentary factor, a disruption of nasal respiration, etc. Thus, for the occurrence of an angina, there is not enough pathogenic microorganisms to occur, but should be the one-time impact of exogenous and endogenous factors in Combining with a decrease in the resistance of the macroorganism. The development of angina occurs by the type of allergic-hyperairgic reaction. The allergic factor can serve as a prerequisite for the occurrence of such complications such as rheumatism, acute jade, polyarthritis and other diseases that have an infectious allergic nature.

Most often amateur almonds are affected, much less frequently, the pharyngeal, paternal, Gundy almonds. Often the disease of the tonsils are directly dependent on the state of the teeth, the oral cavity; Angina can be combined with the lesion of the gum mucosa, cheeks, accompany a number of common severe diseases.

Depending on the severity of the disease, the nature of morphological changes of the tonsils is allocated several types of angine:

Catarial angina. The easiest form of the disease. The inflammatory process is limited to defeat only the mucous membrane of the sky almonds.

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

Clinical picture. Farlingoscopically defines the pronounced hyperemia of the mucous membrane, covering almonds, arms (Fig.83). The soft panel and the mucous membrane of the rear wall of the pharynx is not changed, which allows you to differentiate this shape of an angina from pharyngitis. The tongue is dry, covered by a raid. Often there is a slight increase in regional lymph nodes. The course of such an angina is favorable and the disease ends after 3-4 days.

Fig.83. Catarial angina.

Follicular angina. The heavier shape of the angina flowing with the involvement in the process of not only the mucous membrane, but also applies to follicles.

Symptoms. The disease usually begins with an increase in body temperature up to 38-39 about C. A pronounced throat pain appears, increasing when swallowing, often irradiages in the ear. The total reaction of the body is also expressed - intoxication, headache, general weakness, fever, chills, sometimes pain in the lower back and joints. In blood, neutrophilic leukocytosis is noted, the ESO can be accelerated to 30 mm / hour.

Clinical picture. Farlingoscopically, in addition to the pronounced swelling and redness of the Sky almonds themselves and the surrounding fabrics on the background of a sharp hyperemia, a yellowish-white color of the point, 1-2mm, corresponding to the ventulous follicles (Fig.84). The duration of the disease is usually 6-8 days.

Fig.84. Follicular angina.

Treatment. The same as with lacunar angina.

Lacooner aneg. Heavy disease, inflammatory process captures deeper almond departments. Under the influence of Streptococcus, the epithelial swelling arises in the depths of Lakun Almonds, then necrosis of the epithelium both on the surface of the almonds and in the depths of the lacuna. There is a lunch of the epithelium, the wound surfaces appear on the mucous membrane, fibrous raids are formed, located along the lacuna and near their mouths. Hence the name of this kind of angina - lacunar.

Symptoms. Strong sore throat when swallowing food and saliva, headache, weakness, breakdown, chills, sleep disruption, body temperature increase to 38-39 ° C.

Clinical picture. When examining the mouth of the pharynx, swells, swelling almonds, the mucous membrane of the almonds are hypereminated, on the surface of the almonds near the mouth of the Lakun, grayish-white raids are visible (Fig. 85). Regional lymph nodes, located behind the angle of the lower jaw, are preserved, they are painful and increased in size. As the disease develops, the nodes are reacting deeply along the outdoor jugular vein. Often, the same patient can simultaneously observe the signs of follicular and lacunar angina. The duration of the disease is 6-8 days.

Fig.85. Lacooner angina.

Treatment. It is usually carried out outpatient at home with the insulation of the patient and call a doctor to the house. In severe cases, hospitalization in the infectious department is shown. It is necessary to observe strict bed regime in the first days of the disease, and then home, with restriction of physical exertion, which is necessary both in the treatment of the disease itself and for the prevention of complications. The patient is distinguished separate dishes and objects of care. Children, as the most susceptible to the sore, are not allowed to the patient.

The basis of therapy in the treatment of angins is the preparations of the penicillin group, to which the most sensitive streptococci. It is necessary to take antibiotics at least 10 days. Most often antibiotics resistant to beta lactamases (Augmentin, Amoxiclav) are prescribed. In case of intolerance of penicillin, other groups of antibiotics are used, in particular cephalosporins and macrolides. It is also advisable to appoint antihistamine drugs. Recommended rich warm drink. Locally, it is possible to apply an inhalation antibiotic - bioparox. Plugs are prescribed with warm grasses with warm grasses (sage, chamomile, calendula, etc.), soda solution, furaticiline, warming compresses on the submandibular region. Perhaps the appointment of salicylates (aspirin), analgesics, mucolithics, immunostimulating drugs, polyvitamins. The bed mode is recommended 7-8 days. The term of disability is equal to an average of 10-12 days.

Diseases of pharynx and larynx include sharp and chronic pharyngitis, laryngitis and tonsillites.
One of the most frequent and known to each adult person is a painful state is the sharp catarrhal inflammation of the throat. It is noted mainly in autumn and spring. Most often, such states are observed in people suffering from chronic pathologies by the Lor organs, accompanied by a violation of the nose passability, as a result of which breathing mouth. At the same time, the mucous membrane of the rodoglotka and the larynx is forced to directly contact with cold air, often, especially during the period of Mass Sali diseases containing pathogens.

Inflammatory changes in the throat and larynx are most often caused by viral infection, significantly less often with bacteria. The most active viruses attack the body during the period of reducing its resistance and the general weakening of it - for example, after supercooling, when overwork, after long-term treatment with antibiotics, etc.
Inflammatory throat processes can be combined with inflammatory processes in the nose, trachea or bronchi. Often, symptoms of the disease are observed first from the side of the throat, and later the signs of malaise from other bodies are joined.
Of the inflammatory diseases of the pharynx and larynx, which are successfully treated with modern techniques, the otolaryngologists of our medical center can be allocated as follows:

Inflammation of almonds (tonsillitis):

Inflammation of the pharynx (pharyngitis):

• acute
• chronic

Inflammation of the larynx (laryngitis):

The main symptoms of the catarrhal inflammation of the throat are the feeling of dryness, burning and tingling, the pain during swallowing, temperature rise, weakness, malaise, headache can be joined. In some types of acute pheeliness, the increase can be joined and pain in the field of submandibular lymph nodes. Perhaps the occurrence of spelliness - dysphony. Usually all these symptoms in the absence of complications pass quite quickly, after 4-5 days.

However, in the absence of timely and rational treatment, as well as in improper self-medication, acute catarrhal inflammation in the throat can be delayed and proceeding into a chronic form, to spread to neighboring ENT organs and respiratory organs (trachea, bronchi, pulmonary tissue), lead to various complications.
Therefore, it is so important in any case of sharp inflammatory phenomena in the throat in a timely manner to apply for qualified medical care. ENT doctor will put the correct diagnosis and will choose the correct treatment tactics, which will make it possible to cure inflammatory diseases of the throat as quickly and fully and fully, as well as avoid their complications associated with them and further health care. This is especially important in childhood, because children are most susceptible to inflammatory diseases and respiratory tract infections and ENT organs, and possible complications can affect their growth and development.

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

Preventive and therapeutic measures conducted by the specialists of our clinic, as well as recommendations for the prevention and prevention of diseases of the ENT authorities will help you as possible to meet with sore throat.

MILITARY-MEDICAL ACADEMY

Department of Otolaryngology Ex. № _____

"I argue"

Vrid Chief of the Department of Otaginolaryngology

Colonel of medical service

M. Govorun.

"____" ______________ 2003.

lecturer of the Department of Otolaryngology

candidate of Medical Sciences

major Medical Service D.

Lecture No. 18.

by otolaryngology

on the topic: "POWDER DISEASES. Abscesses pharynx "

For students of the Faculty of Steering Medical Makeup

Discussed and approved at the meeting of the Department

protocol number ______

"___" __________ 2003

Clarified (supplemented):

«___» ______________ _____________

Inflammatory diseases of the pharynx.

Abscess pharynx.

Literature

Otolaryngology / Ed. I. B. Soldatova and V. R. Gofman. - SPB., 2000.- 472 C.: IL.

Elander B.V. Operational otorinolaryngology. -Alma-Ata, 1959, 520 p.

Soldatov I.B. Lectures for otorinolaryngology. - M., 1990, 287 p.

Tarasov D.I., Minkovsky A.H., Nazarova G.F. Ambulance and emergency assistance in otorhinolaryngology. - M., 1977,248c.

Schuster MA Emergency care in otorinolaryngology. - m. 1989, 304 p.

Diseases of GLAGE

Inflammatory diseases of the Glotka

Angina

Angina- acute inflammation of the lymphadenoid tissue of the pharynx (almonds), which is considered as a common infectious disease. Angina can occur hard and give a variety of complications. More often there are angins of palatal almonds. Their clinical picture is well known. These angins are differentiated from diphtheria, scarletins, specific angins and lesions of almonds with common infectious, systemic and oncological diseases, which is very important for appointing adequate urgent therapy.

