THE FREQUENCY AND TYPES OF NEOPLASMS AMONG LARYNGEAL DISEASES AND THEIR TREATMENT
1Amonov A.Sh., 2Salomov K.M.
1DSc. Associate Professor of the Department of Otorhinolaryngology, pediatric otorhinolaryngology, pediatric dentistry, Tashkent Pediatric Medical Institute 2PhD. Assistant of the Department of Otorhinolaryngology, pediatric otorhinolaryngology, pediatric dentistry, Tashkent Pediatric Medical Institute https://doi.org/10.5281/zenodo.12975385
Abstract. Diagnosis and treatment of laryngeal diseases remain one of the most important and urgent tasks of otolaryngologists. Most often, wheezing diseases are manifested by a violation of the voice, that is, dysphonia. Voice changes affect not only the relationships between people, but also create difficulties in professional activities. This is especially difficult for vocalists, artists, singers and others whose activities are related to sound. When dysphonia develops, patients first turn to an otolaryngologist at the clinic so that the doctor can make the correct diagnosis and apply the right treatment methods.
Keywords: wheezing, dysphonia, hoarseness of voice, voice disorders, vocal cord polyp, vocal cord node.
Introduction. The voice is a unique phenomenon, not only physiological or acoustic, but also social. With the help of voice, people transmit information fully, having a healthy, beautiful voice, which serves as both a means of communication and a tool for earning money for people of a huge number of professions — teachers, actors, politicians and the like [1,5]. Dysphonia is a concept denoting a qualitative violation of vocal function, manifested by hoarseness, nasal, hoarseness, weakness and rapid fatigue of the voice; patients may also be disturbed by paresthesia and pain in the larynx, pharynx and neck. Due to the fact that the same complaints are typical both for patients with a banal cold and for those who have a serious pathology of the larynx, for all voice disorders, you should contact an otolaryngologist or a phoniatrist [2,3,6].
According to the recommendations of the board of the American Academy of Otorhinolaryngology - Head and Neck Surgery from 2018, dysphonia is one of the signs of laryngeal diseases, which are a frequent clinical condition that affects one third of the population of our planet at one time or another. Recommendations identify voice changes (dysphonia) as a violation of vocal formation, diagnosed by an otorhinolaryngologist. The number of patients with altered voice timbre - from mild hoarseness, hypernasality to more pronounced violations of tonality, sound strength, up to whispered speech — do not tend to decrease [4].
The most common possible causes of voice disorders include: neoplasms of the larynx or neck organs, psychological trauma, stress overload, overstrain of the vocal cords, paresis on either side of the larynx, etc. [1]. Of the functional ones, hypotonic (54.1%) and mutational (18.1%) dysphonia are the most common, while organic ones include nodules of the vocal folds (20.0%) and inflammatory diseases of the larynx (19.4%) [4,5].
Many of our foreign research colleagues note that in children, nodules of the vocal folds are the most common cause of voice impairment. (Y.S. Vasilenko; T.I. Garashchenko, E.Y. Radzig, E.S. Astakhova, Y.E. Stepanova) The reasons for this situation are the insufficient coverage of this problem in the speech therapy literature and the lack of interrelated work of a
doctor and a speech therapist for the early detection, prevention and correction of voice disorders in children with vocal fold nodules.
The purpose of the work is to study the causes and etiological factors of laryngeal disease, and optimize their diagnosis and treatment.
Materials and methods of research
The study was performed on the basis of the clinic "Happy life medical centre" in the period 2019-2023. 84 patients with voice disorders, aged from 6 to 80 years, were examined and treated. Of these, 58 are men, 26 are women (Diagram No. 1), among them children - 14, adults - 70 (Diagram № 2).
The average duration of the disease is 3 months or more.
Number of patients by gender
Diagram №. 1.
Women
Men
0 10 20 30 40 50 60 70
Men Women
Number of patients 58 26
Patients by age
Diagram № 2
80 60 40 20 0
By age
Children
70
14
Adults
The research included:
1. Assessment of the patient's condition (complaints, ENT examination, objective picture).
2. Electrolaryngostroboscopy and endoscopy with optics under 70°.
3. Multispiral computed tomography of the neck organs.
4. Esophagogastroduodenoscopy.
5. Morphological examination.
Results and discussion
Upon admission, all patients complained of hoarseness of varying severity. The main complaint was hoarseness, scratching and discomfort in the throat when talking or singing. School teachers - 6 (13.3%) of patients complained of fatigue, deterioration of voice at the end of the school year or on Thursdays. Of the causes of voice impairment, 43 (51.2%) of patients indicated vocal strain, acute inflammatory (colds) diseases. The majority of the studied groups in 69% (31 patients) of cases were employees of voice-speech professions. These were teachers of schools, universities, kindergarten teachers, managers, sales consultants, clergymen, as well as students. The duration of the disease in most patients - 29 (64%) - was from 1 to 10 years. The most common of the concomitant diseases of the ENT organs were pharyngeal diseases: chronic tonsillitis and chronic pharyngitis - in 38 (45.2%) people. Concomitant diseases of the gastrointestinal tract: chronic catarrhal gastritis in 35 (41.7%) patients, erosive gastritis in 5 (5.9%) patients, duodenal ulcer exacerbation - in 12. It was difficult to determine the causes of voice impairment in 5 (5.9%) patients. All patients repeatedly received general anti-inflammatory, neurological therapy and local treatment in the form of rinses, pharyngeal lubrication, instillation of oil drops into the nose from an otolaryngologist at their place of residence. With indirect laryngoscopy using an endoscope, incomplete closure of the vocal folds during phonation was detected in 6 (13.3%) patients, hyperemia of the edges of the vocal folds in 2 (4.4%) patients. Marginal changes in the vocal folds were represented by: thickened mucous membrane in 4 (8.88%) patients, polyps in 20 (28.5%), nodules of the vocal folds in 14 (20.0%) patients, and in 14 cases the nodules were less than 0.2 mm., in 5 (7.14%) patients - a cyst of the vocal cords, in 2 (2.8%) patients - with post-intubation laryngeal stenosis. In one case, pachyderma of the interstitial space and others were revealed. Thus, marginal changes in the vocal folds were detected in 70 (83.3%) patients. Morphological examination of the formations of the vocal folds and larynx was carried out in the Ipsum clinic of the histological laboratory and in the laboratory of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology (RSNPMTSOIR) of the Ministry of Health of the Republic of Uzbekistan.
In the structure of the revealed pathology, functional disorders of the voice were in 14 (16.6%) people, and the hypotonic nature of dysphonia was detected in 8 (54.1%) patients. Of the organic diseases, polyps were found in 20 (28.5%), nodules of the vocal folds in 14 (20.0%) patients, and a cyst of the vocal cords in 5 (7.14%) patients. In 2 (2.8%) patients - with postintubation laryngeal stenosis. The distribution of patients according to the identified diseases of the larynx is shown in diagram No. 3.
Patients with identified diseases of the larynx
Diagram № 3
30,00% 28,50%
25,00% 20,00% 15,00% 10,00% 5,00% 0,00%
7,14%
20,00%
16,60%
2,80%
Polyps of the Vocal cord cysts Nodules of the Functional Postintubation vocal cords vocal cords change laryngeal
stenosis
Treatment results
All patients, after a comprehensive examination, depending on the etiology and dysphonia, were treated, which consisted of observing the voice regime, medication, the use of physiotherapy and breathing exercises. Treatment of functional dysphonia depended on the state of tone of the vocal muscles and in hypotonic dysphonia included electrophoresis with 0.5% novocaine in the collar area, 4-5 sessions per course. Inhalations were carried out with decasan solution, 5 sessions of 10 minutes each. As well as lessons with a phonopedom for 1 course with a duration of 2 weeks. Surgical treatment consisted of endolaryngeal removal of laryngeal neoplasms under general anesthesia.
Polyp of the vocal cords
Figure No. 1 Before surgery Figure No.2 After surgery
Next, a histological examination. After surgery, patients received treatment aimed at antibacterial, anti-gastric hypersecretion, hyposensitizing therapy. Two patients with functional dysphonia had their voices restored after treatment. Patients after surgical treatment were re-examined after 1-3 months.
Polyp of the vocal cords
Figure № 3 Before surgery Figure № 4 Immediately after surgery
Figure № 5 The same patient 1 month after surgery
Dysphonia persisted in two patients, the rest were satisfied with the results, that is, the voice was restored.
Conclusions
1. Among neoplasms, polyps of the vocal cords are most often found
2. Voice changes are a polyethological pathological condition, the dominant causal factors of its development are polyps of the vocal folds, chronic hypertrophic laryngitis and paresis of the vocal folds of various origins.
3. Comprehensive early diagnosis and surgery using modern endomicroscopic equipment is important in the treatment of voice changes.
4. Diseases of the gastrointestinal tract adversely affect the condition of the larynx and subsequently leads to laryngeal disease.
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