Inflammatory diseases of the larynx are divided into acute and chronic. Of acute inflammatory diseases of the larynx the most common are acute laryngitis. This term means catarrhal inflammation of the mucous membrane, the submucosal layer and the internal muscles of the larynx.
Among the causes of acute laryngitis, respiratory viral infection comes first. Bacterial flora (primarily cocci) can also cause acute inflammation of the mucous membrane of the larynx. In doing so, it can cause the disease itself or in conjunction with respiratory viruses. Bacteria that caused the disease are most often saprophytes, they become pathogenic under the influence of exogenous and endogenous factors.
Exogenous factors contributing to the activation of infection in the larynx include thermal irritation, abuse of alcoholic beverages and smoking, overstrain of the vocal apparatus, exposure to dust, steam, gases and other occupational hazards.
Endogenous factors include, first of all, metabolic disorders, in which there is an increased sensitivity of the mucous membrane of the larynx even to mildly expressed irritants.
The clinical picture of acute laryngitis is characterized by a sudden onset of a generally satisfactory condition. The body temperature is normal or increased slightly. There is a feeling of dryness, burning in the larynx, dry cough, sometimes soreness when swallowing. The voice becomes hoarse. A dry cough is replaced by a wet cough with a significant separation at first mucous, and then mucopurulent sputum.
The diagnosis of acute laryngitis is made with laryngoscopy. Laryngoscopic picture is as follows: the mucous membrane is hyperopic, the vocal folds pink or bright red, thickened, there is a viscous secret in the laryngeal lumen in the form of mucopurulent cords. Often during phonation, incomplete closure of the vocal folds can be detected due to inflammation of the vocal or transverse arytenoid muscles. Edema in this disease is expressed slightly, and therefore, difficulty breathing, as a rule, is not observed.
Treatment for acute laryngitis is carried out on an outpatient basis without being released from work. The exception is made by persons of vocal and speech professions, who are issued with a sheet of temporary incapacity for work. Patients are recommended a strict voice mode, the reception of acute and hot food, alcoholic beverages and smoking are prohibited.
With a dry cough, funds are prescribed that lower the excitability of the cough center. Dilution of mucus and elimination-dryness is achieved by the intake of alkaline mineral waters in a heated form, undiluted or in half with hot milk. With an excessive amount of thick viscous secretions are shown-expectorants - thermopsis, ipecacuan.
A good anti-inflammatory effect is the local application of heat in the form of steam inhalations, warming compresses, UHF and microwave therapy on the larynx. Inhalations can be not only steam but also with the addition of medicinal substances: oily, alkaline, with solutions of antibiotics and sulfanilamide preparations.
Widely prescribed ready-mixed medicines in aerosol cans for pulverization and inhalation. Apply infusion into the larynx of medicines (installations) - 1% oily solution of menthol, antibiotics, hydrocortisone, vasoconstrictors. Use distractions and sweatshops: hot foot baths, mustards to gastrocnemius muscles, to the larynx and thorax.
If the disease takes a protracted character and the local treatment is ineffective, anti-inflammatory agents of general action are prescribed: antibiotics, sulfonamides, antihistamines, calcium preparations, ascorbic acid.
With the correct mode and treatment, the process in the larynx with acute catarrhal laryngitis is completely eliminated within 5-10 days.
An incomparably heavier acute inflammatory disease of the larynx is laryngeal angina (I already mentioned it in the tenth lecture). This name should be understood as an infectious disease with local manifestations in the form of acute inflammation of lymphadenoid tissue of the larynx. Since the clinical picture of guttural angina is characterized by difficulty breathing, the term "angina" here is quite legitimate due to the fact that it comes from the Latin verb "ango" - squeeze, choke. The disease is caused by pathogenic cocci, an important role in its development is played by cooling.
The severe course of the laryngeal tonsillitis is characterized by a significant violation of the general condition of the patient, the body temperature rises to 100-102 ° F, there is a strong pain in the throat when swallowing, hoarseness, often - labored breathing through the larynx. Palpation of the larynx is painful. The regional lymph nodes of the neck are enlarged, painful.
With laryngoscopy, there is hyperemia and infiltration of the epiglottis mucosa, pear-shaped pockets, aryepiglottic and vocal folds, as well as folds of the vestibule. Sometimes there is significant swelling, which causes difficulty in breathing. This determines the risk of the disease and the corresponding therapeutic tactics: a patient with a laryngeal sore should be treated in a hospital, since tracheostomy may be required.
Treatment of patients with laryngeal angina is carried out with antibacterial and dehydration medications. Antibiotics are prescribed according to the schemes I have already mentioned when treating patients with acute tonsillitis. To reduce edema intravenously, 40% glucose solution, 30% calcium chloride solution, 60-90 mg prednisolopium, diuretics, intramuscular - antihistamines are prescribed. Apply distracting procedures. A good therapeutic effect is achieved when using the cervical Novocaine blockade. In those cases when decompensated stenosis of the larynx develops, resort to tracheostomy.
With a favorable course of the disease after 6-8 days ends in recovery. Sometimes the process turns into diffuse purulent inflammation of the submucosal layer, muscles, intermuscular tissue - phlegmonous laryngitis develops.
The cause of phlegmonous laryngitis can be not only guttural angina, external injuries of the larynx and damage to its mucous membrane (foreign body trauma, chemical and thermal burns) are also important. An important factor in the occurrence of the disease is the cooling factor. Phlegmonous laryngitis can develop as a secondary disease in paratonzillitis, abscess of the root of the tongue, erysipelas, typhoid, diphtheria of the larynx, blood diseases, sepsis.
There is no specific causative agent of acute phlegmonous laryngitis. Pathogens can be streptococci, staphylococci, pneumococci, in some cases - a symbiosis of the spindle-shaped rod and spirochetes of the oral cavity.
The disease begins acutely. Patients complain of general weakness, malaise, sore throat, fever. Especially severe pain is noted when the abscess is located on the epiglottis, aryepiglottic folds.
Most often, the disease manifests itself in the development of edema, infiltration, abscess formation of the epiglottis mucosa, aryepiglottic folds, arytenoid cartilage area.
Treatment of acute phlegmonous laryngitis includes the use of large doses of broad-spectrum antibiotics and sulfonamide preparations. Along with the use of antibacterial agents, anti-edema therapy is provided - antihistamines and diuretics, corticosteroids. If an abscess is found, it is necessary to open it with a laryngeal knife. In the case of acute stenosis, urgent tracheostomy is indicated. When the abscess spreads to the neck or to the mediastinum, these abscesses are opened or transcervical mediastinotomy is produced.
The inflammatory process in the larynx can spread to the perichondrium and cartilage, then chondroperichondritis of the larynx develops. Distinguish between chondroperichondritis and diffuse, acute and chronic. A common cause of the disease is trauma. Chondroperichondritis can develop as a result of radiation therapy for malignant tumors of the larynx.
Perichondritis usually is purulent. The pus exfoliates the perichondrium, and therefore the cartilage nutrition is disturbed. As a result, the cartilage is absorbed or pecrotized with the formation of fistulas, sequestrants released through fistulas. Another form of the disease is sclerosing. With it develop granulation followed by scarring.
The clinical picture is characterized by pain in the larynx, painful swallowing, fever, hoarseness, shortness of breath. Defining the contour of the larynx, a slight increase in the volume of the neck and a sharp pain during palpation are determined. Laryngoscopy can detect puffiness and infiltration of the mucous membrane. With chronic chondroperichondritis, the symptomatology is less pronounced. Late complications of chondroperichondritis include persistent cicatricial stenoses of the larynx.