Laryngitis is an inflammatory disease of the mucous membrane of the larynx. Usually this disease is associated with other diseases, for example, colds or infectious lesions in the nasopharynx, and manifests itself as a concomitant manifestation of the pathological process on the mucous membranes. However, laryngitis can act as an independent process.
Doctors call laryngitis primarily a childhood disease, because in children the larynx, due to its anatomical features, is more susceptible to inflammation. Adults also suffer from laryngitis, although less often.
Forms of the disease
Depending on the characteristics of the symptoms, the type and duration of the course of the disease, physicians distinguish several forms of laryngitis. Each of them is characterized by typical manifestations, and is not equally treatable.
The most common form that is common in children is acute laryngitis. By name it is clear that this is an acute inflammation of the mucous membrane of the larynx. Occurs mainly as a result of infectious activity on the tissues, if the pathogen has got into a weakened organism, which is predisposed to the disease. Among the factors that accompany the development of laryngitis, doctors lead to smoking, hypothermia, overstrain of ligaments and voice apparatus in general, as well as negative environmental effects, for example, prolonged exposure to highly dusty rooms. Sometimes the disease develops after injury or burn of the larynx. The presence in the body of a chronic focus of inflammation, that is, purulent sinusitis, pharyngitis or chronic tonsillitis, makes a person more susceptible to the appearance of laryngitis in the acute state.
Mucous tissue taken for histological analysis from a patient looks damaged. The cells of the ciliated epithelium lose cilia and are rejected. Deeper tissues are usually not affected - it is in them that the regeneration process begins. Infiltration of the mucous membrane is weak and unevenly expressed, and the blood vessels are dilated and crimped.
The onset of an infectious type of illness is acute, although at first the sick person feels satisfactory, and the temperature rises only to subfebrile values. In the throat there is a sharp feeling of dryness and tickling, the voice grows coarse, hoarseness appears. Sometimes the patient completely loses his voice. There is increased sputum formation.
After 2-3 days, there is a dry cough with a slight viscous sputum. Gradually, the amount of discharge increases, pus may appear in it (if tracheitis joins).
If the disease appears as a result of hypothermia, injury to the larynx, or over-voltage of the vocal apparatus, the patient does not experience a general deterioration of health.
The presence of an elevated temperature does not always speak only of the presence of an infection — it may indicate the onset of inflammation of the lower respiratory tract or the transition of the catarrhal form of the disease to phlegmonous.
Infiltrative and abscess types of acute course are accompanied by severe pain in the throat, while the patient is disturbed by the process of swallowing, and it is very difficult for him to swallow even a sip of fluid. At the same time, the patient feels like with severe intoxication, he has symptoms of laryngeal stenosis.
The disease lasts from 5 to 14 days. Acute catarrhal form tends to become chronic, phlegmonous or infiltrative laryngitis.
This form of inflammation of the mucous larynx is less pronounced, often accompanied by chronic pharyngitis. Developed in the background:
- persistent acute laryngitis, in the absence of adequate treatment;
- chronic inflammatory pathologies of the trachea, bronchi, and lungs;
- vasomotor rhinitis;
- long and strong overstrain of the vocal cords;
- smoking (smoker's laryngitis) and passive smoking;
- taking alcohol;
- prolonged inhalation of harmful gases, dust particles and debris.
The defense reaction in the form of the narrowing of the glottis is accompanied by coughing, swelling of the larynx. The function of sound formation in the voice apparatus is impaired.
Chronic laryngitis has several types of flow:
Chronic catarrhal laryngitis is accompanied by a feeling of sore throat, coughing, and a slight separation of mucus. The voice of the patient becomes lower and hoarse, especially in the evening and after prolonged speaking. If there is a strong cough, it means that the inflammation of the back wall of the pharynx develops. The doctor during the examination sees hyperemia of the mucous membrane of the larynx of a weak degree of activity. The fabric thus acquires a red-gray tint, localized or over the entire surface. Symptoms appear symmetrically on both sides.
Hyperplastic chronic laryngitis appears to be similar, but the color of the mucous membrane is different - it becomes blue-red, and the voice hoarse even stronger than with the catarrhal form. The vocal cords thicken and visually look like red rollers. The lesion affects the mucous tissue under the ligaments. When the patient tries to compensate for the hoarseness of his voice, constantly straining the ligaments more than necessary, the so-called calluses at the intersection of the front and middle parts, singing nodules, are formed on the ligaments. It is believed that this form of the disease is precancerous, so its treatment is outpatient.
