Chronic stenosis of a throat — gradually arising narrowing of a throat which is followed by the progressing decrease in amount of the air coming to airways with slow development of a hypoxia. The leading symptoms of a chronic stenosis of a throat are inspiratory short wind and hoarseness of a voice, various on expressiveness. Diagnostics of a chronic stenosis of a throat consists in carrying out a mikrolaringoskopiya, researches of a fonation, KT of a throat, the analysis of gas composition of blood, a X-ray analysis of lungs, the ECG and so forth. Concerning a chronic stenosis of a throat application of a number of surgeries and medicamentous remedies which choice is dictated by the reason of a stenosis and the arisen pulmonary and warm complications is possible.
Chronic stenosis of a throat
Thanks to gradual development of narrowing of a glottis at a chronic stenosis of a throat, unlike a sharp stenosis of a throat, the mechanisms compensating the reduced intake of air on a breath manage to work. In response to the lowered content of oxygen blood join haemo dynamic, respiratory, blood and fabric adaptive reactions of an organism.
The respiratory compensatory mechanism consists in increase and deepening of breath, participation in it of auxiliary muscles. The haemo dynamic mechanism is implemented by means of increase in number of warm reductions, increase in a vascular tone, a blood conclusion from depot therefore the minute volume of a blood-groove increases and blood supply of vitals improves. The blood adaptive mechanism is characterized by the increased ability of hemoglobin to saturation by oxygen, strengthening of an eritropoez and an exit of erythrocytes from a spleen. Increase in ability of fabrics to absorb oxygen from blood, if necessary partially to pass to an anaerobic type of a metabolism is the cornerstone of fabric adaptive reaction.
Reasons of a chronic stenosis of a throat
The anomalies of development of a throat which are followed by narrowing of a throat or existence in it of cicatricial membranes can become the reason of a congenital chronic stenosis. The acquired chronic stenosis of a throat arises against the background of pathological processes in a throat or the areas, neighboring to it, at which there is a gradual change of morphological structure of anatomic formations of a throat or their progressing sdavleniye.
The acquired chronic stenosis of a throat most often is caused by a bilateral anchylosis a ring-cherpalovidnykh of joints or neyropatichesky paresis of a throat. In turn ankiloza a ring-cherpalovidnykh of joints are connected with the postponed infectious or traumatic arthritises. The bilateral neyropatichesky paresis of a throat causing a chronic stenosis of a throat can be caused by bilateral injury of the nerves innervating a throat (at a toxic craw, an autoimmune tireoidit, increase in a thyroid gland in connection with an iodine deficiency disease, diverticulums and tumors of a gullet, bilateral cervical lymphadenitis, carrying out operations on a thyroid gland), their toxic defeat (at various poisonings, sypny or a typhoid, tuberculosis, etc. infections) or to have the central origin (at neurosyphilis, tumors of a brain, a siringomiyeliya, botulism, a hemorrhagic stroke, an ischemic stroke, a severe craniocereberal injury).
Its cicatricial changes after injuries, burns, long finding of a foreign matter in a throat can be the cause of a chronic stenosis of a throat. The chronic stenosis of a throat is possible as a result of the progressing growth of a benign tumor of a throat, throat cancer, her specific diseases (syphilis, tuberculosis, a scleroma).
The chronic stenosis of a throat can have secondary character and develop after a sharp stenosis. So, the chronic stenosis of a throat is often observed in connection with violation of the technology of performance of a trakheostomiya. For example, at introduction of a trakheostomichesky tube through a section of the first ring of a trachea, but not the 2-3rd, it touches a cricoid cartilage and is the reason of development of its hondroperikhondrit leading to a stenosis. The wrong selection or carrying a trakheostomichesky tube can also cause a chronic stenosis of a throat for a long time.
Symptoms of a chronic stenosis of a throat
Expressiveness of symptoms at a chronic stenosis of a throat directly correlates with extent of narrowing of a glottis. In this regard the clinical otolaryngology allocates 4 stages of a chronic stenosis of a throat: compensated, subcompensated, dekompensirovanny and a stage of asphyxia. However in case of a chronic stenosis of a throat, unlike sharp, the condition of the patient depends also on adaptability of his organism to the arising hypoxia.
