Persistent cough, hoarseness, shortness of breath and impaired swallowing are the main symptoms of the development of the disease. Penetrating into the tissues of the pharynx, mycobacteria provoke thickening (infiltration) of tissues, therefore, over time, stenosis is observed, i.e. decrease in the lumen of the larynx. Respiratory failure leads to a lack of oxygen in the body, as a result of which patients begin to complain of chronic fatigue, lethargy and dizziness. The disease is diagnosed by the results of laryngoscopy, radiography and laboratory tests. Treatment consists in taking anti-inflammatory and antibacterial medications.
Development mechanism
How does tuberculosis of the larynx develop? As already mentioned, the causative agents of infection are acid-fast bacteria - mycobacteria. They were first discovered by Robert Koch back in 1882, which is why they are also called Koch's sticks. The peculiarity of pathogenic microbes is that they do not emit exotoxins, therefore the immune system “does not notice” the presence of foreign agents in the body for some time. In the initial stages of development, the disease is almost asymptomatic.
In the absence of inflammatory processes, the respiratory organs are protected from the penetration of viruses, fungi and microbes by mucociliary clearance. If pathogens enter the respiratory system, goblet cells secrete mucus, which sticks them together and prevents them from invading tissues. An increase in the amount of mucus stimulates the activity of the ciliated epithelium, due to which the viscous secretion, along with foreign objects, is quickly evacuated from the respiratory tract when coughing or sneezing.
Inflammation of the bronchi, trachea and larynx leads to loosening of the mucous membranes, which significantly increases the chances of mycobacteria to penetrate deep into the soft tissues.
The primary infection of the body with Koch's rods usually occurs aerogenic, i.e. by airborne droplets. Fecal-oral, contact-household and transplacental routes of infection are much less common.
Etiological factors
Why does tuberculosis of the larynx occur and what contributes to its development? Since mycoplasmas do not secrete any enzymes, timely activation of defense mechanisms (phagocytosis) does not occur. For a long time, the number of microbes increases exponentially. When the concentration of inflammatory mediators in the intercellular spaces increases strongly, this leads to "liquefaction" of the mucous membranes.
Loose soft tissues are an ideal breeding ground for mycobacteria, so they begin to multiply with even greater intensity. Pathological processes lead to an increase in capillary permeability and the formation of tuberculous granulomas. Over time, the granulomas break open, forming painful ulcers.
Decreased immunity is one of the key reasons for the development of the disease, in which a relatively small number of protective cells cannot resist the influx of mycoplasmas.
There are a number of factors that can provoke tuberculosis of the larynx, these include:
- chronic inflammation (pharyngitis, laryngitis);
- alcohol abuse and tobacco smoking;
- frequent irritation of mucous membranes with allergens;
- unfavorable environmental conditions;
- constant overstrain of the vocal cords.
The severity of the symptoms of the disease depends on the severity of the course of pulmonary tuberculosis. In some patients, it proceeds in a chronic form, therefore, clinical manifestations are poorly expressed.
Symptomatic picture
How can tuberculosis of the larynx be identified? Symptoms largely depend on the clinical and morphological form of the disease and the location of pathogenic microbes. In otolaryngology, it is customary to distinguish between the following types of ENT diseases:
- chronic infiltrative - the most common form of tuberculosis, which occurs in 76% of cases. In the initial stages of development, the disease is almost asymptomatic with a slight increase in temperature. As the number of mycobacteria in the throat increases, the body temperature rises. Patients complain of dry cough, hoarseness, chills and a feeling of fullness in the throat. Over time, the hoarseness of the voice increases and leads to aphonia and a violation of the swallowing reflex. Increasing
in the throat, pain can radiate to the back of the head and ears; - acute miliary - occurs with hematogenous penetration of Koch's rods into the throat tissue. This form of the disease is characterized by the rapid development of pathological processes in the respiratory tract. From the moment of infection to complete aphonia, no more than 4-5 days pass. Typical manifestations include impaired swallowing, sore throat when turning the head, drooling, persistent cough, paresis of the soft palate, and shortness of breath;
- hyperacute is the most dangerous form of pathology, which is often fatal. Diffuse ulceration of the soft tissues of the larynx with the subsequent formation of abscesses (abscesses) leads to the disintegration of the mucous membrane and arrosive bleeding.
in the throat, pain can radiate to the back of the head and ears;Tuberculosis is a dangerous disease that, if not treated promptly, leads to the death of the patient.