Atrophic chronic course is accompanied by atrophic processes in the nasal cavity and pharynx. The patient feels dry in the throat, he suffers from a dry cough, general weakness with a decrease in working capacity. The viscous secret in the throat dries up, forming crusts that are badly expectorated.
Inflammatory disease in which inflammation is localized in the trachea and larynx. Develops as a result of viral or bacterial damage. The patient is disturbed by a voice disorder, an abundant cough with outgoing mucopurulent sputum. In addition, there are pains behind the sternum and larynx, and the regional lymph nodes are inflamed. In some cases, the disease is complicated by the spread of inflammation in the lower respiratory tract, the development of bronchitis, pneumonia, bronchiolitis.
Most often, the etiology of the lesion lies in the activity of the virus, for example, parainfluenza, SARS, rubella, measles, chicken pox or scarlet fever. Bacterial laryngotracheitis develops due to streptococcus, pneumococcus or staphylococcus, less often due to mycoplasma or chlamydial infection.
Laryngitis turns into laryngotracheitis on the background of weakening of the body, hypothermia, pulmonary emphysema, as well as in the presence of chronic diseases:
- hepatitis A;
- cirrhosis of the liver;
- bronchial asthma;
In addition, if a patient with an acute form is constantly in adverse conditions, breathes in too dry or humid air, or air contaminated with dust, the disease can develop into an extensive inflammatory process, affecting the trachea.
Laryngotracheitis is catarrhal, hypertrophic and atrophic, as well as acute and chronic. In the case of acute development of the disease, the patient feels fever, runny nose, sore throat and sore throat, an unpleasant sensation when swallowing, after which a dry cough of the “barking” type appears due to a narrowing of the larynx in the vocal cords. The pain behind the sternum, characteristic of tracheitis, appears during cough, more often in the morning and at night. A cough may have the character of an attack, for example, after inhaling cold or dusty air, after crying or laughing.
During cough, the mucous viscous sputum is secreted, which gradually becomes more abundant and liquid, and pus can be traced in it. The voice becomes hoarse. An increase in the cervical lymph nodes is often observed. Palpation of the nodes give pain. Breathing becomes more noisy and hoarse.
The chronic course has similar symptoms, but they are not so pronounced. A voice may disappear, there is a cough and burning sensation in the larynx, behind the sternum. After a long vocal load, ligament fatigue is noticeable. If the patient has persistent dysphonia, this indicates morphological changes in the structure of the vocal cords.
This form of laryngitis is considered the easiest in its course. Occurs due to general or local hypothermia, smoking, laryngeal surge, strong cry, eating too cold or too hot food, alcoholic beverages. At risk of developing the disease - people whose profession is associated with the constant tension of the vocal cords (singers, teachers), as well as those patients who have chronic pathologies of the lungs, heart and blood vessels.
The manifestation of the catarrhal acute form is felt already several hours after the onset, and the incubation period sometimes lasts up to several weeks.
In acute catarrhal flow, mucous is reddening and swelling dramatically. Puffiness is especially noticeable in the folds of the vestibule. On the mucous membrane are visible dilated vessels, from which blood can flow in the form of small hemorrhages.
The patient feels hoarseness, it becomes difficult for him to speak and breathe due to the significant narrowing of the glottis and the pain accompanying this process. Muscle spasms appear, mucus accumulates in the throat, pain and tickling is felt. Initially, the cough is dry, “barking”, and after a few days it becomes wet. Chronic catarrhal laryngitis is accompanied by a feeling of discomfort in the throat, constant hoarseness of the voice, because of which the patient has to make efforts all the time to talk with the usual volume.
Why is catarrhal laryngitis called the first stage of the disease? Doctors pay attention to pathological changes in this form, and refer them to the least significant, that is, to those after which the processes of regeneration and restoration of tissue to a normal state are possible.
Due to the disease in the mucous membrane, blood circulation is disturbed, hyperemia appears, small-cell infiltration and serous soaking of the mucous membrane is monitored. If the inflammatory process affects the vestibular region of the larynx, the vocal cords are covered with edematous and infiltrated vestibular tissue folds. There is also such a thing as podskladkovy laryngitis - when podskladkovaya area is involved in the process of inflammation.
On examination, the doctor notices a significant or weak hyperemia of the mucous tissue of the entire larynx, or of the vocal cords only, as well as thickening, puffiness and incomplete closure of the ligaments. Fibrous inflammation appears under the vocal cords and dirty gray films associated with the underlying tissues are visible.
