Нейродистрофии как дополнительный критерий в классификации дисфоний

Abstract

Introduction. Based on the fact that all classifications are a method of generalization, most authors in their own research, as a rule, use several classifications. On the one hand, this allows obtaining the most accurate characterization of the disease and substantiating the methods of its treatment. On the other hand, it significantly reduces the possibility of comparing various data and an adequate assessment of the etiological and pathogenetic mechanisms of the disease. The results of a long-term study of laryngeal diseases, considering one of the main etiological and pathogenetic causes, which is a violation of the adaptive-trophic function of the autonomic nervous system (ANS), allow, to some extent, eliminating the existing difficulties. Objective. Transformation of the classification systematics of dysphonia considering the neurogenic link of pathogenesis. Materials and methods. A comprehensive clinical and physiological examination of 125 patients aged 18 to 75 years was carried out for voice disorders with clinical diagnoses of “polyp of the vocal fold” (60), “chronic laryngitis” (20), “hypotonic type of functional dysphonia in combination with laryngeal hypersensitivity” (45). During the examination, the medical history was studied, an objective examination of the upper respiratory tract according to generally accepted methods and with the help of videostroboscopic unit, cytological examination of impression smears from the affected laryngeal area, and a study of the functional state of the ANS as well as the surgical material, including histological and histochemical examination of the removed tissue, were carried out. Surgical intervention to remove pathological formations was performed in 60 cases in patients with polyps of the vocal folds and in 3 cases in patients with chronic laryngitis. Results. The conducted studies have shown that the changes that lead to chronic hypertrophic laryngitis, functional dysphonia, tumor-like hyperplastic-dystrophic processes as well as the changes in the sensitivity of the larynx by the type of «denervation hypersensitivity» are largely associated with neurogenic, including neurodystrophic, pathogenicity factors. In groups of patients with inadequate autonomic maintenance of activity, where it is a question of violations of the functional activity of the ANS (insufficient or excessive autonomic maintenance of activity), pathological dystrophic changes of varying severity develop in the mucous membrane of the larynx. Conclusion. The proposed classification of dysphonia is based on the clinical and morphological features of laryngeal diseases, including the neurodystrophic component of the development of the pathological process.