Causes of irritation of the upper respiratory tract. The structure of the upper and lower respiratory tract in humans. Bleeding from the nose

Both upper and lower are diagnosed in every fourth inhabitant of the planet. These diseases include tonsillitis, sinusitis, rhinitis, laryngitis and pharyngitis. Most often, diseases begin to develop in the autumn-winter period, since it is then that influenza or ARVI diseases become widespread. According to statistics, every adult gets sick three times a year, diseases in children are diagnosed up to ten times a year.

Description of the human respiratory system

The respiratory system is a collection of organs interconnected and providing oxygen supply, excretion carbon dioxide and the process of gas exchange in the blood. This system consists of the upper and lower respiratory tract and lungs.

The respiratory system performs the following functions:

• participates in thermoregulation of the body;
• provides the ability to reproduce speech and distinguish smells;
• participates in metabolic processes;
• humidifies the air inhaled by a person;
• provides additional protection of the body from environmental influences.

When air is inhaled, it first enters the nose, where it is cleaned with the help of villi, warmed up thanks to the mesh blood vessels. After that, the air enters the pharyngeal plane, which has several sections, then it passes through the pharynx into the lower respiratory tract.

Today, inflammation of the respiratory tract is a common occurrence. One of the very first and fairly common signs of pathology is a cough and runny nose. Diseases that affect the respiratory tract include tonsillitis, pharyngitis, tonsillitis, sinusitis, rhinitis and laryngitis, tracheitis and acute respiratory infections.

Reasons for the development of the disease

Inflammation occurs for several reasons:

• Viruses: influenza, rotovirus, adenovirus, measles and others - when they enter the body, they cause an inflammatory reaction.
• Bacteria: pneumococci, staphylococci, mycoplasmas, mycobacteria and others - also provoke the development inflammatory process.
• Mushrooms: candida, actinomyceles and others - cause local inflammation.

Many of the above microorganisms are transmitted from one person to another. Some viruses and fungi can for a long time live in the human body, but manifest themselves only with a decrease in immunity. Infection can occur through household or by airborne droplets. Infection can be transmitted through contact with infected person. However, the first barrier to pathogenic microorganisms airways become, as a result of this, an inflammatory process develops in them.

Inflammation of the respiratory tract can occur in a person of any age, gender and nationality. play no role in this and social status, and material condition.

Risk group

The risk group includes:

• People with frequent colds, chronic pathologies upper respiratory tract, which leads to a decrease in resistance to negative environmental influences.
• Persons constantly exposed to hypothermia and other negative factors nature.
• HIV-infected people with concomitant secondary diseases.
• Childhood and old age.

Symptoms and signs of the disease

Symptoms of inflammation of the airways are similar to each other with various diseases, they differ only in localization pain syndrome and discomfort. It is possible to identify the location of the inflammatory process by the symptoms of the pathology, but put accurate diagnosis and can only identify the pathogen experienced doctor after a comprehensive examination.

All diseases are incubation period lasting from two to ten days, it all depends on the causative agent of the disease. For example, with influenza, signs of pathology appear quickly, a person's body temperature rises strongly, which does not subside for about three days. When parainfluenza enters the body, the patient develops laryngitis. Adenovirus infection occurs in the form of tonsillitis and pharyngitis.

Rhinitis and sinusitis

Rhinitis (runny nose) - inflammation of the mucous epithelium of the nose. A person has a runny nose, which profusely goes out during the reproduction of pathogenic microorganisms. As the infection spreads rapidly, both sinuses are affected. In some cases, inflammation of the airways, the symptoms and treatment of which are discussed in this article, leads to the development of not a runny nose, but nasal congestion. Sometimes the separated exudate is presented in the form of green pus or clear liquid.

Inflammation of the sinuses, accompanied by difficulty breathing and severe congestion called sinusitis. At the same time, swelling of the nasal sinuses leads to the development of headache, impaired vision and smell. Pain in the region of the nose indicates a running inflammatory process, pus may begin to drain from the nose. All this is accompanied by an increase in temperature, fever and malaise.

Tonsillitis

Tonsillitis is an inflammation of the tonsils. In this case, the person shows the following symptoms of the disease:

• pain during swallowing;
• increase in body temperature;
• swelling of the palatine tonsils;
• the appearance of plaque on the tonsils;
• muscle weakness.

Tonsillitis develops as a result of a virus or pathogenic bacteria entering the body. In some cases, pus may appear in the form of yellow overlays on the mucous epithelium of the throat. If the pathology is caused by fungi, then the plaque will have a white color and a curdled consistency.

Pharyngitis, laryngitis and tracheitis

In this case, inflammation of the respiratory tract is manifested by perspiration and dry cough, periodic difficulty in breathing. Body temperature is increased inconsistently. Pharyngitis usually develops as a complication of influenza or SARS.

Laryngitis, or inflammation of the larynx and vocal cords, is also a complication of the flu, whooping cough, or measles. In this case, a person develops hoarseness and cough, swelling of the larynx and difficulty breathing. In the absence of therapy, the disease can provoke muscle spasm.

Tracheitis - inflammation of the trachea, which is accompanied by a prolonged dry cough.

Bronchitis and pneumonia

Moving lower, pathogenic microorganisms cause inflammation of the lower respiratory tract. A person develops bronchitis. The disease is caused by a dry cough or sputum discharge. A person experiences signs of intoxication and malaise. If left untreated, the infection spreads to the lungs, causing pneumonia. In this case, the patient complains of a sharp increase in body temperature, intoxication, chills, cough. If the disease is not caused by an infection, but by other reasons, the symptoms may not appear, the person will only feel the signs of a cold.

AT severe cases pathology leads to a disorder of consciousness, the development of convulsions and even lethal outcome. It is very important to prevent the development of serious complications in a timely manner. In this case, it is recommended to pay attention to non-specific manifestations of cough, it is impossible to treat it on your own.

Diagnostic measures

Antibiotics are usually prescribed for inflammation of the respiratory tract. But before that, the doctor must make an accurate diagnosis in order to choose the most appropriate drug. Diagnosis begins with the collection of anamnesis, examination and questioning of the patient. Further appointed laboratory tests. It is important in this case to distinguish between viral and bacterial diseases respiratory tract.

Laboratory research methods include:

• A blood and urine test, which will make it possible to determine the nature of the disease.
• The study of mucus from the nose and throat in order to determine the causative agent of the infection, as well as the choice of the drug to which it is sensitive.
• Bacteriological culture throat mucus for the causative agent of diphtheria.
• PCR and ELISA for suspected specific infections.

