Diseases of the throat and larynx: causes, treatment, prevention

06.08.2021

If we talk about the most common reasons for visiting an otolaryngologist, diseases of the throat and larynx are, perhaps, only superior to a runny nose. In most cases, patients struggle with unpleasant symptoms on their own, which often leads to complications and chronic forms of pathologies.

There are many causes of throat and larynx diseases. The lion's share of them are the consequences of the activity of bacteria and viruses, which have similar symptoms to fungal and tumor diseases. There are throat diseases without elevated body temperature; their appearance is provoked by allergens, dry air and substances that irritate the mucous membrane.

Signs and causes

Most diseases of the throat and larynx are infectious in nature. The causative agents are bacteria, viruses and fungi.

The most common bacterial

throat disease - sore throat. Its appearance is caused by streptococci, chlamydia, mycoplasmas, gonococci and tubercle bacilli. Scarlet fever, diphtheria and epiglottitis are also caused by bacteria. All three diseases are manifested by a sore throat, and epiglottitis is generally life-threatening as it can lead to airway obstruction.

Symptoms of bacterial diseases:

• general weakness;
• swelling of the larynx, tonsils;
• high body temperature;
• pain and discomfort in the throat.

For viral

diseases, a sore throat can be one of the symptoms of an illness, for example, ARVI, influenza or measles. Infectious mononucleosis caused by the Epstein-Barr virus (herpes type IV) stands apart. Its development is dangerous due to the rapid spread of inflammation to the spleen and liver, which in turn leads to enlargement of the lymph nodes.

Viral diseases are similar in symptoms:

• heat;
• prostration;
• headache;
• general weakness;
• runny nose;
• cough;
• rash;
• pain and sore throat.

Fungal diseases

genesis - a consequence of the active activity of yeast-like fungi, which looks like a cheesy mass on the mucous membrane during tonsillitis or pharyngitis. Symptoms of a fungal infection of the throat:

• severe sore throat;
• the temperature remains normal.

Fungi quickly multiply in the body during disorders of the gastrointestinal tract, against the background of vitamin deficiency, abuse of antibiotics and hormonal drugs.

A special place as a cause of pain in the throat and larynx is occupied by tumors. It can be primary, that is, formed for the first time, or it can be secondary, the result of metastasis of oncological processes in other parts and organs of the body. The larger the tumor, the more discomfort it brings: the voice changes, becoming hoarse, a feeling of a lump appears in the throat, and it becomes difficult to swallow.

Tonsillitis

Symptoms How to treat? Complications. Prevention.

Tonsillitis is a disease that is characterized by inflammation of one or more lymphoid formations of the pharyngeal ring (usually the tonsils) and is one of the widespread infections of the upper respiratory tract.

Tonsillitis can be acute or chronic. Acute tonsillitis is known as tonsillitis. The most significant bacterial causative agent of acute tonsillitis is group A hemolytic streptococcus. Less commonly, acute tonsillitis is caused by other streptococci, viruses, pneumococci, fungi, mycoplasmas and chlamydia.

The pathogen is transmitted by airborne droplets. Sources of infection are sick and less often asymptomatic carriers. The highest incidence is observed in the winter-spring period.

The incubation period for acute tonsillitis ranges from several hours to 2-4 days. This disease is characterized by an acute onset with an elevated temperature of up to 37.5 - 39 ° C, chills or chills, headache, general malaise, sore throat, aggravated by swallowing; pain in muscles and joints, enlarged lymph nodes are common. Children may have nausea, vomiting, and abdominal pain. The duration of the disease period (without treatment) is 5-7 days. Subsequently, in the absence of complications, the main clinical manifestations of the disease (fever, symptoms of intoxication, inflammatory changes in the tonsils) quickly disappear, and the blood picture normalizes. Enlarged lymph nodes can persist for up to 10-12 days.

Under the influence of various factors (weakened body, highly pathogenic pathogen, improper treatment, lack of treatment, chronic diseases), acute tonsillitis can become chronic. Chronic tonsillitis is characterized by periodic exacerbations (after hypothermia, emotional stress, and other factors). Chronic tonsillitis is a source of infection in the body. It weakens the body and can contribute to the spread of infection to other organs (most often the kidneys, heart, joints).

