TUBERCULOSIS OF EAR, NOSE AND THROAT

 

Tuberculous otitis

 

Arises when infection is spread by the blood­stream from any distant primary focus, usually from the lung. This is confirmed by frequent affection of the mastoid process (mostly in infants) without antecedent inflammation of the middle ear

 

The morphological changes: Formation of specific tubercles which later undergo caseous degeneration. Soft tissues undergo purulent disintegration and the tuberculous gran­ulations rapidly proliferate.

 

If the tympanic membrane is affected: isolated tubercular foci develop, which decompose and cause multiple perforations. Extension of the process to the bone dissolves the osseous tissue under the action of invading granulations. Tuberculous otitis usual­ly runs a chronic course.

 

Treatment :should begin with active general anti-tuberculosis ther­apy which includes streptomycin, para-aminosalicylic acid (PASA), phthivazid and other preparations; along with adequate nutrition, etc. Radical operation on the ear is indicated for carious-granulation process in the middle ear together with the general anti-tuberculosis ther­apy.

 

Tuberculosis of the nose.

 

Mycobacteria enter the nose from the tuberculosis focus in the lung, the joints, or the larynx.

The patho-morphological changes: infiltration, which is accumulation of tubercles in the submucous layer. Destruction or curd-like degene­ration of these tubercles causes ulcers. Crusts are formed in the involved side of the nose. When the crusts are removed, accumu­lations of translucent tubercles can be seen in the mucous mem­brane.

Treatment:General and local. PASA, phthivazid, streptomycin and other preparations are used. The local treatment includes cau­tery of the infiltrations and ulcers with various acids (trichloroacetic acid or 80 per cent lactic acid, etc.). A 10-20 per cent ointment of pyrogallic acid is applied externally: 2-3 g/day of potassium iodide are taken per os for 4-8 weeks. The affected part of the nasal septum or of the choanae are sometimes excised with subsequent galvanocautery of the defect margins. A positive effect is attained with irradiation of the nasal mucosa with the light of a quartz lamp (through a cone), and also with radiation therapy.

 

Tuberculosis of the pharynx

 

 Occurs comparatively rarely. It is usual­ly associated with decreased general and local resistance of the body and is only secondary to pulmonary tuberculosis or tuberculosis of the larynx.

The clinical symptoms: Severe pain during swallowing of both solid food and liquids. As a rule. joining secondary infection accounts for the fetid breath. These symptoms are associated with formation of ulcers mainly on the palatine arches and the mucous membrane of the posterior wall of the pharynx.

At later stages, the diagnosis is established by the clinical picture, Pirquet's test, microscopic study of granulation taken from the region of the ulcers, and by general examination.

Treatment. In addition to general therapy, patients should be treat­ed by exposing ulcers to the light of a quartz lamp (through a cone). Frequent gargling of the oropharynx with a warm camo­mile tea. garden sage tea. or hydrogen peroxide solution is indicated. In order to relieve pain during swallowing, the ulcerated surfaces should be treated with anaesthesin ointment or powder. Food should be warm, liquid, and not irritating.

 

Tuberculosis of the larynx

 

 Is the most frequently occurring tuber­culous affection of the airways, but during past decades its inci­dence has become low.

 

The larynx is infected with tuberculosis mycobacteria mainly by three routes.

 

[1] The most common -contact infection with sputum expectorated from the lungs of patients with pulmonary tuberculosis.

[2] With blood (haematogenic route).

 

[3] lymphatics.

 

Three stages are distinguished in the devel­opment of a tuberculous process in the larynx:

 

 The first stage is infiltration: the second is characterized by formation of ulcers;

And the third stage is associated with affection of the cartilages and perichondrium.

 

The vocal function is upset only in cases when the vocal or vestibular folds and the interarytenoid notch are involved. Develop­ment of the pain syndrome is associated with infiltration in the epiglottis, posterior surface of the arytenoid cartilages and the ary-epiglottic folds.

The laryngoscopic picture: corresponds to the stages of the patho­logical process. most common sites of infection are the interarytenoid space, ary­tenoid cartilages and the adjacent parts of the vocal cords. Tu­berculosis of the larynx progresses slowly and its development mainly depends on the progress of pathology in the lungs.

 

If the tuberculous process in the larynx is eliminated (usually at the infiltration stage), the vocal function is usually restored.

Treatment: Aimed at elimination of the main disease (usually pulmonary tuberculosis). Measures to pro­vide optimum living and working conditions for the patient should also be taken.

Streptomycin is the main medicinal preparation used in medicamentous treatment. Streptomycin should be administered intramuscularly, 2 times a day (in 0.25 g doses) or once a day (0.5 g dose) diluted in a 0.25 per cent novocain solution. Not less than 60-80 g of streptomycin should be given in one course. PASA, phthivazid and other antituberculous preparations are also used. The combined use of these preparations is believed to have the best effect. But mycobacteria can survive in the submucous layer of the larynx and they can be reactivated to cause a relapse of the disease under appropriate conditions. For this reason, courses of che­motherapy should be used repeatedly.

Ulcerated surfaces should be cauterized with trichloroacetic acid after preliminary anaesthesia of the larynx with a 5 per cent cocaine solution and a 0.5 per cent citral solution. Anaesthetics should be used to prevent or relieve pain during swallowing.

 

Rp.: Anaesthesini 0.3 D. t. d. N. 6 S. To suck 15 minutes before meals

Rp.: Spiritus vini rectificati Acidi tannici, aa 10.0 Anaesthesini 3.0 Mentholi 0.1

M.D.S. To treat the pharyngeal surface for dysphagia (Zobin's mix­ture)

 

Alcoholization of the superior laryngeal nerve and intracutaneous novocain block of the anterior surface of the neck are indi­cated for severe cases.

 

 

Lupus of the airways

Is a variety of the tuberculous process with specific changes in the skin and the mucous membrane. Lupus erythematosus runs a slow painless course and usually leaves scars. The disease occurs mainly in children from 5 to 15 years of age. Lupus often concurs with other tuberculous affections. The patient is infected by microbial invasion through lesions on the skin of the vestibule of the nose, damaged skin of the face, by haematogenic and lymphogenic routes. Lupus is characterized by painless nodular eruptions on the skin of the nose, lips, nasal mucosa, mucosa of the pharynx and less frequently of the larynx. Lupus tubercles are red-brown; they fuse to form large grey-yellow or red granular infil­trates. The infiltrates ulcerate in rare cases. Cicatrization of ulcera-tive infiltrates causes defects in the apex of the nose, the ala of the nose, and the soft palate. Laryngeal infiltrates usually affect the epiglottis with destruction of its cartilaginous framework and formation of a cicatricial ridge.

Treatment is almost the same as for tuberculosis of the upper airways. Radiation therapy can be successfully used for local treat­ment.

 

 

Source of information:

[1] Disease of the ear ,throat and nose By V.T.Palchun; N.L.Voznesensky