Throat tuberculosis

Description:

Throat tuberculosis (guttural tuberculosis, tuberculosis of a respiratory organs) - the chronic infectious disease caused by tuberculosis mycobacteria, developing, as a rule, against the background of widespread tuberculosis of a respiratory organs, hematogenous (lymphogenous) disseminironanny process of extra pulmonary localization or a contact way (sputogenno). It is characterized by development of a cellular allergy, specific granulomas and a polymorphic clinical picture.

Tuberculosis is known from an extreme antiquity. According to the published data, the pathological changes of bones of a backbone characteristic of tubercular defeat were found on a skeleton at excavation near Heidelberg; the age of a find is referred to the early period of the Stone Age (5000 years BC). Among 10 skeletons of the Egyptian mummies carried to the 27th century BC at four backbone caries was found. As V. L. Eyniye writes, possibly the pulmonary tuberculosis was not found at excavation because in the ancient time interiors, except for heart, buried separately. The first convincing descriptions of manifestations of a pulmonary consumption are available for the ancient people of east countries. In Ancient Greece Aesculapians were familiar with displays of tuberculosis, and Izokrat (390 BC) spoke about transmissibility of this disease. In ancient to Rima (I-II v. n. e.) Aretey, Galen, etc. give rather complete description of symptoms of a pulmonary tuberculosis which dominated throughout many next centuries. We find these data in works of Avicenna, Silvius, Frakastro and other outstanding doctors of the Middle Ages. In the Russian doctor books of the second half of the 17th century.

Tuberculosis was called by a "sukhotny disease" and "chakhotny grief". However during this period of idea of tuberculosis were very superficial. Essential achievements in the doctrine about tuberculosis were reached in XVIII-XIX of centuries in the field of pathological anatomy of this disease when its main pathomorphologic manifestations were open, however, though transmissibility of this disease was already proved, still there was the unknown his activator. And here in 1882 the outstanding German bacteriologist, one of founders of modern microbiology Robert Koch (1843-1910) reported about opening of the causative agent of tuberculosis by him. In its report in the Berlin physiological society MBT morphology, ways of their detection, etc. were in detail characterized. In Russia to the middle of the 19th century N.I.Pirogov described generalized forms of tuberculosis, acute miliary tuberculosis, a pulmonary tuberculosis, bones and joints.

Stage of huge importance was opening by the French scientific K. Geren in 1921-1926 of antitubercular preventive vaccination by introduction of the weakened culture of MBT of bull type (vaccine BTsZh). The big role in diagnosis of tuberculosis was played by works of the large Austrian pathologist and pediatrician K.Pirke who opened in 1907 diagnostic skin test on tuberculosis (tuberculinodiagnosis). The mentioned works, along with opening in 1895. "H-beams" the great German physicist V.K.Rentgen gave the chance of clinical differentiation of changes in bodies and first of all in lungs, a GIT and bones. However progress in diagnosis and other areas of a problem of tuberculosis within all the 19th century rested against lack of etiological treatment. Within the 19th century and even in its second half the doctor had mainly gigiyeno-dietary methods of treatment of a tuberculosis infection. The principles of sanatorium treatment were developed abroad (H.Вrehmer) and in Russia (V. A. Manassein, G. A. Zakharyin, V. A. Vorobyov, etc.).

Theoretical reasons of I. I. Mechnikov about antagonism of microorganisms became a basis in the newest direction of antibiotic therapy of tuberculosis. In 1943-1944 S. Vaksman, A. Schatz and E.Byozhi (S.Vaksman, A.Schtz, E.Вugie) discovered streptomycin - a powerful antitubercular antibiotic. Further chemotherapeutic antitubercular drugs, such as PASK, an isoniazid, Ftivazidum, etc. were synthesized. Developed as well the surgical direction in treatment of tuberculosis.