Angina Pipper Almonds (acute adenoitis). This disease is typical for childhood. It occurs more often simultaneously with sharp respiratory viral diseases (ORVI) or with angina skynote almonds and in these cases usually remains unrecognized. Adenoiditis is accompanied by the same changes in the overall state, like angina. The main clinical signs are a sudden violation of free nasal breathing or its deterioration, if it was not normal, a runny nose, a feeling of laying the ears. There may be cough and throat pain. In case of inspection, the hyperemia of the rear wall of the pharynx, flowing down the mucinous-purulent separated. Sulfing almond increases, swelling, hyperemia of its surface appears, sometimes raids. By the time of the maximum development of the disease, the continuing 5-b days, changes in regional lymph nodes are usually noted.

Adenoids should be differentiated primarily from caps of abscesses and diphtheria. It must be remembered that with the appearance of symptoms of acute adenoiditis, king, rubella, scarletin and cough can begin, and if the headache is joined, meningitis or polio.

Angina of the paternal almonds. This kind of angin meets much less frequently of its other forms. Patients complain of pain in the root of the tongue root or throat, as well as when swallowing, tonging the language is painful. The tongue almond blushes and swells, raids can appear on its surface. At the time of the pharyingoscopy, pain is performed with a pressure with a spatula on the back of the tongue. General violations are the same as with other angins.

If the inflammation of the tongue almond takes a phlegmosis character, the disease occurs is more severe with high body temperature and the spread of eulinary-inflammatory changes to the outer departments of the larynx, primarily on the native. The lymph nodes of the neck increase and become painful. In this case, the disease must be differentiated from the inflammation of cysts and ectopied tissue of the thyroid gland in the root of the language.

Treatment. With the development of any angina, which is an acute infectious disease that may cause serious complications, it is necessary to immediately begin treatment. Periodic antibiotics of the penicillin row (with intolerance - macrolides) are prescribed (with intolerance - macrolides), food must be gentle, it is necessary to drink abundant drinking, vitamins. With severe thread, the anesthes prescribe strict bed regime and intensive parenteral antibiotic therapy, primarily penicillin in combination with desensitizing drugs. If necessary, apply the antibiotics of a wide range of action (cephalosporins, aminoglycosides, fluoroquinolones, metrged).

As for local treatment, it depends on the localization of inflammation. With adenoidits, vesseloring drops are prescribed (naphtizin, galazoline,), protorgol. With angina, the skyless and paternal almonds are warm dressings or compress on the neck, rinse 2% solution of naic acid or sodium bicarbonate, a solution of furacin (1: 4000), and the like.

Anglary of the peptic-film (Simanovsky). The causative agents of the ulcer-film angina are the spherose-like wand and the mouth of the oral cavity in symbiosis. After the short-term phase of the catarrhal angina on the almonds, superficial, easily removable whitish-yellowish raids are formed. Less often such raids also appear in the oral cavity and sip. Ulzes remain on the site of the tight raids, usually superficial, but sometimes deeper. Regional lymph nodes on the side of the lesion increase. Pain feelings are not strong. Body temperature is normal or subfebrile. There may be a smell of mouth, associated with necrotic changes in the bottom of the yazv. In assessing the clinical picture, it should be borne in mind that occasionally there is a lacunar form of the disease, similar to ordinary angina, as well as bilateral lesions of the almonds.

The diagnosis is made on the basis of detection in smears from the top of the tonsils (films removed, prints from the bottom of the ulcer) fusospyrillate symbiosis. The peptic-film angina should be differentiated from diphtheria, lesions of almonds for diseases of blood-forming organs, malignant tumors.

For treatment with hydrogen peroxide rinsing (1-2 tablespoons per glass of water), a solution of rivocheol (1: 1000), furaticilline (1: 3000), potassium permanganate (1: 2000) and lubrication with 5% iodine alcohol solution, 50% solution Sugar, 10% solution of salicylic acid, diluted in equal parts of glycerol and alcohol, 5% formalin solution. In the event of clinical signs of secondary infection, antibiotics are prescribed.

Angina with infectious mononucleosis. This is a general disease of viral etiology, starting to acutely with high body temperature (up to 40 ° C) and usually pain in the throat. Most patients have a lesion of almonds that are significantly increasing in size. Often the third and fourth almonds are also increasing, which can lead to breathing. On the surface of the almonds, raids of various character and coloring, sometimes a bull-wagged look, usually easily removed. Anniversary smell of mouth appears. Spray syndrome is expressed by Narrow. The cervical lymph nodes of all groups increase, as well as the spleen and sometimes lymph nodes in other areas of the body, which become painful.

The diagnosis is set based on the results of blood test results, but in the first 3-5 days in the blood may not be characteristic. In the future, as a rule, moderate leukocytosis reflect, sometimes up to 20-30 L0 9 / l, neutropenia with the presence of a nuclear shift to the left and pronounced mononucleosis. At the same time, there is a certain increase in the number of lymphocytes and monocytes, the presence of plasma cells, varied in size and structure, with the appearance of peculiar mononuclear. High relative (up to 90%) and absolute mononucleosis with typical mononuclears in the midst of the disease and determines the diagnosis of this disease. It is differentiated from banal angins, diphtheria, acute leukemia.

Treatment is mainly symptomatic, prescribe the rinse of the throat with a solution of furacin (1: 4000) 4-6 times a day. When signs of secondary infection, antibiotics are prescribed.

Anglazozithosis. Currently, agranulocytosis is developing most often as a result of taking cytostatics, salicylates and some other drugs.

The disease usually begins acutely, and the body temperature quickly rises to 40 ° C, odors and throat pains are marked. In the sky almonds and the surrounding areas, dirty gray raids are formed with necrotic-gangrene disintegration, which often apply to the rear wall of the ointment, the inner surface of the cheeks, and in more severe cases there are in the larynx or the initial part of the esophagus. Sometimes there is a sharp smell of mouth. Occasionally almonds necrotize completely. When studying the blood, leukopenia is found to 1 10 9 / l and below, a sharp decrease in the number of neutrophils, eosinophils and basophils up to their absence with a simultaneous increase in the percentage of lymphocytes and monocytes.

Differential follows from diphtheria, simanovsky angina, lesions of almonds for blood diseases.

Treatment is to carry out intense antibiotic therapy (semi-synthetic penicillins), appointing corticosteroid preparations, pentoxyl, vitamins of group B, nicotinic acid. In severe cases, the leukocytic mass is transfused.

Diphtheria

Patients of diphtheria need emergency assistance in connection with the possibility of developing severe common complications or stenosis in the event of a gastal location of the lesion. Even if the patient's diphtheria is suggested, it is necessary to immediately hospitalize in the infectious department. Currently, adults are sick diphtheria at least and more hard than children.

The most often occurs the pharynx difftheria. It should be remembered that the light forms of pharmacy of the pharynx may flow under the guise of lacunar or even a catarrhal angina at a low or normal (in adults) body temperature. The raids on the surface of hyperemic almonds first tender, film, whitish, easily removed, but soon they acquire a characteristic look:

they go beyond almonds, become dense, thick, grayish or yellowish. The raids with difficulty are removed, after which the erosion surface remains.

During the propagation of diphtheria, the violation of the overall state of the patient is more pronounced, the film overlay is also discovered in the throat, the nasopharynx, sometimes in the nose, and the disorders of the nasal respiration and the suction discharge from the nose are noted. However, the distribution of the process is spread more often with the development of true cereals. The pastosity of the subcutaneous fatty fiber of the neck is also detected.

The toxic form of diphtheria begins as a common acute infectious disease that flows with a sharp increase in body temperature, headache, sometimes vomiting. A characteristic feature is an early appearance of edema in the area of \u200b\u200bzea and soft tissues of the neck. The cervical lymph nodes are also increased and painful. The face is pale, pastoral, the succulent discharge from the nose, the smell of mouth, cracks on the lips, bellows. Pares are developing in late stages of the disease. The hemorrhagic form is rare and occurs very hard.

The diagnosis in typical cases can be installed in a clinical picture, in the remaining majority, bacteriological confirmation is necessary. The best is the study of the sweeps of the raids and films, in the absence of strokes from the surface of the almonds and from the nose (or from the larynx during the hydrangean localization). The material from the pharynx take on an empty stomach, and before that should not rinse the throat. Sometimes diphtheria wand detect immediately on the basis of only bacterioscopy smear.

The diphtheria of the region and pharynx area should be differentiated from banal angins, phlegmonous angina, thrush, simanovsky angina, necrothic angina, including Scarlantine; Hemorrhagic form should be distinguished from the lesions of the area of \u200b\u200bthe zea associated with diseases of the blood-forming organs.

