We have examined 86 adult patients (middle age 44.8 years) with AE, 59 patients (69%) had IF, and 27 patients (31%) -had AF, that was the subject of our study in acute and remote period. In modern conditions there is a tendency of increasing the age of patients (41-60 years, p=0,052), the presence of concomitant chronic tonsillitis in 15% of patients, complications of laryngeal stenosis in 18.5%, parapharyngeal abscess in 11%. As well as the independence of the inflammation form from the anatomical variants of its structure.
At microbiological research the big lg7-lg9 CFU / g degree of microbic density among 72% of the patients was stated. In both infiltration and abscessing, in contrast to pediatric patients, the predominance of staphylococcal-streptococcal flora over H. influenzae was determined. A statistically significant dominance was obtained in the abscess of S. aureus, associations of Candida spp with two or more microorganisms sensitive to cephalosporins of III-IV generations, respiratory fluoroquinolones and lincosamides.
High degree of systemic inflammatory response syndrome at the beginning of the disease was determined on the basis of the study of acute phase parameters, endogenous intoxication (CRP, fibrinogen, haptoglobin, the content of molecules of average mass), that changed proportionaly to the severity of the patient's condition and the form of inflammation of the epiglottis. In a month after discharge from the hospital, the preservation of the increased level of СRP in AF in 3,24 times, in IF in 1,5 times that is an indication for inclusion in the treatment of NSAIDs until the normalization of indicators.
It is proved that at the beginning of the disease in IF and AF of epiglottitis there is a violation of the functional state of the liver in the form of an increase in the Veltman test, thymol test in 1,9-2,7 times, respectively, De Ritis ratio, alkaline phosphatase in 1,9-2,2 times, respectively, low-density lipoprotein, severe dysproteinemia, requiring the appointment of hepatoprotectors with mandatory monitoring of abnormalities in a month. The results of the performed studies showed that in patients with AF epiglottitis there are significant deviations in the content of connective tissue metabolites in the serum: increased levels of glycoproteins, total chondroitin sulfates, all fractions of hydroxyproline, especially general. It is possible to accurately diagnose an epiglottis abscess on the basis of discriminant analysis: at simultaneous increase by more than 50%, such indicators as α1-globulin, glycoproteins, CRP, prothrombin time. The lack of normalization of these data in a month indicates the incompleteness of pathological processes in the connective tissue and the need for correction by long-term intake of vitamin C, and sometimes chondroprotectors. The possibility of using the method of two-dimensional ultrasound of the larynx with color Doppler is substantiated and tested. It is determined that the signs of infiltration of the epiglottis are the asymmetry of the shape with blurred contours, thickening of the anterior-posterior size and the inability to differentiate its center, decrease in echogenicity, increase in the number of blood flow loci. A reliable sign of an abscess is the presence of cavity cells with hypoechoic inhomogeneous content on the background of heterogeneity of the structure, with increased blood flow on the periphery of the cavity formation.
This study recommends a new decision of an actual scientific and practical problem. This decision consists of increasing efficiency of diagnostics of AE in adults by using ultrasound of an epiglottis and definition of the most significant informative biochemical indicators characterizing degree of endogenous intoxication and disturbance connective tissue functions, to facilitate the differentiation of infiltrative and abscessive forms at the beginning of the disease and the correction of treatment tactics in the near and long term.