Throat tuberculosis reasons:

Causative agents of tuberculosis of a throat consider the acid resisting mycobacteria opened by R. Koch in 1882. There are several types of mycobacteria of tuberculosis (a human look, intermediate and bull). Causative agents of tuberculosis at the person most often (80-85% of cases) are mycobacteria of tuberculosis of human type. Mycobacteria of intermediate and bull type cause tuberculosis in the person respectively in 10 and 15% is accidental.

Mycobacteria consider aerobes, however they can be also facultative anaerobes. Mycobacteria are not mobile, do not form endospores, conidiums and capsules. They are very steady against influence of various factors of the environment. Under the influence of antibacterial substances of a mycobacterium can gain medicinal stability. Cultures such the mycobacteria which ultrasmall are (filtered) persistirut a long time in an organism and maintain antitubercular immunity. In case of immunity easing the described forms of the activator are capable to pass into typical again and to cause activation of specific tubercular process. Besides, refer development of stability to antitubercular medicines to other manifestations of variability of a mycobacterium.

Infection sources. The main thing from them is the sick person, and all his allocations can be an infection source. The phlegm of the TB patient of easy and upper respiratory tracts which dried in dust and extending in the atmosphere has the greatest value (Koch's theory - the Cornet). Across Flyugge, the main source of infection is the droplet infection extending at cough, a conversation sneezing. The cattle can be a source of infection: the infection is transmitted through milk of suffering from tuberculosis animals.

Entrance infection atriums the person can have a skin, a mucous membrane and an epithelium of alveoluses of lungs. Limfoadenoidny tissue of a throat, a conjunctiva of eyes, a mucous membrane of generative organs can be the place of occurrence of MBT. The tuberculosis infection extends in the lymphogenous and hematogenous way, and also per continuitatem.

Medicinal stability of MBT is caused by broad use of chemotherapeutic drugs. In 1961 60% of strains of MBT were steady against streptomycin, 66% - against Ftivazidum, 32% - against PASK. Emergence of the MBT steady forms is caused by more or less long impact on them of subbacteriostatic doses of drug. Now the corresponding specific drugs resistance of MBT significantly decreases thanks to their combined use with synthetic antitubercular medicines, immunomodulators, vitamin therapy and rationally picked up nutritional supplements.

The pathogeny is difficult and depends on variety of conditions in which there is an interaction of the activator and an organism. Infection not always causes development of tubercular process. V. A. Manasein in a pathogeny of tuberculosis attached great value to the general body resistance. This situation drew attention of phthisiatricians to studying of reactivity of an organism, an allergy and immunity that deepened knowledge of the doctrine about tuberculosis and allowed to claim that, apparently, earlier fatal disease tuberculosis - is curable. The leading role in developing of tuberculosis is played by unfavorable conditions of life and also decrease in body resistance. There are data on genetic predisposition to a disease. In development of tuberculosis allocate primary and secondary periods. High sensitivity of fabrics to MBT and their toxins is characteristic of primary tuberculosis. During this period in the place of implementation of an infection there can be primary center (primary affect) in response to which in connection with a sensitization of an organism specific process on the course of absorbent vessels and in lymph nodes with formation of primary complex develops, is more often in lungs and intrathoracic lymph nodes. In the course of formation of the centers of primary tuberculosis bacteremia is observed that can lead to lymphogenous and hematogenous dissimination with formation of tuberculous focuses in various bodies - easy, upper respiratory tracts, bones, kidneys, etc. Bacteremia leads to increase of immune activity of an organism.

Immunity at tuberculosis on modern representations depends on existence in an organism of live MBT, and also on functions of immunocompetent cells; cellular immunity acts as the leading link in formation of resilience to a tuberculosis infection.

Pathogeny:

Tuberculosis of a throat is considered a secondary disease. The most frequent source of damage of a throat - lungs. Ways of infection of a throat are various: hematogenous, lymphogenous, contact (sputogenny).