An otorhinolaryngologist may prescribe conservative or surgical treatment.

Conservative method - restoring the health of the tonsils by washing, using antibiotics, and physiotherapeutic procedures.

The surgical method is partial removal of damaged tissue by physical exposure to radio waves, lasers, cryotherapy, or complete removal of the tonsils surgically.

Treatment of diseases of the throat and larynx

For any form of the disease, frequent and abundant drinking and rinsing is recommended; this allows you to “wash away” the waste products of viruses and bacteria, relieve inflammation and maintain the mucous membrane in the desired shape (it tends to dry out due to high body temperature during illness).

Most cases respond well to drug treatment if it is started on time. Surgical intervention is sought when purulent or tumor processes begin, that is, the disease takes on a severe form, threatening the patient’s life with suffocation.

What and how to treat:

• ARVI is the most common throat disease. It is characterized by dry throat, sore throat, runny nose, sneezing and coughing. The temperature usually stays between 37–38 degrees. Treated with antiviral drugs based on existing symptoms. Gargling with infusions of chamomile, sage and herbal lozenges helps with sore throat; they relieve irritation and make the treatment pleasantly tasty. Along with this, it is recommended to take vitamin C to support and strengthen the immune system, as well as plenty of warm drinks (herbal teas with honey are welcome);
• tonsillitis is an infectious-allergic disease that mainly affects the tonsils. It is characterized by high body temperature, up to 40 degrees, and unbearable pain in the throat. The larynx and tonsils are red - a sure sign of an inflammatory process - and have a white coating. High fever is accompanied by aching joints and headache. Treatment is prescribed by a doctor, since it is important to prevent complications. Drinking plenty of fluids, gargling with antiseptic herbs, and herbal lozenges help with a sore throat. Food should be taken pureed and liquid, not hot, so as not to injure damaged areas of the mucous membrane;
• pharyngitis is an acute inflammatory process in the pharynx, with a characteristic dry cough, soreness, stabbing pain, a feeling of a lump and inflammation in the mucous membrane, developing into purulent processes. During illness, all solid, spicy, sour and hot foods are excluded from the patient’s diet. Treatment is medicinal, the doctor prescribes antiseptics, since the disease is inflammatory in nature. Self-medication in this case is strictly prohibited: the disease develops quickly and becomes chronic;
• laryngitis - inflammation of the vocal cords and larynx is characterized by a barking cough with sputum, a hoarse voice until its complete disappearance, and a scratching pain in the throat. Children often suffer from laryngitis. Laryngitis causes swelling of the throat when lying down, which can lead to suffocation. Therefore, if you find that your child begins to choke while lying in bed, call an ambulance, lift the child to an upright position and take him to the bathroom, under a warm shower, to relieve the spasm. Laryngitis is treated with inhalations, warm compresses, warm drinks and silence. To alleviate the patient's condition, high humidity is needed in the room: a container of water, a diffuser or a wet towel on a radiator;
• Tonsillitis is an inflammation of the tonsils, which is characterized by high body temperature, acute sore throat, and bad breath due to purulent plaque on the tonsils. The main causes of tonsillitis are viruses and bacteria. The course of treatment includes gargling with a solution of soda and salt - it acts as an antiseptic and “washes away” the pus.

Bacterial throat diseases develop very quickly, within a few hours. Viral ones - a little slower. But only a doctor can determine the real etiology of the disease, and then only based on test results.

Sore throat: possible causes, diagnosis and treatment

Sore throat is a common complaint of patients when visiting an otolaryngologist, therapist, pediatrician and general practitioner. The causes of sore throat can be infectious and inflammatory diseases of bacterial and viral etiology, inflammatory processes in the pharynx, larynx and surrounding organs caused by non-infectious factors, and non-infectious pathology (

). Before proceeding with pharyngoscopy, it is necessary to carefully detail the patient’s complaints and collect an anamnesis. The patient can call a sore throat the unpleasant sensations of scratching, burning, soreness, rawness, the feeling of a “foreign body,” the intensity of which is conveniently assessed on a 10-point scale, where the maximum manifestation of pain is rated at 10 points, the minimum at 1 point.