The main difficulty in determining the diagnosis in a child is the need to differentiate catarrhal laryngitis with diphtheria.
This type of disease is less common than catarrhal, and is the next stage of mucosal tissue damage - it is found in only 10% of patients. The disease leads to exhaustion of the mucous membrane, sclerosing pathology of the capillaries, glands and intraguttic muscles. Basically, atrophic laryngitis occurs as a chronic disease, periodically exacerbated.
All provocative factors are divided into 5 groups:
- Neurogenic: we are talking about frequent acute respiratory viral infections, the presence of diphtheria or tuberculosis, which reduces the protective function of the larynx, stenosis, as well as lack of vitamins, improper and inadequate treatment.
- Functional: natural processes of aging of the body, in which over the years the intensity of the ability of tissues to regenerate decreases, as well as deterioration of nasal breathing as a result of the curvature of the nasal septum or proliferating polyps, congenital malformations of the nasopharynx.
- Hormonal: mucosal atrophy sometimes develops due to dysfunction of the pancreas and thyroid glands in people with diabetes mellitus, with hormonal treatment of bronchial asthma.
- Food: vitamin deficiency, smoking, drinking alcohol, spicy and spicy foods, hot dishes.
- Professional: exposure to high temperatures, adverse working conditions with highly humid or over-dried air, as well as constant over-tension of the vocal cords.
In addition, mucosal atrophy can develop on the background of radiation therapy, chemical burns and injuries.
If the patient does not receive proper treatment, atrophy is transferred to the bone tissue, and if a secondary infection joins, brain tissue can be affected, cerebellar ataxia is formed.
Atrophy is a pathological process in which the volume decreases and the functional capacity of the tissues decreases, and their fibrous replacement occurs. In atrophic laryngitis, metaplasia of the normal ciliated cylindrical epithelium occurs in the flat and keratinizing, and fibrosis of the vessels and mucous glands, their hypotrophy is observed. The secret released at the same time quickly dries out, forms crusts which are badly expectorated. In addition to normal age-related atrophy, the pathology can develop in trophoneurotic form, in which regional arteries and nerve endings are affected, due to which the larynx loses its normal functionality. At the same time, tissues do not receive sufficient nutrition and vitamins, local immunity decreases, which further increases the risk of inflammatory processes.
The first sign of the disease is a dramatic change in the tone of the voice, a decrease in its power due to the negative impact on the vocal cords. Severe hoarseness and hoarseness appear, especially in the morning after sleep and in the evening. Further joins dry throat, sore throat, pain when swallowing and talking. If the disease becomes acute, after a few hours there is a rise in temperature, concomitant chills, a sensation of the presence of a foreign object in the throat. Children have a dry paroxysmal cough, which especially torments the baby at night. On examination, a strong expansion of the larynx, depletion of the vocal cords and pale pink color of the mucous membrane are visible, connective tissue seals are noticeable. When coughing, expectorated mucus with blood.
Most often atrophic laryngitis is formed in adults, as a result of constant over-voltage of the vocal cords or age-related changes.
The disease may appear on its own, but more often it develops from an undertreated catarrhal or atrophic form. First of all, the lesion affects the vocal cords - they become inflamed together with the laryngeal mucosa and the sub-folding space, and also become edematous. Voice noticeably wheezing or disappears altogether. The patient complains of discomfort in the oropharynx: scratchy, dry and burning sensation. Hypertrophic this form is called due to the active proliferation of the submucosal layer and epithelial tissue. At the same time, the functioning of the glands in the larynx is disrupted, rollers and bumps appear on it. All this is accompanied by a sense of the presence of a lump in the throat. The cough is predominantly dry, from weak coughing to intense attacks with exacerbations. In the case of an acute course, fever, headache and general weakening of the body join signs of the disease.
Classification of the disease depending on the location:
- local: at the same time affected a small part of the mucous;
- diffuse: pathology is visible on a large part of the larynx.
The resulting hyperplasia is divided into several varieties:
- fibrous formations, or “vocal nodules”: appear on the vocal cords in the form of paired formations, usually symmetrically with respect to each other in the middle part of the ligaments, grow less frequently over the entire area of the larynx;
- laryngeal pachydermia: in this case, the lesion affects the vestibular folds, cartilage and partly the vocal cords, and has the appearance of growths, plaques, warts;
- podskladkovy chronic laryngitis: causes chronic hypertrophy of the mucous membrane of the podskladochnogo space;
- Morgan's ventricular prolapse: proceeds with severe ventricular hypertrophy, with tumors protruding towards the ligamentous apparatus and partially closing the glottis;
- cystic formations: usually have an unpaired appearance, filled with air inside;
- Polyps: grow on the mucous tissue as small growths, and interfere with the normal functioning of the ligamentous apparatus.
