Good afternoon. Me unpleasant sensations in a nasopharynx (disturbed an epiglottis... [Архив]

Doctor V.I.Kochenov.

12.05.2004, 23:21

Kochenov Century d. M. n.
THE SYNDROME OF THE EPIGLOTTIS AND ITS or HIS CRYOGENIC TREATMENT.
Russia. The Nizhniy Novgorod center of medical researches "Diamed". 603104, N.Novgorod, Medical, 1. Ph.: (312 396907. E-mail: kriol@kis. ru

Very much frequently patients complain of sensation alien body in a throat. After attentive survey the reason it increase with age of tongve tonsil, deformation of a petal epiglottis becomes clear that. It is possible to name it status " epiglottis syndrome ". Cryotherapy in oropharynx with recurrence in 1 month 2 3 times, sometimes cryodestruction of the tongve tonsil decide this problem.

Extremely a plenty of patients of average years man's, and in overwhelming majority of a female, address to doctors of the most various specialities with typical complaints on komok in a throat . They describe the sensations as presence of an alien or a foreign body in a throat, feeling zadevanija something about something at proglatyvanii, shchekotanie, a prelum, a burning sensation, pershenie, a dyspnea, sadnenie, a dyscomfort . The majority of them has an expressed cancerophobia, as similar sensations in a throat natalkivajut them on an idea on presence of tumoral body height in the top respiratory ways. More often such patients show on a level of unpleasant sensations in a throat in the field of a root of tongue, a larynx.
Neuropathologists, vertebrologi, endocrinologists, therapists of the general or common structure, surgeons endocrinologists, otolaryngologists, gynecologists, even psychiatrists try to solve Problems of this group of patients. to. The majority of patients of this group mature women with labile nervous system, with appreciable social claims to own I and to a state of health, in the premenopausal period. On our observations not less, than at 60 % of such patients palatine tonsils earlier have been removed.
And not having found out finally the reasons causing the complaints, doctors of the listed specialities as it is assiduous, as well as unsuccessfully, treat patients with komkom in a throat calmatives down to tranquilizers, massage, gargles and inhalations, dushespasitelnymi conversations, hormonal agents, operate even at its or her insignificant augmentation at a thyroid gland . And more often the tendency to direct such not the clear patient to other interfacing expert or the psychiatrist is precisely traced.
The Problem is. Its or her decision lays in a floor or field of adequate use of a cryogenic method of treatment.
Having experience of treatment of patients with complaints on komok in a throat and a fright in opinion of, 20 30 similar references or manipulations numbering more in a month during twenty years of job otorinolaringologom-the oncologist, we have come to conclusion, that the basic morphological substrate of similar disease, the reason of primary occurrence of complaints is elementary mechanical contact of edge or territory of a petal of own epiglottis of the patient to own lingual tonsil.
With the years the epiglottis is a little deformed, more turned off or more folded in a tube, its or his free end, the petal shows the tendency to be bent forward aside a root of tongue. At women the epiglottis hardens and okostenevaet later, therefore in a greater degree and is deformed. Simultaneously with weakening immunologic functions of palatine tonsils in process of offensive or approach of mature age and at first attributes of ageing of an organism the volume of palatine tonsils decreases. It is connected with weakening their immunologic functional activity. Simultaneously kompensatorno some tendency of augmentation of volume of a lingual tonsil is shown. (It is necessary to note law of shift of the tendency to a hypertrophy from children's to advanced age in the lymphoid ring Pirogova-Valdejera, going from top to down. At children to the greatest degree also it is is more often hypertrophied nasopharyngeal, at young men nebnye, and at elderly - lingual tonsils).
Even at absence of any pathology these drinks or pharynxes two processes, on the one hand in an epiglottis, with another - in a lingual tonsil, lead to occurrence at people of mature age to occurrence of mechanical contact of an epiglottis and a root of tongue. Most emotsinalnye and impressionable, a little ekzaltirovannye women start to notice this contact, constantly to bring on itself the to a focus first of all. Feeling in a throat which was not earlier, such patients start to check mechanical contact constantly - was saved or the new unpleasant sensation has disappeared. They often make an empty drink for this purpose - without nutrition and water. Thus the epiglottis does not deviate, as it occurs or happens at a full drink from a root of tongue, naturally enters contact with a mucosa of a root of tongue. This site just corresponds or meets to a lingual tonsil, is essentially displaced in a plane of contact. There is a present or true rigid friction at each empty drink. To us there were patients at which during the moment of an empty drink there was a present or true not feigned dyspnea of that there was a present or true dislocation of an epiglottis, its or his free extremity or end was bent downwards on a course of moving of a root of tongue at a swallowing without alimentary komka. Thus the basis of an epiglottis was inevitably essentially displaced forward, deforming all vestibular department of a larynx, blocking itself a lumen of a respiratory way. Such situation has easily been overcome by deliberate calling a vomitive reflex.
