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DIAGNOSTIC ALGORITHM FOR LARYNGEAL PATHOLOGY
Mavlonova Nargiza Ikhtiyor kizi
6th year student of the pediatrics faculty of the
Samarkand State Medical University
https://doi.org/10.5281/zenodo.14887602
Introduction.
The treatment of laryngeal diseases requires a multidisciplinary approach.
However, choosing the right treatment strategy largely depends on an adequate diagnosis of all
nuances of the disease. The similarity of the clinical and endoscopic presentation of laryngeal
lesions does not always allow for a definitive diagnosis. In these cases, computed tomography
(CT) of the larynx helps. However, it is difficult for clinicians to determine the appropriate CT
examination option, including intravenous contrast enhancement, which necessitates the
development of guidelines.
Objective:
To develop an algorithm for CT diagnostics of pathological conditions of the
larynx depending on the clinical situation. To develop an algorithm for CT diagnostics of
pathological conditions of the throat depending on the clinical situation
Materials and methods.
The study included 11 patients who were referred for hiatal CT
with intravenous contrast after clinical examination and laryngoscopy, as well as 40 patients
who did not undergo hiatal CT without intravenous contrast in 2019-2021. The main clinical
reasons for Al's in-depth diagnosis were hoarseness or loss of voice (100%), dry mouth (70%),
pain or a feeling of coma in the throat (20%), and difficulty breathing (10%). Laryngoscopic
signs were unilateral/asymmetrical changes (80%), impaired mobility of the palatine mucosa
(60%), mucous membrane hyperplasia (20%), areas of hyperkeratosis (20%), pathological
vessels (15%), the presence of areas inaccessible to examination (15%), and areas of stenosis
that hinder examination (20%).
Results and discussion.
We identified 4 categories of patients: 1) the primary cause of
the changes in the throat, the diagnosis is unclear; 2) the primary cause of the changes in the
throat, the diagnosis is clear; 3) the primary cause of the changes is not in the throat, the
diagnosis is unclear; 4) The primary cause of the changes is not obvious, the diagnosis is clear.
In the first group (n=55), hipline CT with intravenous contrasting was required in all
cases, even if contrasting was not initially planned. The most common pathology was
hyperplastic larynx (p=30), however, the severity of changes did not allow for the exclusion of
tumor damage. Thoracic contrast CT in this category of patients allowed to determine the areas
of pathological contrast, from which the target biopsy was taken.
In the second group (n=55), the most frequent pathology was the cysts of the throat of
various localizations (n=25). However, the absence of difficulties in establishing the diagnosis
did not eliminate the need for CTgortany with intravenous contrasting of Al to clarify the details
of the pathology. In the case of differential diagnosis between benign mycista formation (n=9)
and the nature of contrast and the dynamics of contrast preparation accumulation on CT, the
issues were resolved.
In the third group (n=10), the main reason for Al's pre-examination was the absence of
structural changes according to laryngoscopy. In this category of patients, the diagnostic
algorithm was completely changed after contrast-free throat CT: b patients were diagnosed
with pulmonary tumors, and u2 patients with midsection tumors were diagnosed with tumors
of the posterior cranial fossa.
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In the fourth group (n=30), the main cause of the pre-examination Al was a stenosis of the
throat, and in all cases, the diagnosis was known, and the patient was admitted to correct these
changes. Thoracic CT without intravenous contrast in this category provided comprehensive
information, based on which further treatment tactics were determined.
Conclusion.
In our opinion, the first step is to conduct a clinical examination and
laryngoscopy of all patients suspected of developing hiatal roof. This allows us to determine
where the primary cause of the changes is located - in the throat or outside it. In case of
impaired tracheal airway throughput (as a rule, this is indicated by the data of the medical
history), the KT of the throat without contrast in most cases is sufficient to determine the exact
location and severity of the changes.
We believe that using such an algorithm allows for the rational use of existing diagnostic
resources and the resolution of most clinical situations.
