Throat tuberculosis — a specific infectious disease of a throat which causative agents are tuberculosis mikobakteriya. As a rule, tuberculosis of a throat has secondary character and develops at penetration of an infection into a throat in the ascending, hematogenic or limfogenny way. Tuberculosis of a throat is shown by a voice osiplost, pain and violation of swallowing, a poperkhivaniye with hit of liquid food in a trachea and bronchial tubes, the dry painful cough, respiratory violations arising in connection with a throat gleam stenozirovaniye, formation of external fistulas. Throat tuberculosis by results of laboratory analyses, laringoskopiya, KT of a throat, a X-ray analysis of lungs, a research of voice function is diagnosed. Treatment consists in antibacterial and anti-inflammatory therapy, removal of a pain syndrome, hanging of protective forces of an organism, carrying out the surgical interventions directed to elimination of the tubercular centers.
Most often tuberculosis of a throat is a complication of tuberculosis of pulmonary localization. Tuberculosis of a throat is noted in 10% of cases of initial tuberculosis of lungs, in 30% of cases of a long course of tubercular process and in 70% of cases of autopsy of the dead of tuberculosis. With active and open forms of tuberculosis of lungs tuberculosis of a throat occurs at patients more often than at patients with productive forms. In certain cases symptoms of a disease of a throat are the first symptoms of tubercular defeat. Inspection of such patients often reveals earlier not recognizable primary center in lungs or activation of chronic inaktivny tuberculosis.
At women development of tuberculosis of a throat is usually observed during pregnancy or in the postnatal period. Men get sick with throat tuberculosis more often than women. The highest incidence among them is noted aged from 20 up to 40 years. Children, especially aged up to 10 years, are least of all subject to a disease. Tuberculosis of a throat is a studying subject as otolaryngology, so phthisiology and pulmonology.
Causes of tuberculosis of a throat
The causative agent of a disease is the tubercular stick. Throat tuberculosis usually develops at penetration of an infection into it from other centers at tuberculosis of lungs, genital tuberculosis, tuberculosis of a mammary gland, tuberculosis of kidneys and so forth. In the majority of clinical observations tuberculosis of a throat is caused by the ascending distribution of the activator together with the phlegm allocated from the pulmonary tubercular center and its introduction in a mucous membrane of a throat. At the same time tuberculosis of a throat is often combined with tuberculosis of a trachea and bronchial tubes.
At the miliarny and closed forms of pulmonary tuberculosis tuberculosis of a throat arises usually in a consequence of hematogenic distribution of mikobakteriya. Such tuberculosis of a throat is characterized by emergence of the inflammatory centers which are randomly located in various areas of mucous. In other cases tuberculosis of a throat can be caused by limfogenny distribution of mikobakteriya from the affected lung root lymph nodes. At the same time unilateral damage of a throat, gomolateralny to the pulmonary tubercular center is characteristic.
The factors favoring to developing of tuberculosis of a throat are her inflammatory diseases (laryngitis, laryngotracheitis), smoking, the abuse of alcohol connected with professional activity constant inhalation of the polluted air.
Throat tuberculosis symptoms
Tuberculosis of a throat can have various clinical manifestations depending on its kliniko-pathological form.
Chronic infiltrative tuberculosis of a throat meets most often. In an initial stage for it typically asymptomatic current with a small subfebrilitet in the evening. The proceeding dissemination of mikobakteriya of tuberculosis from the center in a lung gradually leads to considerable rises in body temperature, emergence of oznob, constant dry cough, morbidity and feeling of a foreign matter of a throat, a voice osiplost. Over time changes of a voice amplify and accept constant character. In general the clinical picture is similar to an aggravation of tubercular process in lungs. Emergence of guttural symptoms, atypical for pulmonary tuberculosis, which gradually become very expressed allows to suspect throat tuberculosis.
Tuberculosis of a throat is followed by progressing of an osiplost up to a perfect aphonia, violation of swallowing and its morbidity with irradiation of pain in an ear. Quite often painfully even a saliva proglatyvaniye in this connection patients cease to eat food and quickly grow thin. Disorder of locking function of a throat causes hit of liquid food in airways with development of aspiration pneumonia. Infiltrative tuberculosis of a throat causes the progressing reduction of its gleam with clinic of a chronic stenosis of a throat which at extreme degree of expressiveness leads to emergence of the sharp stenosis of a throat needing urgent tracheotomy.
