What are the clinical manifestations of diphtheria in the ear, nose and throat

Diphtheria is an acute respiratory infectious disease caused by Diphtheria bacilli. Mainly through direct transmission of air droplets; secondly, indirect transmission, that is, through the use of hand towels, tableware, toys, books and newspapers, etc. Diphtheria is common in autumn, winter and spring, and mostly occurs in children under 10 years old, with the highest incidence among 2 to 5 years old. Our country has attached great importance to prevention since liberation, so this disease is now relatively rare.

The occurrence and development process of diphtheria is mainly divided into two categories: local lesions and systemic lesions based on the pathological changes that occur after diphtheria bacilli infection.

(1) Local lesions: Diphtheria bacilli produce an exotoxin after invading human tissue, damaging mucosal epithelial cells, causing necrosis, and exudation of cellulose and white blood cells. After the cellulose solidifies, a layer of pseudomembrane is formed. Diphtheria bacilli multiply and grow under the pseudomembrane, producing more exotoxins, causing the lesions to expand and the pseudomembrane to spread around. The pseudomembrane in the larynx is loosely attached and can sometimes be coughed up.

(2) Systemic lesions: Diphtheria exotoxins enter the blood and cause systemic poisoning, which can cause toxic myocarditis, nephritis, peripheral neuritis or cranial nerve damage.

The clinical manifestations of otolaryngology diphtheria are:

(1) Pharyngeal diphtheria: It is the most common form of diphtheria. There are three types according to the symptoms: ① Localized type: systemic symptoms may include fever, fatigue, discomfort, etc. Local symptoms are mild, with mild sore throat. Gray-white pseudomembranes appear on one or both tonsils. The pseudomembranes may extend beyond the palatal arch and cover the soft palate, sag, or posterior pharyngeal wall. The false membrane is difficult to wipe off, and if it is separated by force, bleeding will occur. Diphtheria bacilli can be detected by smear or culture of pseudomembranous bacteria. ② Poisoning type: The onset is rapid, the pseudomembrane expands rapidly, and systemic poisoning symptoms appear quickly. For example, combined with streptococcal infection, there is often high fever, severe swelling of local tonsils, sagging, soft palate and other tissues; swollen cervical lymph nodes, and even thickening of the neck like a "cow neck".

(2) Laryngeal diphtheria: Laryngeal diphtheria is mostly caused by the downward spread of pharyngeal diphtheria, but there are also cases that originate in the laryngeal cavity. After the lesion invades the laryngeal cavity, cough and hoarseness often occur. When the laryngeal mucosa is swollen or there is a pseudomembrane blocking the glottis, it can cause inspiratory dyspnea and laryngeal stridor. As the disease continues to progress, three concave signs appear. If the obstruction is not removed in time, death will result from suffocation. The laryngeal mucosa can sometimes extend downward into the tracheobronchial tubes, causing lower respiratory tract obstruction.

(3) Nasal diphtheria: rare. It is divided into two categories: primary and secondary. The former is caused by diphtheria bacilli directly invading the nasal cavity, and the systemic poisoning is mild; the latter is caused by the spread of pharyngeal diphtheria, and the systemic symptoms and poisoning are severe. The symptoms are basically the same as those of ordinary rhinitis, including nasal congestion and runny nose, but the nasal mucus is often bloody. Examination shows that the skin of the nasal vestibule and upper lip is flushed and eroded, and the surface of the nasal mucosa is covered with a gray-white pseudomembrane, which is especially common on the nasal septum. Removal of the pseudomembrane often leaves bleeding ulcers.

(4) Auricular diphtheria: Diphtheria of the middle ear is extremely rare. Secondary to nasal and pharyngeal diphtheria, diphtheria bacilli enter the tympanic cavity through the Eustachian tube or enter the tympanic cavity through perforation of the tympanic membrane. Symptoms are similar to those of general suppurative otitis media, with severe earache and, after the tympanic membrane is perforated, bloody pus and filthy pseudomembranous secretions with a foul odor.