Sharp stenosis of a throat — the narrowing of a throat arising during a short period leading to violation of intake of air in airways. Manifestations of a sharp stenosis of a throat depend on extent of narrowing of a glottis. The main symptoms are inspiratory short wind, change of a voice, noisy breath, pallor and cyanosis of integuments. Diagnostics of a sharp stenosis is based on his characteristic clinical picture, the laringoskopiya, a trakheobronkhoskopiya, throat KT, dabs from a pharynx and so forth in addition can be carried out. Treatment of the first stages of a sharp stenosis of a throat by perhaps medicamentous methods with use of antihistaminic, kortikosteroidny, dehydrational, anti-inflammatory and antibacterial medicines. In case of considerable narrowing of a glottis the urgent trakheostomiya is shown.
Sharp stenosis of a throat
Bystry development of a sharp stenosis of a throat does not leave time for realization of protective mechanisms which work at a chronic stenosis of a throat. In this regard the accruing hypoxia (oxygen insufficiency) and a giperkapniya (excess content of carbon dioxide in blood) lead to heavy frustration in work of vitals and systems, up to their full paralysis leading to the death of the patient.
The sharp stenosis of a throat can have reversible character and quickly enough respond to the carried-out treatment. When the cause of a sharp stenosis of a throat cannot be removed, after rescue of the patient by a trakheostomiya the stenosis passes into a chronic form. On the other hand, gradually accruing chronic stenosis can lead to emergence of a sharp stenosis of a throat as a result.
Reasons of a sharp stenosis of a throat
The sharp stenosis of a throat is not a separate disease, but the simptomokompleks arising as a complication of various pathological states. Distinguish local and general factors from its reasons. The general factors of emergence of a sharp stenosis of a throat most often are infectious diseases: measles, malaria, scarlet fever, belly and sypny typhus, syphilis, tuberculosis, etc.
Local etiologichesky factors of a sharp stenosis of a throat subdivide on exogenous and endogenous. Treat local exogenous factors: foreign matters of a throat, its mechanical and chemical injuries, gunshot wounds, medical manipulations (trachea intubation, bronkhoskopiya, gastroscopy). As local endogenous factors congenital defects of a throat can act; inflammatory processes of a throat and trachea: laryngitis, guttural quinsy, tracheitis, true and false croup; volume processes: benign tumors and throat cancer; bilateral paresis of a throat; pathological changes of the structures adjoining to a throat: zaglotochny abscess, sredosteniye tumors, benign tumors and cancer of a gullet, increase in a thyroid gland (autoimmune tireoidit, iodine deficiency diseases, tumors of a thyroid gland, a diffusion toxic craw).
The variety of diseases at which the sharp stenosis of a throat can be observed causes a wide range of the highly specialized fields of medicine which are engaged in its diagnostics and knocking over. Treat them: otolaryngology, resuscitation, allergology, pulmonology, oncology, neurology.
Symptoms of a sharp stenosis of a throat
The sharp stenosis of a throat is shown by noisy breath, change of a voice as hoarseness or an osiplost, an inspiratory otdyshka at which it is difficult for patient to make a breath. Inspiratory short wind is followed by retraction of mezhreberiya and a zapadeniye of jugular poles on a breath. Expressiveness of short wind and a proyavlennost of others symptoms of a sharp stenosis of a throat depend on its stage.
The stage of compensation of a sharp stenosis of a throat is characterized by absence of inspiratory short wind at rest and its emergence when walking and other physical activity. This stage arises when narrowing a glottis to 6-5 mm. The changes of gas composition of blood happening in a consequence of insufficient intake of oxygen and excess accumulation of carbonic acid lead to activation of the respiratory center. As a result breath of the patient becomes deeper and frequent, pauses between a breath and an exhalation are reduced.
The stage of subcompensation of a sharp stenosis of a throat develops when narrowing a glottis to 4-5 mm. In this stage inspiratory short wind is observed at rest, breath is followed by participation of auxiliary respiratory muscles, on a breath inflating of wings of a nose is observed. Noisy breath, pallor of the person and integuments, uneasy behavior of the patient is noted.
Stage of a decompensation of a sharp stenosis of a throat. The gleam of a glottis is narrowed to 2-3 mm. Work of respiratory muscles is strained to a limit. The patient breathes often, but is not deep. For simplification of respiratory movements it holds a semi-sitting position with the emphasis on hands. Cyanosis of the person and nail phalanxes, a hoarse voice, the increased sweating, tachycardia is observed.
Asphyxia (terminal stage). The faltering whistling breath as Cheyna-Stokes, threadlike pulse, sharp falling of arterial pressure, pale gray skin color takes place. The glottis is narrowed to 0-1 mm. Gradually there is an increase in pauses between respiratory acts up to their complete cessation. The patient faints and, in the absence of emergency aid, perishes.
Diagnostics of a sharp stenosis of a throat
The diagnosis of a sharp stenosis of a throat is based in most cases on his typical clinical picture. At the same time the differentiation of a sharp stenosis from an attack of bronchial asthma, a stenosis of a trachea, a laryngospasm, a language zapadeniye at a craniocereberal trauma is carried out or losses of consciousness of various genesis.
In diagnostics of a sharp stenosis of a throat definition of its reason is of great importance. Carrying out MSKT of a throat, a laringoskopiya, trakheobronkhoskopiya, X-ray analysis of a gullet, ultrasonography of a thyroid gland, a bacteriological research of dabs from a pharynx is for this purpose possible.
Treatment of a sharp stenosis of a throat
Medical actions at a sharp stenosis of a throat depend on its degree and the reason. Their purpose is urgent removal or at least reduction of symptoms of suffocation and respiratory insufficiency. Not only the otolaryngologist, but also any doctor who is nearby has to give first aid to the patient with a sharp stenosis of a throat.
The compensated and subcompensated sharp stenosis of a throat are subject to medicamentous therapy for which performing the patient is hospitalized in a hospital. Existence of inflammatory diseases of respiratory tract is the indication to antibiotic treatment and purpose of anti-inflammatory medicines. At puffiness of a throat apply the antihistaminic and kortikosteroidny medicines having antiedematous effect; carry out dehydrational therapy. If diphtheria is diagnosed, then introduction of antidiphtherial serum or an anatoksin is necessary. At detection of foreign matters in a throat make their removal.
It is important to limit physical activity of the patient, to provide him access of the fresh and rather moistened air. The emotional condition of the patient, his concern, aggravates breath violations that is especially noticeable at children. Therefore it is necessary to calm the patient what sedative and psychotropic drugs can be applied to. For control of hypoxia degree during treatment carry out monitoring of the acid and main condition of blood (BRAIDS) and its gas structure.
The Dekompensirovanny sharp stenosis of a throat is the indication for an urgent trakheostomiya. Operation consists in creation of an opening in a lobby of a wall of a trachea and introduction to it of a special tube through which further there is an intake of air in airways. In pediatric practice the nazotrakhealny intubation at which the special tube through a nose is entered into a trachea is sometimes applied. However such way of breath can be applied not longer than 3 days as long stay of a tube in airways causes a necrosis mucous in places of contact with a tube.