Difteria of the larynx (true croup) arises as an isolated lesion mainly in children of nursery and is rare. More often, the lads are amazed with the common form of diphtheria (downward croup). Initially, catarrhal laryngitis is developing with violation violation and barking cough. The body temperature becomes subfebrile. In the future, the overall state of the patient is worsening, Aphony develops, cough becomes silent and signs of breathing difficulties appear - inspiratory stridor with the increase in the "compliant" beds of the chest. When the stenosis is strengthened, the patient is disturbed, the skin is covered with cold later, pale or cyanotic, rapid pulse or arrhythmical. Then gradually comes the stage of asphyxia.

The raids appear first within the opposite of the larynx, then in the zone of the voice slot, which is the main cause of the stenosis. Film-cheese-yellowed or grayish raids are formed, but in the light shapes of the diphtheria, they may not appear at all.

The diagnosis must be confirmed by bacteriologically, which manages not always. The diphtheria of the laryngeal should be differentiated from false cereals, laryngitis and laryngo-trachetes of viral etiology, foreign bodies, tumors localized at the level of voice folds and below, plug abscesses.

Nasal difftheria as an independent form is found quite rare, mainly in young children. In some patients, only a clinical picture of catarrhal rhinitis is detected. Characteristic films, after rejection or removal of which erosion remains, are not always formed. In most patients, the hostess of the nose is one-sided, which makes it easier to establish a diagnosis that must be confirmed by the results of the microbiological research. The nose diphtheria should be differentiated from foreign bodies, purulent rhinosinuitis, tumors, syphilis, tuberculosis.

Features of the diphtheria of the respiratory tract in adults. The disease often proceeds in severe toxic form with the development of a groove descending into the trachea and bronchi. At the same time, in the initial period, it may be erased in nature and disguised by other manifestations of diphtheria, its complications or pathological processes in the internal organs, which makes it difficult to make a timely establishment of a diagnosis. With the criterion in patients with the toxic form of diphtheria, especially with a downward croup with the involvement of tracheas (and bronchi), already in early terms, the imposition of tracheostas is shown, and intubation is not an idea.

Treatment. When identifying any form of diphtheria and even if suspected of the presence of this disease, it is necessary to immediately begin treatment - the introduction of anti-informy serum. With severe forms, multiple injections are made to the regression of the raids. Serum is injected according to the method of charter: first, 0.1 ml of serum is subcutaneously introduced, after 30 minutes - 0.2 ml and after another 1-1.5 hours - the rest of the dose. With a localized light form of a sufficiently single administration of 10,000-30,000 me, with a common - 40,000 ME, with toxic form - up to 80,000 me, with a diphtheria descending criterion in children - 20,000-30,000 serum me. For two years, the dose is reduced by 1.5-2 times.

Painty patients need oxygen therapy and correction of acid-base state. It is advisable to parenteral administration of corticosteroid hormones (taking into account the age of the patient) and the purpose of sedative preparations, and in connection with frequent complications of pneumonia - and antibiotics. If there is a stenosis of the larynx and over the next hours after the start of treatment with anti-informy serum there is no positive effect, then intubation or tracheostomy is needed.

Tuberculosis (pharynx, tongue root)

Patients with common, mainly exud-ulcer, tuberculosis of the upper respiratory tract may need emergency care due to sharp pain in the throat, dysphagia, and sometimes stenosis of the larynx. The defeat of the upper respiratory tract is always secondary in relation to the tuberculous process in the lungs, but the latter is not always diagnosed in a timely manner.

Fresh, recently developed tuberculosis of mucous membranes is characterized by hyperemia, infiltration, and often the swelling of the affected departments, as a result of which the vascular pattern disappears. Formed surface ulcers, with gear edges; Their bottom is covered with a thin layer of purulent separated white-gray painting. Ulcers first small, but soon their area increases; Merging, they capture large plots. In other cases, the damage to the affected areas is destroyed with the formation of defects of almonds, tongue or the sand. With damage to the larynx worsen the voice down to Afony. The state of patients with medium gravity or severe, the temperature of the body is high, ESP is elevated, there is leukocytosis with an increase in the number of pulp neutrophils; The patient notices the weight loss.

The diagnosis is established on the basis of the clinical picture and detecting the tuberculosis process in the lungs (radiography). With peptic forms, a good non-traumatic method of fast diagnostics is a cytological examination of the scraping or imprint from the surface of the ulcer. In case of obtaining a negative result and an unclear clinical picture, biopsy is produced.

Tuberculosis (predominantly exudative peptic) area of \u200b\u200bthe oz and the pharynx should be differentiated from acute banal angins and simanovsky's angins, faces, agranulocyte angina. Located in the same form of tuberculosis of the larynx, you need to distinguish from influenza submembratus septic laryngitis and abscesses of larynx, herpes, injuries, fabrics, acute insulated pemphus, lesions in diseases of the blood-made organs.

Emergency goal - elimination or at least a decrease in pain syndrome. To do this, intracutaneous blockages of 0.25% novocaine solution are produced. Local painkillers are in the anesthesia of the mucous membrane using pulverizations or lubrication with 2% diene solution (10% cocaine solution) with adrenaline. After that, the ulcerative surface is lubricated with an anesthetic mixture of zobane (0.1 g of menthol, 3 g of anesthesine, 10 g of tannin and ethyl dusty alcohol) or Voznesensky (0.5 g of menthol, 1 g of formalin, 5 g of anesthesine, 30 ml of distilled water) . Before taking food, you can rinse the throat with a 5% novocaine solution.

At the same time, the overall tuberculosis treatment is beginning: streptomycin (1 g / day), vyomycin (1 g / day), rifampicin (0.5 g / day) intramuscularly; Inside the isoniazide is given (0.3 g 2 times a day) or protion mideos (0.5 g 2 times a day), etc. It is necessary to assign at least two drugs of different groups.

Abscess pharynx.

Paragonzillitis, paratonulate abscess

Parapesillitis of palatine almonds. Paratonzillitis - inflammation of the inflammation of the almond fiber arising in most cases due to the penetration of infection beyond its capsules and with complication of an angina. Often this inflammation ends with abscess. Occasionally, paratrozyllitis may have a traumatic, odontogenic (rear teeth) or bean origin with intact almond or be a consequence of hematogenous drift of pathogens in infectious diseases.

In its development, the process passes the stage of exudative-infiltrative, abscess and involution. Depending on where the zone of the most intense inflammation is located, the front, frontion, rear (retrotonzillar) and outer (side) paratrozillitis (abscesses) are distinguished. Most often there are insertion (supratonzillary) abscesses. Sometimes they can develop on both sides. The tonsillar phlegmonous process in the olomindal fiber may develop during an angina or shortly after it.

Parapesillites (abscesses) are usually accompanied by fever, chills, general intoxication, strong throat pains, usually with irradiation in the ear or teeth. Some patients do not take food because of pain and do not swallow saliva, which flows from their mouth, do not sleep. In addition, they may have dysphagia with throwing food or fluid in the nasopharynx and the nasal cavity. A characteristic symptom is triumism, which makes it very difficult to inspect the oral cavity and pharynx; Also noted the smell of mouth, the forced position of the head with a tilt forward and in the sore side. The submandibular lymph nodes increase and become painful during palpation. Eso and leukocytosis are usually increasing.

With pharyngoscopy, the patient with paragonzillitis usually detects that the most pronounced inflammatory changes are localized near the almonds. The latter is increased and offset, squeezing inflamed, sometimes sweeping tongue. The process is involved both the mild sky, the mobility of which is disturbed as a result. With pea-redger paratrozillite, the shifted down the book and the pin almond can be covered with anterior hand.

The rear paratonic abscess develops near the rear sky alignment or directly in it. It is inflated, thickened, sometimes swells, becoming almost vitreous. These changes to one degree or another apply to the adjacent part of the soft sky and the tongue. The regional lymph nodes will sweat and become painful, often rejects the corresponding damn-shaped cartilage, there is dysphagia, triumph can be less pronounced.

Lower paraphalitis is rare. The abscess of this localization is accompanied by strong pains when swallowing and progressing the language, irradiating in the ear. The most pronounced inflammatory changes are observed at the base of the sky-tongue handle and in the furrowes separating the sky almond from the root of the tongue and the paternal almond. The prudent language of the language is sharply painful when pressing the spatula and hyperemic. Inflammatory swelling with the swelling or without any applies to the front surface of the nastestrian.

The outer paratronzillar abscess is most dangerous, in which the suppuration occurs laterally almonds, the abscess cavity is deeply and difficult to be available, more often than with other forms, respiratory decompensation occurs. However, he, like the lower paratronzillitis, is rare. Almonds and the surrounding soft tissues are relatively little changed, however, the almond is protruding. The soreness during the palpation of the neck with the appropriate side, the forced position of the head and triumism, is developing regional cervical lymphadenitis.