Constant swallowings without alimentary komka cause occurrence of the inflammatory centers, puffinesses, even erosions, keratoses (change as a callositas) both on an epiglottis, and on a lingual tonsil. All this sharply strengthens complaints, scares before a cancer tumour of pharynx, there are ideas on a hopelessness of a situation with health, legkovozbudimye patients at times panic literally, annoy different doctors, usual treatment does not help or assist.
At a syndrome of an epiglottis is very simple differentsialno-diagnostic reception with the different neoplasms often developing in a drink or pharynx. If at presence of a tumour unpleasant sensations, pains and feeling of an alien or a foreign body at proglatyvanii nutrition, water amplifies, at a syndrome of an epiglottis of patients specify that at reception of nutrition, proglatyvanii them nothing disturbs liquids. The knowledge of it or this patients would relieve them of very many experiences.
Practically at all patients presence chronic subatrophic or, more often, a hyperplastic pharyngitis accompanied typical complaints. At a quarter of patients which earlier at young age tonsilectomies have not undergone was marked or celebrated active education a proside in palatine tonsils. These accompanying pathological processes in a drink or pharynx distracted attention of doctors, at which patients were treated earlier, for ascertaining anatomic features of interposition of edge or territory of a petal of an epiglottis and a root of tongue. Even, if mirror research of a laryngopharynx was made, an ENT the doctor only ascertained absence of neoplasms. The accent or stress in an expected treatment was done or made on elimination of displays of these diseases which, as is known, are treated by the therapeutic agents accepted on today practically without results.
At 25 patients presence of an extreme degree of the expressed hypertrophy of a lingual tonsil was observed. And at 8 it is more on the one hand (thus complaints on komok in a throat were lateralizovannymi in one party or side). The sizes of a lingual tonsil forced to suspect presence of tumoral process of this group of patients in the field of a root of tongue. In such situations applied a biopsy, and histological research. However, its or his results testified to presence of a hyperplasia of an adenoid tissue. Among the reasons of such sharp hypertrophy the deep mycotic affection of pharynx in the field of a lingual tonsil, a lesion of a tissue a mycoplasma is more often appeared.
Spent after an establishment of the diagnosis a syndrome of an epiglottis treatment included always and first of all a detailed explanation to the patient of anatomic features of a structure its or his drinks or pharynxes with graphic demonstration of the image of section of pharynx at this level at each concrete patient. One only comprehension by the sick person of a short of unpleasant sensations disturbing it or him gave the expressed positive effect in all situations, calmed or abirritated the sick person.
To Absolutely all patients who have addressed with complaints on komok in a throat, made cryotherapy of a stomatopharynx and a nose by the standard individualized technique. After local anesthesia of 2 % Lidocainum, thin long krioinstrumentom with a spherical convex applicator of 3 4 mm in diameter, cooled due to active circulation of liquid nitrogen inside of a cannula up to temperature - 160 --190 With, without adhesion touched repeatedly with an exposition of each touch in 1 3 seconds a mucosa of palatine tonsils (to cicatrixes in mindalikovyh niches), to lymphoid granules of a back wall of pharynx, lateral platens, a root of tongue. Or at atrophic changes carried out a stroking of a mucosa of tonsils and a back wall of pharynx an end of an applicator which temperature continued to be supported or maintained by constant circulation of liquid nitrogen at a level of absence of adhesive effect. Between applications the applicator was cleared of the frozen saliva and slime by pure or clean ethyl alcohol. Then an applicator again cooled up to ultralow temperature. Procedure in a drink or pharynx repeated 5 7 multiply with drawing at punctual or dot kriovozdejstvii 7 14 zones of freezing, or with triple repetition kriomassazha mucous pharynx.
Used krioinstrumenty the medical cryogenic equipment or installation "Penguin" or the independent manual apparatus in the form of an attachment or a nozzle on a household thermos - "Ledok".
The Main thing at exercise of cryotherapy in a drink or pharynx consist in that up to a touch to a mucosa to create on an applicator constant temperature below - 140 With and to continue active cooling a handpiece during carrying out of touches by an applicator to a mucosa. It allowed to guarantee absence of attachment or adherence of an applicator to tissues. Thus there were no anguishes, traumas of a mucosa, bleedings.
Manipulation of cryotherapy of pharynx was transferred or carried by all patients very easily. Some complexities arose only at presence of very expressed pharyngeal vomitive reflex at the patient.
At the majority of patients with a syndrome of an epiglottis in addition quickly (2 3 sec) made local freezing at ultralow temperature krioapplikatora for a nose and the forward extremities or ends of the bottom nasal conchas - reflexogenic, all respiratory ways of a zone operating or controlling a functional status.
After cryotherapy of pharynx and a nose within 1 3 days of patients marked or celebrated some morbid sensations at proglatyvanii nutrition, nasal respiration a little worsened. It did not demand special treatment. However to all patients recommended to start right after cryogenic therapeutic influence regular gargles of pharynx broths of medicinal grasses (as on a regular basis as cleaning of a teeth is made, during all life).