Developing of tuberculosis of a throat is connected with a number of adverse factors as the general, and local. обпщх factors refer reduced reactivity of an organism to number. From among local factors it is necessary to consider topografo-anatomic features of a throat. Its arrangement such is that the phlegm from bronchial tubes and a trachea, getting into a throat, can be late for a long time and interarytenoid space, guttural ventricles, causing maceration superficially about a layer of a mucous membrane of a throat, a loosening and exfoliating an epithelium. Thus, mycobacteria through damaged (and even unimpaired) an epithelium get into the closed lymphatic space of a subepithelial layer of voice folds and interarytenoid space and cause specific tubercular process there. Besides, refer to the local contributing moments also chronic inflammatory processes in a throat.

Development of tuberculosis of a throat takes place in 3 stages:
formation of infiltrate;
formation of an ulcer;
damage of cartilages.

Infiltration conducts to a thickening of a mucous membrane of a throat, emergence of the hillocks similar to papillomas, and then the tuberculoma with the subsequent syo an ulceration is formed. Accession of consecutive infection is followed by involvement in process of a nadkhryashchnitsa and a cartilage, can become the reason of development of a stenosis of a throat.

Primary tuberculosis of a throat meets seldom, it is secondary process at primary localization of an infection in lungs with damage of intrathoracic lymph nodes more often. Quite often tuberculosis of a throat is accompanied by tuberculosis of a trachea and bronchial tubes, tubercular pleurisy and tuberculosis of other localization (tuberculosis of a nose, throat, palatine tonsils, bone, joint, skin tuberculosis forms). Secondary tuberculosis of a throat, along with tuberculosis of a trachea and bronchial tubes, is the most frequent and terrible a pulmonary tuberculosis complication. Frequency of developing of tuberculosis of a throat and weight of a clinical current is in direct dependence on duration and a form of a disease. According to A. A.Ruedi, tuberculosis of a throat occurs approximately at 10% of patients with an initial form of a pulmonary tuberculosis, at 30% of persons with the long course of process and in 70% of cases at autopsy of the dead from a pulmonary tuberculosis. Throat tuberculosis meets at patients with exudative, open and active forms of a pulmonary tuberculosis less often at productive forms more often. Sometimes at primary pulmonary tuberculosis or at the old inaktivny, earlier not recognizable tuberculosis centers symptoms of damage of a throat can be the first symptoms of the systemic tuberculosis infection that gives a reason for the corresponding inspection of the patient and identification of either primary center, or activation of the dozing tuberculosis infection. Much more often tuberculosis of a throat men at the age of 20-40 years have. At women tuberculosis of a throat meets more often during pregnancy or later short time after the delivery. Children are ill less often, and at the age of less than 10 years - is very rare.

Usually in a clinical current between tuberculosis of a throat and a pulmonary tuberculosis there is a certain parallelism which is shown by the same exudative or productive phenomena. However in some cases such parallelism is not observed: or tuberculosis of a throat becomes aggravated and the pulmonary tuberculosis, or on the contrary is reduced. At many patients compliance between quantity of the infected phlegm allocated from the pulmonary center and frequency or a form of tubercular damage of a throat is not observed. This fact demonstrates either existence, or about lack of individual predisposition of the TB patient of lungs to a disease of throat tuberculosis. Possibly, it is about quality of so-called local immunity or being in an active state, or suppressed by some external harmful factors. For example it is proved that a pulmonary tuberculosis, secondary and primary tuberculosis of a throat smokers, alcoholics and persons whose professions are connected with existence in the inhaled air of the harmful agents reducing the resilience of a mucous membrane of upper respiratory tracts and lungs concerning an infection have preferential.