To instrumental methods diagnostics include:

• Laryngoscopy to determine the nature of the inflammatory process.
• Bronchoscopy.
• X-ray of the lungs to determine the degree of spread of inflammation.

Based on the results of a comprehensive examination, a final diagnosis is made and appropriate treatment is prescribed.

Therapy of diseases

In medicine, four types of therapy are used:

1. Etiotropic treatment aimed at stopping the reproduction of the infectious agent and its spread throughout the body. If the pathology is caused by viruses, the doctor prescribes antiviral drugs, such as Kagocel or Arbidol. Antibiotics are prescribed for inflammation of the lower respiratory tract, as well as upper, when the disease is caused by pathogenic bacteria. The choice of means in this case depends on the localization. pathological process, the age of the patient and the severity of the course of the disease. For example, with angina, macrolides are often prescribed.
2. Pathogenetic therapy is aimed at stopping the inflammatory process, as well as shortening the recovery period. In this case, the treatment of inflammation of the upper respiratory tract, as well as the lower ones, is performed using immunomodulators, anti-inflammatory combined drugs, NSAIDs.
3. Symptomatic treatment, the purpose of which is to alleviate the patient's condition, improve the quality of his life. The doctor prescribes nasal drops to eliminate congestion, throat sprays, expectorants and antitussive drugs. These medicines must be taken along with antibiotics for inflammation of the upper respiratory tract and the lower ones as well.
4. Inhalation treatment allows you to quickly get rid of cough and inflammatory processes. For this, steam inhalations, nebulizers are used.

As you can see, the treatment of inflammation of the respiratory tract should be comprehensive. In the absence of therapy, it is possible to develop serious complications which are sometimes fatal.

Forecast

At timely handling in a medical institution, the prognosis is usually favorable, subject to compliance with all prescriptions and recommendations of the doctor. Often diseases provoke the development of serious negative consequences. Diseases such as influenza, tonsillitis and pneumonia can cause complications that are difficult to treat.

Prevention

Preventive actions include primarily vaccination for certain infections. In the autumn-winter period, it is recommended to use special preparations. You can also use traditional medicine, which help to increase defensive forces organism. In this case, you can include onion and garlic, honey, linden decoction in the diet. People who are at risk should avoid disease-provoking factors. Hypothermia should not be allowed. It is recommended to stay away bad habits.

For inflammation of the upper respiratory tract, doctors recommend:

• Refuse cough drops, as they will not help cure sore throat.
• In addition to gargling, you also need to take medications that the doctor should prescribe. In some cases, rinsing with a soda solution is contraindicated, as this only aggravates the course of the disease.
• Vasoconstrictor drops can be used for no more than five days, otherwise drug addiction occurs.

Quite often, a person suffers from inflammation of the respiratory tract. The provoking factors are hypothermia or, SARS, influenza, various infectious diseases. If timely treatment is not started, everything can end in serious complications. Is it possible to prevent the inflammatory process? What treatments are available? Is inflammation dangerous? respiratory organs?

The main symptoms of inflammation of the respiratory tract

Symptoms of the disease will depend on the individual characteristics of the patient's body and the degree of damage to the respiratory tract. We can distinguish such general signs that appear during the introduction of the virus. It often leads to severe intoxication of the body:

• The temperature rises.
• There is a severe headache.
• Sleep is disturbed.
• Appetite decreases.
• There is nausea, which ends with vomiting.

In severe cases, the patient has an excited and inhibited state, consciousness is upset, convulsive state. Separately, it is worth noting the signs that depend on which particular organ is affected:

• Inflammation of the nasal mucosa (rhinitis). First comes severe runny nose, the patient constantly sneezes, his nasal breathing is difficult.
• Inflammation of the pharyngeal mucosa (). The patient has a strong perspiration in the throat, the patient cannot swallow.
• Inflammation of the larynx (laryngitis). The patient is worried coughing, the voice is hoarse.
• Tonsillitis (tonsillitis). There is severe pain when swallowing, the tonsils also increase significantly, the mucous membrane reddens.
• Inflammation of the trachea (tracheitis). In this case, he suffers from a dry cough that does not go away within a month.

Symptoms also depend on the pathogen that provoked the disease. If the inflammation of the respiratory tract is caused by influenza, the patient's temperature rises to 40 degrees, he does not fall for three days. In this case, symptoms of rhinitis, tracheitis are most often observed.

If the respiratory disease is caused by parainfluenza, the temperature rises no higher than 38 degrees for about 2 days. Symptoms are moderate. With parainfluenza, laryngitis most often develops.

It is worth noting separately adenovirus infection that affects the respiratory tract. It most often occurs in the form of tonsillitis, pharyngitis, the digestive system and eyes are also affected.

Medical treatment of airway inflammation

The attending physician in the inflammatory process prescribes:

• Antiseptic drugs - Chlorhexidine, Hexetidine, Timol, etc.
• Antibiotics - Framycetin, Fusafunzhin, Polymyxin.
• Sulfonamides can be combined with anesthetics - Lidocoin, Menthol, Tetracaine.
• Hemostatic drugs, this group of drugs contains plant extracts, sometimes bee products.
• Antiviral drugs - Interferon, Lysozyme.
• Vitamins A, B, C.

Bioparox - antibacterial agent

Antibiotic has proven itself well, it releases in the form of an aerosol, it can be used to effectively cure acute infections respiratory tract. Due to the fact that Bioparox contains aerosol particles, it immediately affects all organs of the respiratory tract, therefore it has complex action. Bioparox can be used to treat acute rhinosinusitis, pharyngitis, tracheobronchitis, laryngitis.

Gestetidine is an antifungal drug.

This is the best medicine for the treatment of inflammation in the pharynx. The drug is released in the form of an aerosol solution for rinsing. Hexetidine is a low-toxic agent, so it can be used to treat infants. In addition to the antimicrobial action, Hexetidine has an analgesic effect.

Alternative methods of treatment of inflammation of the respiratory tract

Recipes for the treatment of rhinitis

• Fresh beetroot juice. Drip 6 drops of fresh beet juice, you need to do this in the morning, afternoon and evening. It is also recommended to use beetroot decoction for instillation of the nose.
• Boiled potatoes. Cut boiled potatoes into several parts: one is applied to the forehead, the other two parts to the sinuses.
• Soda inhalation. Take 500 ml of water, add 2 tablespoons, if there is no allergy, you can add eucalyptus oil - 10 drops. The procedure is carried out at night.

