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Chronic pharyngitis
Last reviewed: 23.04.2024
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Chronic pharyngitis is a group of diseases of the mucous membrane of the pharynx and the mucous glands and lymphoadenoid granules diffusely located in it. Depending on the depth of the lesion of the elements of the mucous membrane, its prevalence, it can be defined as diffuse, limited, catarrhal, granular, hypertrophic, atrophic and combined.
What causes chronic pharyngitis?
Chronic pharyngitis is caused by a variety of bacteria nesting in the crypts and parenchyma of the lymphadenoid formations of the nasopharynx and pharynx, which are activated after an adenoviral infection, which sharply weakens the local tissue immunity.
Pathogenesis of chronic pharyngitis
The pathogenesis of chronic pharyngitis largely depends on the causes of this disease and a number of contributing factors. Causes of chronic pharyngitis can be local and general. Local most common causes that play an important pathogenetic role in the occurrence of chronic pharyngitis include chronic rhinitis and sinusitis, chronic adenoiditis and tonsillitis. Common causes and contributing factors include metabolic diseases, constitutional susceptibility to diseases of the mucous membrane of the upper respiratory tract and lymphoadenoid apparatus of the pharynx, hemodynamic disturbances in the upper respiratory tract (congestion leading to hypoxia and hyponutric structures)) due to the corresponding cardiovascular diseases system, liver, kidneys, lungs. In conditions of harmful production, sharp temperature fluctuations, dry hot air, dustiness of the atmosphere (cement, clay in porcelain production, flour in the milling industry), a pair of various substances with free radicals, pronounced oxidative, alkalizing and certain toxic properties. Great importance in the occurrence of chronic diseases of the upper respiratory tract and in particular of chronic pharyngitis is attributed to household hazards (smoking, abuse of strong alcoholic beverages, especially surrogates, the consumption of hot hot dishes).
Pathogenesis of chronic pharyngitis
Pathogenesis of chronic pharyngitis is largely dependent on the causes of this disease and a number of contributing factors. Causes of chronic pharyngitis can be local and general. Chronic rhinitis and sinusitis, chronic adenoiditis and tonsillitis belong to the most common local causes, playing an important pathogenic role in the occurrence of chronic pharyngitis. The general causes and contributing factors include metabolic diseases, constitutional predisposition to diseases of the mucous membrane of the upper respiratory tract and lymphoepithelial apparatus of throat, hemodynamic disturbances of the upper respiratory tract (stagnations, leading to hypoxia and hyponutria of their structures), caused by the respective diseases of cardiovascular system, liver, kidneys, and lungs. In the conditions of hazardous industry, dramatic variations in temperature, dry hot air, atmospheric dust (cement, clay in the production of china, flour in the milling industry), gases of different substances, having free radicals, bright oxidizing, alkalizing and certain toxic properties have a great importance in the damage of upper respiratory tract tissues. The great importance in the occurrence of chronic diseases of the upper respiratory tract and, in particular chronic pharyngitis, is connected with daily hazards (smoking, alcoholic beverages abuse, especially of substitutes, consumption of spicy hot dishes).
Diffuse catarrhal chronic pharyngitis
In fact, this chronic pharyngitis is a total catarrhal inflammation of the throat, including the nasal mucosa, often otosalpinx, and especially, excretory ducts of paranasal sinus front. Chronic pharyngitis is more common in children, due to a significant development of the lymphoepithelial apparatus which is a location of chronic infection and rarely in adults, in whom the apparatus is largely atrophied.
In the pathogenesis of the disease nasal infection and impaired nasal breathing are important, they exclude protective functions of the nasal mucosa from the act of breathing, and cause a contact of air, coming into the respiratory tract with the mucosa of the pharynx. Oral breathing is not a normal physiological process, it is a significant factor, affecting negatively many processes in the throat tissue, ultimately leading to disturbance of local metabolism, hypoxia, drying of mucus protective layer, containing biologically active substances that protect mucous membrane of the pharynx from harmful atmospheric agents. Finally, all this processes lead altogether to a disruption of cellular homeostasis and a deficit of local immunity. All of these factors, acting on the different cell lineages of the mucosa, lead to the different pathological changes, finding reflection in the names of different clinical pharyngitis forms.
Symptoms of chronic pharyngitis
Symptoms of chronic pharyngitis consist of patient complaints, his general and local objective state. Subjective symptoms of chronic diffuse catarrhal pharyngitis that are absent without an exacerbation in children, appear as moderate complaints of a tickling in the throat, difficultly expectorated viscous secretions, overactive vomiting reflex during crust accumulation, cough in adults. Patients often resort to gargarism at night. In the morning the above-mentioned symptoms are more pronounced.
