Гранулема гортани -опухолеподобное образование, ограничивающее подвижность голосовых связок, харак-теризуется неспецифическим воспалением c компактной инфильтрацией зрелых и активных мононуклеарных фа-гоцитов. Заболевание встречается довольно редко в ото-риноларингологической практике: 0,9-2,7% от всех рас-стройств голосовых связок у взрослых. Особенностью за-болевания является высокая частота рецидивов после хи-рургического лечения. Недостаточная изученность этио-логии болезни, ее рецидивирующий характер, отсутствие предикторов выздоровления или возможного рецидива, необходимость повторных оперативных вмешательств де-лают гранулему гортани актуальной проблемой, разработ-ка которой требует междисциплинарного подхода [1].К наиболее частым факторам, провоцирующим рост гранулемы, относятся гиперфункциональное использова- Цель исследования -психопатологический и клинико-психологический анализ на основе аффективно-стрессовой модели расстройств тревожно-депрессивного спектра (РТДС) при воспалительном оториноларингологическом заболевании -гранулеме гортани. Материал и методы. Были обследованы 30 пациентов в возрасте 33-65 лет. У 13 больных был рецидив гранулемы после оперативного вмешательства, у 17 -впервые выявленная гранулема. Результаты и заключение. Установлена связь гранулемы гортани с расстройствами тревожно-депрессивного спектра (РТДС). Последние имели преимущественно хроническое течение. Определена значимая роль длительно действующих психотравмирующих факторов в развитии РТДС. Подтверждена роль тревоги в структуре РТДС, а также значимость их диагностики для выбора терапевтической тактики. Психофармакотерапия привела к снижению частоты рецидивов гранулемы. Полученные данные подтверждают продуктивность использования аффективно-стрессовой модели заболевания при анализе РТДС с учетом типа аффективности. Ключевые слова: депрессия, тревога, гранулема гортани, воспаление, психотравмирующие факторы, аффективно-стрессовая модель.Objective. To perform a psychopathological and clinical/psychological analysis of anxiety-depressive spectrum disorders (ADSD) in inflammatory otorhinolaryngological disease -larynx granuloma. Material and methods. We examined 30 patients, aged 33-65 years, including 13 patients with post-surgical recurrence of granuloma and 17 patients diagnosed for the first time with granuloma. Results and conclusion. The relationship between larynx granuloma and ADSD, predominantly of chronic type was shown. Prolonged psychotraumatic factors play a significant role in the development of ADSD. A role of anxiety in the ADSD structure as well as an importance of their diagnosis for a choice of therapeutic tactics was confirmed. Psychopharmacotherapy has led to a reduction in the frequency of granuloma relapses. The results confirmed the productivity of affective-stress model, based on the type of affectivity, in the analysis of ADSD.Key words : depression, anxiety, larynx granuloma, inflammation, psycho-traumatic factors, affectivity-stress model. ние голоса, интубация при хирургическом вмешательстве в обла...
The objective of the present study was to elaborate the therapeutic algorithm for the treatment of laryngomycosis. We have examined a total of 430 patients suffering from chronic laryngitis including 100 ones (23.2%) having the fungal flora. Mycosis was diagnosed by the microscopic study of the stained preparations with the application of various techniques; moreover, cultivation in elective nutrient media was used. The yeast-like fungi of the genus Candida were identified in 98 (98%) and mold fungi of the genus Aspergillus in the remaining 2 (2%) patients. All these 100 patients were given the antifungal treatment. 98 of them presenting with candidal laryngitis were allocated to three groups. Group A was comprised of 33 patients who received the local treatment alone, group B contained 31 patients given only systemic therapy, and group C included 34 patients undergoing the combined treatment with the use of the medications possessed of both the local and systemic actions. The best clinical results were obtained in the patients of the latter group in which the therapeutic efficiency proved to be as high as 79.4%. It is concluded that all the patients suffering from laryngomycosis are in need of the combined treatment designed to eradicate the causative agent, restore the vocal function, and achieve the stable remission of the chronic inflammatory process in the larynx. The combined treatment with the antimycotic medications exhibiting both the general systemic and local activities during 3 weeks appears to be the optimal therapeutic modality for the management of laryngomycosis. Of special importance is the dynamic follow-up of the treated patients including the control examinations in the course of the treatment (days 7, 14, and 21) to be followed by the mycological study after the termination of therapy and its repetition every 3 months during the subsequent period.