It is important to determine what, in the patient’s opinion, preceded the onset of pain and what other symptoms it is accompanied by. If there is hyperthermia, then the inflammatory nature of the disease is most likely: pharyngitis, tonsillitis (tonsillitis) [16]. Refusal of food and water can provoke severe pain in aphthous stomatitis (Fig. 2), tonsillitis of the lingual tonsil, paratonsillar and retropharyngeal abscess, Ludwig's angina (phlegmon of the floor of the mouth). With these diseases, drooling is possible, and inflammation of the paramygdaloid tissue and tissues of the floor of the mouth leads to trismus of the masticatory muscles (inability to open the mouth), a forced position of the head tilted to the painful side.

The occurrence of such a condition requires immediate contact with a medical specialist to sanitize the area of ​​inflammation. Epiglottitis, an inflammation of the epiglottis caused by Haemophilus influenzae (more common in young children), gives similar symptoms. Along with refusal to eat, salivation, pain and hyperthermic symptoms, epiglottitis is accompanied by voice disturbance (it becomes dull, hoarse) and difficulty breathing. There is a forced position of the patient in a sniffing position, as if holding porridge in the mouth, the mouth opens freely, but a rough examination of the pharynx with a spatula can lead to laryngospasm and death. Therefore, with the above symptoms, pharyngoscopy is performed carefully; during it, you can see a hyperemic, edematous epiglottis behind the root of the tongue.

Other causes of sore throat accompanied by sore throat and cough can be in children and young people: drainage of discharge from the nasopharynx due to adenoiditis or sinusitis; irritation of the respiratory tract by dry air, smoke, including active and passive smoking; childhood infectious diseases [9]. In adults, a common cause of such complaints, often with a feeling of a lump in the throat, a “foreign body,” is an exacerbation of chronic pharyngitis associated with pathology of the gastrointestinal tract: gastritis, esophagitis, gastroesophageal reflux, cholecystitis, gastric ulcer. Severe dysphagia, regurgitation and pain when swallowing can be caused by esophageal varices [14].

A carefully collected anamnesis allows us to find out the dynamics of complaints, the time of their appearance, the connection with a previous injury or medical examination (gastroscopy), foreign body entry, contact with an infectious patient, hypothermia (drinking cold beer, ice cream), occupational or household hazards (irritants, dust , hot air, taking concentrated solutions of vinegar, spices, medications: corticosteroids, antibiotics, diuretics, local decongestants and others). Sore throat can occur as a manifestation of sexually transmitted diseases: gonococcal pharyngitis, syphilis, chlamydia of the respiratory tract. Infection with the human immunodeficiency virus contributes to the formation of inflammatory viral, tumor and mycotic lesions of the mucous membranes [3].

Chronic pathology of the kidneys, endocrine system, blood, previous radiation and chemotherapy can lead to the formation of a chronic inflammatory and atrophic process in the pharynx. The first manifestation of hyperglycemia [5] may be thirst and dry mouth, accompanied by catarrhal changes in the pharynx. Similar complaints occur with Itsenko–Cushing syndrome [5]. In patients with hypothyroidism, swallowing is often impaired, speech becomes slurred due to swelling and dryness of the tongue and lips, and it is difficult to perform pharyngoscopy.

Non-infectious pathology of the organs of the neck and chest cavity - angina pectoris, myocardial infarction - can manifest itself as intense pain in the pharynx and behind the sternum. Long-lasting dysphagia and unpleasant sensations in the form of a lump or foreign body in the throat, which are not amenable to anti-inflammatory therapy, can cause [14] tumors of the larynx, laryngopharynx, thyroid gland, and pharyngoesophageal (Zencker) diverticula. Many days of fasting, dieting, dyspepsia and heavy menstruation lead to a deficiency of vitamins and minerals. Vitamin A deficiency [5] causes dryness and erosion of the mucous membranes.