How to recognize chronic pharyngitis?
During the pharyngoscopy against the general, not very bright hyperaemia of mucous membrane on the back of the throat, on the soft palate viscous mucous depositions are determined and difficulty during the removal with tweezers. In cold season, the hyperaemia of the mucous membrane exacerbates, an amount of mucous secretions increases, and they become more liquid.
In the presence of pharynx infection with adenoviruses or bacteria (own conditionally pathogenic microbiota) mucous secretions obtain mucopurulent character, and an inflammation acquires clinical signs of acute or subacute bacterial diffuse pharyngitis. A headache, low-grade fever and all signs of moderate intoxication appear.
Treatment of diffuse catarrhal chronic pharyngitis
Treatment of chronic diffuse catarrhal pharyngitis consists primarily of the elimination of the main cause of the disease, it is either chronic sinusitis or chronic adenoiditis, and also, pathologically altered remnants of tonsils, if they are remained after tonsil removing in the past. In case of an exacerbation of an inflammatory process the same treatment as in the presence of acute catarrhal pharyngitis is used.
Hypertrophic chronic pharyngitis
Hypertrophic chronic pharyngitis often serves as the next stage of the development of the chronic diffuse catarrhal pharyngitis due to the above described reasons. Most often, hypertrophy of lymphoepithelial masses of pharynx is interpreted as a compensatory (protective) response, increasing the amount of structures of local cellular immunity.
Symptoms of chronic pharyngitis
Hypertrophic chronic pharyngitis is clinically regarded as adenopharyngitis, caused and maintained by the same rhinosinus or adenoid chronic infection. During many months and years a long contact with the mucous membrane of the pharynx with mucopurulent secretions, containing decomposition products of blood cells, mucus and interstitial tissue, having toxic allergic properties relatively the mucosa, leads to not only hypertrophy of pharynx superficial tissues, but of underlying muscle and interstitial tissue. That’s why nasal cavity looks as constricted one, mucous membrane looks as thickened one, nasopharyngeal hole look as "buried" ones in the swollen and hypertrophied tissue. These changes have a negative impact on the function of otosalpinx, therefore, many people with chronic hypertrophic pharyngitis, also impose a complaint on hearing loss.
How to recognize hypertrophic chronic pharyngitis?
During the pharyngoscopy pharyngeal mucosa of pharynx, of soft palate, of palatine arches is hyperemic, covered with watery mucopurulent secretions, flowing down from the nasopharynx, palatine arches and lateral ridges of throat are thickened. According to the secretions hyperaemic mucosa is determined, after some time in some small areas it begins to fade and becomes thinner, that, in fact, marks the transition to the next stage of chronic pharyngitis, to the atrophic one. On the way to this stage in half of patients so-called granulose chronic pharyngitis appears, it is widespread in the presence of atrophic pharyngitis.
Granulose chronic pharyngitis
Granulose chronic pharyngitis is manifested by the hypertrophy of lymphoid granules, covering the back of the throat. The process of granule hypertrophy begins from the modifications of the mucopurulent secretions, flowing down the back of the throat, in the course of the further development of the process, they become viscous, dense, dried into hardly removing crusts. At this stage of the mucosa of the back of the throat pales, and pellets are increasing and blushing. On the back wall of the pharynx by these granules lymphoid tissue islets are formed, in essence, the last constitute analogs of infected granules of tonsils only in the disperse state and cause the same local and general pathological phenomena as chronic tonsillitis.
On the side walls of the pharynx, behind the posterior arches of the soft palate, follicles are combined into the lymphoid lateral ridges of pharynx, they are also subjected to the infection and hypertrophy, giving the impression of additional posterior palatine arches. Their inflammation and hypertrophy are defined as lateral pharyngitis, which, in essence, is just one of the symptoms of chronic hypertrophic pharyngitis.
Flowing down on the back of the throat, mucopurulent secretions reach a laryngopharynx and, in particular, an interarytenoid space. Here they are macerated mucosa of the laryngeal inlet, have on it the same pathological effect as on the rest of the mucous membrane of the throat, drying and transforming into crusts, and thus irritating nerve endings of superior laryngeal nerve, provoking coughing and causing hoarseness.
In future, chronic pharyngitis enters into the stage with dramatically pronounced tissue dystrophic processes.