Infection of a throat happens or the ascending way at which the infection gets into a mucous membrane from the phlegm allocated from the pulmonary center, or, much more often, a hematogenous way. The hematogenous dessimination is observed at the closed and miliary forms of tuberculosis. Existence of banal laryngitis promotes implementation of MW in a mucous membrane of a throat. It is established that damages of a throat most often are on the same party, as primary center in lungs. This results from the fact that infection of a throat happened in the lymphogenous way from lymph nodes of a trachea and bronchial tubes of the party of the same name. Other explanation гомолотералыюго damages of a throat consists in operation a resnitchatny epithelium which "brings" an infection from "the" party to the same party in a throat. This explanation confirms the channel mechanism of local gomolateralny damage of a throat or in the field of "a back commissure", in interarytenoid space or monolateralno while at a hematogenous way the centers of a tuberculosis infection can randomly arise on all surface of a throat, taking also its threshold.

Throat tuberculosis symptoms:

The characteristic complaint of TB patients of a throat - the hoarseness of a voice expressed and this or that degree, pain in a throat. At localization of process in subvoice space respiratory insufficiency develops.

At an indirect laringoskopiya of day early display of tuberculosis of voice folds restriction of mobility of one or both voice folds is characteristic, however their full immovability never happens. The mucous membrane of a throat is hyperemic. The hyperemia is caused by subepitednalny rashes of tubercular hillocks. In process of process progressing the quantity of hillocks increases, and they begin to raise an epithelium, and the hyperemic site of a mucous membrane becomes reinforced (infiltrirovanny). Infiltrates ulcerate, on a fold erosion and ulcers are formed, imitating "a contact ulcer" which gets a lentikulyarny form: the bottom gets pale gray coloring.

Tubercular process in a throat can begin also with defeat of interarytenoid space. Initial displays of tuberculosis in this area, as well as in cases of defeat of true voice folds, are presented by limited sites of a hyperemia and infiltration with the subsequent ulceration, emergence of gray and dirty coloring of a mucous membrane.

Tuberculous focus in guttural ventricles, progressing, extends to the lower surface of a vestibular fold, and then - voice. It is a so-called sign of "napolzaniye" of infiltrate on a fold. The unilaterality, and also incompleteness of defeat is characteristic of tubercular defeat of vestibular folds. Process by an unsharp hyperemia of certain sites of vestibular folds, then small infiltration of all or parts of a vestibular fold is shown. The last in this case almost completely covers voice folds. Process comes to an end with an ulceration with the subsequent scarring. Extremely seldom (3% of cases) tubercular process strikes subvoice space. At the same time define infiltrates which can ulcerate.

Early displays of tuberculosis of an epiglottis: infiltration of a submucosal layer at a joint of guttural and lingual surfaces, or in the field of border of an epiglottis and vestibular folds. Extremely seldom tubercular process strikes a petal of an epiglottis and arytenoid cartilages. Therefore, at tuberculosis of a throat the mosaic, polymorphic clinical picture takes place.

Tubercular process in a stomatopharynx proves a hyperemia, infiltration and an ulceration of lobbies (seldom back) handles, almonds, a soft palate and a uvula. On a mucous membrane define a large number of yellowish-gray small knots tuberculomas. At the same time palpate increased (to the size of plum) submaxillary lymph nodes, superficial and deep lymph nodes of a neck, firm on a consistence.

Tubercular process in a nose can be localized as in anticipation of a nose (the internal surface of wings of a nose), and in a cartilaginous part of a nasal partition, and also in the field of the front ends of the lower and average nasal sinks. As a rule, one half of a nose is struck. Clinical forms of tuberculosis of a nose: infiltrative and diffusion, limited (tuberculoma), ulcer (superficial and deep with a perichondritis).

Are characteristic of tubercular otitis multiple perforation of a tympanic membrane which, merging, lead to its bystry disintegration; plentiful allocations with a pungent putrefactive smell. At the same time quite often the bone, with formation of sequesters and development of paresis or paralysis of a facial nerve is involved in process.