To repeat cryotherapy recommended depending on an expression of a hyperplastic pharyngitis, a hypertrophy of a lingual tonsil 2 4 times with an interval in a month. Then to use cryotherapy for prophylaxis of exacerbations of a pharyngitis and the prevention or warning of predilection to augmentation of a lingual tonsil with the years once a year, or in three years necessarily.
At 68 patients with the expressed augmentation of a lingual tonsil have carried out immediate freezing a tissue of this tonsil immediately in a zone of its or her contact to a petal of an epiglottis at an indirect hypopharyngoscopy in addition to kriovozdejstvijam in a stomatopharynx and a nasal cavity. Used krioinstrument with izognutoj an arch teploizolirovannoj a cannula. Under local anesthesia at an indirect mirror hypopharyngoscopy entered preliminary as much as possible cooled applicator for a root of tongue, touched without adhesion the hypertrophied lingual tonsil repeatedly till some seconds. Time krioapplikatsii, their quantity or amount were very individual and depend on an expression of pathological process, ability of the patient to relax and easy to allow to manipulate in a laryngopharynx. It is noted, what even very short-term touch to the inflamed lingual tonsil an applicator having temperatures - 170 --190 With promoted appreciable decrease of the lingual tonsil amazed or struck by a fungus in 1 month. In this group of patients immediate kriovozdejstvie on a lingual tonsil repeated together with repeated cryotherapy in a stomatopharynx. Decrease of a lingual tonsil up to limits at which its or her constant contact to an epiglottis more was not felt as patients or patient, will reach or achieve at all patients for 3 7 sessions of cryotherapy.
At 5 patients with a hypertrophy of a lingual tonsil of the highest degree of an expression when this process quite could be regarded as tumoral, the cryolysis of the superfluous inflamed tissue in a laryngopharynx under a narcosis has been made at a direct basic hypopharyngoscopy. At such variant of cryogenic treatment used krioinstrument with diameter of a working part in 1 see Humidified or Wetted it or him in addition, entered into contact to a pathological tissue warm, cooled, keeping krioapplikator densely pressed to sharply increased lingual tonsil. Thus fast deep freezing a superfluous tissue on its or her all depth with an average exposition 2 3 minutes was realized. Cycles of freezing and thawing repeated, at least, three times in each fragment of volume of the hypertrophied tissue. Thus, carried out a cryolysis of very sharply increased lingual tonsil duly destructions by a deep cold of neoplasms.
After a deep cryolysis in a laryngopharynx the postoperative period was transferred or carried essentially more hardly, than after therapeutic kriovozdejstvy. However sharp pains and a bleeding it was not marked or celebrated. The patients or patient appointed or nominated a sparing delivery soft and liquid nutrition. Antiseptics for proglatyvanija and inhalations, powerful or potent antibakteri alnye preparations in the nearest postoperative period. Krionekroz it was torn away in 1 2 months, the cuticularization was full, signs of presence komka in a throat and caused or called them opuholepodobnaja a hypertrophy of a lingual tonsil disappeared.
During the moment of carrying out of cryotherapy at an indirect laryngoscope at all patients in addition quickly influenced at ultralow temperature without adhesion applikatsionno and edge or territory of a petal of an epiglottis. Such quickly freezing had therapeutic character, promoted the prompt liquidation of a chronic inflammation caused or called by constant mechanical friction in this zone of a mucosa.
Only at 1 patient we have made the limited resection of essentially deformed edge or territory of a petal of an epiglottis under a narcosis at a direct hypopharyngoscopy. The additional indication for this purpose was the thickening of tissues, is long not disappearing hyperkeratosis. The resection had more likely character of a deep biopsy during a cryogenic surgical intervention. After excising or coretraction to a box of the removed tissue it was triple it is subjected to freezing. The result of treatment was favorable.
Thus, cryotherapy, and in a number of situations and the present or true cryolysis are a good method of disposal of patients from the complaints connected with occurrence of a syndrome of an epiglottis, and a pathology of pharynx accompanying it or these.
After cryotherapy to all patients recommended to supervise itself and never to carry out a "empty" drink. To hold always at itself mineral water without gas, tea, broth of a camomile, and at occurrence of the unpleasant sensations connected with a pharyngitis, to swallow together with this liquid. The certain positive role rendered and zakapyvanie it is rare (1 2 times a week) through a nose, laying butters or oils of a dogrose, other butters of a phytogenesis, as umashchivanie drinks or pharynxes through a mouth in the usual way.
Well-timed detection of the true reasons of occurrence of complaints to sensation komka in a throat, diagnostics of a syndrome of the epiglottis, the individualized cryogenic treatment, an explanation to the patient of a short of it or this frequently absolutely and not pathological process, local therapeutic influences allow to solve rather easily more often a problem with health at this group of patients.