Recipes for the treatment of tonsillitis, pharyngitis and laryngitis

• Lemon. Eat one lemon at once with the peel, before that cut it. You can add sugar or honey.
• Herbal collection is used for gargling. Need to take chamomile- 2 tablespoons, eucalyptus leaves - 2 tablespoons, lime blossom - 2 tablespoons, linseeds - a tablespoon. Means to insist for half an hour. Gargle up to 5 times a day.
• Propolis infusion. Crushed propolis - pour 10 grams in half a glass of alcohol. Leave everything for a week. Rinse three times a day. When treating, drink tea with honey and herbs.
• Egg yolk remedy. It is necessary to take the yolk - 2 eggs, beat it with sugar until foam forms. With the help of the tool, you can quickly get rid of a hoarse voice.
• Dill seeds. It is necessary to take 200 ml of boiling water and brew dill seeds in it - a tablespoon. Leave for about 30 minutes. Drink after eating no more than two tablespoons.
• Curd compress on the throat will help relieve inflammation, irritation from the throat. After a few procedures, you will feel better.

So, in order to avoid the inflammatory process of the respiratory organs, it is necessary to treat a cold in a timely manner. Do not think that the disease will go away on its own. If you start a runny nose, the bacteria from your nose will start to descend. First they will be in the nose, then in the pharynx, then in the larynx, trachea and bronchi. Everything can end with pneumonia (pneumonia). To prevent complications, it is necessary to take measures at the first symptoms, and do not forget to consult a doctor.

Infection respiratory system- the most common disease that almost every person suffers at least once a year. This diagnosis is one of the most common causes hospitalization and can lead to death. In order to prevent critical complications, it is important to diagnose the infection in time and treat it.

What it is?

• nasal cavity;
• pharynx;
• larynx;
• trachea;
• bronchi;
• lungs.

• bacteria-, diphtheria, mycoplasmas, mycobacteria, whooping cough;
• viruses-, parainfluenza, adenovirus, roto- and rhinovirus, parotitis, measles;
• - Aspergillus, actinomycetes, Candida.

• During communication, microparticles of saliva of a coughing and sneezing patient, who is the carrier of the infection, enter the organs.
• The disease is transmitted by inhalation of dust particles that contain infectious agents. Particularly resistant microorganisms are carried through household items - towels, dishes, toys and even furniture. These are scarlet fever, diphtheria, tonsillitis, mumps, tuberculosis. Remaining on the hands, they are subsequently transferred to the mucous membranes.

• pathology of the liver and lungs;
• oncology.

Vaccinations aimed at developing resistance to viruses will help reduce the risk.

Classification of infections

According to the type of spread in the body, infections are divided into 4 groups:

1. Reproduction of infection at the injection site:

• SARS - a group of diseases that combines catarrhal inflammation of the upper respiratory tract;
• whooping cough - is expressed by bouts of convulsive cough and occurs mainly in children;
• measles - accompanied by fever, cough, conjunctivitis, rash on the body.

• - tonsillitis (inflammation of the palatine tonsils);
• scarlet fever - manifested by sore throat, rash and subsequent peeling of the skin;
• diphtheria - swelling of the tonsils, the formation of a white membranous plaque on them, and the disease is dangerous by intoxication of the body;
• - damage to the pharynx and lymph nodes.

• meningococcal meningitis - the disease is manifested by a runny nose, affects the mucous membranes of the brain, lungs;
• encephalitis of viral etiology - a complication of a generalized infectious disease that affects the brain;
• pneumonia () - complication bacterial group diseases, damage to the lung tissue;
• mumps (mumps) - inflammation of the salivary glands.

• exanthema - the disease is accompanied by high temperature and rash different nature after its decline;
• enanthema - characterized by a rash on the mucous membranes;
• - accompanied by fever and papulovesicular rash on the body.

Acute respiratory diseases cause significant discomfort to the patient and this is knocked out of normal rhythm life for at least a few days. The latent period can last from 2 to 10 days.

Symptoms depending on the type of infection

• itchy nose, sneezing, runny nose ( watery discharge from the nose);
• , cough is possible;
• slightly fever, chills;
• headache.

• Rhinitis is an inflammation of the nasal mucosa. Symptoms are runny nose and watery eyes. At the same time, yellow purulent discharge from the nose they talk about the bacterial nature of the disease.
• , sinusitis, frontal sinusitis - inflammation of the mucous membrane of the sinuses caused by a bacterial infection. It is characterized by shortness of breath due to swelling of the soft tissues of the nose, loss of smell, headache.
• Tonsillitis (tonsillitis) - a lesion of the tonsils in the oropharynx. Caused by a viral and bacterial infection. It is accompanied by an increase in the tonsils, chills and general malaise. The presence of a yellow-green coating on the tonsils indicates purulent tonsillitis.
• Pharyngitis is an inflammation of the pharyngeal mucosa. It is characterized by a sore throat, dry cough and general weakness.
• Laryngitis is an inflammation of the larynx. Accompanied by hoarseness, "barking" cough, heavy breathing, fever.
• Tracheitis is a disease of the tube located between the larynx and the main bronchi. Characterized by dry cough, weakness.
• Bronchitis is a lesion of the bronchial mucosa.
• Pneumonia is an inflammation of the tissues of the lungs. Bacterial infection, accompanied by high fever and cough.
• ARI, SARS - total defeat respiratory tract, combining several symptoms.

The main difference between a viral pathogen and a bacterial one is a sharp increase in temperature, symptoms of the development of an infection of the upper respiratory tract (nose, throat), hard breath. The presence of wheezing in viral etiology indicates the accession secondary infection. At bacterial form pathogen, there is an increasing development of the disease, yellow purulent discharge from the nose, their presence on the palatine tonsils, dry or wet cough with sputum.

Diagnostics

• features of the development of the disease;
• symptoms;
• the results of the examination of the patient;
• laboratory confirmations ( general analysis blood).