Developing further tuberculosis of a throat takes all her cartilaginous skeleton, brings to is purulent-kazeoznomu to disintegration of surrounding fabrics with formation of fistulas. During this period the pain syndrome is so expressed that demands purpose of opiates. At the same time there is an aggravation of tubercular process in pulmonary fabric. Disintegration of the tubercular centers causes a blood spitting, developing of profuzny arrozivny and pulmonary bleedings.
Sharp miliarny tuberculosis of a throat develops at the hematogenic mechanism of infection. For it typically bystry progressing of all symptoms with development of an aphonia for 3-4 day from the moment of emergence of an osiplost, the expressed swallowing violations which are followed by sharp morbidity, attacks of extremely painful painful cough, a salivation, paresis of a throat and a soft palate, the accruing obstruction and respiratory insufficiency.
Supersharp tuberculosis of a throat differs in extraordinary bystry development of process and within several weeks comes to an end with death of the patient. The diffusion ulceration of a mucous throat, formation of abscesses and phlegmon, the bystry disintegration of the throat tissues affected with tuberculosis which is followed by the expressed intoxication, arrozivny bleedings is characteristic.
Diagnosis of tuberculosis of a throat
Tuberculosis of a throat is diagnosed by the otolaryngologist on the basis of yielded laringoskopiya and results of laboratory researches. Consultation of the phthisiatrician and conducting tuberkulinovy test is without fail necessary. For identification of primary tubercular center the patient with suspicion of tuberculosis of a throat has to be directed to a X-ray analysis of lungs and survey of the pulmonologist.
At throat tuberculosis depending on its form the laringoskopiya can reveal the disseminirovanny inflammatory centers; the granulematozny educations containing typical tubercular small knots; granulomas; diffusion ulcers with a grayish raid. Specific monochondrite of a voice sheaf at which it looks reinforced with edematous free edge can be observed. In an initial stage tuberculosis of a throat masks a picture of usual laryngitis. The research the pugovchaty probe can find signs of destruction of a cartilaginous framework of a throat.
Laboratory diagnostics at suspicion of tuberculosis of a throat is directed to identification of mikobakteriya of tuberculosis by carrying out the analysis of a phlegm on the CUBE, the PTsR-research of a phlegm and its bacteriological crops. For an exception of the syphilitic nature of damage of a throat carry out the RPR test. In doubtful cases the endoscopic biopsy of a throat with the subsequent histologic research of material is shown.
Auxiliary diagnostic method at tuberculosis of a throat is the research of voice function: fonetografiya, definition of the maximum fonation, elektroglottografiya. Stroboskopiya reveals violation of mobility of vocal chords which expressiveness depends on extent of defeat a ring-cherpalovidnykh of joints and muscles of a throat. For the purpose of assessment of prevalence of the destructive processes connected with tuberculosis of a throat carry out KT and a X-ray analysis of a throat, ultrasonography of tissues of neck.
Treatment of tuberculosis of a throat
Tuberculosis of a throat is subject to the general and local treatment. The general treatment consists in the actions directed to fight against an infection and surgical interventions for the purpose of elimination of primary tubercular center. Massive antibiotic treatment with application of a kanamitsin, streptomycin, rifampicin, a rifabutin, tsikloserin is carried out; anti-inflammatory therapy by glucocorticosteroids (methylprednisolonum, hydrocortisone, dexamethasone), immunomodulatory treatment, vitamin therapy. In a combination with antibiotics synthetic antibacterial medicines are successfully applied (, metazid, an isoniazid). Depending on the nature of cough and a phlegm appoint mucolytics and stimulators of motility of airways. For the purpose of removal of primary center of an infection at tuberculosis of a throat carrying out a kavernotomiya or resection of lungs is possible (segmentektomiya, lobectomies, bilobektomiya).
Local treatment at tuberculosis of a throat has symptomatic character. It can include inhalation therapy, use of anesthetics of aerosols, carrying out intra guttural operations. At the painful pain syndrome extending to an ear crossing of the top guttural nerve on the party of defeat is shown. If tuberculosis of a throat is followed by its expressed stenosis, make a trakheostomiya. At the expressed destructive changes the throat resection with the subsequent carrying out reconstructive operation for its restoration can be required.