Vitamin B2 deficiency produces a triad of symptoms: dermatitis, cheilitis and glossitis (bright red, smooth and shiny dry tongue), accompanied by burning and pain in the mouth when talking and eating. Vitamin C hypovitaminosis occurs with dietary deficiency of ascorbic acid, inflammatory processes in the intestines and is manifested by pain, hemorrhagic and ulcerative-necrotic manifestations in the oral cavity and in the area of ​​the palatine tonsils, mobility and tooth loss. Similar changes in the oral cavity and pharynx give rise to blood diseases (leukemia). Against the background of iron loss (with hyperpolymenorrhea), Plammer-Vinson syndrome is formed, characterized by superficial glossitis, dysphagia, cracks in the corners of the mouth, nail dystrophy, seborrheic dermatitis of the face, blepharitis, conjunctivitis, and decreased vision at dusk. B12 deficiency anemia associated with impaired absorption of this vitamin in the stomach due to anacid gastritis, tapeworm infestation, or increased consumption in pregnant women, manifested by Möller-Gunter glossitis (bright red tongue with smoothed papillae) and atrophy of the pharyngeal mucosa, burning pain in the tongue, weakness, crawling sensation in the limbs. A blood test reveals macrocytes, megalocytes, hyperchromic anemia, leukopenia.

Diseases of the spine [2] (cervical osteochondrosis, tuberculous spondylitis, radiculitis) can cause pain in the pharynx. Neuralgia of the glossopharyngeal nerve manifests itself as intense pain in the pharynx, especially against the background of chronic stress in anxious and suspicious patients. Metabolic disorders, intoxication, and trauma contribute to its occurrence. Characterized by unilateral pain in the root of the tongue, tonsil, lasting several minutes, accompanied by dry throat and subsequent hypersalivation. The therapeutic effect is achieved by lubricating the root of the tongue and pharynx with local anesthetics. Neuralgia of the superior laryngeal nerve [1, 6] gives similar symptoms, but also includes a painful dry cough and spasm of the vocal folds during inspiration [6].

Pain in the pharynx can be caused by an odontogenic process: periodontitis, teething pathology, galvanism [4, 17]. Rarely, unilateral pain in the pharynx occurs, the cause of which is the long styloid process (Eagle syndrome), accessible to palpation in the area of ​​the palatine tonsil [15].

Rare causes of pain in the pharynx are ulcerations on the mucous membrane of tuberculous etiology [14]. In this case, there is a prolonged cough, weight loss, and swollen lymph nodes.

A final diagnosis is possible based on oropharyngoscopy. The main differential diagnosis for pain in the pharynx is between its most common causes - acute (or exacerbation of chronic) pharyngitis and sore throats caused by streptococcal infection (group A beta-hemolytic streptococcus - GABHS).

Acute pharyngitis is a viral infection of the pharynx in 90% of cases. Its main symptoms are: increased body temperature, sore throat when the throat is empty, when eating, soreness and a dry cough that does not bring relief. Patients indicate the localization of unpleasant sensations on the back wall of the pharynx. In the pharynx (Fig. 3), hyperemia of all parts is detected: the posterior wall, arches, tonsils, and there may be vesicular rashes (herpes, enterovirus). Plaques are not typical, there is often a runny nose and other catarrhal phenomena - nasal congestion, sneezing. If a rash is detected on the skin and mucous membranes, it is necessary to exclude an infectious disease - measles, scarlet fever, rubella [8]. Adenoviral infection manifests itself in the form of conjunctivitis, enlarged lymph nodes, fever, runny nose, and there may be plaque in the throat.

The disease progresses in waves: on the 7th–10th day of illness, a repeated increase in body temperature and a return of symptoms are possible. Enterovirus infection (“summer flu”) manifests itself in the form of dyspeptic, myalgic, and meningeal syndromes. Pharyngoscopy reveals bubbles on the mucous membrane of the oropharynx. In making the diagnosis of viral pharyngitis, the following help: knowledge of the epidemiological situation, dynamic observation of the patient, a variety of clinical manifestations (abdominal pain, vomiting, eye damage, meningeal symptoms, myalgia), lymphocytosis in the blood with normal ESR, lack of effect from antibacterial therapy, serological data research, polymerase chain reaction and others.

Sore throat is a general infectious disease with local manifestations in the form of acute inflammation of one or more components of the lymphadenoid pharyngeal ring, most often the palatine tonsils (tonsillitis), pharyngeal tonsil (adenoiditis), lingual tonsil, lateral ridges of the pharynx and larynx.

