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 diseases included in this class last for a long time (months and years). In principle, this is both true and not true, because in fact the duration of the disease is determined by a great variety and a multitude of factors, such as etiology, pathogenesis, pathomorphology, clinical forms and clinical course, etc. When dividing diseases of the pharynx into acute and chronic, one should remember the fundamental position expressed by outstanding Russian scientists I.R. Petrov and Ya.L. Rapoport (1958).

"It would be more correct to say that all diseases are divided into predominantly acute and predominantly chronic, since there are diseases that usually proceed acutely, just as there are those for which a chronic, long-term course is the rule. Thus, an acute or chronic course is usually a property of a given disease; a chronic course is only occasionally a protracted form of an acute disease" - "In determining an acute and chronic disease, not only its duration is taken into account. The rapid increase and the same disappearance of all symptoms of the disease are the most important sign of an acute disease; in the same way, a long duration of existence of these symptoms is the most essential sign of a chronic disease. However, an important difference between an acute disease and a chronic one is that, developing over a certain, more or less limited period of time, all the phenomena of an acute disease eventually disappear. For a chronic disease, not only a long course is extremely characteristic; "The alternation of periods of attenuation of the disease, sometimes even apparent recovery, with periods of exacerbation, outbreaks of acute symptoms of the disease is essential. Death from a chronic disease often occurs during such an exacerbation."

A number of direct and indirect conclusions follow from the above quotation. Firstly, the chronic course of a disease is one of its properties, depending not only on the pathogenic qualities of the pathogen, which is given by nature to cause exactly such a disease, but also on the properties of the macroorganism, with the help of which it organizes the pathological process within the framework of those evolutionarily formed protective mechanisms and responses that are most adequate to this pathological process. Secondly, by organizing the pathological process, the macroorganism "chronometers" it, establishing its duration depending on the achieved effect. Thirdly, the limit of this duration is determined by many factors: the virulence of the pathological agent, its resistance in the fight against the protective factors of the organism, the "safety margin" of these factors themselves, etc., i.e. the status of the disease as a chronic pathological process is a function of the interaction of many opposing systems, which together constitute the essence of the elements (structural, humoral, bioelectrical) participating in this grandiose struggle of "good with evil". Fourthly: without the organism there is no disease; without its self-organizing and arising from far-unknown reserves, called defense mechanisms, such a grandiose "battle" as the interaction of the macro- and microorganism, called the pathological process, could not exist. Consequently, it is the organism that is the "force" that takes upon itself all the details of this process. And finally, fifthly: in the balance of opposing forces, the time factor is of great importance, playing in almost all cases on the side of the macroorganism, because only time gives the organism the opportunity to turn on more and more new defense mechanisms, replenish the "soldiers who fell on the battlefield", strengthen its redoubts and pull up more and more reserves, thereby weakening the enemy, bringing it to a state of avirulence and death. From all of the above, we come to the conclusion that time in a chronic disease: a) is a function of the multifactorial influence of the organism on the pathological process and b) it is the organism's strategy in the fight against infection, its defense mechanism and ally. These postulates do not require special proof, although one example should be given for those who doubt: the transfer of acute leukemia to the chronic stage prolongs the life of the patient, makes the disease recede.

This abstract excursion into the "philosophy" of "medical time" is only a small etude to a very important problem, which could be formulated as "disease and its time". But our goal was different: to demonstrate the extremely complex formation of a chronic pathological process, the patterns of which must be taken into account when compiling any scientific medical classification, to show the difficulties that may be encountered on the path to developing a classification of chronic diseases of the throat.

List of chronic non-specific (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 granular pharyngitis;
  • ozena of the pharynx;
  • 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 the palatine tonsils;
  • hypertrophy of the 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, therefore this list cannot claim the “rank” of classification.

In general terms characterizing the above list of diseases, it should be noted that many of them are only stages of transition of some pathological processes into others. These diseases do not represent an “unshakable”, unchanging pathological state, but can “flow” from one to another depending on many internal and external factors influencing the current pathological process. Thus, diffuse catarrhal pharyngitis can have as its final state limited or diffuse sub- or atrophic pharyngitis, chronic hypertrophic pharyngitis can simultaneously occur with chronic granular pharyngitis, and tonsillitis, having reached the phase of hypertrophy of the palatine tonsils and being cured by non-surgical methods, retains cicatricial-parenchymatous hypertrophy of the palatine tonsils, etc. Consequently, this classification largely pursues a didactic goal, although it plays an important role in formulating a working diagnosis, on the basis of which the patient's treatment tactics are developed.

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