Due to painful swallowing, patients often refuse to eat, which leads to a critical decrease in body weight. Violation of the swallowing act is associated with a disorder of the obturator function, i.e. with untimely closure of the epiglottis cartilage during the passage of food through the esophageal canal. The constant penetration of food particles into the respiratory tract leads to the development of aspiration pneumonia.
Inflammatory mucosal infiltration leads to a decrease in the lumen of the larynx and, accordingly, the development of stenosis. With the progression of the disease, not only soft tissues are affected, but also the cartilaginous skeleton. The resulting fistulas and ulcers cause severe pain, so strong opiates are prescribed to patients, which help reduce the severity of pain.
The disintegration of tuberculous foci entails profuse bleeding not only in the larynx, but also in the lungs, as evidenced by constant hemoptysis and pallor of the skin.
Pharyngeal tuberculosis
Pharyngeal tuberculosis is a concomitant complication of the disease that occurs with the rapid spread of infection and damage to the mucous membranes of the pharynx. It should be noted that glands function in the pharynx, which secrete an antibacterial secret that prevents the reproduction of pathogenic microbes. Therefore, a complication occurs only with miliary tuberculosis.
As a rule, there is a certain parallelism between pulmonary and pharyngeal tuberculosis, since infiltrative and exudative processes proceed in the same way.
Pharyngeal tuberculosis most often occurs with exacerbation of chronic laryngitis or pharyngitis. Inflammation of the mucous membrane undermines immunity, as a result of which mycobacteria begin to multiply actively.
The mucous membrane of the pharynx quickly becomes covered with small tubercles, which "lift" the ciliated epithelium.The appearance of a polymorphic rash on the walls of the throat leads to a thickening of the mucous membrane, as a result of which breathing becomes difficult and asphyxia occurs if treatment is not timely. Over time, the infiltrates (thickening) ulcerate, causing pain, which may worsen with talking or swallowing.
Local manifestations of the disease include:
- redness of the soft palate and uvula;
- ulceration of the back of the throat;
- enlargement of the glands and submandibular lymph nodes;
- the formation of yellow-gray nodules on the mucous membrane of the oropharynx.
Pharyngeal tuberculosis can be complicated by damage to the nasal mucosa. Over time, dense nodules develop in the nasal passages and paranasal concha. When the infiltrates are opened, a dirty gray mucous mass that has an unpleasant odor flows out of the nose.
Treatment principles
What medicines can cure a dangerous disease? When drawing up a treatment regimen, the emphasis is on taking antibacterial agents. Their active components have a destructive effect on mycobacteria, contributing to the destruction of their cellular structures and, accordingly, death. Reducing the number of pathogenic microbes in the body prevents the "liquefaction" of soft and cartilaginous tissues.
There are two main methods of treatment for tuberculosis of the larynx, namely:
- general treatment - complex therapy, which involves taking a variety of medicines and undergoing physiotherapy procedures. To stop the development of Koch's rods, the patient is prescribed several types of antibiotics at once. Eliminate the primary lesions in the mucous membranes allows the use of powerful anti-inflammatory drugs. To stimulate phagocytosis and strengthen the immune system, a course of vitamin therapy is prescribed with the intake of immunostimulating agents and vitamin-mineral complexes;
- local treatment - taking medications of symptomatic action, which help to reduce the severity of the clinical manifestations of the disease. The treatment regimen includes drugs that help restore the functions of the epiglottis cartilage and vocal cords, as well as pain relievers.