Paramatonzillitis should be differentiated from phlegmonous processes arising from blood diseases, diphtheria, scarletins, facets of the throat, abscesses of the tongue almonds, phlegmons of the language and the bottom of the oral cavity, tumors. When ripening and favorable flow, paratronzillar abscess on the 3-5th day can open independently, although often the disease is delayed.

According to V. D. Dragomyretsky (1982), complications of parapharic are observed in 2% of patients. These are purulent lymphadenitis, reprahydic, mediastinite, sepsis, vapotitis, phlegmon bottom of the oral cavity, thrombophlebitis, jade, peelitis, diseases of the heart, etc. With all paratrozillites, antibiotic therapy is shown. It is advisable to appoint semi-synthetic penicillins, as well as various combinations of wide range antibiotics, metrogil ..

Paragonzillites in children are characterized by certain features, which are sick, although rarely, since the breast. The smaller the child, the harder there may be a disease: with a high body temperature, leukocytosis and an increase in social, accompanied by toxicosis, diarrhea and difficulty breathing. Complications are developing rarely and normally favorably.

When the patient's patient arrives in the hospital, it is necessary to immediately define therapeutic tactics. In case of primary paratrozillite without signs of ABS, as well as the development of the disease in young children, medication is shown. Antibiotics so patients are prescribed in the maximum age doses.

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

The main method of treatment of paratonic lines and mandatory - paratonic abscesses is their autopsy. With the most common reserved form of paratrozillitis, abscess is opened through the upper part of the necological paternal (front) alumni.

The incision should be long enough (wide), but not deeper than 5 mm. It is permissible to move on a large depth only with a blunt way with the help of Corncang towards the almond capsule. Under the rear abscesses, the incision should be carried out vertically, and with front-line - through the lower part of the gentle-tongue handle, after which it is necessary to penetrate the duck and a book on 1 cm or go through the lower pole of almonds.

The typical opening of the front abscesses is taken or at the point of translucent pus, or in the middle of the distance between the edge of the tongue base and the rear teeth of the upper jaw on the side of the lesion, or at the place of intersection of this line with a vertical spent on the sky-tongue handicuit. To prevent the injury of vessels, the scalpel blade is recommended at a distance of 1 cm from the tip to wind by several layers of sticky plastering or impregnated with a furaticiline solution with a gauze strip (used for the tamponade of the nose cavity). Only a mucous membrane should be cut, but to move deeper with a blunt way. Increased in the abscess at its opening is determined by the sudden cessation of the resistance of the tissue to the promotion of Corncang.

At the opening of the rear abscesses make a vertical incision behind the almonds in the place of the greatest protrusion, but it is first necessary to make sure that there are no arterial ripples in this area. The tip of the scalpel should not be sent to the rear agent side.

The incineration is usually produced under surface anesthesia, carried out by lubricating a 3% solution of dicaine, which, however, is ineffective, therefore it is pre-appropriate to produce premedicated by Promero. Reduces pain sensations when opening an abscess sublipal administration of novocaine or lidocaine solution. After opening the abscess, the move in it should be expanded, spreading the branches of the entered Corncang to the sides. In the same way, the velocked hole is expanding and in cases where the pnoe is not obtained as a result of the permission.

The radical method of treating paratrozillite and paratrozillic abscesses is abscess monoxillectomy, which is carried out with frequent angins in history or re-developing paratrozillitis, poor drainage of the opened abscess, when its course is delayed if bleeding occurred due to the incidence or spontaneously as a result of the vessel arrosion, as well as with other tonsilogenic complications [Nazarova G. F., 1977, and others]. Tonsillectomy is shown at all side (outer) abscesses. After the already produced incidence of tonsillectomy is necessary, if during the day after that there is no positive dynamics, if the abundant isolation of the pus is continued from the cut or if the scratch of the abscess is not liquidated. The contraindication to abscess monitorcilactomy is the terminal or very severe condition of the patient with sharp changes in parenchymal organs, brain vessel thrombosis, spilled meningitis.

Acute inflammatory diseases of the pharynx and larynx

Acute inflammation of the pharynx sharp inflammation of the nasopharynk TO linen.The main complaints of patients are the unpleasant sensations in the nasopharynx - burning, tingling, dryness, often accumulation of the secrecy of the secret; Headache, localized in the occipital region. Children often have a disruption of breathing and bent. With the predominant localization of the process in the area of \u200b\u200bthe mouth of hearing tubes, there is pain in the ears, a decrease in the hearing of the type of sound engineering. In adults, this disease flows without a sharp deterioration in the overall state, and in children the temperature reaction is significant, in particular, in cases where inflammation applies to the larynx and the trachea. Painful cervical and occipital lymph nodes are increased. Differential diagnosis It should be carried out with diphtheria noodopharygitis (dirty-gray raids are usually visualized; the study of nasopharynk smear usually allows you to clearly establish the diphtheria nature of the lesion); with congenital syphilitic and gonococcal process (here other signs are the following signs - gonorial conjunctivitis, with luece - hepatosplegegaly, characteristic skin changes); With diseases of a wedge-shaped sinus and a lattice labyrinth cell (here, a radiographic study helps to establish the correct diagnosis). Treatment. Carry out infusion into every half of the nose of 2% (for children) and 5% (for adults) of the protargol solution or collargol 3 times a day; In pronounced inflammation, a 0.25% solution of nitric acid silver is poured into the cavity of the nose, and then the vasoconducting droplets. Conducting general anti-inflammatory and antibacterial treatment is justified only with a pronounced temperature reaction and the development of complications. It is shown the appointment of polyvitamins, physiotherapy - quartz on the soles of the feet, UHF to the nose area.

Acute inflammation of the octopling (pharyngitis) Clinic. With acute pharyngitis, patients are most often imposed complaints of dryness, fellowship and soreness in the throat. Pain may radiate in the ear when swallowing. With pharyngoscopy, hyperemia and swelling of the oral mucosa are determined, an increase and bright hyperemia of lymphoid granules located on the rear wall of the pharynx. The pronounced forms of acute pharyngitis are accompanied by an increase in regional lymph nodes, in children in some cases - a temperature response. The process can be distributed both up (involving the nasopharynk, the mouth of the hearingpipes) and down (on the mucous membrane of the larynx and the trachea). The transition to chronic forms is usually due to the continuing impact of the pathogenic factor (professional harm, chronic somatic pathology). Differential diagnosis In children, they spend with a hymealic pharyngitis, syphilitic defeat. In adults it is necessary to consider pharyngitis (in the case of its non-infectious genesis) as a manifestation of the exacerbation of chronic somatic pathology, primarily the disease of the gastrointestinal tract (since the pharynx is a kind of "mirror", which reflects the problems in the organs below). Treatment It consists in the exclusion of irritating food, the use of inhalation and pulverizations of warm alkaline and antibacterial solutions, with a general response of the body shows the purpose of paracetamol, as well as abundant drinking liquid rich in vitamin C. With a pronounced edema, the purpose of antihistamine drugs is shown.

Angina

Among the clinicians, it is customary to divide all available forms of an angino on vulgar (banal) and atypical ..

