Ozena of the pharynx: causes, symptoms, diagnosis, treatment

This disease can spread to the nasopharynx, pharynx, trachea and bronchi, as well as to the auditory tube and lacrimal ducts, causing corresponding morphological and functional disorders. Sometimes ozena manifests itself more actively in the nasal part of the pharynx than in the nasal cavity. In most cases, ozena occurs at the beginning of puberty and most often in women. It is assumed that the causative agent of ozena is a gram-negative non-motile rod of the genus Klebsiella. However, not only an infectious origin is the cause of this depressing disease, but also, probably, a number of neuroendocrine disorders and genetically determined causes, which gives this disease a systemic nature.

Ozena is a chronic disease of the upper respiratory tract, which most often begins in the nasal cavity, characterized by atrophy of its mucous membrane and bone-cartilaginous skeleton, the appearance of thick discharge, turning into foul-smelling crusts. A similar process is observed in the pharynx. It has been noted that people who had diphtheria, scarlet fever, measles, whooping cough in childhood, in the following years more often develop chronic inflammatory diseases of the nasal cavity and nasopharynx, which, according to some foreign authors, in some cases are a pre-osenotic phase, which under certain unfavorable conditions can further develop into a clinical picture of classic ozena. Along with this, there are also erased forms of ozena, manifested only by an atrophic process. It should be emphasized that ozena is often accompanied by chronic purulent sinusitis, which, if not its trigger, play a significant role in maintaining the disease and its progression.

Pathologically, ozena of the pharynx is manifested by progressive atrophy of the mucous membrane of the nasopharynx, in which the ciliated epithelium is gradually replaced by a multilayered flat keratinized epithelium. The glandular apparatus of the mucous membrane begins to produce mucus with a sharply altered biochemical composition, which quickly dries into foul-smelling crusts. The spread of the atrophic process to the submucosal layer, muscles, lymphadenoid and bone formations leads to a significant increase in the volume of the nasopharynx, which, during posterior rhinoscopy, appears as a gaping cavity, the walls of which are covered with yellowish layers, spreading to the choanae and further into the nasal cavity.

Almost simultaneously, similar pathomorphological changes occur on the back wall of the pharynx. Here, the mucous membrane is thinned; when the crusts are removed, it appears as a pale-blue formation of an opalescent appearance.

Symptoms. Subjectively, patients feel constant excruciating dryness and are forced to constantly irrigate the throat with alkaline and oil solutions to remove crusts and soften the mucous membrane. The progression of the process to the laryngopharynx and the area of the entrance to the larynx causes constant excruciating cough, hoarseness, difficulty swallowing. Foul-smelling mouth breathing appears, not felt by the patient himself due to the loss of olfactory function, but becoming unbearable for others. The disease lasts for years and decades, ending in the stage of total atrophy of the upper respiratory tract. In some cases, with early complex treatment, the process can be suspended and even regress, stopping at a certain stage of morphological changes.

Treatment of ozena of the pharynx is an integral part of the complex systemic treatment of ozena as an independent nosological form, including symptomatic, physiotherapeutic, medicinal and surgical methods. It should be noted that treatment of ozena of the pharynx should be combined with intensive therapy carried out in relation to ozena of the nose, since it has been noted that the beneficial effect on the nasal cavity obtained from this treatment always has a positive effect on the condition of the mucous membrane of the pharynx. This phenomenon is noted not only in non-surgical treatment, but mainly in surgical recalibration of the nasal cavity. The most effective drug is streptomycin, which is prescribed in the form of inhalations, nasal ointments, intramuscular injections, along with other broad-spectrum antibiotics (metacycline, ceporin, etc.). To improve the trophism of the mucous membrane of the nose and throat, it is irrigated with solutions of vitaminized oils (sea buckthorn oil, rosehip oil, carotolin, oil solutions of vitamins A and E). Chlorophyllocarotene paste is applied to the nose, multivitamins with microelements, iron preparations are prescribed. Physiotherapeutic methods are widely used (electrophoresis of potassium iodide, diathermy, UHF, laser therapy).

A positive effect from UFO blood transfusion and the use of extracorporeal therapy methods (plasmapheresis) cannot be ruled out. A very effective method for treating common forms of ozena is, first of all, the sanitation of chronic foci of infection (adenotomy and tonsillectomy are contraindicated and, on the contrary, surgical sanitation of the paranasal sinuses is indicated with maximum sparing of the "tissue resource"). A very effective method is recalibration of the nasal cavity, aimed at narrowing the nasal passages by implanting special spongy alloplastic materials under the mucous membrane, close in their structure to tissue collagen (collopan), or autocartilage, which play the role of not only a mechanical recalibrator of the nasal passages, but also stimulators of tissue regeneration processes.

As promising proposals for their use in rhinology for ozena and other atrophic processes in the nasal cavity, we recommend turning to the experience of dentists, who widely use agents stimulating reparative processes in periodontal lesions in flap surgeries. To stimulate reparative processes in ozena, a certain effect could probably be achieved by using bone meal, collagen preparations such as collagen sponge and collagen powder, embryoplast (tissues of embryos of early (7-12 weeks) pregnancy), which has a pronounced biostimulating effect and the property of almost complete absence of antigenicity. In case of especially pronounced atrophy of anatomical structures of the nose, affecting bone tissue, a significant regenerative effect can probably be obtained from implantation of hydroxyapatite mixed with collagen into the area of the bottom and lateral wall of the nose. Hydroxyapatite is compatible with body tissues, since its crystalline form, along with amorphous calcium phosphate, makes up the mineral matrix of bone tissue and, by stimulating osteogenesis, promotes the restoration of not only periodontal tissues, but also any other bone tissues, including bone formations of the nasal cavity. For practical use in ozena of the nose and pharynx, we can recommend such modern domestic drugs as "Hydroxyapole", a drug patented in Russia and the CIS countries, tested, "Kollapol" (a collagen sponge containing hydroxyapatite) and other drugs with similar action, produced by the company "Polikom". For example, Kollapol has not only a hemostatic, but also an anti-inflammatory property, and also stimulates reparative processes."

Modern general therapeutic treatment of ozena must be comprehensive and systemic with the use of the following drug groups: antioxidants and antihypoxants (dibunol, sodium oxybutyrate, olifen), drugs with non-specific stimulating action (metacil, pentoxyl, potassium orotate, acemin, biosed, FiBS or peloid distillate for injection, honsuride, vitreous body, Proposol aerosol, Propoceum ointment, solcoseryl), drugs with specific action (thiamine, thymogen, taktivin, levamisole, etc.), desensitizing agents (diphenhydramine, fenkarol, diprazine, diazolin, suprastin, etc.), calcium preparations (calcium chloride, calcium gluconate, calcium lactate), drugs that improve microcirculation (parmidine, glivenol, escusai, complamin, etc.). The listed drugs are combined according to the relevant indications and individual contraindications to achieve the effect of mutual potentiation and complementarity and to replenish the deficiency of humoral and tissue resources.

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