The chronic infiltrative form meets more often other forms. At an initial stage the specific inflammation develops slowly and asymptomatically; the general condition of the patient significantly does not suffer, evening subfebrile condition can be observed. In process of progressing of dissimination of MBT from the pulmonary center of an infection body temperature increases, there are oznoba. Gradually the patient has a feeling of a foreign body in a throat, the amplifying morbidity at phonation, by the evening - a voice osiplost which soon becomes a constant and steadily amplifies. The patient is disturbed by the constant dry cough caused both by feeling of a foreign body in a throat and the developing pathological process of N in it in lungs. Quite often these phenomena ignore both the sick, and attending physician as initial morphological changes in a throat are very similar to an exacerbation of the chronic catarral laryngitis observed at the patient for a long time. However for an exacerbation of chronic catarral laryngitis progressing of expressiveness of an aphonia which soon becomes very expressed is atypical, up to a full aphonia. Emergence of ulcerations on an epiglottis, cherpalonadgortanny folds, a perichondritis arytenoid and cricoid cartilages supplements complaints of the patient to difficulty and morbidity when swallowing. The deglutitory movements are followed also by irradiation of pain in the ear corresponding to the party of damage of a throat. Quite often even the proglatyvaniye of saliva causes painful pains, and patients refuse food because of what at them the cachexia very quickly develops. Disturbance of locking function of a throat because of the defeat of an epiglottis and muscles which are pulling together arytenoid cartilages leads to hit of liquid in the lower respiratory tracts and to development of bronchial pneumonia. Disturbance of breath in view of gradual development of a stenosis and adaptation of an organism to gradually accruing hypoxia arises only at extreme degree of a stenozirovaniye of a throat, however short wind and tachycardia at exercise stresses arise also at a moderate stenosis of a throat. Progressing of a stenosis of a throat is the indication to preventive tracheotomy as the obstructive phenomena can suddenly reach a critical state at which tracheotomy should be done in big haste without thorough preparation for it.

The endoscopic picture of a throat at this form of tuberculosis varies depending on localization and prevalence of defeat which in turn depend on a tuberculosis form - exudative or productive. In an initial stage the arising changes in a throat are hardly noticeable and hardly differ from displays of banal laryngitis. Pallor of a mucous membrane of a soft palate and vestibule of the larynx can be an indirect sign of tuberculosis of a throat, and in mezhchernalovidny space it is possible to notice the papillary infiltration similar to a pachydermia. This infiltration interferes with full rapprochement of voice shoots of arytenoid cartilages, causing the dysphonia phenomena.

Other place of frequent development of tubercular process are voice folds on one of which specific develops monokhordit which to find does not represent special work. The struck voice fold is represented swelled up a little with reinforced free edge. Such often found monolateral localization of a tuberculosis infection can exist is long, even during all main tubercular process before its end inclusive, at the same time the opposite fold can remain practically in a normality.

Further development of tuberculosis of a throat is defined by dynamics of a clinical course of the main tubercular process. At its progressing and decrease in protective properties of an organism also specific inflammatory process in a throat progresses: infiltrates increase and ulcerate, edges of voice folds take the jagged form. At an indirect laringoskopiya in interarytenoid space only the part of an ulcer surrounded with the infiltrates of irregular shape similar to a reinforced cock crest is visible. The similar infiltrative phenomena are observed also on a voice fold, in subdepository space, is more rare - on an epiglottis. The last has an appearance of the reinforced motionless shaft covered with the ulcers and uviform infiltrates covering a vestibule of the larynx. Sometimes hypostasis of an epiglottis of reddish-gray color hides these changes. The specified changes are characteristic of an exudative form of tuberculosis of a throat while the productive form is shown by the limited defeats like circumscripta acting in a throat gleam in the form of a single tuberculoma. Expressiveness of disturbance of mobility of voice folds depends on extent of damage of internal muscles of a throat, secondary arthritis of perstnecherpalovidny joints, the infiltrative and productive phenomena. Infiltration of a mucous membrane of a ventricle which covers the corresponding voice skradka is in rare instances observed.

