Chronic laryngitis usually occurs as a result of untreated acute laryngitis. Often, its occurrence is due to pathological changes in the nose, paranasal sinuses, throat, and lower respiratory tract. Among the most frequent causes of chronic laryngitis, it is necessary to allocate increased voice load, smoking, various professional harmfulness, abuse of alcohol or food irritating the mucous membrane.
As a result of prolonged exposure to the above factors, the trophic tissue is disrupted, their reactivity changes and the dystrophic process develops. Depending on the depth of this process, chronic laryngitis is divided into catarrhal, hyperplastic (hypertrophic) and atrophic.
In patients with catarrhal laryngitis, the disorders of local circulation and changes in the cover epithelium come to the fore, which in some areas can be metaplated from cylindrical to flat, loosened and irradiated. In the subepithelial layer, there is a circular cell infiltration.
The morphological essence of hyperplastic laryngitis is characterized by the proliferation of connective tissue in its own layer of the mucous membrane due to the appearance of exudate, which causes a thickening of the soft tissues.
Chronic hyperplastic laryngitis can be diffuse and limited. With limited hyperplastic laryngitis, there is limited hyperplasia in the area of vocal and vestibular folds, laryngeal ventricles, and inter-head space.
In patients with atrophic laryngitis, more profound changes are observed, which are manifested by the hyalinization of the connective tissue mainly in the walls of the veins and capillaries. In the glands are also observed pathological processes up to fatty degeneration and decay. Often, the excretory ducts of the mucous glands are squeezed by a hyperplastic connective tissue.
The clinical picture of chronic laryngitis depends on the localization of the pathological process in the larynx. One of the main symptoms, characteristic of all forms of chronic laryngitis, is hoarseness. Its expression varies (from insignificant to aphonia).
In patients with catarrhal laryngitis, voice fatigue, hoarseness, coughing, and increased sputum production are noted. With the aggravation of the process, these phenomena intensify.
The objective picture is characterized by a change in the color of the mucous membrane in catarrhal laryngitis, when it is hyperplastic it is thickened, and with atrophic it is thin, dry, covered with crusts. The usual symptom of inflammation is hyperemia of the mucous membrane - when exacerbation of chronic laryngitis is different. Change in color is most noticeable on the vocal folds: they become pink. The folds are usually thickened, their free edge somewhat rounded.
In the diffuse form of hypertrophic laryngitis, hypertrophy is exposed to the mucous membrane of almost the whole larynx, to a lesser degree - the epiglottis, in greater - to the vestibules and vocal folds. In the presence of limited forms, certain departments are involved in the process.
There are four main types of limited form of hyperplastic laryngitis.
1. Vocal cord nodules
Vocal cord nodules formed at the border of the anterior and middle third of the vocal folds, in symmetrical areas, in the form of semicircular protrusions the size of a poppy seed or millet.
More often these formations arise as a result of prolonged overstrain of the vocal apparatus, especially often in singers, therefore they are also called knots of singers. Nodules of vocal cords in small children are sometimes called knots of screamers.
2. Dyskeratosis of the larynx (pachydermia and leukoplakia).
Pachydermia is hyperplasia of the mucous membrane with cornification of the integumentary epithelium in the form of tubercular or crista growths of grayish-white or pink-white color, which occurs in the intercapital space and in the region of the posterior third of the vocal folds. Thickening of the flat epithelium in the region of the vocal appendages of the arytenoid cartilages may have the appearance of a mushroom-shaped elevation in one fold with a central depression on the opposite - a "hammer and anvil" (Fig. 139). But most often the thickening of the epithelium occurs on the back wall of the larynx, in the inter-pellular space. The location of these formations is symmetrical or strictly medial, which distinguishes them from tuberculosis of the larynx.
Leukoplakia in clinical practice is a disease characterized by the appearance of whitish spots on the hyperemic mucosa of the larynx.
3. Reinke's Edema (Polypoid Corditis)
Reinke's Edema (Polypoid Corditis) is a puffy form of limited hyperplastic laryngitis that is characterized by a swollen swelling in the anterior sections of the vocal folds in the form of a sail.
4. Hyperplasia of the mucous membrane of the laryngeal ventricle
Hyperplasia of the mucous membrane of the laryngeal ventricle causes its prolapse, prolapse. It has the following appearance: between the vestibule and voice folds, a red or cyanotic color roller is formed, partially or completely covering the vocal fold. In patients with atrophic laryngitis, dryness, perspiration, a sensation of a foreign body, cough with heavily receding phlegm are observed. Characteristic changes in the voice during the day. In the severe atrophic process in the larynx, there is a persistent violation of voice up to aphonia and a violation of breathing due to the concentration of crusts. At the same time during laryngoscopy, atrophy of the entire mucous membrane of the larynx is determined. It looks dry, rough, devoid of brilliance all over. Cortex is located both on the vocal folds and on the vestibule and inter-head regions.