Chronic rhinopharyngitis
Chronic rhinopharyngitis, causing acute and chronic inflammatory processes in the lower parts of the throat, can occur as an independent disease, having as a "feed" source of infection adenoid vegetations (chronic adenoiditis), or being caused by rhinosinus chronic infection. Nasopharynx mucosa, in contrast to the pharyngeal mucosa, is covered by respiratory epithelium, which is more susceptible to infectious agents and always responds more pronounced in the presence of the infection than multilayer (planar) epithelium, covering the mucosa of the oropharynx.
Chronic rhinopharyngitis in the first stage is manifested by the chronic catarrhal inflammation of the mucous membrane, which is hyperemic and covered with the mucopurulent secretions. The patient complains on dryness and a sensation of a foreign organism behind the soft palate, especially in the morning hours. These sensations arise as a result of dry crust formation in the nasopharynx during overnight, they are difficultly removed even with the considerable efforts of the patient. Instillation of nasal alkaline or oil drops contributes to their softening and removal. Chronic rhinopharyngitis provokes quite often headaches of deep localization, resembling those ones in chronic inflammation of posterior paranasal sinuses.
In the second stage the mucous membrane thickens, especially in the area of pipe tonsils, thus nasal cavity is represented as constricted and filled with mucopurulent secretions, flowing down on the back of the throat. Inflammation of the pharyngeal tonsils and chronic tubootitis in the presence of chronic rhinopharyngitis is a frequent phenomenon, aggravating the clinical picture of the disease by the common hearing loss, pain in the nasopharynx, periodic exacerbations of chronic adenoiditis. This stage of chronic rhinopharyngitis is usually combined with hypertrophic chronic rhinitis.
The third stage of chronic rhinopharyngitis is characterized by an increase of atrophic phenomenon which occurs many years after, and most often, it is observed in elderly people, as well as employees of hazardous occupations, in individuals of vocal professions, in young people with moronity syndrome, in the stage of pretuberculosis, after scarlet fever and diphtheria. However, chronic rhinopharyngitis can arise primarily as a kind of constitutional disease. In the process of atrophy the mucous membrane appears pale, flat, covered with dry crusts, and looks like crust in case of ozena, but it is differed from them by an absence of a specific smell.
Chronic smoker’s pharyngitis
Chronic pharyngitis of smoker occurs in people, who have started smoking early and have been continuing this detrimental activity practically throughout all the life. Tobacco smoking (nicotinism) is one of the most common types of home drug addiction, caused by organism nicotine addiction. During the tobacco smoking dry distillation occurs with the formation of the significant amount of the different products, such as nicotine, hydrogen sulfide, acetic, formic, butyric and hydrocyanic acids, pyridine, carbon oxide and etc. According to the chemical composition these substances belong to toxins, naturally, they are foreign for the organism and in case of contact with it cause harm, affecting various organs and systems.
Tobacco smoking is not a physiological need of the organism. As L. V. Brusilovsky (1960) noted, it is rather a pathological act, firstly, caused by an imitation, and then in case of further smoking it chronically destroys the organism. Without describing the details of the harm which nicotine causes to the organism, we note only that its negative effect impacts practically on all vital organs and systems (CNS, cardiovascular system, endocrine and respiratory systems, genital system, gastrointestinal tract, liver, kidneys, pancreas, interstitial tissue). In the presence of this in a greater or lesser extent all types of metabolism, adaptive trophic function of ANS, immunity are disturbed, dystrophic processes appear in the upper respiratory tract, throat, esophagus, and so on.
Nicotine acts directly on the mucous membrane of the mouth, nose, pharynx, larynx, acting on it by a pronounced damaging effect. Teeth are usually covered with a specific yellow dental deposit and quickly affected by caries. In case of smoking salivation, unpleasant mouth smell is often marked. In pipers mouthpiece lip irritation often causes the lower lip cancer. Smokers often suffer from various diseases of the oral mucosa. The damage of the pharynx by nicotine is manifested as severe hyperaemia and dryness of mucous membrane (smoker pharynx) that provokes a persistent cough and viscous gray secretions in the form of hardly expectorated sputum, especially in the morning. Smoking cessation normalizes pharynx mucosa within 3-4 weeks.
Nicotine acts directly on the mucous membrane of the esophagus, stomach and intestines, resulting in these individuals in the development of chronic catarrhal inflammation of these organs, and in those particularly sensitive ones to nicotine gastric ulcer and even cancer can develop. According to the data by some researchers, prolonged inhalation of tobacco smoke causes destructive changes in the spinal cord and peripheral nervous system in experimental animals. In addition to lesions of the respiratory and digestive tracts, workers, employed for many years in the tobacco industry, develop neurological complex, resembling amyelotrophy (according to A. Shtryumpell - "nicotine tabes").