The classification of acute tonsillitis (according to I.B. Soldatov, 1975) involves the division into primary tonsillitis: catarrhal, lacunar, follicular, ulcerative-membranous; and secondary: for acute infectious diseases (diphtheria, scarlet fever, measles, tularemia, typhoid fever, infectious mononucleosis) and diseases of the blood system (agranulocytosis, alimentary-toxic aleukia, leukemia). There are special forms of tonsillitis [10]: viral, fungal, syphilitic.

With catarrhal tonsillitis, there is hyperemia and enlargement of the palatine tonsils, regional lymphadenitis, no plaque, a blood test shows slight leukocytosis, increased ESR. Catarrhal sore throat often has to be differentiated from viral pharyngitis, in which there is a cough, there may be a runny nose, and there is no enlargement or tenderness of the lymph nodes.

Follicular tonsillitis is manifested by bright hyperemia and swelling of the tonsils, subepithelial rounded yellowish elevations (follicles).

With lacunar tonsillitis, white-yellow plaques appear at the mouths of the lacunae of the tonsils (Fig. 4), which can merge with each other and cover the entire surface without going beyond the tonsils, being removed without leaving a bleeding surface, rubbing between two spatulas, dissolving in the vessel with water.

It is important to determine the streptococcal etiology of acute tonsillitis. This can be done using the McIsaac screening scale [12], which includes symptoms and their assessment in points (

).

A patient’s symptoms with a score of 3 means the probability of streptococcal etiology is 30%, and a score of 4 means about 70%. If the clinical picture is determined to be 0–1 points, then systemic antibiotic therapy is not indicated. At 2–3 points, antibiotics are necessary only if the infection is bacteriologically confirmed. Antibiotics should be prescribed when symptoms of 4–5 points are detected.

Diphtheria of the pharynx occurs in the form of localized, widespread, toxic I, II, III degrees and hypertoxic forms. With it, gray plaques are detected on the surface of the tonsils, tightly fused with the underlying tissues, they may spread to the arches, the mucous membrane of the posterior pharyngeal wall, the uvula (Fig. 5), and when you try to remove them, the mucous membrane bleeds. Plaques do not rub down and do not dissolve in water. In the toxic form, the neck is noticeably thickened due to swelling of the subcutaneous fat, pressure is painless and does not leave pits.

Infectious mononucleosis is an acute infectious disease caused by the Epstein-Barr virus, characterized by fever, sore throat, enlarged lymph nodes, pharyngeal tonsil, liver, and spleen. Plaques on the tonsils, as in lacunar tonsillitis (Fig. 6), but can spread beyond them. A general blood test (the appearance of atypical mononuclear cells), serological research methods (enzyme-linked immunosorbent assay (ELISA), Paul-Bunnel-Davidson reaction) help in diagnosing the disease.

Fungal infections of the pharynx in the form of curdled films, easily removed when scraped with a spatula, are caused mainly by yeast-like fungi of the genus Candida (about 90% of cases); less commonly, there are mold fungi of the genus Aspergillus, Penicillium [7]. C. albicans permanently or temporarily lives on human mucous membranes, skin and intestines. Factors contributing to the development of mycoses are: treatment with broad-spectrum antibacterial drugs, cytostatics and corticosteroids, diabetes mellitus, blood diseases, tumors, gastrointestinal diseases, vitamin imbalance. Candidiasis of the oral cavity, pharynx and esophagus occurs in more than 90% of AIDS patients (Fig. 7) [3].

Diagnosis of sore throats should include throat and nasal swabs for diphtheria (BL). Express determination of streptococcal antigen using test strips from the surface of the tonsils makes it possible to justify antibacterial therapy. A general blood test facilitates the differential diagnosis of primary and secondary acute tonsillitis. Opinions on the question “Should I do a smear?” controversial. It is needed to confirm the GABHS etiology of the disease in doubtful cases [16].

Therapeutic tactics for pain in the pharynx can be presented in the form of a diagram ().