The present article was designed to analyze the prevalence and clinical features of laryngomycosis associated with chronic inflammatory diseases of the larynx. We examined 430 patients suffering from chronic pharyngitis and found the fungal flora in 100 (23.2%) of them. Diagnostics of the fungal infection was performed by the microscopic study of the stained preparations (including the Gram method, Romanovskiy-Giemsa and fluorescent microscopy). The sowing on elective nutrient media was used. The study revealed the presence of yeast fungi (Candida) in 98 patients (98%) and mold fungi (Aspergillus) in the remaining two (2%). The hyperplastic form of fungal pharyngitis was diagnosed in 55% of the patients. We have identified the following predisposing factors for fungal laryngitis: the gastroesophageal reflux disease in 56% of the patients, smoking in 50%, the long-term use of the removable dentures with the inadequate care for them in 30%, and the consistent use of inhaled corticosteroids in 27%. Hyperglycemia was documented in 6% and the history of long-term treatment with antibiotics in in 10% of the patients. The scheme for the combined antifungal therapy has been developed. Its practical application allowed to achieve the eradication of the fungal flora and to improve the clinical course of chronic laryngitis in 75% of the patients.
The article The article describes in detail the main stages of the diagnosis of voice disorders with an indication of the methods and major errors leading to an incorrect diagnosis. Since in some cases, impaired voice quality is the first and/ or only symptom of concomitant diseases of organs or systems of various etiologies, an expanded diagnostic search is required to make a correct diagnosis. The features of receiving of complaints and medical history from patients with laryngeal diseases, the guidelines for laryngoscopy are described. A description of the laryngoscopic vew is presented, which helps in the diagnosis of the initial stages of Reinke’s edema, hyperplastic laryngitis and early stages of laryngeal cancer. The relationship between the functional and organic pathology of the larynx is very close, it can be difficult to understand the root cause of voice disorder, this leads to incorrect treatment tactics, the progression and relapse of the disease. The causes of laryngeal diseases of an organic and functional nature, the features of the clinical picture and the differential diagnosis of voice disorders are considered. Cases of diagnosis, a clinic of chronic laryngitis, laryngomycosis, and laryngeal cancer are described; the main approaches to the treatment of laryngeal diseases are presented. The article will be useful to otorhinolaryngologists, phoniatricians of outpatient and inpatient care.
The article describes the present-day approaches to the diagnostics and treatment of fungal infections of the larynx. The proportion of laryngomycosis in chronic inflammatory pathology is up to 24%, the main causative agents of laryngomycosis are yeast-like Candida fungi (up to 98%). The specific feature of treatment of patients with laryngomycosis is the combination of antimycotic therapy with complex laryngitis therapy. The optimal fungal laryngitis treatment method is the combined treatment with both systemic and topical antimycotics for 3 weeks using itraconazole (100–200 mg/day) or fluconazole (50–150 mg/day) and inhalations of 0.01% benzyldimethyl-myristoilamine-propylammonium solution or inhalations of amphotericin B. In case of combination of mycosis of larynx and pharynx, the treatment must be supplemented with topical pharyngomycosis therapy. The best results in the treatment of patients with fungal laryngitis are provided by combined antifungal therapy for 3 weeks in combination with endolaryngeal PhDT using 0.01% amethylene blue aqueous solution as a photosensitizer, and 0.3–0.5W laser radiation for 90–120 s under the control of indirect light guide microlaryngoscopy with diffusing tip using the apparatus Kreolka. Such combination of pharmacological and physical treatment methods has provided good results even in the patients in which the previous courses of antifungal therapy were ineffective.
Проведено комплексное обследование 120 пациентов с парестезиями верхних дыхательных путей (42 (35%) мужчины и 78 (65%) женщин) в возрасте от 56 до 90 лет. В структуре жалоб обследованных пациентов отмечали кашель (72%), ощущение «кома в горле» (46%), першение (43%) и сухость в горле (38%), затруднение глотания (28%). Длительность симптоматики составляла от 1 мес до 3 лет. У пациентов старшей возрастной группы по сравнению с пациентами моложе 55 лет этиологическими факторами парестезий являлись заболевания желудочно-кишечного тракта, сердечно-сосудистой, бронхолегочной систем, неврологическая патология. ЛОР-патология диагностировалась одинаково часто в обеих группах. Эндокринная патология и стрессовые расстройства чаще выявлялись у пациентов моложе 55 лет, тогда как непереносимость лекарственных препаратов чаще встречалась у пациентов старшей возрастной группы и составила 35%. Окончательным критерием оценки этиологии парестезий служили не только факт выявления той или иной патологии, но и динамика жалоб после проведения соответствующей терапии.
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