Stenosing laryngitis occurs in the form of acute inflammation of the larynx, and can spread to the bronchi and trachea, worsening the patient's condition. It develops in parallel with the onset of ARVI or as a complication of a viral infection, with the addition of a bacterial lesion.
The most common cause of the appearance of doctors is the ingestion of viruses of influenza and parainfluenza, adenovirus, rhinoviruses and enteroviruses, herpes, measles, chicken pox.
- smoking, inhalation of smoke and polluted air;
- taking alcohol, food and drinks that irritate the mucous membrane;
- reduction of body defenses and hypothermia;
- injuries, mucosal burns, any other mechanical damage;
constant excessive tension of the vocal cords.
Laryngeal stenosis in an acute form is not in itself a disease - it is rather a symptom complex, which is expressed in a sharp narrowing of the laryngeal lumen, because of which the patient blocks the access of air to the respiratory tract. The mechanism of stenosis development is as follows: first, edema of the laryngeal mucosa occurs, then spastic contraction of the muscles of the larynx is formed. Some physicians and scientists note the role of allergic reactions in the appearance of stenosis in laryngitis.
Most often stenosing laryngitis occurs in one-year-old babies, children under the age of 6 years, due to the anatomical features of the structure of the larynx:
- the thin mucous membrane of the larynx, saturated with cellular elements;
- loose submucosal layer with a developed network of vessels and a large number of mast cells;
- relative muscle weakness;
- soft elongated epiglottic cartilage.
The development of a stenotic pathology takes several days from the onset of respiratory damage, seizures are noted at night. The acute condition threatens the patient's life, therefore, requires the provision of first aid, and then hospitalization.
Depending on the severity of the patient's condition, the clinical manifestation is divided into 4 degrees:
- The first stage (compensation): sharp hoarseness of the voice, noisy breathing, shortness of breath, shortness of breathlessness, rough barking cough, blue nasolabial triangle.
- The second stage (subcompensation): the condition worsens markedly, breathing quickens and becomes harsh, sketchy, while the patient behaves restlessly, he has a strong cough and sleep disturbance. The chest cage is somewhat retracted in the intercostal spaces during inhalation, breathing and air ingress are difficult, the condition lasts up to 5 days.
- The third stage (decompensation): signs of acute respiratory failure appear, the chest is strongly drawn in between the ribs, there is inspiratory-expiratory dyspnea. The patient is very restless, he has increased sweating and there is blanching of the skin, cyanosis of the nasolabial triangle, confusion.
- Fourth stage (asphyxia): against the background of shallow breathing, immobility, diffuse cyanosis, loss of consciousness, respiratory activity may be interrupted, pupils dilated, pulse weak.
The pathogenesis is explained by the effect of the pathogenic factor on the mucous membrane, due to which puffiness and infiltration appear, the muscles of the larynx spasm. In the oropharynx accumulates thick mucous or mucopurulent exudate, blocking the lumen of the respiratory tract. As a result, an obstruction of the lumen of the larynx is formed.
This form is characterized by a spilled purulent process in the submucosal layer of tissues, in the ligaments and muscles of the larynx, sometimes cartilage and the epiglottis are also involved in the process. Most often diagnosed in men aged 20-30 years. In children, it may develop as a complication of scarlet fever or measles.
The reason for the appearance lies in the internal and external injuries of the larynx, for example, when a burn or foreign body hit, as well as in the presence of a primary disease, such as peritonsillitis, erysipelas, typhoid, abscess of the root of the tongue, blood diseases, sepsis, laryngeal angina. In addition, phlegmonous laryngitis can develop as a concomitant lesion in syphilis, laryngeal cancer or tuberculosis.
A sero-purulent or purulent exudate begins to accumulate in the larynx - first this occurs in areas where the submucosal layer is well developed, after which the process becomes diffuse. If there is a tendency to delimit inflammation, an abscess may appear, sometimes several, in different parts of the larynx, if the infection spreads through the lymphatic and blood vessels.
Further, the infiltrate can be resolved, or purulent fusion of tissues occurs and the abscess is opened through the mucous tissue, and the purulent lesion spreads to the perichelf. If the pathology extends beyond the larynx, it spreads through the interstitial crevices of the neck, in some cases reaching the mediastinum.
