LARYNGITIS

From Big Medical Encyclopedia

LARYNGITIS (laryngitis; grech, larynx, laryng[os] a throat + - itis) — an inflammation of a throat. Manifestations of L. are various depending on whether only the mucous membrane, or a mucous membrane and a fibrous and elastic membrane is affected, or the nadkhryashchnitsa and cartilages (hondroperikhondrit) throats. L. meets at any age. Distinguish L. acute and chronic.

Acute laryngitis

The Laringoskopichesky picture is normal also at some types of pathology. Fig. 1. The throat is normal: 1 — an epiglottis; 2 — vestibular folds; 3 — voice folds; 4 — a cherpalonadgortanny fold; 5 — an arytenoid cartilage; 6 — interarytenoid space; 7 — a back wall of a throat. Fig. 2. Acute laryngitis: sharp hyperemia and infiltration of an epiglottis, vestibular and voice folds, cherpalonadgortanny folds, interarytenoid space. Fig. 3. Acute epiglottiditis: hyperemia and infiltration of a mucous membrane of an epiglottis. Fig. 4. Acute inflammation of vestibular folds: sharp hyperemia and infiltration. Fig. 5. Acute inflammation of voice folds: sharp hyperemia and infiltration of a mucous membrane of voice folds. Fig. 6. Acute inflammation of interarytenoid space: sharp hyperemia and infiltration of a mucous membrane of arytenoid cartilages and interarytenoid space. Fig. 7. Hemorrhagic acute laryngitis: hemorrhage in the field of voice folds. Fig. 8. Acute subdepository (subcopular) laryngitis: sharp hyperemia and infiltration of a mucous membrane of subvoice area. Fig. 9. Phlegmonous laryngitis: abscess in the field of the left cherpalonadgortanny fold. Fig. 10. Chronic laryngitis: hyperemia and swelling of voice folds. Fig. 11. Pachydermia of voice folds: a massive thickening of an epithelium in the form of a fungoid eminence on voice folds. Fig. 12. Pachydermia of interarytenoid space: a thickening of an epithelium in interarytenoid space. Fig. 13. Singing small knots of a throat: symmetrically located dot eminences at free edge of voice folds.

Acute laryngitis arises as independent diseases as a result of local overcooling or an excessive overstrain of a voice (and sometimes under the influence of both factors at the same time) or as one of displays of the systemic acute infections: flu, measles, etc. Special form of acute L. diphtheria of a throat is (see. Diphtheria ). Inflammatory process can take or all mucous membrane of a throat — a diffuse form (fig. 2), or (more rare) mucous an epiglottis, voice folds, interarytenoid cutting, walls of a cavum infraglotticum (the isolated forms).

At diffuse acute L. the mucous membrane is sharply hyperemic; swelling is stronger expressed in the field of folds of a threshold and cherpalonadgortanny folds; the free edge of voice folds is as if rounded, folds become more thickly and rykhly (catarral L.). The epithelium is exfoliated by places, superficial sores are sometimes formed. From expanded vessels blood (fig. 7), forming purple-red points can filter (hemorrhagic L.), what is more often at flu; secretion is increased, slime sometimes dries up in crusts. At the isolated form of acute L. the sharp hyperemia and infiltration of a mucous membrane can be expressed only in an epiglottis — an acute epiglottiditis (fig. 3); at the same time pain during the swallowing dominates. In other cases inflammatory process is localized preferential on folds of a threshold or voice folds (fig. 4 and 5); at the same time frustration of a voice, pe reaching, however, a full aphonia prevail. In some cases the sharp hyperemia of a mucous membrane is observed only in arytenoid cartilages and mezhcherpalovidiy cutting (fig. 6) that is followed by a severe cough. The most severe form of the isolated L. represents subdepository L. (fig. 8), at Krom is observed an inflammation and swelling of a lower surface of voice folds, and also walls of a cavum infraglotticum where there is a friable connecting fabric. This disease happens preferential at children with exudative or limf, diathesis, is rare at adults. That form of subdepository L., at a cut periodically there are spasms of a throat, is called a false croup (see. Croup ). Quite often acute inflammatory process covers a mucous membrane not only throats, but also tracheas (laryngotracheitis). At the same time the severe cough, usually with expectoration, the produced mucous membrane of a throat and a trachea is often observed.

On a surface of voice folds the whitish or yellowish plaques formed as a result of an exudate of an intercellular lymph and disturbance of an integrity of an epithelial layer can be visible; it is fibrinous L. (guttural fibrinous quinsy). The separate inflamed follicles or groups of follicles (such group can be very considerable — a guttural almond) are sometimes visible that gives the grounds to allocate a special form — follicular laryngitis, or follicular guttural quinsy. In certain cases considerable accumulations of an adenoid tissue happen in a pear-shaped pocket; the acute inflammation of this fabric received the name of quinsy of an almond of a pear-shaped pocket. Except described, allocate also submucosal L., which some authors call fibrinous, follicular L., guttural quinsy. Allocate three forms of submucosal L.: edematous L., at Krom the mucous membrane of a throat happens swelled up a little, edematous and wax-like, to a yellowish-grayish shade; infiltrative L. — the mucous membrane is brightly hyperemic and sharply thickened (infiltrirovana); the phlegmonous (abscessing) L., characterized by sharply expressed inflammation of soft tissues (fig. 9), and sometimes and internal a perikhondriya of a throat with existence of abscess in this or that site.