For the treatment of acute pharyngitis, a gentle diet, hot foot baths, warm compresses on the front surface of the neck, warm alkaline drink (mineral water, milk with honey), steam inhalations, and smoking cessation are recommended. The attitude towards gargling is ambiguous [16]. Fresh infusions of mint, chamomile, calendula, eucalyptus, sage, and caragana are effective for relieving sore throat. Antiseptics of artificial origin (dichlorobenzene, metacresol, hexethidine, benzalkonium, thymol, ambazone, chlorhexidine) are bactericidal in their mechanism of action, which can lead to suppression of the normal microflora of the oral cavity, so they should be used with caution in children under 6 years of age [9]. For the treatment of sore throat, the most important painkillers are those containing menthol, tetracaine, lidocaine or flurbiprofen. Children from 6 months of age can use the herbal preparation Tonsilgon, which has an antiseptic and analgesic effect, but does not contain either menthol or lidocaine.

Menthol preparations and any sprays cannot be used before 3 years of age due to the possible development of laryngospasm.

Local combination drugs (antiseptics and painkillers) in the form of finished dosage forms are the most popular for the treatment of sore throat. One of them is TheraFlu LAR, a universal and highly effective local drug with an antiseptic and analgesic effect. TheraFlu LAR contains benzoxonium chloride and lidocaine. Available in the form of a spray and tablets, the content of lidocaine in which is 0–75 mg and 1 mg, respectively.

Recent in vitro and in vivo studies confirm the broad antiseptic spectrum of benzoxonium chloride and its activity against the main pathogens of the most common diseases of the oral cavity and pharynx. At the same time, the balance of the bacterial flora in the mouth is not disturbed, even with prolonged use of benzoxonium chloride.

Benzoxonium chloride has:

• bactericidal effect against aerobic and anaerobic gram-positive and gram-negative bacteria;
• fungicidal effect against Candida albicans, Aspergillus spp. and yeast fungi;
• antiviral activity against membrane viruses, including herpes virus, influenza virus, parainfluenza viruses, the causative agent of vesicular stomatitis.

Lidocaine is a local anesthetic that reduces pain in the throat when swallowing.

Adults should take the drug 1 lozenge every 2–3 hours (no more than 10 tablets per day) or as a spray, 4 sprays 3–6 times a day. Children aged 4 years and older are prescribed 1 lozenge every 2-3 hours (no more than 6 tablets per day) or as a spray, 2-3 sprays 3-6 times a day. The required duration of treatment, as a rule, does not exceed five days. The drug is well tolerated by patients, side effects are recorded extremely rarely. Possible short-term local irritation of the mucous membrane, allergic reactions.

Indications for its use are: pharyngitis, laryngitis, catarrhal tonsillitis, stomatitis, ulcerative gingivitis. Contraindications to the use of TheraFlu LAR: pregnancy (first trimester), breastfeeding, hypersensitivity to lidocaine, children under 4 years of age. TheraFlu LAR can be used by people with diabetes, as it does not contain sugar. Thanks to the combined effect - antibacterial and analgesic, TeraFlu LAR can relieve all symptoms of viral pharyngitis and be used in the complex therapy of bacterial sore throats.

Systemic antibiotic therapy in the treatment of patients with “sore throat” is indicated mainly for acute tonsillitis (angina) of suspected or established streptococcal etiology (GABHS) and is carried out with penicillins, and if they are intolerant, with macrolides; cefuroxime (Axetin) is effective. Clindamycin and lincomycin are reserve drugs [11]. Epiglottitis caused by Haemophilus influenzae is effectively treated with protected penicillins.

