Phlegmonous laryngitis is an acute inflammation of the larynx, characterized by the proliferation of a purulent process not only in the submucosa but also in the muscles and ligaments of the larynx, sometimes the perichondrium and cartilages are involved in this process.
Etiology of phlegmonous laryngitis
The cause of the disease can be laryngeal angina, external injuries of the larynx and damage to its mucous membrane (foreign body, chemical, and thermal burns, etc.). Supercooling plays an important role in the development of the disease.
A specific causative agent of the disease is absent. They can be staphylococci, streptococci, pneumococci.
Clinical picture of phlegmonous laryngitis
The disease begins acutely, patients complain of general weakness, malaise, weakness, sore throat, worse when swallowing, fever. If the inflammatory process is localized in the area of the glottis, hoarseness, difficulty breathing, rough cough, often develops an acute stenosis of the larynx, and carry out urgent tracheostomy.
The most common disease is manifested by the development of edema, infiltration, abscess formation of the epiglottis mucosa, aryepiglottic folds, a segment of arytenoid cartilage or one-half of the larynx with the phenomena of perichondritis.
The mucous membrane of the site of inflammation is colored bright red with islands of dead epithelium and clots of mucopurulent discharge. When abscessed, a limited area of infiltration is determined, at the top of which pus appears. Isolated ulcers are most often formed on the lingual surface of the epiglottis and aryepiglottic folds.
In patients with phlegmonous laryngitis, limited mobility of the arytenoid cartilages and vocal folds may develop, which together with the swelling of the mucous membrane causes the development of stenosis. It is possible to spread the process beyond the larynx, the development of deep neck phlegmon, jugular vein thrombosis, mediastinitis, sepsis. Aspiration of pus can cause the development of bronchopneumonia or lung abscess.
Phlegmonous laryngitis must be differentiated from laryngeal angina, edema of the larynx, perichondritis. Edema of the mucous membrane of the larynx is easy to distinguish by color, jelly-like character, an absence of signs of inflammation. The course is similar to that of chondroperichondritis, since the affected and often sequestered cartilage can be in a closed purulent cavity for a long time.
One manifestation of phlegmonous laryngitis can be acute inflammation of the epiglottis with the development of edema and abscess formation. Recently, some researchers tend to isolate acute epiglottitis as a separate disease, but this is not necessary. The disease is allocated only at the site of localization and most often does not differ from other lesion localizations.
Acute Epiglottitis occurs frequently and it is difficult. Absidence of epiglottis with phlegmonous laryngitis occurs quite often (in 35.7% of patients).
The prerequisite for the development of epiglottitis may be OCD. Of great importance, in this case, is the hypothermia of the whole organism or the local larynx. During the study, streptococcus and staphylococcus are predominantly sown.
The disease develops sharply and rapidly progresses. Against the background of a general condition disorder, weakness, an increase in body temperature, there is a sharp pain in the throat, swallowing becomes painful. Shortly there is inspiratory dyspnea, breathing becomes noisy, voice - hoarse.
Inflammatory edema, infiltration and the formation of an abscess are observed on the lingual surface of the epiglottis. The latter is intensely pierced, infiltrated, often an ulcer is seen through the mucous membrane.
Edema and hyperemia extend to the arthropoda, vestibular folds, arytenoid cartilages. In this case, the function of the neuromuscular apparatus of the larynx may be disturbed and stenosis develops, which requires an urgent tracheostomy.
Treatment of phlegmonous laryngitis
Apply large doses of broad-spectrum antibiotics or groups of antibiotics, decongestants: antihistamines, corticosteroids and diuretics. Sometimes a significant anti-inflammatory effect is achieved as a result of the application of cervical Novocain blockades, paralarigene administration of antibiotics, general body warming, mustard foot baths, mustard plasters on the larynx and chest.
Often the process of recovery is significantly accelerated after applying 10% calcium chloride solution, 1% dimedrol solution, antibiotics and alkaline-oil inhalations to the larynx of the larynx and infusing 2-3% solution of collargolum, hips, sea-buckthorn, peach, apricot oils into the larynx.
The discovered abscess should be opened with the help of a laryngeal knife with subsequent irrigation with antiseptics, washing of the abscess, lubrication of the wound with a solution of collargol.
With the rapid development of acute stenosis, urgent tracheostomy is indicated, and in the case of dissemination of ulcers on the neck or in the mediastinum, they are opened or carried out by a collateral mediastinotomy.
In the uncomplicated course of the inflammatory process, the prognosis is always favorable. If complications develop, the forecast largely depends on their severity.