At further development of tubercular process the arising perichondritis affects all skeleton of a throat, there are infiltrates and is purulent - caseous disintegration of pregortanny fabrics with formation of outside fistulas through which the bellied probe probes cartilaginous tissue, fragments of sequesters are selected. During this period of the patient feels the most severe spontaneous pains in a throat which are sharply amplifying at night and not decreasing not only under the influence of usual analgetics, but also morphine, Promedolum and other opiates. In the same time also process in lungs escalates. The arising pneumorrhagia can be not only pulmonary, but also guttural. Quite often patients perish from profuse pulmonary or guttural bleedings at an arrosion of a large artery.

The acute miliary form of tuberculosis of a throat arises in the hematogenous way and is caused by planting of MBT of a throat and quite often drinks. The disease quickly progresses, body temperature increases to 39-40 °C, the general state of disrepair, the expressed dysphonia reaching within several days of full loss of voice function. At the same time come the swallowing dysfunction which is followed by a painful pain syndrome, extremely painful pristupoobrazny cough, hypersalivation, paralysis of a soft palate, the accruing respiratory obstruction.

At a laringoskopiya on pale and an edematous mucous membrane the set of the miliary rashes disseminated everywhere size about a pin head, gray color surrounded with a pink nimbus is noted. In an initial stage these rashes are isolated from each other, then merge, forming a continuous inflammatory surface, and are exposed to caseous disintegration, leaving behind the superficial ulcers which are at different stages of development - from fresh rashes to hems. Similar changes arise also on a mucous membrane of a throat. At the same form of tuberculosis of a throat also the adenopathy of lymph nodes of a throat differing in the expressed pain syndrome develops it is frequent with their caseous disintegration, formation of fistulas both the subsequent calcification and scarring. Several forms of acute miliary tuberculosis of a throat are described: acute, superacute, subacute.

The superacute form differs in very bystry development of the inflammatory process leading of the patient within 1-2 weeks to death. It is characterized by a diffusion ulceration of a mucous membrane, abscessing and development of phlegmon of a throat, with extremely expressed pain and obstructive syndrome, the expressed intoxication, bystry disintegration of cartilages of a throat and surrounding fabrics, developing of arrozioniy bleedings. At this form all existing types of treatment are ineffective. The subacute form evolves slowly, within several months, is characterized by planting of a mucous membrane the nodular educations which are at a different stage of development.

The throat lupus, as a rule, - process the descending, primary center of which is or in an outside nose, or in the field of a nasal cavity, a nasopharynx and a throat. According to stastistichesky data of Albrecht, among patients with the specified forms of primary lupus 10% have a throat lupus. Primary lupus of a throat meets seldom. Most often the epiglottis and cherpalonadgortanny folds are surprised a lupus. Men are ill in the middle age, is slightly more often - women.

Features of clinical manifestations. The syndrome of the general intoxication can be different expressiveness. Reproduction of bacteria, their dissimination and effect of tubercular toxin is its cornerstone. On expressiveness of local changes it is possible to allocate the limited centers (small forms) of defeats, widespread changes without destruction, including with defeat of several bodies, the progressing destructive process. In former times often such forms as tubercular caseous pneumonia, miliary tuberculosis and tubercular meningitis, and also generalized forms of tuberculosis met multiple defeat of various bodies. And though presently these forms of tuberculosis meet much less often, the problem of primary and secondary tuberculosis remains urgent, especially for the closed collectives.

Secondary tuberculosis proceeds is long, wavy, with change of the periods of an aggravation and zatikhaniye. Local displays of primary tuberculosis (for example, throats, bronchial tubes, a throat and other ENT organs) come to light generally at not vaccinated children, at children and teenagers with the phenomena immunodepressive and immunodeficiency. At persons of advanced and senile age symptoms of tuberculosis are observed against the background of signs of age changes in various bodies and systems (first of all, in upper respiratory tracts and bronchopulmonary system), and also associated diseases.

Negatively influence the clinical course of tuberculosis pregnancy, especially early, and the puerperal period. However at mothers, TB patients, full-fledged, almost healthy children are born. They are, as a rule, not infected, and BTsZh needs to vaccinate them.