Literature

1. Alimetov Kh. A. Secondary neuropathy of the upper laryngeal nerve / M materials of the anniversary All-Russian. scientific-practical conf. with international participation “Modern aspects and prospects for the development of otorhinolaryngology. M., September 29–30, 2005. P. 46.
2. Alimetov Kh. A. Spondylogenic pharyngeal dyskinesia / Materials of the anniversary All-Russian. scientific-practical conf. with international participation “Modern aspects and prospects for the development of otorhinolaryngology. M., September 29–30, 2005. P. 22.
3. Bessarab T.P., Yushchuk N.D., Anyutin R.G., Potekaev S.N. HIV infection in otorhinolaryngological practice // Attending Doctor, 2000. No. 1. P. 26–30.
4. Inflammatory diseases of the mucous membrane of the pharynx, oral cavity and periodontium. Scientific review. Solvay pharma, 2002. P. 2.
5. Diseases of the mucous membrane of the oral cavity and lips / Ed. E. V. Borovsky, A. L. Mashkilleyson. 1984. 400 p.
6. Karpova O. Yu. Clinic, diagnosis and treatment of laryngoneurosis / Materials of the anniversary All-Russian. scientific-practical conf. with international participation “Modern aspects and prospects for the development of otorhinolaryngology. M., September 29–30, 2005. P. 53.
7. Kunelskaya V. Ya., Kasimov K. On the issue of the clinic, diagnosis and treatment of candidal tonsillitis in children // Vestn. otorhinolaryngology. 1980. No. 4. P. 50–52.
8. Nisevich N. I., Uchaikin V. F. Infectious diseases in children. M.: Medicine, 1985. 298 p.
9. Acute respiratory diseases in children: treatment and prevention. Scientific and practical program of the Union of Pediatricians of Russia / Ed. A. A. Baranova. M., 2008.
10. Otorhinolaryngology: national guide / Ed. V. T. Palchuna. M.: GEOTAR-Media, 2008. 960 p.
11. Rational antimicrobial pharmacotherapy: Hand. for practicing doctors. Under general ed. V. P. Yakovleva, S. V. Yakovleva. M.: Litterra, 2003. 108 p.
12. Sidorenko S.V., Guchev I.A. Tonsillopharyngitis: issues of diagnosis and antibacterial therapy // Consilium medicum. Infections and antimicrobial therapy. 2004. 4: 36–38.
13. Folomeeva O. M., Amirdzhanova V. N., Yakusheva E. O. et al. Incidence of rheumatic diseases in the Russian population (analysis over 10 years) // Ter. Archive. 2002. No. 5. P. 5–11.
14. Shevrygin B.V., Mchedlidze T.P. Handbook of otorhinolaryngology. M.: Triada-X, 1998. 448 p.
15. Shulga I. A., Zaitsev N. V., Zaitseva V. S. Variants of the structure of the stylohyoid complex / Materials of the Anniversary All-Russian. scientific-practical conf. with international participation “Modern aspects and prospects for the development of otorhinolaryngology. M., September 29–30, 2005. P. 75.
16. Etiopathogenetic therapy of diseases of the upper respiratory tract and ear: Methodological recommendations. Compiled by S.V. Ryazantsev, Kotserovets V.I. St. Petersburg: National Register, 2008. 100 p.
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M. V. Subbotina , Candidate of Medical Sciences Irkutsk State Medical University , Irkutsk

Contact information about the author for correspondence

Prevention

It is impossible to ensure that your throat never hurts, especially in the autumn-winter period. But prevention can be carried out regularly to reduce the risk of illness and strengthen the immune system. For this:

• stop smoking if you smoke - nicotine irritates and dries out the mucous membrane of the nose and throat, making them vulnerable to pathogens;
• eat a varied and nutritious diet so that the body receives vitamins and minerals in full;
• humidify the indoor air - artificial indoor fountains, aquariums, diffusers, and water containers are suitable for this. Too dry air is a strong irritant to the throat and contributes to the appearance of microtraumas on the mucous membrane;
• wash your hands more often - pathogenic bacteria, as a rule, enter our body from dirty hands;
• take vitamins - they support the immune system;
• dress according to the weather - during hypothermia, blood vessels narrow, which destroys the protective mechanism of the mucous membrane and the person catches a cold. The cold itself does not contribute to this;
• do not self-medicate - there is a high risk of complications, for example, in the form of hearing loss or disease of the ears, lungs, eyes or brain.

If you feel unwell, consult a doctor. You can make an appointment with a multidisciplinary medical otolaryngologist using the feedback form or by calling.

What to do?

Of course, says the ENT doctor, every person can look into his own throat with the help of an ordinary flashlight and mirror. However, you should not turn into your own doctor, warns Vladimir Zaitsev. “Because, for example, the use of antibiotics where it is not required, but antiseptics are needed, can seriously harm. For the same pharyngomycosis, the use of antibiotics will further suppress the flora and allow more active growth of fungi. It is also dangerous not to use antibiotics where they are required. And only a doctor can determine exactly what exactly, in what situation and what courses will be required,” says Vladimir Zaitsev. This means that if you experience a sore throat, an in-person examination and the prescription of adequate therapy are required.