It is possible to allocate also deeper damage of a throat, namely cartilage and a nadkhryashchnitsa (hondroperikhondrit throats), and the diffuse purulent process covering the parts of a throat which are not only in a cartilaginous skeleton but also outside of (phlegmons of a throat).

In the slime taken from a throat at L. not diphtheritic origin pathogenic coccal flora usually is found.

A clinical picture

At L. the general state worsens, temperature quite often increases. In typical cases the leukocytosis develops, ROE accelerates. At preferential localization of process in the field of an epiglottis or a back wall of a throat there can be pains during the swallowing. The voice becomes hoarse. Difficulty of breath can be caused by narrowing of a glottis owing to a spasm, hypostasis, infiltrate or even abscess. At edematous L. the general phenomena are usually less expressed, but development of an acute stenosis is always possible (see. Laryngostenosis ). Weight of symptomatology depends on a form L.

The diagnosis

the Diagnosis can be made only in the way laringoskopiya (see). At defeat only of one fold or hypostasis only of a back wall of a throat of L. it is necessary to differentiate with tuberculosis throats (see). The differential diagnosis of H.p. diphtheria of a throat is especially important, (see. Diphtheria ). Edematous L. it is necessary to differentiate with the hypostasis of a throat resulting from its injury or being private display of hypostasis of fabrics (a neck, the head, a trunk and so forth) at the general cordial or renal decompensation. Fibrinous L. it is necessary to differentiate with seldom meeting isolated (without damage of a mucous membrane of a pharynx and a nose) diphtheria of a throat (see Diphtheria). At the last plaques usually have gray, rather dirty-brown color, and at fibrinous L. they whitish or whitish-yellow. The research on diphtheritic sticks of the plaque taken not only from a pharynx and a nose, but, the main thing, from a throat is important. At the differential diagnosis of infiltrative L. it must be kept in mind syphilitic L. (see. Throat ) and seldom found ugly face of a throat. The last develops sometimes after emergence of erysipelatous changes on head skin, necks; the sharp redness of a throat going beyond area of a throat, a serious general condition of the patient is characteristic.

Treatment

the mode of silence Is necessary. At the beginning of a disease mustard plasters are recommended for area of a breast or a compress on a neck, drink of warm alkaline liquid with milk, inhalations (see), spraying by alkaline liquids; at cough apply antibechics. In hard cases systematic injection is carried out to a throat of 0,5% of solution of menthol in vegetable oil or 0,5% of solution of citral in vegetable oil in number of 0,5 — 1 ml. In case of difficulty of breath hot foot baths are shown. At edematous L. Dimedrol in (0,05 g 3 times a day), inhalations with a hydrocortisone is usually effective; at the fibrinous, infiltrative, abscessing L. use of streptocides and antibiotics is necessary. The created abscess is opened endolaringealno. At edematous and infiltrative forms L. in hard cases apply intubation (see), it is in rare instances necessary tracheostomy (see).

The forecast

the Forecast at catarral L. favorable; treatment is carried out on an outpatient basis. However at non-compliance with the mode transition of L is possible. in a subacute form, at a cut symptoms are less sharply expressed, and then in chronic. At the fibrinous, edematous, infiltrative and abscessing (phlegmonous) L. the forecast is serious, especially in view of a possibility of bystry development of an acute stenosis of a throat; at these forms L. hospitalization is necessary. In rare instances acute L. is complicated by a perichondritis of a throat, phlegmon of a neck, sepsis. Duration of a disease at catarral L. 5 — 7 days, at others on average 7 — 14 days.

Prevention

Prevention of acute L. it is directed to the prevention of overcooling and an overstrain of a voice, especially in the presence of flu, acute respiratory diseases.

Chronic laryngitis

Chronic laryngitis (fig. 10) is caused by the same etiol, factors, as acute, but at repeated or their long action. Develop at men more often (quite often as a result of abuse of tobacco and alcohol), at the persons occupied on the productions connected with formation of dust, harmful gases, sharp temperature variations, dryness or excessive humidity of inhaled air; the large role is played by an overstrain of the voice device (L. at lecturers, teachers, singers). The contributing moments are all those diseases of lungs and heart which lead to persistent cough, cause developments of stagnation in upper respiratory tracts; besides, the inflammation of a mucous membrane of a nose and throat can sometimes extend to a throat.

At hron. L. the inflammatory phenomena are less sharply expressed and less widespread, than at acute L. Changes develop hl. obr. in the field of voice folds and in interarytenoid cutting. Distinguish three main forms hron. L.: catarral, hyperplastic and atrophic.

At a catarral form note a hyperemia, as a rule, of congestive character: swelling is caused by kruglokletochny infiltration; the flat epithelium of voice folds is thickened, on a back wall the ciliary epithelium is replaced by flat; glands of folds of a threshold are increased and allocate more secret. At simultaneous similar damage of a trachea — laryngotracheitis there is a significant amount of a phlegm, convulsive cough is often observed strong, sometimes.