Professional chronic pharyngitis
Professional chronic pharyngitis is observed in almost all people, working in industries, related to air emissions of dust particles and vapors of aggressive substances. In recently employed workers at the industry the first phase is catarrhal inflammation, lasts for no more than 3-5 months, then the phase of the atrophic process with the formation of crusts and the occurrence of recurrent nasal and pharyngeal bleeding from small blood vessels begins. In the presence of idiosyncrasy to certain industrial hazards workers develop often so-called intolerant pharyngitis.
Chronic pharyngitis of idiosyncratic genesis
Chronic pharyngitis of idiosyncratic genesis is characterized by diffuse reddening of the mucous membrane of the pharynx, a sensation of dryness and burning, discomfort sensations at swallowing. This chronic pharyngitis occurs after a few minutes of a direct contact of mucosa with reactogenic substance (drug, specific spice or drink containing one or another preservative, and etc.) or by a hematogenous way by substance suction through the upper respiratory tract or gastrointestinal tract. In this case, the reaction can occur in 10-15 minutes. Chronic pharyngitis of idiosyncratic genesis belongs to the category of allergic or toxic ones. The most common type of the toxic lesions of the pharynx is chronic pharyngitis of alcoholics, caused by not so much local scorching and dehydrating action of alcoholic beverages, as the presence of expressed alcoholic avitaminosis in these patients (A, B6, PP and C).
Senile chronic pharyngitis
Senile chronic pharyngitis, caused by age-related involution process, is one of the syndromes of systemic aging, which is a general biological regularity, it is inherent in all living things. According to the definition of Yu. N. Dobrovolsky (1963), "Old age is the final stage of the aging process, the final period of ontogenesis, which precedes the end of life, the last is death." As a rule, senile chronic pharyngitis does not occur in a pronounced form in the presence of physiological aging, under which it should be understood naturally coming and gradually developing process of age-related changes, accompanied by lower levels (but not distortion!) of metabolism, changes of organism adaptive abilities. The lasts lead to a decrease of organism tolerance to environmental factors, medications etc., as well as predominance of natural decomposition of tissues over their reproduction.
S.P. Botkin pointed out the need to distinguish between the concepts of senescence and premature aging. This view has obtained a wide acceptance of coryphaei of national biological science (I.I. Mechnikov, I.V. Pavlov, A.A. Bogomolets, A.V. Nagornyi and others), who appeared the pioneers in the world science about the senility in their works. Premature aging should be considered as a pathological phenomenon which occurs as a result of effects on the organism of a number of damaging factors, the origin of which is caused by an individual's lifestyle in any way, or acquired diseases, traumas, intoxications or hereditary predisposition to acceleration of processes of physiological senescence. Just in case of premature (pathological) aging characteristic signs of subatrophic and atrophic pharyngitis (rhinitis, laryngitis, esophagitis, tracheitis, etc.) are observed. They constitute a part of general morphological changes of all tissues of an aging organism.
A characteristic feature of involutional processes, appearing in the mucosa of the upper respiratory tract, is a selective atrophy of mucous membrane elements. In case of such atrophy, enhancing an activity under the influence of the night activation of the vagus nerve (complaints of older people on the abundance of mucus in the nose, throat, larynx at night), mucous glands maintain its function. At the same time the atrophy of the ciliary epithelium, interstitial tissue, submucosal layer, and also lymphoid elements occur. In the daytime, the mucosa appears dry, pale with translucent vessels through it. Granules on the back of the throat are absent, tonsils and lateral ridges are not practically defined. Due to the atrophy of the muscle layers of the pharynx, the soft palate, the palatine arches, pharynx and pharyngeal cavity are increased. Sensory nerve reflexes are reduced or absent.
Diffuse catarrhal chronic pharyngitis
In fact, this chronic pharyngitis is a total catarrhal inflammation of the pharynx, including the mucous membrane of the nasopharynx, often the auditory tube, and especially the excretory ducts of the anterior paranasal sinuses. Chronic pharyngitis is more common in children due to the more significant development of the lymphadenoid apparatus - the nest of chronic infection and less often in adults, in whom this apparatus is largely atrophied.