The narrowing of a glottis arising at a chronic stenosis of a throat leads to violations of breath and a fonation (phonation). Disorders of respiratory function are shown by difficulty of a breath, i.e. inspiratory short wind. Depending on a stage of a chronic stenosis of a throat short wind can be observed only at physical efforts of the patient (the compensated stenosis) or at rest too (sub - and a dekompensirovanny stenosis). The expressed inspiratory short wind is followed by participation in the respiratory movements of additional muscles, a zapadeniye on a breath of mezhreberiya and jugular poles, retraction of epigastralny area. Violations of a fonation are shown various, depending on height of narrowing of a throat, by hoarseness degree. The aphonia — total absence of a voice is in certain cases observed.
The chronic stenosis of a throat is followed by development of respiratory insufficiency of obstructive character. The accruing hypoxia leads to compensatory tachycardia and arterial hypertension. The brain first of all suffers from chronic oxygen insufficiency that is shown by a memory impairment, absent-mindedness of the patient, a sleep disorder. Due to the accumulation in blood of carbon dioxide there is a headache, nausea.
Complications of a chronic stenosis of a throat
Insufficiency of external breath at a chronic stenosis of a throat conducts to developments of stagnation and a congestion in phlegm airways that is the reason of frequent bronchitis and pneumonia. At patients with a tracheostoma the air coming to a trachea does not undergo the procedure of warming, moistening and biological cleaning which is normal carried out in the top airways. At them tracheitises and trakheobronkhita often result. Bronchitis at a chronic stenosis of a throat has mainly chronic current. Inflammatory diseases of lungs proceed in the form of long or stagnant pneumonia, lead to development of a bronkhoektatichesky disease. The raised load of a small circle of blood circulation and the right departments of heart at patients with a chronic stenosis of a throat leads to development of pulmonary hypertensia and formation of pulmonary heart.
Diagnostics of a chronic stenosis of a throat
Diagnostics purpose at a chronic stenosis of a throat is not so much statement of the diagnosis, how many determination of the cause of a stenosis. For implementation of this task the otolaryngologist first of all carries out a laringoskopiya during which tumors and foreign matters of a throat, its cicatricial changes and congenital defects can be revealed. In need of the course of a mikrolaringoskopiya make an endoscopic biopsy of a throat. The subsequent histologic studying of material gives information on the nature of the happening morphological changes of walls and muscles of a throat.
Important value at a chronic stenosis of a throat has a research of voice function: fonetografiya and definition of time of the maximum fonation. Elektroglottografiya and a stroboskopiya allow to estimate degree of passive and active mobility of vocal chords.
During establishment of an etiology of a chronic stenosis of a throat performance of MSKT of a throat, ultrasonography of a thyroid gland, MPT and KT of a brain, a bacteriological research of dabs from a pharynx, a gullet X-ray analysis can be required. Degree of a hypoxia and a gipoksemiya define at a research of gas structure and BRAIDS of blood. For diagnostics of pulmonary and warm complications of a chronic stenosis of a throat carry out a X-ray analysis of lungs, the ECG, Ekho-KG.
Treatment of a chronic stenosis of a throat
Basis of treatment of a chronic stenosis of a throat is elimination of its reason. For this purpose carry out removal of foreign matters and removal of tumors of a throat, open and endoscopic excision of hems of a throat, removal of a parafaringealny tumor. At tumors of vocal chords the external and endolaringealny hordektomiya is carried out. Removal of extensive or malignant tumors demands carrying out the subsequent reconstructive plasticity of a throat. At the tumors of a thyroid gland leading to a chronic stenosis of a throat due to squeezing of guttural nerves carry out a subtotal resection of a thyroid gland or a tireoidektomiya. According to indications perform operations on removal of tumors of a gullet. In case of impossibility of elimination of the reason of a chronic stenosis of a throat carry out a trakheostomiya.
Along with surgical treatment carry out medicamentous therapy of a chronic stenosis of a throat with use of antibacterial, anti-inflammatory, antiedematous, glyukokortikosteroidny, antihistaminic medicines. Fight against a hypoxia is carried out by regular carrying out an oksigenobaroterapiya. Additional drug treatment of a chronic stenosis of a throat is performed according to the main disease or the developed stenosis complications.