Ozena of the pharynx: causes, symptoms, diagnosis, treatment

This disease can spread to the nasopharynx, pharynx, trachea and bronchi, as well as to the auditory tube and tear ducts, causing the corresponding morphological and functional disorders. Sometimes the ozona is more active in the nose of the throat than in the nasal cavity. In most cases, the ozone occurs at the onset of puberty and most often in women. It is suggested that the causative agent of the lake is the Gram-negative fixed rod of the genus Klebsiella. However, not only the infectious origin is the cause of this debilitating disease, but, probably, a number of neuroendocrine disorders and genetically determined causes, which gives this disease a systemic character.

Ozena is a chronic disease of the upper respiratory tract, which begins most often in the nasal cavity, characterized by atrophy of its mucous membrane and bone-cartilaginous skeleton, the appearance of a thick detachable, turning into fetid crusts. A similar process is observed in the throat. It is noticed that in persons who have recovered as a child diphtheria, scarlet fever, measles, whooping cough, in subsequent years there are more chronic inflammatory diseases of the nasal cavity and nasopharynx, which, in the opinion of some foreign authors, are in some cases the preoenotic phase, which under certain unfavorable conditions can further develop into a clinical picture of the classical lake. Along with this, there are also erased forms of the lake, which are manifested only by an atrophic process. It should be emphasized that often the lake is accompanied by chronic purulent sinusitis, which, if not its trigger, play an essential role in maintaining the disease and its progression.

Pathomorphologically, the pharyngeal region is manifested by a progressive atrophy of the nasopharyngeal mucosa, in which the ciliated epithelium is gradually replaced by a multilayer flat keratinizing one. The glandular apparatus of the mucous membrane begins to produce a mucus that has been dramatically changed in its biochemical composition, which rapidly dries into fetid crusts. The spread of the atrophic process to the submucosal layer, muscles, lymphadenoid and bone formations leads to a significant increase in the volume of the nasopharynx, which in posterior rhinoscopy is represented by a gaping cavity, the walls of which are covered with yellowish layers, extending to the choana and further into the nasal cavity.

Almost simultaneously, similar pathomorphological changes occur on the posterior wall of the pharynx. Here the mucous membrane is thinned, when removing the crusts, it appears as a pale cyanotic formation of an opalescent species.

Symptoms. Subjectively, the patients feel a constant painful dryness and are forced to constantly irrigate the pharynx with alkaline and oily solutions to remove crusts and soften the mucous membrane. Advancement of the process to the laryngopharynx and the area of entry into the larynx causes a constant agonizing cough, hoarseness of the voice, difficulty in swallowing. Appears malodorous mouth breathing, not felt by the patient himself because of the loss of the olfactory function, but becomes unbearable to others. The disease lasts for years and decades, ending with a stage of total atrophy of the upper respiratory tract. In some cases, with early complex treatment, the process can be suspended and even regressed, stopping at a certain stage of morphological changes.

Treatment for pharyngeal throat is an integral part of complex systemic treatment of the oes, as an independent nosological form, including symptomatic, physiotherapeutic, medical and surgical methods. It should be noted that treatment in cases of osteoporosis should be combined with intensive therapy for nose nose, as it is noticed that the effect favorable for the nasal cavity obtained from this treatment always has a positive effect on the mucous membrane of the pharynx. This phenomenon is noted not only for nonoperative treatment, but mainly for surgical recalibration of the nasal cavity. The most effective drug is streptomycin, which is prescribed in the form of inhalations, ointments for the nose, intramuscular injections, along with other broad-spectrum antibiotics (metacycline, chainin, etc.). To improve the trophism of the nasal mucosa and pharynx, it is irrigated with solutions of vitaminized oils (sea buckthorn oil, dog rose, carotolin, oil solutions of vitamins A and E). In the nose use chlorophyllokarotinovuyu paste, appoint multivitamins with microelements, iron preparations. Widely used physiotherapy methods (electrophoresis of potassium iodide, diathermy, UHF, laser therapy).

The positive effect of hemotransfusion of UFO-blood, the use of extracorporal therapy (plasmapheresis) is not excluded. A very effective method for treating common forms of the oeda is, first of all, the sanation of chronic foci of infection (adenotomy and tonsillectomy are contraindicated and, conversely, surgical sanitation of the paranasal sinuses is shown with maximal shade of the "tissue resource"). The method of recalibration of the nasal cavity aimed at narrowing the nasal passages with the help of implantation under the mucous membrane of special spongy alloplastic materials, close in structure to tissue collagen (collopane) or autochondria, plays the role of not only a mechanical recalibrator of the nasal passages, but also stimulators of the tissue regenerative processes.

As promising proposals for their use in rhinology in the lake and other atrophic processes in the nasal cavity, we recommend referring to the experience of dentists who widely use in patchwork operations to stimulate reparative processes during periodontal damage. To stimulate the reparative processes in the lake, probably a certain effect could be achieved by the use of bone meal, such collagen preparations as collagen sponge and collagen powder, embryoplast (embryo tissue of early (7-12 weeks) gestation period), which has a pronounced biostimulating effect and property of almost complete absence of antigenicity. With a particularly pronounced atrophy of the anatomical formations of the nose affecting the bone tissue, it is likely that a significant regeneration effect can be obtained from implantation in the bottom and side wall of the nose of hydroxyapatite in a mixture with collagen. Hydroxyapatite is compatible with body tissues, since its crystalline form, along with amorphous calcium phosphate, constitutes the mineral matrix of bone tissue and, by stimulating osteogenesis, promotes the restoration of not only the periodontal tissues, but also any other bone tissues, including bone formations of the nasal cavity . For practical use in the nose and throat, it is possible to recommend such modern Russian preparations as "Hydroxyapol", patented in Russia and CIS countries, the tested drug, "Collapol" (collagen sponge, which contains hydroxyapatite), and other drugs of similar effect, produced by the firm "Polikom". For example, Collapol, has not only hemostatic, but also anti-inflammatory properties, and also stimulates reparative processes. "

Modern therapeutical treatment of the lake must necessarily be complex and systemic with the use of the following medicinal groups: antioxidants and antihypoxants (dibunol, sodium oxybutyrate, olifene), preparations of non-specific stimulating action (metacil, pentoxyl, potassium orotate, atemin, biodoside, FIBS or peloidodistillate for injections, khonsurid, vitreous, "Proposol" -aerosol, ointment "Propoceum", solcoseryl), drugs of specific action (thiamine, thymogen, tactivin, levamisole, etc.), desensitizing agents and (diphenhydramine, Phencarolum, Promethazine, Diazolinum, Suprastinum et al.), calcium preparations (calcium chloride, calcium gluconate, calcium lactate), preparations improving microcirculation (parmidin, glivenol, Aescusan, komplamin et al.). The listed preparations are complexed according to the appropriate indications and individual contraindications to achieve the effect of mutual potentiation and complementarity and to fill the deficit of humoral and tissue resources.

[1], [2], [3], [4]