Vulgar (banal) angina Vulgar (banal) angins are mainly recognized by pharyngoscopic features. For vulgar angins, the presence of four common features: 1) the pronounced symptoms of general intoxication of the body; 2) pathological changes in palatine almonds; 3) the duration of the process is not more than 7 days; 4) Bacterial or viral infection as a primary factor in etiology. Distinguish between their forms: Catarial angina It begins acutely, burning, perfense, a small pain when swallowing. In case of inspection, the tissue of almonds, the edges of the sky, almonds are spilled, the almonds are increased in the amount, places are covered with a film of the mucous-purulent exudate. Dry language, covered. Regional lymphouoslas are moderately increased. Follicular angina It is usually begins sharply with an increase in body temperature up to 38-39 0 s, sharp throat pain, increasing when swallowing, general phenomena of intoxication are more pronounced - headache, sometimes pain in the lower back, fever, chills, general weakness. In the blood of pronounced inflammatory changes - neutrophilee to 12-15 thousand, moderate roded shift to the left, eosinophilia, SE reaches 30-40 mm / h. Regional lymph nodes are increased and painful. With pharyngoscopy - spilled hyperemia and infiltration of a soft sky and a mudget, an increase and hyperemia of palatal almonds, numerous magic follicles are determined on their surface, which are usually revealed for 2-3 days from the beginning of the disease. Lacooner aneg It takes more hard. In case of inspection on the hyperemic surface of the sky, almonds, yellowish-white raids are observed, easily removable with a spatula, two-way localization. Incixing phenomena are more pronounced. Fibrinic (fibrinic-film) ahinka It is a type of two previous anneas and develops when the burst follicle follicles or fibrinous raids form a film. Here it is necessary to conduct a differential diagnosis with diphtheritic damage (based on the data of the bacteriological examination of the smear). Treatment. The basis of rational treatment of angin consists of compliance with the gentle regime, local and general therapy. In the first days, the bed regime is required, the allocation of individual dishes, care products; Hospitalization in the infectious department is necessary only in severe and diagnostically obscure cases of the disease. Food should be soft, unprazing, nutritious, abundant drink will contribute to disintellation. When prescribing drugs, the complexity of the approach is necessary. The basis of treatment is antibiotic therapy (the advantage is given to antibiotics of a wide range of action - semi-synthetic penicillins, macrolides, cephalosporins), a rate of 5 days. The purpose of antihistamine preparations will help to stop the phenomena of edema, which mainly provokes pain syndrome. With pronounced intoxication, it is necessary to monitor the condition of cardiovascular and respiratory systems. In terms of local treatment, it is advisable to use drugs that provide local anti-inflammatory, anesthetic and antiseptic effect (septol, streptils, neo-angine). Rinsing with preparations that have a comprehensive action (OCI, Texetidine) are also highly effective. Phlegmonous angina (inttenonzillar abscess) is relatively rare, usually as a consequence of the purulent melting of the almond section; This defeat is usually one-sided. In this case, the almond is hyperemic, increased, the surface of it is tense, palpation is painful. Small inttenzillary abscesses usually revealed spontaneously and can proceed asymptomatic, but mostly it takes place in the breakthrough of the mouth to the oral cavity, the parapesillar abscess clinic is developing in paratrozillary cells. The treatment consists of a wide autopsy of the abscess, with recurrence, tonsillectomy is shown. Herpety angina It develops mainly in children of younger, high-contagon, and usually applies to air-droplet, less often - fecal-oral. Caused by adenoviruses, influenza virus, coke virus. The disease begins sharply, from fever up to 38-40 0 s, pain in the throat when swallowing, head and muscle pain develops, it is also vomiting and diarrhea as signs of general intoxication. With pharyngoscopy - in the field of soft sky, spilled hyperemia, on the entire surface of the oral mucosa, there are small reddish bubbles that are resolved after 3-4 days. To atypical angina applies first of all angina Simanovsky-Wenzan (The pathogen is the symbiosis of the spindle-shaped stick and spirochetes of the oral cavity), the basis for setting the correct diagnosis here is the microbiological storing of the smear. The differential diagnosis of such anneas should be carried out with the diphtheria of the pharynx, syphilis of all stages, tuberculous lesion of the almonds, systemic diseases of the blood-forming organs, which are accompanied by the formation of necrotic masses in the field of almonds, with tumors of tonsils. Angina Naso-cell almonds (acute adenoitis) is mainly found in children, which is associated with the growth of this almond in childhood. The causative agent can be both a virus and microorganism. In older children, with acute adenoy, there is a slight disorder of the general condition, the subfebilitation, the first symptom is the feeling of burning in the nasopharynk, and then the disease occurs as acute rhinitis, i.e. The difficulty of nasal breathing, watery, mucous membranes, and subsequently purulent discharge from the nose appear. Pains in the ears, bellows, in some cases it is possible to join the acute average otitis. With pharyngoscopy and rear rososcopy, the bright hyperemia of the mucous membrane of the rear wall of the pharynx is observed, according to which the mucous-purulent discharge flows from the nasophary. The nasopharynk almond is increased in size, it is hypered, it has point or solid raids on its surface. In early age children, acute adenoiditis begins suddenly with an increase in body temperature to 40 0 \u200b\u200bC, often with pronounced inxication-vomiting, liquid stool, symptoms of brain shell irritation. After 1-2 days, the difficulty of nasal respiration, discharge from the nose, an increase in regional lymph nodes appears. Complications of adenoiditis - catarrhal or purulent average otitis, retrofaring the abscess, the suppuration of regional lymph nodes. Differential diagnosis in children are carried out with children's infectious diseases, in which inflammation is possible in the nasopharynxal almond. Treatment, the general and local, spend on the same principles as with an angina, acute rhinestone. At heart age it is necessary to prescribe vesseloring drops into the nose before each feeding. The following are less frequent angns. Defeating side rollers - Usually combined with acute adenoiditis or occurs after the operation of tonsillectomy. For this species, angina is characterized by the appearance at the beginning of the development of the pain in the throat with irradiation in the ears. For angina Tubar Almonds (which is also basically noted during acute inflammatory diseases of the pharynx) a typical sign, along with sore throat, irradiating in the ears, is the labeling of the ears. The correct diagnosis is easy to install at rear rososcopy. Angina of the paternal almonds It is found mainly in the middle and old age, and the painfulness is characteristic of tongue and its palpation. Diagnostics are carried out with a laryngoscopic examination. It is important to remember that such terrible complications of the paternal sore throat, as swelling and stenosis of the larynx, are sometimes observed the glossite and phlegmon bottom of the oral cavity. For a general practitioner, it is important to correctly and promptly recognize the local complications of an angino, requiring consultations and treatment of an otorinolangologist specialist. This is first paratonzillitwhich develops a few days after the exacerbation of chronic tonsillitis or an angina. The process is most often localized in the front or reserved department between the capsule of the sky almond and the upper part of the front pacific. His rear localization is between almond and rear handle, bottom - between the lower pole and the side wall of the pharynx, the lateral - between the middle of the almond and the side wall of the pharynx. A typical clinic is the emergence of one-sided pain when swallowing, which with the development of the process becomes constant in nature and is sharply intensified when swallowing. Trices arises - the tonic spasm of chewing muscles, the speech becomes bent and an alignant. As a result of regional cervical lymphadenitis, pain reaction occurs when head turns. The transition of paraphalitis from the edema, the infiltrative phase in the absced usually occurs on the 3-4 days. On the 4-5th day, an independent opening of an abscess can occur - either into the oral cavity, or into parafaring aleacional space, which leads to the development of severe complication - parapharing. At the beginning of the disease before the abscess breakthrough with pharyngoscopy, the asymmetry of the 13th, due to the protrusion, most often of the superdalist area, hyperemia and infiltration of these tissues are noted. In the area of \u200b\u200bthe greatest protrusion, it is often possible to see thinning and yellowish edema - the place of the smoking breakthrough of the pus. In obscure cases, the diagnostic puncture is carried out. Differential diagnostics are carried out with diphtheria (however, for this infection, triumph is uncharactertene and often there are raids) and scarletina, in which the characteristic rash is developing, as well as indications of typical epidanamnez. Tumor lesions of the pharynx usually flow without increasing the temperature and severe throat pain. In the face of inflammation, which also flows without increasing the temperature and severe throat pain. In the face of inflammation, which also flows without a trismity, there are spilled hyperemia and swelling with a brilliant background of the mucous membrane on the mucous membrane with a glittering background, and bubbles are poured on the soft sky. Paragonzillitis treatment In the stage of infiltration and abscess, surgical is the opening of an ulotnik, regular emptying, according to the testimony - abscess-tonsillectomy. The scheme of complex treatment of purulent pathology is presented earlier.

Pilot abscessIt is usually found in small children due to the fact that the retrofaring (inseignant) space is filled with loose connective tissue with lymph nodes as expressed as much as possible in childhood. After 4-5 years, these lymph nodes are reduced. Symptomatics - Pain in swallowing, which, however, do not achieve such an extent as with paratonic abscess. In young children, these pains cause strong anxiety, a weakness, cry, sleep impairment, etc. Small patients refuse their breasts, cough, jerk milk through the nose, which is very soon entails a nutrition. Further symptoms depend on the reactivity of the body and the localization of the abscess. When it is located in the nasopharynk to the fore, there are breathing disorders, cyanosis appears, the inspiratory rapidness of the chest, the voice acquires a nasal shade. With a low position of the cap abscess, a narrowing of the entrance to the larynx is developing with an increasing respiratory impairment, which has a snoring character, which can later lead to the phenomena. With an even lower abscess location, symptoms of the esophagus and trachea appear. When viewing the oz, you can see a round or oval pillow-like swelling of the rear wall of the pharynx located on one (side) side and giving fluctuation. If the abscess is in the nasopharynk or closer to the entrance to the larynx, then it is unavailable by direct ferris, it is possible to identify it only at rear rososcopy or laryngoscopy, or palpatorially. With secondary plug abscesses, changes from the spine are joined to these symptoms, the impossibility of turning the head to the sides, the rigidity of the nape. Diagnostic valuable palpator examination. Differential diagnosis is carried out with a retrofaring tumor tumor (for example, lipoma), here the puncture will help properly diagnose. Treatmentsurgical.