In the pathogenesis of the disease, an important role is played by infection of the nasal cavity and violation of nasal breathing, which excludes from the act of breathing the protective functions of the nasal mucosa and causes the contact of air entering the respiratory tract with the pharyngeal mucosa. Oral respiration is a significant aphysiological factor that negatively affects many tissue processes in the pharynx, ultimately leading to disturbances in local metabolism, hypoxia, drying of the protective layer of mucus containing biologically active substances that protect the mucous membranes of the pharynx from harmful atmospheric factors, finally, all Taken together, this leads to disruption of cellular homeostasis and a deficiency of local immunity. All these factors, acting on different germs of the mucous membrane, lead to various pathological changes, which are reflected in the clinical names of various forms of pharyngitis.
Symptoms of chronic pharyngitis
Symptoms of chronic pharyngitis consist of complaints of the patient, his general and local objective condition. There are no subjective signs of chronic diffuse catarrhal pharyngitis without exacerbation in children, in adults there are moderate complaints of tickling in the throat, viscous difficultly expectorant secretions, an increased vomiting reflex with accumulation of crusts, cough. Patients often resort to gargling at night. In the morning, the symptoms noted above are more pronounced.
How to recognize chronic pharyngitis?
During pharyngoscopy against the background of a not very bright hyperemia of the mucous membrane on the back of the pharynx, soft palate determines viscous mucous deposits that are difficult to remove with the help of tweezers. In the cold season, hyperemia of the mucous membrane increases, the amount of mucous secretions increases, and they become more fluid.
When the pharynx is infected with adenoviruses or bacteria (with its own conditionally pathogenic microbiota), the mucous secretions acquire a mucopurulent character and the inflammation acquires clinical signs of acute or subacute bacterial diffuse pharyngitis. Headache, subfebrile body temperature and all signs of moderate intoxication appear.
Treatment of diffuse catarrhal chronic pharyngitis
Treatment of chronic diffuse catarrhal pharyngitis is primarily to eliminate the main cause of the disease - chronic sinusitis or chronic adenoiditis, as well as pathologically altered residues of the tonsils, if they persisted after their removal in the past. During exacerbation of the inflammatory process, the same treatment is used as in acute catarrhal pharyngitis.
Hypertrophic chronic pharyngitis
Chronic hypertrophic pharyngitis often serves as the next stage in the development of chronic diffuse catarrhal pharyngitis, due to the reasons described above. Most often, hypertrophy of lymphadenoidal formations of the pharynx is interpreted as a compensatory (protective) reaction, which increases the volume of the structures of local cellular immunity.
Symptoms of chronic pharyngitis
Clinically, chronic hypertrophic pharyngitis is considered as adenopharyngitis, caused and supported by the same rhinosinus or adenoid chronic infection. Long, for many months and years, contact of the pharyngeal mucosa with mucopurulent secretions containing decomposition products of blood cells, mucus and interstitial tissue, which have toxic-allergic properties in relation to the mucous membrane, leads not only to hypertrophy of the superficial pharyngeal tissues, but and underlying muscular and interstitial tissue, due to which the nasopharyngeal cavity appears constricted, the mucous membrane is thickened, and the nasopharyngeal openings are “buried” in edematous and hypertrophic tissues. These changes have a negative effect on the function of the auditory tube, so many people suffering from chronic hypertrophic pharyngitis also present complaints about hearing loss.
How to recognize hypertrophic chronic pharyngitis?
During pharyngoscopy, the mucous membrane of the pharynx, soft palate, palatine arches is hyperemic, covered with watery mucous-purulent secretions flowing from the nasopharynx, the palatine arches and lateral pharyngeal rollers are thickened; thinning, which, in essence, marks the transition to the next stage of chronic pharyngitis - atrophic. On the way to this stage, half of the patients have a so-called granular chronic pharyngitis that is widespread in atrophic pharyngitis.
Chronic pharyngitis
Chronic granular pharyngitis is manifested by hypertrophy of lymphoid granules covering the back wall of the pharynx. The process of hypertrophy of the granules begins with a modification of the mucopurulent secretions flowing along the back of the pharynx, with the further development of the process they become viscous, dense, drying in difficult to remove crusts. In this stage, the mucous membrane of the posterior pharyngeal wall turns pale, and the granules increase and redden. These granules form small islands of lymphoid tissue on the back of the pharynx, which, in essence, are analogs of infected granules of the tonsils, only in a dispersed state, and cause the same local and general pathological phenomena as chronic tonsillitis.
On the side walls of the pharynx, behind the posterior arches of the soft palate, the follicles unite into the lateral lymphoid pharyngeal rollers, which also undergo infection and hypertrophy, giving the impression of an additional posterior palatine arches. Their inflammation and hypertrophy are defined as lateral pharyngitis, which, in essence, is only one of the signs of chronic hypertrophic pharyngitis.