With a critical narrowing of the larynx lumen (acute stenosis), the patient is prescribed surgical treatment - tracheostomy. In addition, resection of the lungs and plastic surgery of the larynx may be required, which will eliminate fistulas and soft and cartilaginous tissues of the respiratory tract. Local treatment is exclusively symptomatic, therefore it is used only as an adjunct to taking anti-tuberculosis drugs.
Antibacterial therapy
What medications are used to treat tuberculosis of the larynx? The development of Koch's sticks can be prevented with the help of antimicrobial agents of the main and reserve series. Antibiotics are highly active against mycobacteria, which makes it possible to minimize their number not only in the larynx, but also in the lungs.
Today there are 3 groups of anti-tuberculosis drugs:
- Group 1 - drugs that are most active against acid-resistant strains of bacteria, especially mycobacteria;
- Group 2 - antibiotics of average efficiency, which are used in the absence of lesions in the cartilaginous tissues;
- Group 3 - the least effective, but the safest (low toxic) drugs that are used in the initial stages of tuberculosis development.
2 and 3 groups of drugs are considered reserve, i.e. they are usually used as an adjunct in the treatment of multidrug-resistant tuberculosis, which affects not only the larynx, but also other parts of the respiratory system. With the correct preparation of the therapy regimen, it is possible to cure up to 96% of patients with tuberculosis. The type of antibiotic, dosage and duration of medication depends on the severity of the course, complications and form of the disease.
In most cases, the following anti-tuberculosis drugs are used in the treatment of the disease:
Cycloserine;- Rifampicin;
- Pyrazinamide;
- "Streptomycin";
- Thioacetazone;
- Viomycin.
Cycloserine;How do medications work? Anti-tuberculosis drugs inhibit the production of mycolic acid, which takes part in the formation of the cellular structures of Koch's rods. Potent drugs have a bactericidal effect on microbes in the resting stage and bacteriostatic - with their active reproduction.
General treatment regimen
Comprehensive treatment of tuberculosis of the pharynx and larynx involves the use of the same drugs that are used in the treatment of pulmonary tuberculosis. In addition to antibiotics, it is necessary to use medications that would help strengthen the immune system, regenerate tissues and eliminate foci of inflammation. Therefore, the therapy regimen must include:
- vitamin-containing drugs ("Ergocalciferol", "Retinol") - accelerate biochemical reactions and normalize redox processes in cells, which stimulates epithelization (restoration) of tissues;
- immunomodulators ("Cytomed", "Glutoxim") - increase the activity of immune cells, as a result of which the destruction of Koch's rods in the ENT organs is accelerated;
- secretolytics ("Bromhexin", "Ambrobene") - stimulate the motor activity of the respiratory system, thereby accelerating the excretion of sputum from the lungs and bronchi;
- hematopoietic stimulants ("Leucogen", "Methyluracil") - accelerate the development of blood corpuscles, in particular leukocytes, which take part in the destruction of pathogenic agents.
Reception of analgesics and inhalation with the use of anti-inflammatory drugs can alleviate the patient's condition. If excruciating pain in the throat radiates to the ears, the patient is offered to cut the laryngeal nerve, but only on the side of the throat affected.
With a strong thickening of the walls of the larynx and pharynx, intra-laryngeal surgery may be required. When carrying out surgical operations, they usually resort to laser microsurgery, galvanocaustics (cauterization of inflammation foci), diathermocoagulation (removal of cicatricial formations).
The prognosis for tuberculosis of the pharynx and larynx is largely determined by the severity of pathological reactions, the stage and form of the development of the disease, the completeness and timeliness of drug treatment.
With timely diagnosis and treatment of tuberculosis in stationary conditions, the forecasts for the condition of the lungs, pharynx and larynx are favorable.
The advanced forms of the disease can lead to irreversible processes that entail a violation of the voice-forming function (aphonia), and sometimes the loss of working capacity, i.e. disability.
