Analysis of diagnosis and treatment of chronic hyperplastic laryngitis in Republic of Belarus on example of patients in Dobrush district of Gomel region

Abstract

Objective. To analyze the current state of diagnosis and treatment of patients with chronic hyperplastic laryngitis (CHL) for the period 2010–2021 in the Republic of Belarus on the example of patients in the Dobrush District of the Gomel Region and to identify shortcomings for the subsequent development of measures to prevent malignant diseases of the larynx. Material and research methods. The material for the study was patients of the Dobrush District of the Gomel Region (61 patients: 39 (64%) men and 22 (36%) women) with a diagnosis of chronic hyperplastic laryngitis who are registered with an otorhinolaryngologist. The median age at diagnosis was 45.6 years (18 to 76 years). In the age distribution, 2 peaks were observed: from 36 to 40 years and from 51 to 55 years – 16% (10 out of 61) of the entire group, 87% of patients were of working age. Results and discussion. Patients with precancerous diseases of the larynx, who are on regular medical check-up in the Dobrush Central District Hospital, were analyzed. Age-specific incidence rates were analyzed and differentiated by gender and place of residence. The analysis of symptoms, the time spent by patients on regular medical check-up, the frequency of visits to the otorhinolaryngologist in the order of regular medical check-up was carried out. All patients had voice changes of various nature and severity: 50 (82%) patients complained of hoarseness, 6 (10%), of hoarseness, 5 (8%) had aphonia. More than half of the patients had the following complaints: feeling of a coma or a foreign body in the throat – 90%, the presence of a cough not associated with colds – 75%, and shortness of breath on exertion – 70% of patients. The median time spent by patients on regular medical check-up was 5 years (from 0 for patients registered in 2021 to 30 years). The frequency of visiting an otorhinolaryngologist in the order of regular medical check-up was from 1 time in 2–4 months (10% of patients) up to 1 time in 5 years (3%), 44% – 1 time per year, 27 (44%) patients received outpatient treatment, 5 (8%) patients received inpatient treatment, and 29 (48%) patients received both outpatient and inpatient treatment. During inpatient treatment, 16 (47%) hospitalized patients underwent surgical treatment to remove hyperplastic areas of the mucosa, the rest received antibiotic therapy, 15 (44%) patients underwent a biopsy. Conclusion. The study revealed a number of problems in the diagnosis and treatment of CHL, the main of which is the establishment of a generalized clinical diagnosis without performing a biopsy and clarifying the form of CHL and, as a result, conducting numerous ineffective courses of conservative treatment, both on an outpatient basis and in a hospital setting. It is necessary to develop a system of measures to improve the effectiveness of treatment of patients with CHL and the prevention of malignant neoplasms of the larynx.

The Program of Early Diagnosis of Malignant and Precancerous Diseases of the Larynx

“…Разработана Программа ранней диагностики злокачественных и предраковых заболеваний гортани, определены «Оториноларингология. Восточная Европа» 2023, том 13…”

“…По определению ВОЗ, данному в Руководстве по ранней диагностике рака в 2018 г., ранняя диагностика -это раннее обнаружение рака у пациентов с уже имеющимися симптомами заболевания. Скрининг -выявление бессимптомного (доклинического) рака или предраковых состояний в практически здоровой целевой популяции [8,12,13]. И далее: «Процесс скрининга включает в себя систему информирования и приглашения целевого контингента населения на скрининг, проведение скринингового теста, контроль его результатов и направление на дополнительное обследование людей с положительными результатами теста» [13][14][15].…”

“…Хронический ларингит, по данным различных авторов, составляет до 34% патологии гортани [19][20][21][22].…”

“…Среди доброкачественных новообразований чаще подвергаются процессам озлокачествления такие доброкачественные опухоли, как папилломы, фибромы, фибропапилломы, дискератозы, и значительно реже, с наименьшей степенью вероятности -опухолеподобные образования: полипы, гранулемы, кисты, инфильтраты [26,27]. Во многих случаях развитию злокачественных процессов гортани предшествуют доброкачественные заболевания, длящиеся многие месяцы, а иногда и годы, к которым относится и ХГЛ [19,22,24,28].…”

“…Пациентов может беспокоить дискомфорт, чувство кома в горле, спонтанная боль в области гортани (в далеко зашедших стадиях), одышка (при локализации процесса в области голосовых складок, подскладковом пространстве), реже кашель. Часть пациентов отмечают: ощущение инородного тела, першение, жжение, покалывание в области гортани, периодически возникающий зуд со стороны гортани [20].…”