Chronic diseases of the pharynx: causes, symptoms, diagnosis, treatment

The expression "chronic diseases of the pharynx" reflects a collective concept in which, it would seem, the only unifying feature is that all the diseases entering into this class proceed for a long time (months and years). In principle, this is not so, because in fact the duration of the disease is determined by a great variety and a variety of factors such as etiology, pathogenesis, pathomorphology, clinical forms and clinical course, etc. Sharing pharyngeal diseases into acute and chronic diseases, one should remember the fundamental position expressed by outstanding Russian scientists IRPetrov and Ya.L. Rapoport (1958).

"It would be more correct to say that all diseases are divided into predominantly acute and mainly chronic diseases, since there are diseases that are usually acute, just as there are those for whom the rule is a chronic, prolonged course. Thus, an acute or chronic course is usually a property of the disease; the chronic course is only a sometimes prolonged form of acute disease "-" In determining the acute and chronic illness, not only its duration is taken into account. Rapid growth and the same disappearance of all the symptoms of the disease are the most important sign of an acute illness; just as the long duration of these symptoms is the most significant sign of chronic illness. However, an important difference between acute and chronic illness is that, developing on a certain, more or less limited time interval, all the phenomena of acute illness eventually disappear. For a chronic disease, it is extremely characteristic not only of a prolonged course; it is essential to alternate periods of decay of the disease, sometimes even an apparent cure with periods of exacerbation, outbreaks of acute disease phenomena. Death from a chronic illness often occurs in the period of such aggravation. "

A number of direct and indirect conclusions follow from the above quotation. First, the chronic course of the disease is one of its properties that depend not only on the pathogenic qualities of the pathogen, which is given by nature to cause just such a disease, but also on the properties of the macroorganism, through which it organizes a pathological process within the framework of those evolutionarily formed defense mechanisms and response reactions, which are most adequate to this pathological process. Secondly, by organizing the pathological process, the macroorganism "chronometers" it, establishing its duration, depending on the effect achieved. Thirdly, the limit of this duration is determined by a number of factors: the virulence of the pathological agent, its resistance in the fight against the protective factors of the organism, the "margin of strength" of these factors themselves, etc., ie, the status of the disease, as a chronic pathological process, is function of the interaction of many opposing systems, collectively their constituent elements (structural, humoral, bioelectric), taking part in this grand struggle of "good with evil." Fourthly: without an organism there is no disease; without its self-organizing and arising from far-unknown reserves, called protective mechanisms, there could not have been such a grandiose "battle" as the interaction of a macro- and a microorganism, called a pathological process. Consequently, it is the body that is the "power" that takes care of all the details of this process. And finally, fifthly: in the balance of opposing forces, the time factor plays an important role in almost all cases on the side of the macroorganism, because only time allows the body to include more and more new defense mechanisms, replenish the "fallen soldiers at the battlefield," strengthen their redoubts and pull up more and more new reserves, thereby weakening the enemy, leading him into a state of avirulence and death. From all that has been said, we come to the conclusion that time in a chronic illness: a) is a function of the multifactorial influence of the organism on the pathological process and b) it is an organism's strategy in the fight against infection, its protective mechanism and ally. These postulates do not require special evidence, although one example should be cited for doubters: the transfer of acute leukemia to the chronic stage prolongs the life of the patient, causes the disease to retreat.

This abstract digression into the "philosophy" of "medical time" is just a small sketch for a very important problem that could be formulated "illness and its time". But our goal was different: at the demonstration of an extremely complex formation of a chronic pathological process, the regularities of which must be taken into account in the compilation of any scientific medical classification, to show the difficulties that may occur in the development of classification of chronic diseases of the pharynx.

The list of chronic pspecific (vulgar) diseases of the pharynx

• Chronic pharyngitis:
  • chronic diffuse catarrhal pharyngitis;
  • chronic limited catarrhal pharyngitis:
    • chronic catarrhal epipharyngitis;
    • chronic catarrhal mesopharyngitis;
    • chronic catarrhal hypopharyngitis;
  • chronic diffuse hypertrophic pharyngitis;
  • chronic diffuse atrophic pharyngitis;
  • chronic granulosa pharyngitis;
  • pharyngeal throat;
  • pharyngokeratosis.
• Chronic inflammation of solitary lymphadenoid formations of the pharynx:
  • chronic tonsillitis;
  • chronic adenoiditis;
  • chronic inflammation of the lingual tonsil;
  • chronic inflammation of the tonsils of the auditory tube.
• Hypertrophy (non-inflammatory nature) of solitary lymphadenoid formations of the pharynx:
  • hypertrophy of palatine tonsils;
  • hypertrophy of pharyngeal tonsils (adenoid vegetations);
  • hypertrophy of the lingual tonsil;
  • hypertrophy of the tubal tonsils.

This list includes multimodal pathological processes, the main quality of which is their chronic nature, hence this list can not claim the "rank" of classification.

Characterizing in general outline the above list of diseases, it should be avenged that many of them are only the stages of the transition of some pathological processes into others. These diseases do not represent an "immutable", unchanging pathological condition, but can "flow" one into another, depending on the multitude of internal and external factors of influence on the current pathological process. Thus, diffuse catarrhal pharyngitis may have a finite or diffuse sub- or atrophic pharyngitis, chronic hypertrophic pharyngitis can simultaneously occur with chronic granulosa pharyngitis, and tonsillitis, reaching a phase of hypertrophy of the palatine tonsils and being cured by non-operative methods, retains a scar-parenchymal hypertrophy of palatine tonsils, etc. Consequently, this classification largely pursues a didactic goal, although it plays an important role in the formulation a working diagnosis based on a patient who developed the treatment tactics.

[1], [2], [3], [4], [5], [6], [7]