Parafaringeal abscessThis type of abscess is a relatively rare complication of the inflammatory process in the almond or near-chain tissue. The most commonly occurred parafaringeal abscess as a complication of paratronzillary abscess. There is a picture of a long non-permitted paratronzillic abscess, when or did not occur in the spontaneous opening of an ulcer, or incoming incoming, or it did not lead to the desired result. The overall condition of the patient continues to deteriorate. High temperatures holds, leukocytosis increases in the blood, ESP increases. In pharyitingoscopy, there is a decrease in the swelling and protrusion of a soft sky in some cases, but the proportion of the side wall of the pharynx in the almond region appears. Protecting in the parafaring land area accompany changes from the neck. Along with increased and painful with palpation with lymphatic nodes, a more diffuse and painful swelling appears in the field of the angle of the lower jaw (both at the angle of the lower jaw and in the region of the mesh). If the specified swelling against the background of the degradation of the general condition of the patient is joined by pain in the course of the vascular beam, then it is necessary to think about the beginning of the development of the septic process. Occonditional abscess, not timely opened, entails further complications: sepsis is most often found due to involvement in the internal jugular vein process. With an abscess in the parafaring-plane space, the process may propagate up to the base of the skull. Distribution of the process of the book leads to mediastinitis. An purulent parotitis may also occur due to a breakthrough in the bed of the parole. Treatment Parafaringent abscess only surgical.

Gundy Angina - acute inflammation of the lymphadenoid tissue of the larynx (in the field of silence-hazardous folds, inter-space-shaped space, in morganic ventricles, pear-shaped sinuses and individual follicles). The disease can develop as a result of injury (in particular, foreign bodies), as well as the complication of ARVI. The patient complains of pain when swallowing, pain when changing the position of the head, dry throat. The phenomena of general intoxication are expressed moderately. Regional lymphadenitis is determined, usually one-sided. With laryngoscopy, hyperemia and infiltration of the mucous membrane of the larynx on one side or a limited area are revealed. Upon the protracted flow of the process, the formation of abscesses in the location of lymphoid fabric is possible. Treatment is the same as in acute catarrhal laryngitis, but in severe cases it is necessary to appoint massive antibiotic therapy. With significant stenosis, the imposition of tracheostas is shown. The patient must observe the regime that is gentle by the diet, useful alkaline inhalations. Anti-inflammatory therapy includes the introduction into the body of sulfanimamides, antibiotics; Mandatory use of antihistamine drugs.

Laryngitis sharp catarrhal laryngitisAcute inflammation of the mucous membrane of the larynx can be observed both as an independent disease (cold, too hot or cold food), chemical or mechanical stimuli (nicotine, alcohol, dusty and smoky air), professional harm, for example, excessive voice tension (strong cry, loud command ), and with common diseases, such as measles, cough, influenza, typhoid, rheumatism, etc. Clinical acute laryngitis is manifested by the occurrence of hoarseness, perversions, sore throats, the patient worries dry cough. Violation voices is expressed in varying degrees of dysfony, right up to Afony. The diagnosis of acute laryngitis is not difficult to deliver, based on the anamnesis, symptoms and characteristic hyperemia of the mucous membrane of the larynx. Differential diagnosis should be carried out with a false criterion (in children) and the damage to the larynx during diphtheria, tuberculosis, syphilis. The treatment must first provide for a strict voice regime, a diet with a restriction of acute, hot, cold food, alcohol, smoking. Highly efficient inhalations with antibiotic solution (fuzafungin 2 inhars 4 times a day), with the predominance of the edema component over inflammatory, it is advisable to appoint inhalations with hydrocortisone or the use of inhaler of the beclometazone of dipropionate 2 inhale 3 times a day, antihistamines are also used from local treatment - infusion In the larynx vegetable oil (peach, olive), hydrocortisone suspension.

Phlegmonous (infiltrative-purulent) laryngitisFlegmonous (infiltrative-purulent) Larygitis is relatively rarely either due to injury, or after the infectious disease (in children - cortex and scarlatine). The pathological process is involved with a submembricted layer, less often - muscular and bunding apparatus of the larynx. Patients complain of a sharp pain when swallowing, especially at the location of the infiltration in the field of the epiglotter and the damage-shaped cartilage. Regional lymphadenitis is palpable. With laryngoscopy, hyperemia and infiltration of the mucous membrane of the larynx, an increase in the scope of the affected area, sometimes with the areas of necrosis are revealed. There is a limitation of mobility of larynx elements. A total inflammatory response is expressed. Treatment is carried out in the hospital, taking into account the severity of the picture. With increasing phenomena, the stenosis is carried out by tracheostomy. Complex therapy is necessary with the inclusion of antibiotics, antihistamine drugs, according to indications - Mukolithics. In the presence of abscess, its treatment is only surgical in a specialized hospital.

Hondroperichondrite cartilage laryngesThe emergence of this pathology is associated with the infection of the cartilage and the superior to the skeleton of the larynx as a result of its injury (including after surgery). As a result of the suffered inflammation, necrosis of cartilage tissue may occur, the scarring, which leads to the deformation of the organ and the narrowing of its lumen. The clinical picture is determined by the localization of the inflammatory process and the degree of its development, during laryngoscopy, a hyperemic area is revealed with thickening to be tissues, their infiltration, often with the formation of a fistula. In addition to massive antibiotic therapy and hyposensibilization, physiotherapeutic treatment is a majority treatment - UV, UHF, microwave, ionogalvanization for larynx with calcium chloride, potassium iodide. The treatment of chondroperichondrites of the larynx must be carried out under a specialized hospital.

Podskaya LarygitSupporting laryngitis (false croup) is a type of acute catarrhal laryngitis, developing in a swinging space. It is observed in children aged 2-5 years against the background of acute inflammation of the mucous membrane of the nose or pharynx. Clinic False cereal is quite characteristic - the disease is developing suddenly among the night, the bout of the cough. Breathing becomes whistling, sharply difficult, expressed inspiratory shortness of breath. Nails and visible mucousse acquire a cyanotic shade. In case of inspection, there is an increase in soft tissues of the yapper, above and connectible spaces. The attack lasts from a few minutes to half an hour, after which the profuse sweat and the improvement of the state appears, the child falls asleep. Diagnostics is based on the clinical picture of the disease and data of laryngoscopy in cases where it is possible to perform. Differential diagnosis is carried out with true (diphtheria) crop. In the latter case, the suffocation develops gradually and does not debut acute rinoparyitis. Regional lymphadenitis is expressed. Typical manifestations - dirty gray raids in the throat and larynx. It is necessary to train parents of children who have similar states, a certain tactics of behavior. Usually these are children prone to laryngospasm suffering in diathesis. LEGAL EVENTS - Moisturizing and air ventilation in the room where the child is located; It is recommended to give warm milk, "Borjomi". Use distracting tools: on the neck mustard pieces, hot foot baths (no more than 3-5 minutes). In efficiency shows the imposition of tracheostas. Highland swelling It is not an independent disease, but only one of the manifestations of many pathological processes. Maudan's swelling is inflammatory and disgraining. The inflammatory swelling of the larynx may accompany the following pathological processes: a gentle angina, phlegmonous laryngitis, the abscess of the nastestrian, the incoding processes in the sip, the side of the spine, the root of the spine, the root of the language and soft tissues of the mouth. One of the frequent causes of the larynx swelling are injuries - firearms, stupid, stitching, cutting, thermal, chemical, foreign bodies. The traumatic swelling of the larynx can develop in response to surgical intervention in the larynx and neck, as a result of long-lasting top tracheobronchoscopy, due to long-term and traumatic larynx intubation, after radiation therapy for diseases of the neck organs. The abnormal swelling of the larynx as a manifestation of allergies occurs when idisincasia to some food products, medicinal and cosmetic drugs. This can also include angioemical swelling of Quinka, in which the swelling of the larynx is combined with edema and neck. Highland swelling can develop with diseases of the cardiovascular system, accompanied by the insufficiency of blood circulation II-III degree; Diseases of kidneys, liver cirrhosis, cachexia. Treatment in the swelling of the larynx is aimed at treating the main disease that led to the edema and includes dihydration, hyposensitizing and sedatives. First of all, the following appointments are appropriate with the inflammatory nature of the larynx swelling: 1) antibacterial therapy parenterally (pre-clarifying the portability of drugs; 2) a solution of semicolound 0.25% 2 ml in the muscle 2 times a day; Calcium gluconate solution is 10% intramuscularly depending on the degree of edema severity; 20 ml of 40% glucose solution, 5 ml of ascorbic acid solution intravenously drip 1 time per day; Rutin 0.02 g inside 3 times a day; 3) hot (42-45 0 c) foot baths for 5 minutes; 4) warming compress on the neck or mustard plants for 10-15 min 1-2 times a day; 5) With the cough, the occurrence of crusts and thick sputum - expectorant and diluting wets of the means (carbocyusein, acetylcysteine). Inhalation: 1 chimotrypsin vial + 1 ephedrine + 15 ml 0.9% sodium chloride solution, breathe 2 times a day to 10 minutes. Treatment should always be carried out in a hospital, since when increasing the difficulty of breathing through the larynx may require tracheostomy.