Treatment

With a viral etiology of the disease, drugs such as:

• Arbidol
• Kagocel
• Remantadine
• Tamiflu

• Azithromycin
• Erythromycin
• Clarithromycin
• Amoxicillin

• Ofloxacin
• Levofloxacin

• IRS-19
• Imudon
• Bronchomunal

• Cycloferon
• Grippferon
• Lavomax
• Amiksin
• Viferon

Symptomatic treatment is prescribed to improve well-being by relieving the symptoms of a cold. Drugs are prescribed depending on the disease. For example:

• with rhinitis - Nazol, Pinosol;
• with angina - Geksoral, Tantum Verde, Pharyngosept;
• when coughing - expectorants, mucolytic agents (ACC, Bromhexine, Ambroxol, Sinekod, Falimint).

Also widely used folk remedies treatment - the same inhalations with the addition of essential oils, taking infusions and decoctions of chamomile, sage, thyme.

Prevention

As a prophylaxis in the cold season of the year, one of the following drugs is also taken:

• Remantadine - 1 time per day (100 mg).
• Amiksin - 1 tablet per week.
• Dibazol - 1/4 tablet 1 time per day.
• Arbidol (in contact with the patient) - 1 tablet 2 times a day with a break of 3-4 days, course - 3 weeks.

The following preventive measures against respiratory diseases are also distinguished:

• In moderation, consume such foods: garlic, onions, honey, lemon, raspberries. Recommends drinking decoctions of oregano, linden.
• Wash your hands and your children's hands often, especially after coughing and blowing your nose. The process should last at least 30 seconds with the obligatory use of soap. Alcohol-based cleansers can also be used. Dry your hands with disposable towels.

  If you have been in contact with a person who is showing symptoms, before you can wash your hands, avoid touching your face (eyes, nose, mouth).

• Avoid hypothermia and strengthen immunity, for which you will need to follow the normal daily routine, healthy sleep and balanced diet. In addition, indispensable prevention of respiratory diseases are walking on fresh air, swimming and hardening, breathing exercises.

Features of respiratory diseases in children

However, some children can endure only a few mild colds per year, while others will have time to catch a cold more than 10 times during this time. This is due to the fact that some children have an innate predisposition to frequent illnesses SARS. The reason is the weak protection of the mucous membrane from viral infections. However, this does not mean that the child is immunocompromised.

The most common causative agents of the common cold are rhinoviruses, of which there are more than 100 varieties. Having been ill with one of these infections, the body does not form immunity resistance to others. Diseases are also caused by coronaviruses, adenoviruses, influenza and parainfluenza.

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For citation: Chelenkova I.N., Uteshev D.B., Bunyatyan N.D. Acute and chronic inflammatory diseases of the upper respiratory tract // RMJ. 2010. No. 30. S. 1878

Inflammatory diseases of the upper respiratory tract include rhinitis, sinusitis, adenoiditis, tonsillitis, tonsillitis, laryngitis and pharyngitis. These diseases are widespread: they occur in every fourth inhabitant of our planet. In Russia, infectious diseases of the upper respiratory tract are diagnosed year-round, but in the period from mid-September to mid-April they become widespread and are associated with acute respiratory viral infections (ARVI). ARVI is the most common infectious disease in developed countries; on average, an adult gets ARVI at least 2-3 times a year, and a child 6-10 times a year.