Flowing down the back of the pharynx mucopurulent discharge reaches the laryngeal part of the pharynx and, in particular, the mesenteropaloid space. Here they macerate the mucous membrane of the entrance to the larynx, exert on it the same pathological effect as on the rest of the mucous membrane of the pharynx, drying out, turn into crusts and irritate the nerve endings of the upper laryngeal nerve, provoking cough and causing hoarseness of voice.
In the future, chronic pharyngitis enters a stage with pronounced tissue dystrophic processes.
Chronic epipharyngitis
Chronic epipharyngitis, being the cause of acute and chronic inflammatory processes in the lower parts of the pharynx, can occur as an independent disease, having adenoid vegetation (chronic adenoiditis) as a “feeding” source of infection, or be due to rhinosinus chronic infection. The mucous membrane of the nasopharynx, in contrast to the mucous membrane of the pharynx, is covered with a respiratory epithelium, which is more sensitive to infectious agents and always more pronouncedly reacts during infection than the multi-layered (flat) epithelium covering the mucous membrane of the oropharynx.
Chronic epipharyngitis in the first stage is manifested by chronic catarrhal inflammation of the mucous membrane, which is hyperemic and covered with mucopurulent secretions. The patient complains of dryness and foreign body sensation behind the soft palate, especially in the morning hours. These sensations result from the formation of dry crusts in the nasopharynx during the night, which are difficult to remove even with considerable patient effort. It helps to soften them and remove alkaline or oily drops into the nose. Very often chronic epipharyngitis provokes deep-seated headaches, resembling those in chronic inflammation of the posterior paranasal sinuses.
In the second stage, the mucous membrane thickens, especially in the area of the tubal tonsils, which is why the nasopharyngeal cavity appears narrowed and filled with mucopurulent secretions that flow down the back of the throat. Inflammation of the pharyngeal tonsils and chronic tubo-otitis in chronic epipharyngitis is a frequent phenomenon that aggravates the clinical picture of the general disease with hearing loss, pain in the nasopharynx, and periodic exacerbations of chronic adenoiditis. This stage of chronic epipharyngitis is usually combined with chronic hypertrophic rhinitis.
The third stage of chronic epipharyngitis is characterized by an increase in atrophic phenomena that occur after many years and is most often observed in the elderly, as well as in workers of harmful professions, in persons of vocal professions, in young people with retardation syndrome, in the pretuberculosis stage, after scarlet fever and diphtheria. However, chronic epipharyngitis can occur primarily as a kind of constitutional disease. The mucous membrane at the stage of atrophy appears to be pale, flat, covered with dry crusts, in appearance resembling crusts at ozen, but differing from them in the absence of a specific odor.
Chronic pharyngitis smoker
Chronic pharyngitis of the smoker occurs in individuals who start smoking early and continue this harmful activity for almost a lifetime. Smoking tobacco (nicotine) is one of the most common types of household addiction, caused by the nicotine addiction of the organism. When smoking, dry distillation of tobacco occurs with the formation of a significant amount of various products: nicotine, hydrogen sulfide, acetic, formic, hydrocyanic and butyric acids, pyridine, carbon oxide and others. These substances, however, belong to chemical composition to toxins, naturally, are foreign to the body and getting into it is harmful to him, affecting various organs and systems.
Smoking tobacco is not the physiological need of the body. As noted by L.V. Brusilovsky (1960), it is rather a pathological act, caused first by imitation, and then with further smoking, a chronically destructive organism. Without going into details of the harm that nicotine causes to the body, we only note that its negative impact concerns almost all vital organs and systems (CNS, cardiovascular system, endocrine and bronchopulmonary systems, genital area, gastrointestinal tract, liver, kidneys, pancreas, interstitial tissue), while in varying degrees, all types of metabolism, adaptation and trophic function of the ANS, immunity are disturbed, dystrophic processes occur in the upper respiratory tract, pharynx, esophagus, etc.
Nicotine acts directly on the mucous membrane of the oral cavity, nose, pharynx, larynx, having a pronounced damaging effect on it. The teeth are usually covered with a specific yellow patina and are quickly affected by caries. When smoking is often marked drooling, bad breath. Smokers of the tube irritation of the lips with a mouthpiece often causes cancer of the lower lip. Smokers often suffer from various diseases of the oral mucosa. The defeat of the pharynx with nicotine is manifested by severe hyperemia and dryness of the mucous membrane (smoker's pharynx), which provokes a constant cough and viscous gray discharge in the form of difficult coughing up sputum, especially in the morning. Smoking cessation normalizes the pharyngeal mucosa for 3-4 weeks.
