Every year, doctors are faced with a huge number of episodes of chemical burns of the oropharynx and larynx. In this case, patients of different age groups need medical care - most often they are children who use an aggressive substance during the game process or simply out of curiosity. However, a chemical burn of the throat cannot be called a rare diagnosis among adults - contact occurs by accident, deliberately, and also as a result of neglect of safety rules. Sometimes chemicals are used for the purpose of treatment - for example, relief of inflammatory diseases. Whatever the cause of chemical damage to the throat mucosa, the patient needs adequate help.
Causes
From an anatomical point of view, the throat includes the pharynx, and in some cases also the larynx. For the occurrence of chemical damage to the mucous membrane, an aggressive substance must get inside - therefore, as a rule, concomitant damage to the oral cavity is also inevitable. There are two ways a chemical aggressor enters the body:
- while swallowing;
- during inhalation.
If a patient swallows a chemical, depending on its amount, concentration and damaging activity, trauma also occurs in the lower parts - the esophagus, stomach. Inhalation may damage not only the pharynx, but also the larynx, trachea, bronchi. Based on the localization of the burn, its spread beyond the boundaries of the pharynx, chemical damage to the throat can be divided as:
- isolated;
- combined.
What substances can provoke a chemical burn of the throat? There are a huge number of chemical aggressors, among which the most common and dangerous are:
- Vinegar essence.
- Battery fluid.
- Ammonia.
- Concentrated iodine solution.
- Hydrogen peroxide 30% (perhydrol).
- Caustic soda (caustic soda, sodium hydroxide).
The vast majority of cases of chemical damage to the throat occurs when using detergents, iodine, ammonia. If the containers are easy to open and are in a conspicuous place, young children may be interested in them, who often taste unfamiliar liquids. Household negligence associated with the lack of marking of an aggressive environment is also widespread.
Alkalis cause a deeper and more extensive burn of the throat mucosa than acids.
When assessing the degree of damage, it is important that the chemical aggressor belongs to the group of acids or alkalis. In the first case, the trauma is accompanied by the development of coagulation-type necrosis. The contact area is covered with a dense fibrin coating - this slows down the penetration of the aggressor into the deep layers of the tissue, reduces the volume of the substance entering the blood. In the second case, colliquation-type necrosis is observed, which is characterized by the absence of a filmy plaque and damage not only to the superficial, but also to the deep layers of tissue.
Although, at first glance, an acid burn should be easier than an alkali burn, both types of damage are dangerous for the patient. Concentrated acids (hydrochloric, nitric, carbolic) and alkalis (sodium hydroxide) can "burn" the mucous membrane. The same goes for potassium permanganate crystals. A less pronounced cauterizing effect, that is, the ability to cause a burn, is characteristic of ammonia, citric and acetic acid. In this case, the damaging effect of alkalis is enhanced as a result of the formation of a water-soluble albuminate - this leads to the spread of the cauterizing substance to tissues located near the site of direct contact.
Symptoms
How does a burn of the pharynx manifest itself with a chemically aggressive substance? It is worth noting that the symptoms occur acutely, abruptly, almost immediately after contact with the cauterizing medium, their severity increases rapidly. This simplifies the collection of anamnesis (data on events that preceded the development of the disease), but only if the patient is an adult or the episode of trauma occurred in front of witnesses. The key symptom is pain - very intense, excruciating.
Complaints
With a burn of the mucous membrane of the pharynx, the patient is worried about:
- pain that worsens when trying to swallow, radiating to the ears;
- difficulty in eating - even a liquid consistency (dysphagia);
- salivation (hypersalivation);
- violation of taste sensitivity;
- difficulty breathing;
- fever.
The clinical characteristics of symptoms can be presented in the table:
A burn of the mucous membrane of the throat affects the entire body as a whole, which is expressed in the development of intoxication.