Treatment of tuberculosis of a throat:

Treatment is directed to elimination of clinical manifestations and laboratory symptoms of tuberculosis of a throat and lungs, regression of radiological signs of specific process in a throat and lungs, recovery of voice and respiratory functions and working ability of patients.

Indications to hospitalization.

Long (more than 3 weeks) hoarseness of a voice and pharyngalgia when swallowing liquid and firm food, not giving in to standard methods of treatment.

Existence of chronic hypertrophic laryngitis, "contact ulcer".

Non-drug treatment of tuberculosis of a throat.
From non-drug methods of treatment recommend:
the sparing voice mode:
the sparing high-calorific food;
balneological treatment.

Drug treatment of tuberculosis of a throat.

Treatment is selected individually, taking into account sensitivity of mycobacteria of tuberculosis to himiopreparata. Treatment is carried out in specialized TB facilities.

Highly effective drugs consider an isoniazid, rifampicin, Pyrazinamidum, Ethambutolum and streptomycin. Usually appoint not less than 3 drugs taking into account sensitivity of mycobacteria to them. For example, an isoniazid, rifampicin, Ethambutolum for a long time (up to 6 months). System therapy combine with inhalations of antitubercular drugs (10% isoniazid solution).

Carry locally out applications of ointment drugs with anesthetic on ulcer surfaces, cauterization of infiltrates and ulcers of 30-40% silver nitrate solution, do novocainic blockade of an upper guttural nerve or intradermal novocainic blockade according to A. N. Voznesensky, vagosympathetic blockade on A.B. To Vishnevsky.

Treatment of the patients having throat tuberculosis is carried out in specialized ftiziatrichesky clinics in which staff there is an otorhinolaryngologist specializing in area of tubercular damages of ENT organs. Its task includes primary and systematic LOR-survey of all patients arriving and being on treatment and participation in medical process. The main objective of "otorhinolaryngological" treatment consists in treatment of the patient from a throat disease (as well as other ENT organs) and prevention of superinfection (a perichondritis, phlegmon, "malignant" cicatricial process), and also in acceptance of emergency measures at asphyxia at an acute stenosis of a throat (tracheotomy).

Treatment is subdivided into the general, directed to stopping by therapeutic means of primary center of a tuberculosis infection, or its elimination by an extirpation of the struck part of pulmonary fabric, and local by means of which try to reduce or even to prevent destructive changes of a throat and their effect. As for chronic Cicatricial stenoses, depending on their degree it is also applied surgical treatments by laryngoplasty methods.

At treatment of patients with tuberculosis of a throat apply the same medicamentous means, as at a pulmonary tuberculosis (antibiotikoteraniye), however it is necessary to consider that the antibiotics applied at tuberculosis render only bacteriostatic, but not bactericidal action therefore under unfavorable conditions (an immunodeficiency, bad hygienic and climatic conditions, alimentary insufficiency, avitaminosis, household harm, etc.) the tuberculosis infection can recur. Therefore the hygienic and preventive actions directed to fixing of the reached therapeutic effect and prevention of a recurrence of a disease without fail have to enter a complex of remedies. The stated above Streptomycin, Kanamycinum, Rifabutin, Rifamitsin, Rifampitsin, Tsikloserin treat the antibiotics applied at treatment of patients with throat tuberculosis. From drugs of other classes apply vitamins and vitaminopodobny means (Retinolum, Ergocalciferol, etc.), glucocorticoids (the Hydrocortisone, Dexamethasone, Methylprednisolonum), synthetic antibacterial agents (aminosalicylic acid, the Isoniazid, Metazid, Opiniziazid, Ftivazidum, etc.), immunomodulators (Glutoksim), macro - and microelements (Calcii chloridum, Pentavit), sekretolitik and stimulators of motor function of respiratory tracts (Atsetiltsistein, Bromgeksin), hemogenesis stimulators (Butilol, Gidroksokobolamin, Glutoksim, gland a gluconate and a lactate and other ferriferous drugs, Leucogenum, Lenograstim, Methyluracil and other stimulators of "white" blood). When using antibiotics good results are yielded by a streptomycin combination with Ftivazidum, especially at miliary and infiltrative and ulcer forms of tuberculosis. It must be kept in mind that a number of the antibiotics applied at treatment of the patients having tuberculosis possess ototoksichesky action (Streptomitsin, Kanamitsin, etc.). Their harmful influence on SPO arises not often, but, having arisen, can lead to full deafness. Usually ototoksichesky action begins with a sonitus therefore at the first emergence of this symptom it is necessary to interrupt treatment with an antibiotic and to direct the patient to the LOR-specialist. In such cases appoint the group B vitamins, drugs improving microcirculation, hold 3-4 sessions of a plasma exchange of N dehydrational therapy, intravenously enter реополиглюкин, Rheoglumanum and other detoksikatsionny means.