Rhinitis is an inflammation of the mucous membrane in the nasal cavity. Rhinitis can manifest itself in both acute and chronic forms. Acute rhinitis occurs as a result of exposure to the mucous membrane of the nasal cavity of a bacterial or viral infection. Often this form of rhinitis accompanies various infectious diseases: influenza, diphtheria, scarlet fever, gonorrhea, etc. In acute rhinitis, the tissues of the nasal region swell (and this swelling extends to both halves of the nose). Usually, acute rhinitis proceeds in three stages. During the first stage (it lasts from 1-2 hours to 1-2 days), patients experience itching and dryness in the nasal cavity, accompanied by frequent sneezing; in addition, they have a headache, malaise, reduced sense of smell, watery eyes, fever. During the second stage, patients develop (usually in large quantities) transparent selection from the nose, nasality and difficulty breathing. During the third stage, the discharge becomes mucus-purulent and gradually disappears, breathing improves. As a rule, with acute rhinitis, patients recover within 7-10 days, but in some cases this disease can become chronic. Acute rhinitis can lead to complications such as sinusitis, otitis media and laryngotracheobronchitis (if inflammation from the nasal cavity passes into the sinuses, auditory tube, pharynx, or lower respiratory tract).
Chronic rhinitis is divided into three types: catarrhal, hypertrophic and atrophic.
Chronic catarrhal rhinitis, as a rule, is a consequence of acute rhinitis. In addition, it can be caused by negative environmental influences, circulatory disorders, endocrine disorders, dysfunction of the autonomic nervous system, sinusitis, chronic adenoiditis, or hereditary predisposition. In chronic catarrhal rhinitis, the ciliated epithelium of the nasal cavity changes into a cubic one and loses cilia, the mucous glands and the amount of mucus they secrete increase. Periodically there is a decrease in the sense of smell and nasal congestion. As a result of prolonged catarrhal rhinitis, chronic hypertrophic rhinitis may occur. With hypertrophic rhinitis, the mucous membranes grow, the epithelium loosens, nasal congestion and mucous discharge are constantly observed. Rhinoscopy reveals hypertrophy of the middle and lower turbinates. As a result of frequent acute rhinitis, professional or climatic harmful effects, atrophic chronic rhinitis may develop. With atrophic chronic rhinitis, the mucous membrane becomes thinner, the vessels and mucous glands become empty, the ciliated epithelium is transformed into a flat one. Atrophic rhinitis is manifested by a weakening (or complete absence) of smell, congestion and dryness of the nasal cavity, the appearance of dry crusts in the nose. Used for rhinitis conservative treatment: vasoconstrictor drugs(nose drops, sprays, aerosols, etc.), topical antimicrobials (ointments, aerosols, etc.) and (in case of allergic rhinitis) antihistamines.
Sinusitis is an inflammation of the paranasal sinuses. Most often, sinusitis is a complication of infectious diseases such as scarlet fever, influenza, measles, acute rhinitis, etc. Sinusitis can manifest itself in both acute and chronic forms. Acute forms of sinusitis include catarrhal and purulent sinusitis. To chronic forms of sinusitis - purulent sinusitis, edematous-polypous sinusitis and mixed sinusitis. Symptoms of acute sinusitis and chronic sinusitis(in the period of exacerbations) are the same. These include an increase in temperature, general malaise, headache, nasal congestion (usually on one side) and profuse mucous discharge from the nasal cavity. An accurate diagnosis of sinusitis is made on the basis of a patient questioning, anamnesis, examination of the nasal cavity, diaphanoscopy, probing and radiography. Inflammations of individual paranasal sinuses include diseases such as aerosinusitis, sinusitis, frontal sinusitis, sphenoiditis and ethmoiditis. If all the sinuses of the nose become inflamed at the same time (on both sides or on one side), this disease is called pansinusitis. At acute form sinusitis is treated conservatively, with chronic - surgical. Conservative treatment includes the use of topical antimicrobial agents(ointments, sprays, etc.), antibiotics a wide range action, restorative drugs and physiotherapy. At surgical treatment the inflamed sinuses are pierced, the purulent mucus accumulated in them is sucked out and antibiotics are applied.
Adenoids are an increase in the nasopharyngeal tonsil as a result of hyperplasia of its tissue (the nasopharyngeal tonsil is located in the nasopharyngeal vault and is part of the lymphadenoid pharyngeal ring). In most cases, adenoiditis affects children aged 3 to 10 years. As a rule, adenoids appear as a result of inflammation of the tonsils or nasal mucosa, which is caused by infectious diseases such as influenza, measles, scarlet fever, acute and chronic diseases upper respiratory tract. There are three degrees of adenoiditis: in the first degree, the adenoids cover only the upper part of the vomer; in the second degree, the adenoids cover two-thirds of the vomer; in the third degree, the adenoids completely cover the entire vomer. At the same time, the negative effects of adenoids on the body do not always correspond to their size. The first symptoms of adenoiditis include difficulty breathing and mucous discharge from the nose. Difficulty breathing leads to sleep problems, fatigue, lethargy, memory impairment, academic performance decline (in schoolchildren), voice changes and nasality, hearing loss, constant headaches. In advanced cases of adenoiditis in patients, the nasolabial folds are smoothed out, the so-called "adenoid" facial expression appears, laryngospasms occur, twitching of the facial muscles, deformed rib cage and the front of the skull, cough and shortness of breath appear, anemia develops. In young children, in addition to all of the above, adenoiditis (inflammation of the adenoids) may also occur. Adenoids are diagnosed on the basis of anamnesis, examination and digital examination of the nasopharynx, rhinoscopy and radiography. With adenoids of the first degree and the absence of breathing difficulties, conservative treatment is prescribed (local antimicrobials, vasoconstrictors etc.); in all other cases, adenotomy is performed ( prompt removal adenoids). Adenotomy is performed permanently, the postoperative period lasts 5-7 days.
Chronic tonsillitis is an inflammation of the palatine tonsils that has developed into a chronic form. In most cases, chronic tonsillitis occurs in children. In people over 60 years of age, this disease is extremely rare. The causes of chronic tonsillitis are bacterial and fungal infections striking palatine tonsils, enhanced by negative environmental influences (cold, gas pollution, dustiness of the air), malnutrition and other diseases (caries, purulent sinusitis, adenoiditis or hypertrophic rhinitis). Long term exposure pathogenic microflora on the palatine tonsils, combined with a general weakness of the body, leads to chronic tonsillitis. In chronic tonsillitis, certain changes occur in the palatine tonsils: keratinization of the epithelium occurs, dense plugs form in the lacunae, and the connective tissue, lymphoid tissue softens, lymph outflow from the tonsils is disturbed, regional The lymph nodes, the receptor functions of the tonsils are disturbed. There are two forms of chronic tonsillitis: compensated and decompensated. With a compensated form of chronic tonsillitis, patients have bad smell from the mouth, pain, dryness and tingling in the throat, sometimes a shooting pain in the ears in the absence of inflammation in the middle ear. In the decompensated form of chronic tonsillitis in patients, relapses of tonsillitis, paratonsillar abscesses, paratonsillitis, pathological reactions distant organs (for example, tonsillocardial syndrome), headaches, fatigue and decreased performance. In chronic tonsillitis, the tonsils become denser, their edges thicken, cicatricial adhesions appear between them and the palatine arches, and purulent plugs enlarged regional lymph nodes. Chronic tonsillitis can affect the occurrence of diseases such as rheumatism, thyrotoxicosis, nephritis, sepsis, exudative erythema multiforme, psoriasis, eczema, lupus erythematosus, dermatomyositis, nodular periarteritis, etc. Prolonged intoxication in chronic tonsillitis can lead to immune diseases such as hemorrhagic vasculitis and thrombocytopenic purpura. As a rule, chronic tonsillitis is fairly easy to diagnose. In some doubtful situations, it is confirmed through such studies as the study of the surface of the tonsils and the study of the contents of the lacunae (the pathogenic microflora, leukocytes, lymphocytes, ESR, serum immunological parameters are examined). With a compensated form of chronic tonsillitis and in the presence of contraindications to operations, conservative treatment is used (vasoconstrictor drugs, local antimicrobial agents, restorative drugs, physiotherapy). With a decompensated form of chronic tonsillitis and the absence of contraindications, as well as in cases where conservative treatment has not yielded results, apply surgical treatment(tonsillectomy). As a rule, with timely detection and adequate treatment, chronic tonsillitis is well cured.
Angina (other name: acute tonsillitis) is an acute inflammation that affects the palatine tonsils (in most cases), the lingual tonsil, pharyngeal tonsil, lateral ridges or larynx. Most often, angina affects children and adults under 35-40 years old. The causative agents of angina are microorganisms such as staphylococci, streptococci, fungi genus Candida etc. Predisposing factors for the development of angina include hypothermia, overheating, decreased immunity, smoke and dustiness of the air, mechanical damage tonsils. Infection with angina can occur in two ways: exogenous (in most cases) and endogenous. Exogenous infection occurs by airborne and alimentary routes, endogenous infection- due to the presence of inflammation in the oral cavity or nasopharynx (caries, gum disease, chronic tonsillitis, etc.). There are four types of angina: catarrhal, follicular, lacunar and phlegmous.
