Laryngeal actinomycosis in most cases is associated with actinomycosis of the oral cavity and pharynx. In rare cases, the actinomycosis of the larynx occurs primarily in an isolated form.
Etiology. The causative agent is Actinomyces Bovis (actinomycete-ray fungus of cattle), however from the works of V. Racovenu it follows that the true activator of actinomycosis is the fungus Actinomyces Israeli.
Pathological anatomy. The disease is manifested by the appearance of the epiglottis, aryepiglottic and pre-door folds of the nodes, which undergo decomposition with the formation of fistulas, through which a yellow pus-like liquid is released into the laryngeal lumen, containing crumblike inclusions and long branching threads (rays) characteristic for actinomycosis. In the primary lesion of the cervicofacial region, the secondary lesion of the larynx is manifested by internal and external perichondritis. Simultaneously, cervical lymph nodes are affected, which break up with the formation of external fistulas and disfiguring scars.
Symptoms and clinical course. Functional disorders are manifested by dysphagia and severe breathing difficulties, which are aggravated by secondary swelling of the larynx. Laryngoscopy reveals inflammatory and destructive changes.
Diagnosis is difficult with isolated actinomycosis of the larynx. In the initial stage, the disease can be considered a benign tumor, in the prograde stage - for syphilis, tuberculosis, cancer. The final diagnosis is established on the basis of the results of the study being separated from the inflammatory focus, in which the actinomycetes druses are found. In addition, a diagnostic skin allergic test with actinolysate and a number of other studies are carried out.
The prognosis for lesion of the larynx is serious both regarding the disability of the patient, doomed to permanent cannulation, with extensive destruction of the larynx and in relation to life in the event of acute stenosis and asphyxia. In modern conditions, the disease is curable.
Treatment is complex. It includes methods to increase specific immunity, general strengthening and stimulating therapy, the appointment of antibacterial, antiseptic and desensitizing drugs, physiotherapy methods, X-ray therapy. The abscesses are widely opened, necrotic tissues and cartilaginous sequestrants are removed.