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ID naloge: 148 Letnik: 2003 Predmet: otorinolaringologija
KRONICNO VNETJE ŽRELA KOT POSLEDICA ODSTRANITVE NEBNIC
Avtor: Jošt Paucic
Mentor: doc. dr. Irena Hocevar Boltežar
IZHODIŠCE: Kronicni faringitis (KF) je pogosta otorinolaringološka bolezen, za katero menijo, da se lahko razvije tudi kot posledica operativne odstranitve nebnic. V tem primeru govorimo o faringitisu tonzilopriva (KFT).
NAMEN: Z raziskavo smo poskušali ugotoviti, kako pogosto odrasli bolniki, ki sta jim bili operativno odstranjeni nebnici, obolevajo za KF. Predvsem nas je zanimalo, kako pogosto je pri teh bolnikih KF neposredno povezan s tonzilektomijo (KFT) in kako pogosto je posledica drugih etioloških dejavnikov, ki tudi lahko sami po sebi povzrocijo razvoj KF. Želeli smo tudi ugotoviti, ali število let, ki je preteklo od tonzilektomije, vpliva na pogostnost pojavljanja KF.
HIPOTEZA: Približno tretjina odraslih bolnikov bo imela po tonzilektomiji težave, ki jih povzroca KF. Od tega bodo pri polovici bolnikov težave posledica same tonzilektomije, pri drugi polovici pa pricakujemo, da obstajajo drugi etiološki dejavniki za težave, ki so bile morda prisotne že pred operacijo. KF, ki je nastal kot posledica tonzilektomije, bo pogostejši v skupini bolnikov, ki so bili operirani pred osmimi leti kot pri tistih, ki so bili operirani pred tremi leti.
METODE: V raziskavo smo zajeli 115 bolnikov, ki so bili tonzilektomirani leta 2000 in leta 1995/96 na Kliniki za ORL in CFK v Ljubljani in so odgovorili na vprašalnik o subjektivnih težavah znacilnih za KF ter dejavnikih, ki vplivajo na nastanek KF (kajenje, alergija, neugodna mikroklima doma in/ali na delovnem mestu, gastroezofagealni refluks, dihanje na usta). Bolnike, ki so navedli težave v smislu KF, smo otorinolaringološko pregledali, napravili endoskopijo grla in spodnjega žrela ter tako objektivno ugotovili KF oz. katerega od dejavnikov, ki vplivajo na nastanek le-tega.
REZULTATI: 61 bolnikov (53%) je v vprašalniku navedlo za KF znacilne težave. 41 izmed teh se je udeležilo pregleda. Pri vseh pregledanih smo ugotovili KF, pri 18 izmed teh (15,7% vseh bolnikov) se je le-ta pojavil šele po tonzilektomiji. Pri bolnikih s KF smo v primerjavi z bolniki, ki težav v smislu KF v vprašalniku niso navedli, ugotovili znacilno pogostejše pojavljanje alergije. Med bolniki s KFT ter ostalimi bolniki s KF statisticno znacilnih razlik v pojavljanju neugodnih dejavnikov za sluznico žrela nismo ugotovili.
ZAKLJUCKI: V raziskavi smo ugotovili subjektivne in objektivne znake KF pri 35,7% bolnikov, ki so bili tonzilektomirani pred 3 oz. 8 leti. Pri slabi polovici teh bolnikov (15,7% vseh bolnikov) se je KF razvil šele po odstranitvi nebnic. Za vse bolnike s KF je bilo znacilno, da so imeli številne neugodne dejavnike, ki že sami po sebi lahko povzrocijo KF. Statisticno znacilne razlike med bolniki, pri katerih se je KF razvil šele po operaciji in ostalimi bolniki s KF, nismo ugotovili. Ugotovili pa smo pogostejše pojavljanje alergije pri bolnikih s KF (neodvisno od tega ali je nastal po operaciji ali pred njo) kot pri bolnikih, ki niso imeli zanj znacilnih težav. Število let, ki je preteklo od operacije, ni znacilno vplivalo na pogostnost pojavljanja KF.
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[Abstract / English version]
KRONICNO VNETJE ŽRELA KOT POSLEDICA ODSTRANITVE NEBNIC
Author: Jošt Paucic
Mentor: doc. dr. Irena Hocevar Boltežar
BACKGROUND: Chronic pharyngitis (CP) is a common otorhinolaryngological disease. It is believed that CP can also develop as a consequence of tonsillectomy.
AIM: The aim of this research is to discover the frequency of CP in adult patients which have undergone tonsillectomy. We focused primarily on the frequency of this disease as a consequence of tonsillectomy (CP also known as tonsilloprive pharyngitis, TP) in comparison with the occurrence of the disease due to other negative factors which are also by themselves a sufficient cause for CP. We also tried to discover whether the time which has passed from the operation influences the frequency of development of CP.
HYPOTHESIS: As a result of tonsillectomy, approximately a third of the adult patients will suffer from CP-related difficulties. In a half of these patients the difficulties will develop as a result of the operation, whereas in the other half of the patients it is expected that the difficulties are due to etiological factors present prior to or irrespective of the operation. TP is more common in the group of patients operated 8 years before our examination, than in the group operated 3 years before.
METHODS: One hundred fifteen patients who underwent tonsillectomy in years 2000 and 1995/1996 in the University Department of Otorhinolaryngology and Cervicofacial Surgery, Ljubljana, answered the questionnaire on their subjective difficulties typical for CP and risk factors for the development of CP (smoking, allergy, unfavourable microclimate conditions at home or at work place, gastroesophageal reflux, mouth breathing). Patients who complained of CP-related problems went through an otorhinolaryngological inspection and laryngoendoscopy. We thus objectively discovered the potential presence of CP and/or any of the risk factors for the disease.
RESULTS: 61 patients (53%) answered that they suffer from CP-related difficulties. We discovered the presence of CP in all of the 41 patients who were subsequently examined. The disease occurred after tonsillectomy in 18 patients (15.7% of all 115). Comparing patients who suffered from CP with patients whose answers did not reflect any presence of such problems we found statistically significant difference in allergy occurrence. We found no statistically significant difference in the occurrence of unfavourable conditions for pharyngeal mucosa between patients suffering from TP and patients suffering from CP.
CONCLUSIONS: The research revealed subjective and objective signs of CP in 35.7% of the patients who underwent tonsillectomy 3 or 8 years before our examination. In a bit less than a half of these patients (15.7% of all) CP developed only after the operation. Presence of numerous risk factors was distinct for all patients who suffered from CP. Statistically significant differences between patients with TP and the rest of the patients suffering from CP were not found. However, comparing all patients suffering from CP with patients who claimed no CP-related symptoms, we proved a statistically significant difference in allergy occurrence. Finally, we found that the time passed from the operation is not significant for the occurrence of CP.
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