Catarrhal angina in the first day is manifested by dryness and perspiration in the throat and pain when swallowing. Then the temperature rises in patients, the general state of health worsens, weakness and headache appear. When examining the pharynx, you can see that the palatine tonsils are slightly swollen (while the posterior pharynx and soft palate do not change). In patients with a catarrhal form of angina, in addition to these symptoms, lymph nodes increase and the composition of the blood changes slightly (ESR moderately increases and leukocytes increase). Follicular and lacunar forms of angina are more acute. Their symptoms are chills, sweating, severe fever, headache, weakness, aching joints, lack of appetite, swollen and sore lymph nodes. With follicular and lacunar forms of angina, the palatine tonsils swell greatly. With the follicular form of angina, festering follicles (small vesicles) are visible through the mucous membrane of the tonsils. yellowish color). With the lacunar form of angina, a yellowish-white coating appears at the mouths of the lacunae, which gradually completely covers the tonsils (this plaque is well removed with a spatula). AT pure form follicular and lacunar forms of angina are quite rare (as a rule, they appear together). The phlegmous form of angina is purulent inflammation peri-almond tissue, which manifests itself, as a rule, against the background of one of the forms of tonsillitis and chronic tonsillitis described above. Signs of phlegmous tonsillitis are: sharp pain when swallowing, a sharp headache, nasality, pain in chewing muscles, bad breath, chills, severe fever, severe enlargement and soreness of the lymph nodes. Any form of angina can lead to complications such as acute otitis media, laryngeal edema, acute laryngitis, neck phlegmon, acute cervical lymphadenitis, peripharyngeal abscess. Angina is diagnosed by means of anamnesis, pharyngoscopy and laboratory tests (bacteriological, cytological, etc.). Patients with angina should, as far as possible, be protected from contact with other people (especially children), since this disease belongs to the category of acute infectious diseases. Angina is usually treated at home. Antibiotics, topical antimicrobials, antipyretics and restorative means. In especially severe cases, patients are hospitalized.
Pharyngitis is an inflammation of the mucous surface of the pharynx. There are two forms of pharyngitis: acute and chronic. Acute pharyngitis occurs as individual disease, and in the form of one of the manifestations of SARS. The factors influencing the development of acute pharyngitis include: the use of excessively cold or excessive hot food, inhalation of polluted or cold air. Symptoms of acute pharyngitis are: pain when swallowing, dryness in the throat. As a rule, a general deterioration in well-being is not observed, the temperature does not rise. When conducting pharyngoscopy, you can see that the back wall of the pharynx and the palate are inflamed. Acute pharyngitis with its symptoms resembles catarrhal angina (but with catarrhal angina, only palatine tonsils become inflamed). Acute pharyngitis is treated by gargling with warm alkaline solutions and decoctions medicinal herbs with anti-inflammatory action. Chronic pharyngitis, as a rule, is a consequence of acute pharyngitis. Sinusitis, rhinitis, diseases of the digestive tract, smoking, abuse contribute to the development of the chronic form of pharyngitis from acute alcoholic drinks. Common symptoms chronic pharyngitis manifested in all patients are dryness and sore throat, sensation of a lump in the throat. In chronic pharyngitis, pharyngoscopy reveals various changes posterior pharyngeal wall. Depending on these changes, three types of chronic pharyngitis are distinguished: hypertrophic, atrophic and catarrhal. With hypertrophic chronic pharyngitis, the mucous membrane of the back of the pharynx and palatine arches thickens. Hyper-trophic chronic pharyngitis is divided into granular and lateral. With hypertrophic granulosa pharyngitis, bright red granules form on the mucous membrane of the back of the throat. With hypertrophic lateral pharyngitis, bright red ridges form behind the palatine arches. With atrophic chronic pharyngitis, the glands atrophy and the mucous membrane of the pharynx dries up, which leads to an unpleasant dryness in the throat, which becomes especially painful after a long conversation. With pharyngoscopy, you can see that the mucous membrane is dry, with dry crusts. With catarrhal chronic pharyngitis, patients experience constant sore throat and accumulation of mucus. With pharyngoscopy, the same picture is observed as with acute pharyngitis. For the treatment of chronic pharyngitis, local antimicrobial agents, antibiotics, restorative drugs and physiotherapy are used. In some cases, the treatment of chronic pharyngitis requires surgery.
Laryngitis is an inflammation of the mucous surface of the larynx. There are two forms of laryngitis: acute and chronic. The causes of acute laryngitis, as a rule, are voice strain, hypothermia, or some diseases (flu, measles, whooping cough, etc.). In acute laryngitis, both the entire mucosa of the larynx and the mucosa of only some parts of the larynx can become inflamed. In places of inflammation, the mucous membrane of the larynx swells and acquires a bright red hue. In some cases, inflammation of the larynx can pass to the mucous surface of the trachea and lead to a disease such as laryngotracheitis. Symptoms of acute laryngitis are: dry throat, perspiration, pain when swallowing, cough (first dry, then wet), hoarseness, in some cases - lack of voice, slight increase temperature, headache. As a rule, acute laryngitis resolves in 7-10 days. In some cases, acute laryngitis can lead to complications such as laryngeal cartilage perichondritis, sepsis, and neck phlegmon. Acute laryngitis is diagnosed by means of anamnesis, examination of the patient, laryngoscopy, bacteriological examination of scrapings from the pharynx, etc. Treatment of acute laryngitis is reduced to the elimination of the causes of this disease (smoking, loud and long conversations, spicy food, alcohol, hypothermia, etc.), mustard plasters or compresses on the sternum and neck, gargling herbal decoctions. As a rule, acute laryngitis is well cured, but in some cases it can become chronic.
There are three forms of chronic laryngitis: catarrhal, hypertrophic and atrophic. With chronic catarrhal laryngitis, the mucous membrane of the larynx becomes bright red, the glands enlarge and secrete a large number of secret, sputum is formed in the mucosa of the trachea. In hypertrophic chronic laryngitis, hyperplasia of the submucosa and epithelium of the larynx is detected, and nodules form on the vocal folds (in case of voice overstrain). With atrophic chronic laryngitis, the mucous membrane of the larynx becomes thinner and covered with crusts. Symptoms of chronic laryngitis are: cough, sore throat, hoarseness, periodic loss of voice. As a rule, otherwise the patient's well-being does not worsen, although in some cases weakness and fatigue are observed. Chronic laryngitis is diagnosed by anamnesis, laryngoscopy and biopsy (in order to differential diagnosis with tumors and syphilitic lesions of the larynx). With timely detection and adequate treatment, catarrhal chronic laryngitis is usually well cured. Hypertrophic and atrophic chronic laryngitis in most cases is irreversible. For the treatment of chronic laryngitis, local antimicrobials, antibiotics, restorative drugs and physiotherapy are used. In some cases, the treatment of chronic laryngitis requires surgery.
Treatment inflammatory diseases the upper respiratory tract as a whole, without taking into account the characteristics of each specific disease, is reduced to the following activities:
. reduction of mucosal edema and restoration of airway patency. For this purpose, vasoconstrictors or decongestants are used;
. the use of local antimicrobial agents (ointments, sprays, etc.). These tools are especially effective for early stages diseases. At later stages, they supplement and enhance (and in some cases replace) antibiotic therapy;
. suppression of pathogenic bacterial flora (systemic antibiotic therapy);
. elimination of stagnation of mucus in the cavities of the upper respiratory tract. For this purpose, mucolytics based on carbocysteine ​​or acetylcysteine, as well as herbal preparations, are used.
The basis for the treatment of inflammatory diseases of the upper respiratory tract is the treatment antibacterial drugs. AT last years For the treatment of inflammatory diseases of the upper respiratory tract, oral antibiotics are mainly used. As a rule, in such cases, antibacterial drugs of the cephalosporin group are used, in particular, cephalosporin III generation- the drug Suprax (cefixime). It is effective, safe and inexpensive antibiotic, which is used in more than 80 countries around the world. Suprax belongs to the third-generation semi-synthetic oral cephalosporins and is characterized by a high bactericidal effect associated with the inhibition of the main structural component. cell membrane various bacteria. This drug is active against gram-negative microorganisms (Bronchanella catarralis, Haemophilus influenza, Klebsiella pneumonia, etc.) and some gram-positive microorganisms (Strepto-coc-cus pyogenes, Streptococcus pneumonia, etc.), which makes it extremely effective in treatment of inflammatory diseases not only of the upper, but also of the lower respiratory tract. The advantages of Suprax compared to other antibacterial drugs are:
. good bioavailability (regardless of food intake), which makes the use of injection therapy unnecessary, allows curing diseases of the upper respiratory tract in a shorter time and preventing their transition to a chronic form;
. the ability to create effective concentrations of the drug in the blood and accumulate in the target organ (the focus of inflammation);
. long (3-4 hours) half-life (half-life), which allows the use this drug only once a day and improves the quality of treatment at home;
. minimal inhibitory effect on the resident microflora of the colon, which makes Suprax safe to use even for children from 6 months old;
. the presence of two dosage forms - tablets and suspension. This allows the use of Suprax not only for adults, but also for small children who are not able to swallow tablets.
Suprax is prescribed for adults and children weighing over 50 kg at a dosage of 400 mg per day, for children aged 6 months to 12 years - at a dosage of 8 mg per 1 kg of body weight per day. The duration of treatment depends on the type and severity of the disease. As studies by Japanese experts have shown, side effects when using Suprax, they are quite rare and are associated with hypersensitivity patients to this drug.