At a hyperplastic form of a hyperplasia both the epithelial cover, and a submucosa is exposed. The thickening of voice folds happens or diffuse, more or less uniform on all length (and then they have the spindle-shaped form with roundish free edge), or partial, places in the form of separate small knots, hillocks. At a constant overstrain of the voice device at free edge of voice folds normal by sight, approximately in the middle of their length, dot eminences in the form of cones — small knots of singers (fig. 13) symmetrically appear; they consist of a reinforced epithelium and elastic fabric (see. Small knots of singers ). Sometimes more massive thickenings of a flat epithelium are observed in the field of a voice shoot where they have an appearance of fungate eminences on one fold with the central deepening on opposite — a pachydermia of voice folds (fig. 11); more often thickenings of an epithelium arise on a back wall of a throat and interarytenoid cutting, the surface to-rogo becomes hilly, gains grayish color — a pachydermia of interarytenoid space (fig. 12). In the same place the hyperplasia of a mucous membrane in the form of a pillow (eminence) with a smooth red surface is observed. Hyperplastic process can develop in ventricles of a throat and a message to education on a mucous membrane of folds or rollers which go beyond ventricles and cover with themselves voice folds; it can develop also in a cavum infraglotticum, forming the rollers parallel to voice folds.

Atrophic form hron. L. meets less often than hyperplastic; at it a mucous membrane of a throat pale, is thinned and covered with dry crusts.

Clinical picture

Symptoms hron. L. are less expressed, than acute. The general state does not change, but bystry fatigue, sometimes the periodic weakness of a voice alternating or a resistant hoarseness is observed; these defects of a voice can be caused as well by paresis of guttural muscles, hl. obr. voice and cricothyroid, attendants sometimes hron. L.

The diagnosis

the Diagnosis is made on the basis a wedge, pictures. At the differential diagnosis it is necessary to consider similarity hron. H.p. an initial form of tuberculosis of a throat, especially at defeat of one voice fold. At uniform infiltration of all throat with a resistant active hyperemia it is necessary to specify the anamnesis, to carry out the general and serol, a research for the purpose of an exception of syphilis of a throat. Emergence of mucous plaques or papular changes confirms the diagnosis. With tuberosity of fabric in view of suspicion of a malignant tumor it is necessary to make a biopsy. At a blastoma the symptom of restriction of mobility of one half of a throat sometimes is early shown. Hron, subdepository L. it is necessary to distinguish from a scleroma of a throat (see. Scleroma ).

Treatment

At all forms hron. L. elimination of the factors which caused development of a disease, especially an overstrain of the voice device is necessary. At diseases of a nose, okolonosovy bosoms and a nasal part of a throat their treatment is necessary.

At catarral L. make spraying of a throat astringents (0,5% solution of zinc sulfate), injection in a throat of 0,5% of solution of menthol in vegetable oil, 2 — 3% of solutions of colloid silver or protargol in number of 0,5 — 1 ml. At considerable accumulations of dense slime do injections of isotonic solution of sodium chloride, inhalation of proteolytic enzymes, napr, chymotrypsin. In some cases, especially at aggravations of process, use of aerosol inhalations of antibiotics (penicillin, streptomycin) is reasonable.

At hyperplastic forms grease affected areas of a throat of 2 — 3 — 5% with water solutions of silver nitrate. Appoint physiotherapeutic procedures — electric field, UVCh, an electrophoresis of medicinal substances (e.g., with 1 — 2% potassium iodide).

Small knots of singers, limited pachydermias delete in the surgical way, is more often at an indirect laringoskopiya. At widespread hyperplastic processes removal of affected areas is made under control of a microscope (see. Laringoskopiya ).

At atrophic L., except sprayings by isotonic solutions of sodium chloride, widely apply greasings of a throat and a throat solution of Lugol, alkaline and alkaline and oil inhalations.

At L., the voice muscles which are followed by the phenomena of paresis, it is reasonable to appoint electrostimulation of a throat.

The forecast

At a catarral form can come recovery if there is an opportunity to eliminate causative factors, or catarral process passes into hyperplastic. At hyperplastic and atrophic L. process is irreversible.

Prevention

Timely treatment of acute L. and elimination of the reasons causing an aggravation of process.



Bibliography: Ratenberg M. A. Physical therapy in an otolyaringologiya, L., 1973; The Reference book on physical therapy, under the editorship of A. N. Obrosov, page 299, M., 1976; Und-r and V. F c. Acute stenoses of a throat, M., 1950, bibliogr.; Surgical diseases of a throat, throat, trachea, bronchial tubes and a gullet, under the editorship of V. G. Yermolaev, etc., page 801, M., 1954; Blumenfeld F.

Laryngitis, Handb. Hals-, Nasen-u. Ohren-heilk., nrsg. v. A. Denker u. O. Kahler, Bd 3, S. 174, B. — Miinchen, 1928.


B. S. Preobrazhensky.

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