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Lecture notes, cheat sheets
Лор-заболевания. Хронические заболевания глотки (конспект лекций)
Directory / Lecture notes, cheat sheets Table of contents (expand) Lecture number 17. Chronic diseases of the pharynx 1. Hypertrophy of the tonsils AdenoidsIn children, there is a tendency to hypertrophy of the tonsils of the pharynx, especially the nasopharyngeal (the so-called adenoids). During puberty, the tonsils usually atrophy, with the exception of the palatine tonsils. The clinic and symptoms of adenoids are due to their special location on the vault of the nasopharynx, therefore they impede or completely exclude nasal breathing, ventilation of the auditory tubes, disrupt the function of the pharynx, which has an extremely adverse effect on the overall development of the child's body. This condition is characterized by a change in facial features, an open mouth, thickening of the wings of the nose, abnormal development of the dental system, sleep disturbance, coughing fits, a tendency to tonsillitis, otitis media, and pneumonia. In addition to complaints, anamnesis, general examination, posterior rhinoscopy is necessary for the diagnosis, but it is difficult in children, especially younger ones. V. I. Voyachek suggested that if adenoids are suspected, an anterior rhinoscopy should be performed with preliminary anemization of the nasal mucosa (for example, with a solution of galazolin or naphthyzinum), while the adenoids are quite clearly visible, and when the patient pronounces the number "3", there is a movement of the soft palate to determine the lower limit adenoids. There is a palpation method for examining adenoids, while the doctor stands behind the sitting child, fixes the head with his left hand, pressing it to himself, and examines the nasopharynx with the index finger of his right hand. The amount of hypertrophy is determined by three degrees: 1) to the upper edge of the coulter - I degree; 2) to middle turbinates - II degree; 3) to the lower shells and below - III degree. Inspection of the pharynx, tonsils, and otoscopy are required to assess the function of the middle ear and the condition of the eardrum. Conservative treatment of adenoids with various oils, a 0,25% solution of silver nitrate, therapy with ultraviolet or laser rays rarely gives a lasting therapeutic effect. The adenotomy operation is more effective, especially with concomitant pathology of the ENT organs or lungs. It is most often performed under local application anesthesia by lubricating the nasopharynx with a special cotton brush on a probe - a cotton holder. An assistant holds the child, previously wrapped in sheets to secure the arms, on his lap. The surgeon presses the tongue with a spatula and carefully inserts the adenoid under the control of vision behind the soft palate into the nasopharynx, gently resting on the fornix, then removes the adenoids with a quick sliding circular movement of the adenoid. Then the pharynx is examined, dried with cotton balls, and sometimes fragments of adenoids hanging into the oropharynx are removed. As a rule, bleeding is minor and stops on its own, complications are rare. Hypertrophy of the palatine tonsils Hypertrophy of the palatine tonsils is less common in children. There are three degrees of hypertrophy depending on the narrowing of the pharynx: 1) narrowing by 1/3 - I degree; 2) narrowing by 2/3 - II degree; 3) tonsils are in contact along the midline - III degree. It is wrong to consider hypertrophy as a sign of chronic tonsillitis, however, enlarged tonsils, like normal ones, can be affected by a chronic process. Enlargement of the tonsils is accompanied by coughing, choking, nasal voice, increased gag reflex, and in combination with chronic tonsillitis - frequent tonsillitis. Treatment is operative. Under local anesthesia, parts of the tonsils protruding beyond the arches are cut off with a special tonsillotomy. There are practically no complications. 