Acute tracheitis

. Typically, the disease begins with acute catarrhal rhinitis and naphorgitis and quickly applies to the book, covering the trachea, often and large bronchi. In other cases, large bronchi is involved simultaneously with the trachea. In this case, the clinical picture acquires the character acute tracheobronchita . The most characteristic clinical sign of acute banal tracheite is cough, especially strongly disturbing the patient at night and in the morning. With a pronounced inflammatory process, for example, influencing hemorrhagic trachelieThe cough is of a painful fitful character and is accompanied by a stupid slandering pain in Zeva and beast. Due to the pain with deep breath, patients are trying to limit the depth of respiratory movements, which is why the breathing is expected to compensate for the oxygen deficiency. The overall state of adults suffers a little, sometimes there is a subfebilitation, headache, a sense of breakdown, pain in the whole body. In children, the clinical picture proceeds sharply with an increase in body temperature up to 39 ° C. Dyspnea usually does not happen, with the exception of sharp heavy generalized Viral lesions of the SDP, in which there are pronounced general intoxication, a violation of cardiac activity, the oppression of the respiratory center.

The wet at the beginning of the disease is scarce, it is difficult to find it, which is explained by the stage of "dry" catarrhal inflammation. Gradually, it acquires mucous-purulent character, becomes more abundant and is more easily separated. Cough ceases to cause unpleasant scrubbing pains, the general condition improves.

With the usual clinical flow and timely treatment, the disease is completed within 1-2 weeks. Under adverse conditions, non-compliance with the prescribed regime, a non-time-started treatment and other negative factors, recovery is delayed and the process can go to the chronic stage.

Diagnostics the acute banal trachea of \u200b\u200bdifficulties does not cause, especially in cases of seasonal colds or flu epidemics. The diagnosis is established on the basis of a typical clinical picture and characteristic symptoms of catarrhal inflammation of the tracheal mucosa. Difficulties occur during influenza toxic forms when the inflammation of the respiratory tract should be differentiated with pneumonia.

Treatment almost identical to such with acute laryngitis. The prevention of complications in the pronounced forms of tracheoobronichite are great importance, for which the patient is prescribed antibacterial, immunomodulatory, a lining treatment with intensive vitamin (A, E, C) and disinfecting therapy. Preventive measures are particularly relevant on dusty production and in periods of influenza epidemics.

Chronic banal tracheitis

Chronic tracheitis is a systemic disease that is addicted to one degree or another all respiratory tract - a disease of a predominantly adult population of large industrial cities, people of harmful industries and abuse of harmful habits. Chronic tracheobronchites can act as complications of children's infections (measles, diphtheria, cough, etc.), the clinical flow of which was accompanied by sharp tracheitis and bronchitis.

Symptoms and clinical current. The main symptom of chronic tracheite is a cough, stronger in the night and morning. This cough is especially painful with a cluster of sputum in the area of \u200b\u200bkarins, drying into dense crusts. With the development of an atrophic process, in which only the surface layer of the mucous membrane is affected, the cough reflex persists, however, with deeper atrophic phenomena, breathtaking and nerve endings, cough severity decreases. The course of the disease is long, alternating with periods of remission and exacerbation.

Diagnosis install using fibroscopy. However, the reason for the occurrence of this disease often remains unknown, with the exception of cases when it occurs in people of harmful professions.

Treatment determined by the form of inflammation. With a hypertrophic trachea, accompanied by the release of mucous-purulent sputum, the inhalation of antibiotics is used, the selection of which is carried out on the basis of the antibioticogram, blowing at the moment of inhalation of the binding powders. In atrophic processes in the trachea, vitamin oils are instilled (carotoline, rosehip oil and sea buckthorn). Corks are removed by infusion in the trachea solutions of proteolytic enzymes. Basically, the treatment corresponds to those in banal laryngitis.

The inflammatory diseases of the esophagus include:

Acute esophagitis.

Chronic esophagitis.

Reflux Ezophagitis.

The peptic ulcer of the esophagus.

The last two diseases are the result of a systematic irritation of the mucous membrane of the esophagus with an acidic content of the stomach, causing inflammation and dystrophy of tissues.

Acute esophagitis.

Acute acute esophagites arise as a result of an acute bacterial or viral infection. They do not have practical significance during the disease and disappear along with other signs of the disease, if they do not acquire an independent chronic flow.

Acute esophagitis can be:

Catarrhal esophagitis.

Hemorrhagic esophagitis.

Purulent esophagitis (abscess and phlegmon of the esophagus).

The reasons for the occurrence of acute esophagitis are a chemical burn (exfoliative esophagitis) or injury (zakost, wound when swallowing acute items, bones).

Clinical picture acute esophagita. Patients complain with acute esophagitis for pain behind the sternum, amplifying when swallowing, sometimes dysphagia. The disease occurs sharply. It is also accompanied by other signs inherent in the main process. With influenza - this is an increase in temperature, headache, pain in the sip, etc. With a chemical burn there are guidelines for reception inside alkali or acid, traces of a chemical burn on the oral mucosa are found in the throat. The abscess or phlegmon of the esophagus is characterized by severe pain behind the sternum when swallowing, the difficulty of swallowing dense food, while the warm and liquid food in it is not delayed. Signs of infection and intoxication appear - an increase in body temperature, leukocytosis in the blood, ESP increased, has a place of proteinuria.

X-ray study It allows you to detect an infiltrate that causes some delay in the food lump, to establish its localization and degree of damage to the wall of the esophagus.

Ezophagoscopy: mucosa in the field of infiltrate hyperemic, edema. With a careful study, it is possible to find the opposition - fish bone or acute bone, stuck in the fabric of the esophagus. With the help of forceps, the foreign body is extracted. The edge of the device is possible to try the density of infiltrate. If the abscess matured, the tissue of a soft consistency is revealed in the center.

Diffuse Ezophagitis accompanied by hyperemia and swelling mucous. It is covered with a white and gray raid, easy to bleed. Erosions have an irregular shape, more often the longitudinal, covered with a gray raid. Peristalistics saved.

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

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Acute and chronic diseases of the pharynx

Adenoids.

This is the growth of nasopharynk almond. It occurs between the ages of 2 to 15 years, by 20 years begin to atrophy. Inflammation of adenoid tissue is called adenoiditis.

There are three degrees of increasing adenoids:

1 degree - couch and boaana closed on 1/3;

2 degree - coulter and Hoans are closed on 1/2;

3 degree - couch and boaana closed on 2/3.

Symptoms:

1. Permanent difficulty of nasal breathing, open mouth;

2. Children sleep with an open mouth, snore, sleep restless;

3. Reducing hearing caused by a violation of the hearing pipe function;

4. Frequent colds, protracted rhinitis, frequent otitis;

5. Blancability;

6. The general condition is suffering: lethargy, apathy, fast fatigue, headaches and, as a result, lagging in mental and physical development;

7. Deformation of the facial skeleton in the form of a characteristic "adenoid" person, bite disruption.

Diagnostics:

Rear rososcopy;

Finger study of nasopharynk;

Radiography with contrasting substance (to eliminate the neoplasm).

1 method - conservative treatment.

It is carried out at 1 and 2 degrees of increasing adenoids and during the period of inflammatory processes in the nasal cavity.

2 Method - Operational treatment - adenotomy. It is conducted in the hospital, the tool is adenot. Indications for surgery: 3 degree, 2 degree in frequent colds and otitis and the absence of effect from conservative treatment, 1 degree in case of hearing impairment.

Care in the postoperative period:

Bed regime, the position of the child on the side;

Explained to periodically spitted saliva into a diaper for monitoring bleeding;

Feed with liquid cool food, you can give ice cream in small quantities;

Restriction of exercise.

3 Method - climature, to increase the protective forces of the body.

The main complications of adenoids and adenoiditis: a decrease in hearing, the development of chronic rhinitis, deformation of the facial skeleton and a bite disruption.

1. Hypertrophy of palatal almonds. An increase can be three degrees, but there is no inflammatory process in almonds. Almonds can interfere with breathing, food, rebuilding. For the third degree of increment, the operation is carried out - tonsillotomy - partial cutting of palatal almonds.

A tonsillet is cut off part of the almonds serving beyond the limits of the sky.