Literature
1. Zhukhovitsky V.G. bacteriological substantiation of rational antibiotic therapy in otorhinolaryngology // Bulletin of otorhinolaryngology, 2004, No. 1, p. 5-15.
2. Kamanin E.I., Stetsyuk O.U. Infections of the upper respiratory tract and ENT organs. A practical guide to anti-infective chemotherapy / Ed. Strachunsky L.S., Belousova Yu.B., Kozlova S.N. Smolensk: MACMAH, 2007, p. 248-258.
3. Zubkov M.N. Algorithm for the treatment of acute and chronic infections of the upper and lower respiratory tract. - 2009. - v.17. - No. 2.- S. 123-131.
4. Benhaberou-Brun D Acute rhinosinusitis. Are antibiotics necessary? Perspect Infirm. 2009-6(3):37-8.
5. Fluit AC, Florijn A, Verhoef J, Milatovic D. Susceptibility of European beta-lactamase-positive and -negative Haemophilus influenzae isolates from the periods 1997/1998 and 2002/2003. // J Antimicrob Chemother. 2005-56(1):133-8
6. Hedrick JA. Community-acquired upper respiratory tract infections and the role of third-generation oral cephalosporins. //Expert Rev Anti Infect Ther. 2010-8(1):15-21.

1. RESPIRATORY

2. UPPER AIRWAY

2.2. PHARYNX

3. LOWER AIRWAY

3.1. LARYNX

3.2. TRACHEA

3.3. MAIN BRONCHI

3.4. LUNGS

4. PHYSIOLOGY OF BREATH

List of used literature

1. RESPIRATORY

Respiration is a set of processes that ensure the entry of oxygen into the body and the removal of carbon dioxide (external respiration), as well as the use of oxygen by cells and tissues for the oxidation of organic substances with the release of the energy necessary for their vital activity (the so-called cellular or tissue respiration ). In unicellular animals and lower plants, the exchange of gases during respiration occurs by diffusion through the surface of the cells, in higher plants - through the intercellular spaces that permeate their entire body. In humans, external respiration is carried out by special respiratory organs, and tissue respiration is provided by blood.

Gas exchange between the body and the external environment is provided by the respiratory organs (Fig.). Respiratory organs are characteristic of animal organisms that receive oxygen from the air of the atmosphere (lungs, tracheae) or dissolved in water (gills).

Picture. Human respiratory organs

The respiratory organs consist of the respiratory tract and paired respiratory organs - the lungs. Depending on the position in the body, the respiratory tract is divided into upper and lower sections. The respiratory tract is a system of tubes, the lumen of which is formed due to the presence of bones and cartilage in them.

The inner surface of the respiratory tract is covered with a mucous membrane, which contains a significant number of glands that secrete mucus. Passing through the respiratory tract, the air is cleaned and humidified, and also acquires the temperature necessary for the lungs. Passing through the larynx, the air plays important role in the process of forming articulate speech in humans.

Through the respiratory tract, air enters the lungs, where gas exchange takes place between the air and the blood. Blood gives off excess carbon dioxide through the lungs and is saturated with oxygen up to necessary for the body concentration.

2. UPPER AIRWAY

The upper respiratory tract includes the nasal cavity, the nasal part of the pharynx, and the oral part of the pharynx.

2.1 NOSE

The nose consists of the outer part, which forms the nasal cavity.

The external nose includes the root, back, apex and wings of the nose. The root of the nose is located in the upper part of the face and is separated from the forehead by the nose bridge. The sides of the nose join in the midline to form the back of the nose. From top to bottom, the back of the nose passes into the top of the nose, below the wings of the nose limit the nostrils. The nostrils are separated along the midline by the membranous part of the nasal septum.

outer part of the nose external nose) has a bone and cartilaginous skeleton, formed by the bones of the skull and several cartilages.