Nicotine acts directly on the mucous membrane of the esophagus, stomach, and intestines, as a result of which people develop chronic catarrhal inflammation of these organs, and people who are especially sensitive to nicotine can develop a stomach ulcer or even cancer. According to a number of researchers, prolonged inhalation of tobacco smoke causes destructive changes in the spinal cord and peripheral nervous system in experimental animals. Workers employed for many years in the tobacco industry, in addition to lesions of the respiratory and digestive tracts, develop a neurological complex resembling a dorsal siderod (according to A. Strumpell, “nicotine tabes”).
Professional chronic pharyngitis
Professional chronic pharyngitis is observed in almost all workers in industries related to emissions of dust particles and vapors of aggressive substances into the atmosphere. The first phase - catarrhal inflammation in the newly admitted to production, lasts no more than 3-5 months, then the atrophic process phase begins with the formation of crusts and the occurrence of periodic nasal and pharyngeal bleeding from small vessels. Often, in the presence of idiosyncrasy to certain industrial hazards in workers, so-called intolerance pharyngitis develops.
Chronic pharyngitis of idiosyncratic genesis
Chronic pharyngitis of idiosyncratic genesis is characterized by diffuse redness of the pharyngeal mucosa, sensations of dryness and burning, unpleasant sensations when swallowing. This chronic pharyngitis occurs a few minutes after direct contact of the mucous membrane with a reactogenic substance (drug, a certain spice or drink containing a particular preservative, etc.) or by hematogenous means by suction of the substance through the upper respiratory tract or gastrointestinal tract. In this case, the reaction may occur in 10-15 minutes. Chronic pharyngitis of idiosyncratic genesis is classified as allergic or toxic. The most common type of toxic lesion of the pharynx is chronic pharyngitis of alcoholics, caused not so much by the local burning and dehydrating effect of strong alcoholic beverages, but rather by the presence of pronounced alcoholic vitamin deficiency in this category of patients (A, B6, C and C).
[37], [38], [39], [40], [41], [42]
Senile chronic pharyngitis
Senile chronic pharyngitis due to age-related involutional processes is one of the syndromes of systemic aging of the body, which is a general biological pattern inherent in all living things. By definition, Yu.N.Dobrovolsky (1963), “Old age is the final stage in the development of the aging process, the final period of ontogenesis, which precedes the completion of the life cycle - death”. As a rule, senile chronic pharyngitis does not occur in a pronounced form during physiological aging, by which we should understand the regularly occurring and gradually developing process of age-related changes, accompanied by a decrease in the level (but not distortion!) Of metabolism, a change in the adaptive abilities of the body, leading to a decrease in body tolerance to environmental factors, drugs, etc., as well as the predominance of the natural decay of tissues over their reproduction. S.P. Botkin pointed out the need to distinguish the concept of physiological aging from premature aging. This presentation was widely recognized by the leading figures of the domestic biological science (I.I. Mechnikova, I.P.Pavlova, A.A.Bogomolets, A.V. Nagorny, and others), who in their writings were pioneers in the global science of old age. Premature aging should be attributed to the category of pathological phenomena that occurs as a result of exposure to the body of a number of damaging factors, the origin of which is due either to the lifestyle of the individual, or acquired diseases, injuries, intoxications, or hereditary susceptibility to acceleration of physiological aging processes. It is during premature (pathological) aging that characteristic signs of subatrophic and atrophic pharyngitis (rhinitis, laryngitis, esophagitis, tracheitis, etc.) are observed, which are part of the general morphological changes of all the tissues of an aging organism.
A characteristic feature of the involutional processes that occur in the mucous membrane of the upper respiratory tract is selective atrophy of the mucous membrane elements, in which the mucous glands retain their function, intensifying activity under the influence of the night activation of the vagus nerve (complaints of the elderly on the abundance of mucus in the nose, throat, larynx at night), at the same time, atrophy of the ciliary epithelium, interstitial tissue, submucosal layer, and lymphoid elements occurs. In the daytime, the mucous membrane appears dry, pale with vessels translucent through it. There are no granules on the back of the pharynx, palatine tonsils and lateral ridges are practically undecidable. Due to the atrophy of the muscular layers of the pharynx, soft palate, palatal arches of the pharynx and pharyngeal cavity are increased. Sensory nerve reflexes are reduced or absent.
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Treatment of chronic pharyngitis
The treatment of chronic pharyngitis is determined by the clinical form of the pathological process and the stage at which this clinical form is located.