There are contraindications. Be sure to consult your doctor.

Why does the temperature rise

Fever accompanies most infectious diseases, including acute tonsillitis2,3. The processes that cause an increase in body temperature are quite well studied. They are triggered by special substances pyrogens, which can enter the body from the outside (exogenous pyrogens) or be synthesized inside it (endogenous pyrogens).

Endogenous pyrogens are substances that enter the bloodstream during the destruction of immune cells and cells of the inflamed mucous membrane of the throat2,3.

Exogenous pyrogens in the case of tonsillitis can be various microorganisms: viruses, bacteria, fungi3. In children aged 3 months to 3 years, tonsillitis most often develops with mixed herpesvirus infections3. When a child reaches the age of 3-7 years, viruses give way to bacteria, and in 30% of cases the disease is caused by group A3 beta-hemolytic streptococcus. In addition, the tonsils are often affected by streptococci of other groups, staphylococci, etc.1 In adults, acute tonsillitis is often viral and accompanies ARVI1.

Exogenous and endogenous pyrogens affect the thermoregulation center located in the brain2,3. As a result, he begins to perceive normal body temperature as lower and increases the level of heat production, which leads to an increase in body temperature2,3.

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Treatment of throat neurosis

Symptoms of neurosis of the pharynx and larynx disrupt the quality of life of patients. At the initial stage of the disease, it is performed on an outpatient basis. The patient is recommended to change his lifestyle, maintain the correct daily routine, alternate between wakefulness and sleep, go to bed on time, and get a good night's sleep. If the cause of neurosis is sleep, the symptoms of the disease disappear after several days of rest.

In the presence of an inflammatory process, anti-inflammatory therapy is carried out. A patient with throat neurosis is prescribed herbal sedatives. The selection of medications and dosage is carried out by a doctor. After several days of taking medications, the symptoms of neurosis of the pharynx and larynx disappear. If the patient feels a lump in the throat during neurosis, pureed liquid food is prepared for him, which does not irritate the mucous membrane of the pharynx. You should stop smoking, drinking alcohol, and eating spicy foods.

If the therapy is ineffective, doctors prescribe small doses of antidepressants in the presence of depression and asthenic syndrome. To treat throat neurosis, which manifests itself as hypochondria (constant worry about the possibility of contracting a serious illness), antipsychotics are used. If the cause of throat neurosis is a disease of the cervical spine, neurologists at the Yusupov Hospital treat it using medications, physiotherapeutic procedures and modern rehabilitation methods. In some cases, manual therapy is performed.

Psychotherapeutic techniques include hypnotherapy and cognitive behavioral therapy. Psychological correction techniques are aimed at teaching the patient effective ways to relax. Treatment has the following goals:

• Leading the patient to understand the true causes of the pathology;
• Identification of psychotraumatic factors;
• Eliminating them or learning to adapt to them.

Children suffering from neurosis of the throat and larynx are observed by several specialists: an otolaryngologist, a psychologist, a speech therapist (depending on age). Correct parental behavior increases the effectiveness of treatment. Most of the psychogenic factors that cause neuroses in children come from home.

Children with throat neurosis undergo restorative therapy, which includes vitamin complexes and mild sedatives. During the treatment of throat neurosis in a child, it is important to suppress obvious physical symptoms. When there is a sore throat, children are prescribed rinses, inhalations, absorbable tablets, and medications that increase the level of immunity. For infectious diseases, dekasan or trachysan are prescribed.

Psychotherapy for children involves classes on general development, training in relaxation techniques, which include breathing exercises. Babies receive a full body massage aimed at finding blocks and relaxing them. Psychotherapists recommend that parents change the psychogenic situation at home, reconsider their behavioral reactions and correct them. It is important that the child follows a daily routine. He needs to introduce healthy foods into his diet, enriched with vitamins and minerals.

A child with neurosis of the pharynx and larynx should be treated carefully. There is no need to scold him, but hysterics must be stopped immediately. With neurosis, a spasm of the throat is often observed. During an attack, it is necessary to help the child cope with the situation, calm him down, and explain how to breathe correctly.