The nasal cavity is divided by the nasal septum into two symmetrical parts, which open in front of the face with the nostrils. Posteriorly, through the choanae, the nasal cavity communicates with the nasal part of the pharynx. The nasal septum is membranous and cartilaginous anteriorly, and bony posteriorly.

Most of the nasal cavity is represented by the nasal passages, with which the paranasal sinuses (air cavities of the skull bones) communicate. There are upper, middle and lower nasal passages, each of which is located under the corresponding nasal concha.

The superior nasal passage communicates with the posterior cells ethmoid bone. The middle nasal passage communicates with frontal sinus, maxillary sinus, middle and anterior cells (sinuses) of the ethmoid bone. The lower nasal passage communicates with the lower opening of the nasolacrimal canal.

In the nasal mucosa, the olfactory region is distinguished - a part of the nasal mucosa covering the right and left upper nasal conchas and part of the middle ones, as well as the corresponding section of the nasal septum. The rest of the nasal mucosa belongs to the respiratory area. In the olfactory region there are nerve cells that perceive odorous substances from the inhaled air.

In the anterior part of the nasal cavity, called the vestibule of the nose, there are sebaceous, sweat glands and short stiff hairs - vibris.

Blood supply and lymphatic drainage of the nasal cavity

The mucous membrane of the nasal cavity is supplied with blood by branches of the maxillary artery, branches from the ophthalmic artery. Venous blood flows from the mucous membrane through the sphenopalatine vein, which flows into the pterygoid plexus.

Lymphatic vessels from the nasal mucosa are sent to the submandibular lymph nodes and submental lymph nodes.

Innervation of the nasal mucosa

Sensitive innervation of the nasal mucosa (anterior part) is carried out by branches of the anterior ethmoid nerve from the nasociliary nerve. The back of the side wall and septum of the nose is innervated by branches of the nasopalatine nerve and the posterior nasal branches from the maxillary nerve. The glands of the nasal mucosa are innervated from the pterygopalatine ganglion, the posterior nasal branches and the nasopalatine nerve from the autonomic nucleus of the intermediate nerve (part of the facial nerve).

2.2 SIP

This is a section of the human alimentary canal; connects oral cavity with the esophagus. From the walls of the pharynx, the lungs develop, as well as the thymus, thyroid and parathyroid glands. Performs swallowing and participates in the process of breathing.

The lower respiratory tract includes the larynx, trachea and bronchi with intrapulmonary branches.

3.1 LARYNX

The larynx occupies a median position in the anterior region of the neck at the level of 4-7 cervical vertebrae. The larynx is suspended above the hyoid bone, below it is connected to the trachea. In men, it forms an elevation - a protrusion of the larynx. In front, the larynx is covered with plates of the cervical fascia and hyoid muscles. Front and sides of the larynx cover the right and left lobes of the thyroid gland. Behind the larynx is the laryngeal part of the pharynx.

Air from the pharynx enters the laryngeal cavity through the entrance to the larynx, which is bounded in front by the epiglottis, laterally by the aryepiglottic folds, and behind by the arytenoid cartilages.

The cavity of the larynx is conditionally divided into three sections: the vestibule of the larynx, the interventricular section and the subvocal cavity. In the interventricular region of the larynx is the human speech apparatus - the glottis. The width of the glottis during quiet breathing is 5 mm, during voice formation it reaches 15 mm.

The mucous membrane of the larynx contains many glands, the secretions of which moisten the vocal folds. In the region of the vocal cords, the mucous membrane of the larynx does not contain glands. In the submucosa of the larynx there is a large number of fibrous and elastic fibers that form the fibrous-elastic membrane of the larynx. It consists of two parts: a quadrangular membrane and an elastic cone. The quadrangular membrane lies under the mucous membrane in upper section larynx and participates in the formation of the vestibule wall. At the top, it reaches the aryepiglottic ligaments, and below, its free edge forms the right and left ligament vestibule. These ligaments are located in the thickness of the folds of the same name.

The elastic cone is located under the mucous membrane in the lower part of the larynx. The fibers of the elastic cone start from top edge arcs of the cricoid cartilage in the form of a cricoid ligament, go up and somewhat outward (laterally) and are attached in front to inner surface thyroid cartilage (near its angle), and behind - to the base and vocal processes of the arytenoid cartilages. The upper free edge of the elastic cone is thickened, stretched between the thyroid cartilage in front and the vocal processes of the arytenoid cartilages behind, forming a VOICE LINK (right and left) on each side of the larynx.

The muscles of the larynx are divided into groups: dilators, constrictors of the glottis and muscles that strain the vocal cords.

The glottis expands only when one muscle contracts. This is a paired muscle that starts on the posterior surface of the plate cricoid cartilage, goes up and attaches to the muscular process of the arytenoid cartilage. Narrow the glottis: lateral cricoarytenoid, thyroarytenoid, transverse and oblique arytenoid muscles.

The cricoid muscle (steam) begins in two bundles from the anterior surface of the cricoid cartilage arch. The muscle goes up and is attached to the lower edge and to lower horn thyroid cartilage. When this muscle contracts, the thyroid cartilage leans forward and the vocal cords tighten (tension).

Voice muscle - steam room (right and left). Each muscle is located in the thickness of the corresponding vocal fold. Muscle fibers are woven into vocal cord to which this muscle is attached. The vocal muscle starts from the inner surface of the angle of the thyroid cartilage, in its lower part, and is attached to the vocal process of the arytenoid cartilage. Contracting, it strains the vocal cord. When a part of the vocal muscle contracts, the corresponding section of the vocal cord is tensed.

Blood supply and lymphatic drainage of the larynx

Branches of the superior laryngeal artery from superior thyroid artery and branches of the inferior laryngeal artery - from the inferior thyroid artery. Venous blood flows through the veins of the same name.

The lymphatic vessels of the larynx flow into the deep cervical lymph nodes.

Innervation of the larynx

The larynx is innervated by branches of the superior laryngeal nerve. At the same time, its outer branch innervates the cricothyroid muscle, the inner - the mucous membrane of the larynx above the glottis. The inferior laryngeal nerve innervates all the other muscles of the larynx and its mucous membrane below the glottis. Both nerves are branches vagus nerve. The laryngopharyngeal branches of the sympathetic nerve also approach the larynx.