Treatment of chronic diffuse catarrhal and hypertrophic pharyngitis, as well as any other disease, regardless of etiology and pathogenesis, should be complex, as far as possible, etiotropic, in most cases pathogenetic and always symptomatic. Given that the cause of chronic diffuse catarrhal pharyngitis in the vast majority of cases are inflammatory diseases of the nasal cavity, all attention should be paid primarily to the reorganization of the nose and paranasal sinuses (elimination of purulent infection, elimination of the causes of violations of nasal breathing, reorganization of lymphoadenoid formations and above all pharyngeal tonsils). In addition, one should pay attention to the general state of the body, exclude diseases of other organs and systems, the presence of allergies, idiosyncrasy, some genetically determined dysmorphia of the nasal cavity, oral cavity and pharynx. These general provisions are also true for the treatment of other forms of chronic pharyngitis.
Treatment of chronic pharyngitis diffuse catarrhal should be carried out taking into account the presence of catarrhal inflammation caused by nesting vulgar pathogenic microbiota in the mucous membrane layers, the virulence of which is supported by impaired trophism and a decrease in local cellular and humoral immunity. On this basis, the etiotropic treatment of chronic pharyngitis should be aimed at identifying the pathogenic microbiota and targeting it with appropriate bactericidal agents. This effect should be directed primarily at the pathogenic focus of infection and, secondarily, on the pharyngeal mucosa. The most effective drug in this case is Clarithromycin macrolide (binoculars, Klabaks, Claritsin, Klacid, Fromilide), used per os. This drug is active against many intracellular microorganisms, gram-positive and gram-negative bacteria.
Of great importance in the treatment of chronic diffuse catarrhal pharyngitis are methods that increase the overall resistance of the body, the use of antiallergic, desensitizing and sedatives, drugs that normalize metabolic processes, vitamin therapy, fill the deficit of microelements that play a crucial role in maintaining the mucosal membrane of the body.
Local treatment of chronic pharyngitis
Local treatment of chronic pharyngitis can only partially be considered pathogenetic, precisely in those cases when the pharyngeal mucosa with the help of drugs and physiotherapeutic agents stimulate immune, metabolic, trophic and reparative processes. The full set of these methods is given in previous sections; an experienced doctor can only make an adequate and effective composition of them, taking into account the individual characteristics of the whole organism and the local pathological process. Since diffuse catarrhal chronic pharyngitis and chronic hypertrophic pharyngitis are, in essence, the combined phases of the same inflammatory process, the methods used to treat them are almost identical, except that with hypertrophic pharyngitis, they (methods) are more radical and invasive. In chronic catarrhal and hypertrophic pharyngitis, weak-binding and anti-inflammatory agents are used to reduce the exudation and swelling of the mucous membrane, and in the hypertrophic form of chronic pharyngitis, cauterizing agents are used (10% silver nitrate solution, trichloroacetic acid, crystalline after anesthesia with 1% dikain solution, applied nursing silver, nitrate, crystalline trichloroacetic acid, 1% dycaine, after the anesthesia, apply nymphaemic agents). Sections of lymphadenoid tissue (granules on the back of the pharynx, lateral ridges). However, one should caution against excessive entrapment of cautery by these outbreak foci in the fight against infection and the centers of trophic regulation of the mucous membrane, otherwise there is a risk of transfer of chronic diffuse catarrhal pharyngitis and chronic hypertrophic pharyngitis to the stage of atrophic process, which in most cases remains irreversible.
Burov's liquid, resorcinol solution (0.25-0.5%), alcohol solution of propolis (30%), eucalyptus tincture (10-15 drops per bottle) are used as the drugs of choice in the local treatment of chronic diffuse catarrhal pharyngitis and chronic hypertrophic pharyngitis. A glass of water for rinsing 3 times a day), etc. As a binder and disinfectant, use 0.5-1% solution of iodine-glycerin (Lugol solution), 1-2% solution of silver nitrate, 2-3% solution of protargol or collargol, tannin mixed with glycerin, menthol in peach oil, 0.5% astvor zinc sulfate.
With timely, adequate and effective treatment, taking into account the elimination of foci of infection in the upper respiratory tract, rehabilitation (if necessary) of other organs and systems, elimination of household and occupational hazards, compliance with the work and rest regimen, personal hygiene and periodic spa treatment "on the waters »Chronic pharyngitis overwhelmingly regresses and disappears completely within 2-3 months. However, despite the most intensive treatment, the use of alcohol and tobacco nullify all the efforts of the doctor and the patient, while the effect is temporary and insignificant, and chronic pharyngitis continues to progress, passing into the stage of chronic subatrophic and atrophic pharyngitis.