2. Acute pharyngitis. This is an acute inflammation of the mucous membrane of the rear wall of the pharynx.

1) supercooling;

2) diseases of the nose and the apparent sinuses;

3) acute infectious diseases;

4) Irritating factors: smoking, dust, gases.

Clinical manifestations:

Dryness, witness, felling in a sip, shaking;

Moderate soreness when swallowing;

Unpleasant sensations in the nasopharynx, the maintenance of the ears;

Rarely subfebrile temperature, deterioration of general well-being.

With pharyitingoscopy: hyperemia, swelling, mucous-purulent discarded on the rear wall of the pharynx. The infection can cover the nasopharynk and descend to the lower respiratory tract.

Treatment: Elimination of annoying factors, gentle diet, warm drink, rinse throat, irrigation with solutions ("Kameton", "Inhalipte"), inhalation, oroseptics ("Faringosept", "Septol"), lubrication of the rear wall of the throat with lugol and oil solutions, Warming compresses, FTL.

3. Chronic pharyngitis. This is a chronic inflammation of the mucous membrane of the rear wall of the pharynx. It is divided into 3 types: catarrhal or simple, hypertrophic and atrophic.

Frequent sharp pharyngitis;

The presence of chronic foci of infection in the nose, the apparent sinuses, oral cavity (carious teeth), palatal almonds;

Prolonged impact of irritating factors (especially when smoking).

Clinical manifestations:

Dryness, alluring, burning, ticking;

Feeling of a foreign body in the throat;

Constant shaking;

The accumulation of viscous mucous membranes of separated, especially in the morning.

With pharyngoscopy:

1. Catarial form - hyperemia and thickening of the mucosa of the rear wall of the pharynx;

2. Hypertrophic form - hyperemia, thickening of mucous membranes, graininess and granules on the mucous membrane;

3. Atrophic shape - mucous, covered with viscous mucus.

Remove the cause;

Diet (eliminate irritating food);

Rinse, irrigation of the rear wall of the throat;

Inhalation, lubrication with antiseptics.

4. Paratonzillitis is the inflammation of the osyindal fiber, in which the process goes beyond the almond capsule and this indicates the termination of its protective effect. The process is one-sided, more often located in the front and upper part. Paratonzyllitis is the most frequent complication of an angina.

Decrease in immunity;

Incorrect or early discontinued angina treatment.

Clinical manifestations:

Strong, constant pain, increasing when swallowing and turning the head;

Irradiation of pain in the ear, teeth;

Salivation;

TRIZM (chewing muscles spasm);

Vague, vile speech;

Forced position of the head (s) caused by inflammation of the muscles of the neck, pharynx;

Cervical lymphadenitis;

Symptoms of intoxication: high temperature, headache, etc.;

Changes in blood test.

With pharyngoscopy: a sharp blowout of one almond, the displacement of a soft sky and tongue (asymmetry of the language) in a healthy side, hyperemia of the mucous membrane, rotten smell of mouth. Different in the course of two stages: infiltration and abscess.

Treatment: - Wide spectrum antibiotics:

Gargling;

Antihistamines;

Vitamins, antipyretic;

Warming compresses.

During the ripening of the abscess, an autopsy is made (local anesthesia - irrigation with a solution of lidocaine) at the site of the greatest protrusion using a scalpel and washing the cavity by antiseptics. In the following days, the edges of the wound are diluted and washed. Paraphalitis patients are put on dispensary accounting with a diagnosis of chronic tonsillitis and should receive prophylactic treatment. When repeated paraphalids, almonds are removed (tonsillectomy operation).

Chronic tonsillitis.

This is chronic inflammation of the skynote almonds. It is more common in middle-aged children and adults up to 40 years. The cause of chronic tonsillitis is: an infectious-allergic process caused by staphylococci, streptococci, adenoviruses, herpes virus, chlamydia, toxoplasmas.

Pre-providing factors:

Decrease in immunity;

Chronic foci of infection: adenoitis, sinuita, rhinitis, carious teeth;

Frequent angins, ORVI, colds, childhood infections;

The structure of almonds, deep branched lacuna (good conditions for microflora development);

Hereditary factor.

Classification:

1. I.B. Soldier: compensated and decompensated;

2. B.S. Preobrazhensky: simple shape, toxic-allergic form (1 and 2 degrees).

Clinical manifestations are divided into local manifestations and common.

Complaints: Throat pain in the mornings, dryness, tingling, feeling of the foreign body in the throat, unpleasant smell of mouth, a history of frequent angens.

Local manifestations with pharyngoscopy:

1. Hyperemia, rolic-shaped thickening and swelling of the edges of the front and rear studies;

2. Spikes of skydly arms with almonds;

3. uneven color of the tonsils, their loosenness or seal;

4. The presence of purulent-occasional traffic jams in lacuna or liquid cream-like pus when pressing the spatula on the front packer;

5. Increase and soreness of regional lymph nodes (submandibular).

General manifestations:

1. Subfebrile temperature in the evenings;

2. Increased fatigue, reduced performance;

3. Periodic joint pains, in the heart;

4. Functional disorders of the nervous system, urinary and others;

5. Heartbeat, arrhythmia.

A compensated or simple form is the presence of complaints and local manifestations. Decompensated or toxic-allergic form - the presence of local signs and general manifestations.

Chronic tonsillitis may have conjugate diseases (general etiological factor) - rheumatism, arthritis, heart disease, urinary system, etc.

Treatment. All patients with chronic tonsillitis should be on dispensary accounting.

Treatment is divided into conservative and surgical.

Conservative treatment includes local and common.

Local treatment:

1. Washing Lakun Almonds and rinsing with antiseptics: furacilin, iodiumol, dioxidine, chlorhexidine);

2. Towing (lubrication) lacuna and almond surfaces with a solution of lugola, a tincture of propolis;

3. Introduction to lacques of antiseptic ointments and pastes, antibiotics and antiseptic preparations;

4. Oroseptic - "Faringosept", "Septol", "Anti-Anhine";

5. FTL - UHF, UFO, drug phonophoresis.

General treatment.

1. Locular therapy, immunostimulants;

2. Antihistamines;

3. Vitamins.

Such treatment is carried out 2-3 times a year. In the absence of an effect from conservative treatment and the presence of frequent exacerbations of the disease, surgical treatment is shown - tonsilectomy is a complete removal of palace almonds, is carried out in patients with chronic decompensated tonsillitis.

Contraindication for tonsillectomy are:

1. Heavy SS diseases;

2. Chronic renal failure;

3. blood diseases;

4. Sugar diabetes;

5. Hypertension of high degree;

6. Oncological diseases.

In this case, high-scoring treatment is carried out - cryotherapy or galvanokauksky. Preparation of patients with tonsilctomy operation includes: a study of blood for clotting and platelet content, inspection of internal organs, the sanitation of foci of infection. Before the operation, a medical sister measures blood pressure, pulse, watches the patient not to take food.

The operation is carried out under local anesthesia using a special toolkit.

Care for patients in the postoperative period includes:

Bedding, patient position on a low pillow;

It is forbidden to talk, get up, actively move in bed;

Under the cheek, a diaper and saliva is not swallowed, but spitches to a diaper;

Observation within 2 hours per patient condition and saliva color;

In the afternoon, you can give a patient a few sips of cold liquid;

In the case of bleeding, urgently inform the doctor;

Feed the patient with liquid, cool food for 5 days after surgery; Adenoid tonsillectomy postoperative

Irrow the throat several times a day as aseptic solutions.

Important prophylactic work: identification of persons with chronic tonsillitis, their dispensary observation and treatment, good hygienic working conditions, etc. Factors.

Angry is an acute infectious disease with the local lesion of the lymphoid tissue of the sky almonds. Inflammation may occur in other almonds pharynx.

Pathogenic microorganisms, more often beta hemolytic streptococcus, staphylococci, adenoviruses.

Less often the causative agent are mushrooms, spirochetes, etc.

Path transmission infection:

Airborne drip;

Alimentary;

With direct contact with the patient;

Autoinfection.

Pre-providing factors: supercooling, almond injuries, the structure of almonds, hereditary predisposition, inflammatory processes in the nasophaling and nasal cavity.

Classification: more often meet - catarrhal, follicular, lacunar, fibrinous.

Less often meet - herpetic, phlegmous, fungal.

List of references

1. Ovchinnikov Yu.M., Directory for otorinolaryngology. - M.: Medicine, 1999.

2. Ovchinnikov, Yu.M., Directory for otorinolaryngology. - M.: Medicine, 1999.

3. Shevrygin, B.V., Directory of otorinolaryngology. - M.: "Triad X", 1998.

4. V.F. Antoniv, etc., ed. I.B. Soldatova, ed. N.S. Strapko, Retz.: D.I. Tarasov, E.S. Ogoltsova, Yu.K. Revian. - Guidelines for otorhinolaryngology. - M.: Medicine, 1997.

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