Topical treatment has symptomatic character (aerosols with anesthetics, mucolytic means, injections in a throat of menthol oil). In some cases at considerable proliferative processes use of endolaryngeal microsurgical operative measures using a galvanocautery, a diatermorkoagulyation, a method of laser microsurgery is possible. At the expressed pain syndrome with an otodiniya in some clinics make crossing of an upper guttural nerve on side of that ear in which irradiate pains.

Treatment of a lupus of a throat includes use of D2 vitamin in combination with calcium drugs by the technique offered in 1943 by the English phthisiatrician K. Charpi: appoint three times a week on 15 mg of vitamin B a current of 2-3 months, then on 15 mg every 2nd week within 3 months - or per os, or parenterally. Appoint also daily calcium a gluconate on 0,5 g parenterally or per os, milk to 1 l/days. Food has to be protein-rich also carbohydrates; animal fats in a daily diet should not be more than 10 g. The patient has to receive many vegetables and fruit.

At expressed infiltrative and cankers of a throat add drugs PASK and streptomycin.

Surgical treatment of tuberculosis of a throat.

At development of a stenosis of a throat the tracheostomy is shown.

Further maintaining.

Patients with tuberculosis of a throat need dispensary observation. Approximate terms of disability at throat tuberculosis: of 10 months and more but to the conclusion of VTEK (when there is a tendency to treatment), or disability registration to patients of-voiced and speech professions.

Forecast:

The forecast depends on duration of a disease, the degree of manifestation of tubercular process accompanying pathology of internals and addictions.

The forecast at tuberculosis of a throat depends on a set of factors: from expressiveness of pathological process, its form and a stage, timeliness and completeness of treatment, the general condition of an organism and, at last, from the same factors relating to tubercular process in lungs. Generally, in modern "civilized" conditions of medical care the forecast concerning a condition both a throat, and other centers of a tuberculosis infection is favorable. However in the started cases it can be adverse concerning functions of a throat (respiratory and golosoobrazovatelny) and the general condition of the patient (disability, an invalidism, a cachexia, death).

The forecast at a tubercular lupus of a throat favorable, if the general resistance of an organism rather high. Local cicatricial complications at which resort to methods of dilatation or microsurgical intervention are not excluded, however. At immunodeficiency there can be tuberculous focuses in other bodies at which the forecast becomes serious or even doubtful.

Diagnosis:

Prevention of tuberculosis of a throat comes down to prevention of a pulmonary tuberculosis. It is accepted to distinguish medical and social prevention.

Specific prevention of tuberculosis is carried out by a dry tuberculous vaccine for intradermal introduction (BTsZh) and a vaccine dry antitubercular for the sparing primary immunization (BTsZh-M). Primary immunization is performed for 3-7-Y day of life of the child. Revaccinations are subject the children at the age of 7-14 years having negative reaction to Mantoux reaction.

The next important point of prevention consider medical examination of TB patients, and also implementation of new diagnostic methods and treatment.