2. Chronic inflammatory diseases Chronic pharyngitisInflammation of the mucous membrane of the pharynx is sluggish, manifested by an intermittent sensation of pain, dryness and discomfort in the pharynx, and rapid fatigue of the voice. Often this happens when exposed to household and professional factors, including alcohol, smoking, air pollution with dust (especially cement), and caustic chemicals. The influence of radioactive impurities in the air was also noted. A significant role in the genesis of this disease is played by the pathology of the nose - sinusitis, rhinitis, profuse purulent or mucous discharge. When examining the pharynx, flaccid hyperemia, moderate dryness of the mucous membrane are noted, on the back wall - often thick mucus. Hypertrophic pharyngitis is characterized by an increase in granules on the back of the pharynx to the size of a lentil grain (granular pharyngitis) or lateral ridges (lateral pharyngitis). atrophic pharyngitis. The mucous membrane of the pharynx is pale, thinned, looks like varnished, palatine tonsils, as a rule, are also atrophic. The etiology of this disease has not been fully elucidated, however, this fairly common disease occurs in more than 20% of women and 5-8% of men. It is manifested by constant dryness in the throat, perspiration, rarely pain, rapid fatigue of the voice during exercise, especially in singers, actors, lecturers, and teachers. Chronic tonsillitis Chronic tonsillitis is a chronic inflammation of the palatine tonsils; if other tonsils are affected, localization is indicated - chronic adenoiditis, tonsillitis of the lingual tonsil. According to the classification, two forms of chronic tonsillitis are distinguished: compensated and decompensated. The tonsils provide both local and general immune responses, especially in children. It is noted that children with removed tonsils are more likely to suffer from infectious diseases. Objective symptoms are of a non-permanent nature: soldering of the arches with the tonsils, their swelling, thickening, hyperemia. Two symptoms are more reliable - the presence of caseous plugs in the lacunae and an increase in regional (anterior cervical) lymph nodes. Exacerbation of chronic tonsillitis always proceeds in the form of a sore throat. The age of patients with chronic tonsillitis is practically unlimited, the same number of men and women are ill. Conservative treatment: antibiotics, sulfonamides, desensitizing drugs, inhalation, hormonal therapy, special mixtures (mephiditis, anginol), washing the lacunae of the tonsils with a thin cannula on a syringe with saline or an antibiotic, irradiating the tonsils with ultraviolet rays (the so-called tube quartz), laser irradiation of the tonsils. These methods do not give a lasting effect, so the main method of treating chronic tonsillitis is surgical - tonsillectomy. Tonsillectomy is performed mainly under local, less often under general anesthesia. The arches of one of the tonsils, the back wall of the pharynx, the root of the tongue are lubricated with a 2% solution of dicaine or a 5% solution of cocaine, then in the region of the anterior arch along the transitional fold, three injections are made with a 1% solution of novocaine at the poles of the tonsils and in the middle between them , lateral to the tonsil capsule into the paratonsillar space. Under this condition, further separation of the tonsil will take place with the least difficulty. The incision is made with a scalpel along the transitional fold at the upper pole, then the upper pole is detached with a special raspator, separated from the arches and separated with a capsule in the paratonsillar space. The lower pole is cut off with a special loop. Bleeding during the detachment of the tonsil and then stops with gauze and cotton balls, pressing them to the tonsil niche with a clamp. The other tonsil is then removed. After the operation, strict bed rest and hunger are necessary for XNUMX hours. Then the regimen is expanded by prescribing a sparing diet. After 5-7 days, the patient is discharged from the hospital for outpatient observation and release from work for 7-10 days. Complications from tonsillectomy are rare, except for bleeding from the tonsil niche - from 1,5 to 5%. It is stopped by pressing a cotton-gauze ball in the tonsil niche, applying a catgut suture to the vessel in the niche, or stitching the temples over the ball with a special needle, or balls with hydrogen peroxide, aminocaproic acid, or a hemostatic sponge. It should be noted that damage to the carotid arteries, retraction of a spatula or removed tonsil into the larynx lead to asphyxia. These complications require emergency care - ligation of the main vessels of the neck or laryngoscopy with removal of a foreign body in the larynx. Collapse and fainting of the patient are not uncommon during tonsillectomy, so patients must be examined by a general practitioner and anesthesiologist before surgery. In some cases, the operation has to be performed under endotracheal anesthesia. The technique of operation is the same. Authors: Drozdov A.A., Drozdova M.V. << Back: Acute inflammatory diseases of the pharynx (Acute pharyngitis. Sore throat) >> Forward: Foreign bodies and damage to the pharynx. Anomalies of the pharynx (Injuries to the pharynx. Anomalies of the pharynx)
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