| Severity of damage | Symptom | ||||||
|---|---|---|---|---|---|---|---|
| Pain | Salivation | Dysphagia | Taste disturbance | Fever | Breathing disorder, cough | Vomit | |
| Grade I | Has a burning or stabbing character, localized in the upper part of the neck. Stored for 5-7 days. | It is observed for 3-4 days, the patient secretes an average of 300 ml of saliva in 24 hours. | It is difficult for the patient to swallow only solid food, the main discomfort is increased pain. | It lasts about a week or longer, the recovery time depends on the area of the burn. | As a rule, not observed. | It is explained by reflex laryngospasm immediately after injury and an increase in tissue edema subsequently; the localization of the damage site is also important. If you burn the lower pharynx or larynx, there is a risk of asphyxiation (suffocation). | Not visible. |
| Grade II | The pain is sharp, burning, with a combined burn, it is felt not only in the pharynx, but also in the esophagus, epigastric region. It can last up to 35 days and even longer. | It lasts up to a week, sometimes up to 10 days. Salivation per day - from 1 to 1.5 liters. | It is impossible to swallow solid food, liquid food with difficulty, which is accompanied by very intense pain. | Lasts about a month, it recovers very slowly. | It develops on days 2-4, indicators can reach subfebrile (37.1-37.9 ° C), less often febrile (38-38.9 ° C) values. | Multiple, occurs with a combined burn (damage to the esophagus, stomach), vomit may contain an admixture of blood, have the color of "coffee grounds". It is explained both by direct damage to the mucous membrane and by irritation of the vagus nerve. | |
| Grade III | The inability to eat food of any consistency. | Taste sensitivity is absent for more than 40-50 days, not all patients recover. | It develops immediately (rarely) or within 2 days, characterized by an increase to pyretic (39-40 ° C) and even hyperpyretic indicators. | ||||
The chemical agent acts not only on the burned area of the throat, it can be absorbed and enter the blood; the products of the burn reaction released during tissue destruction are also able to spread throughout the body. Systemic damage is common in severe, widespread burns. The smell of a chemical agent, which comes from the patient, is felt with a burn with vinegar essence, ammonia, as well as household detergents.
Pharyngoscopy data
During pharyngoscopy, that is, a visual examination of the pharynx, one can see a loosened, reddened (hyperemic) mucous membrane; she often bleeds, swells. Changes are localized on the back of the pharynx, palatine tonsils, soft palate. At the I degree of the severity of the injury, hyperemia and edema predominate, at the II degree the picture is supplemented by the appearance of raids, less often - blisters. A grade III burn causes deep necrosis, resulting in ulceration and scabs.
Treatment
What to do if a throat burn occurs - can the treatment be carried out at home? Even an adult is sometimes unable to objectively assess his condition; meanwhile, chemical damage to the pharynx in a child is not always detected immediately, and the area of contact with the cauterizing substance can be extensive. Therefore, in all cases, an immediate examination by a specialist is required; depending on the condition, the patient can be hospitalized in the department of otolaryngology (ENT department), toxicology.
Urgent care
What to do if a chemical burns your throat? Having established the fact of injury and the type of traumatic agent, you should call an ambulance, be sure to report the alleged diagnosis. Immediately stop the intake of the damaging medium inside. In order to make the right choice of treatment, it is important to know which chemical environment has burned your throat. If this is not known, rinse the oropharynx with cool or slightly warm clean water. Improper use of products based on the principle "acid neutralizes alkali and alkali neutralizes acid" can aggravate damage.
With an isolated injury of the pharynx with alkali, a gentle rinsing with a weak acid solution (1% acetic, citric) is carried out. If the patient has been in contact with acid, a 2% solution of sodium bicarbonate (baking soda) is preferred. When the burn is provoked by potassium permanganate, a 1% solution of ascorbic acid is used. If not only the pharynx is damaged, but also the underlying parts of the digestive tract, the solutions are taken orally in small sips; in case of acid damage, it is allowed to drink milk in an amount of 0.5-1 cups.
Chemical damage to the pharynx from acetic acid cannot be treated by ingestion of sodium bicarbonate.
This provokes an acute expansion of the stomach as a result of the formation of carbon dioxide, aggravates bleeding. If the person providing assistance doubts whether it is possible to give a soda solution, it is better to consult a doctor by phone and, until you are sure of the benefits of your actions, prefer to use pure water.
Specialized assistance
Conducted by a doctor, paramedic. Includes neutralization of a chemical environment capable of burning, if necessary - gastric lavage (in the first 6 hours). To reduce pain, use a solution of Novocaine or other local anesthetics, vegetable oil, Almagel. Oropharyngeal rinsing with antiseptics (Furacilin solution) is prescribed, analgesics (Baralgin), antibiotics (Cefazolin, Ciprofloxacin) are administered. Glucocorticosteroids (Prednisolone), detoxification solutions, parenteral nutrition may be indicated. The therapy regimen is selected individually.
Complications
Among the complications of a burn of the pharynx are such as:
- bleeding;
- perforation of the esophagus, stomach;
- severe intoxication;
- respiratory failure, asphyxia;
- the formation of cicatricial narrowings.
The listed complications do not appear with an isolated burn of the 1st degree of severity and are characteristic of severe combined burns. Patients require urgent medical care, immediate hospitalization.