When the abscess is located on the epiglottis or in scooped-epiglottic folds, the affected person feels severe pain. In the region of the glottis, there is a feeling of difficulty breathing, a voice wheezes, the patient is tormented by a rough cough. A light current is accompanied by a rise in temperature of 37.5-38 degrees, with a heavy body temperature rises to 40 degrees and higher, while the patient has a strong chill, a weakening of the heart activity, severe general intoxication. The condition is dangerous the onset of death.
On examination, the doctor sees a pronounced redness of the mucous membrane of the larynx and noticeable grayish areas of the dead epithelium, in some places thick purulent-mucous exudate is present. Inflammation on the epiglottis makes it visually thickened, displaced to the bottom and back. Isolated purulent formations appear on the lingual surface of the epiglottis, on the scooped-epiglottic folds. If an abscess is emptied, a characteristic scurf remains in its place.
The disease is accompanied by an increase in cervical lymph nodes, they become more dense to the touch, sore on palpation.
Etiology and classification
Doctors identify two groups of etiological factors that influence the development of the disease: the first is the immediate causes causing it, the second is the effect, which is called indirect, because it only weakens the body, increasing the risk of getting sick.
Immediate causes of laryngitis:
- allergic reactions;
- injury and mechanical stress;
- constant overstrain of the larynx and ligaments.
The inflammatory process develops in the larynx, as a comorbid pathology during an allergic reaction, which serves as a trigger. The disease can turn into a chronic form due to the weakening of local immunity.
Acute allergic laryngitis develops as a result of initial contact with the allergen. There is a sharp swelling of the mucous membrane, voice and respiratory function is impaired.
In the chronic course of the disease lasts more than a month, it provokes prolonged contact with a weak allergen and the lack of treatment for an allergic reaction.
The reason for the development of this form of pathology is contact with the allergen. The most common ones are:
- food products;
- pollen, fluff, grass bloom;
- industrial agents, such as automobile exhaust;
- bird feathers, animal dander, dust;
- viruses and fungi.
The disease manifests itself, depending on the form, more or less active. In acute cases, the patient complains of unpleasant feelings when swallowing, shortness of breath, a lump in the throat, difficulty breathing and burning inside the throat. The voice becomes noticeably hoarse. Swallowing is accompanied by pain, and at night and in the morning the patient is tormented by coughing. The chronic form is not so noticeable - there is swelling of the larynx and discomfort in the throat, which is in the throat. Usually the pathology proceeds without temperature.
Viral form of laryngitis is common in children. The main pathogens are adenoviruses, rhinoviruses, viruses of influenza and parainfluenza, less often - viruses of measles and scarlet fever, chickenpox.
Initially, when the viral pathogen gets on the mucous membrane, it causes its swelling, in response to which the reaction of local immunity is activated. The vocal cords are subject to pathological changes - they redden, thicken, swell. An insignificant amount of mucus accumulates on the mucosa. Inflammation of the ligaments provokes changes in the voice - it becomes more rough, hoarse. Without proper treatment, further progression of the disease is characterized by the inclusion of a secondary bacterial infection.
If the disease falls below, the patient develops laryngotracheitis, which turns into bronchitis. Children often have inflammation of the epiglottic cartilage, which is accompanied by a general deterioration of health, depletion of the body. In adults, inflammation of the epiglottis is due to measles or smallpox.
The disease occurs on the background of an increase in regional lymph nodes, which are inflamed and hurt when touched. The more edema of the mucous develops, the smaller becomes the diameter of the glottis, the patient suffers from shortness of breath.
Common symptoms of larynx viral damage:
- increased body temperature;
- weakness in the body, muscle aches;
Viral laryngitis in children occurs with some peculiarities. Along the entire length of the larynx, a pronounced submucous layer is preserved, in which inflammation builds up, the mucous membrane swells and greatly increases in size. Especially noticeable increase under the vocal cords. This state of medicine is called “false croup”. True croup - similar in its manifestations of pathology, which manifests itself only in diphtheria. The heavier the condition, the harder it becomes for the child to breathe. Especially noticeable in newborns and children up to a year, as they have to make an effort to inhale, and exhalation is accompanied by whistling. The child inevitably takes the most comfortable position for breathing - in a sitting position, with his hands on his knees.
The microflora, which normally colonizes some parts of the respiratory tract, including the larynx, is represented by a variety of saprophytic bacteria - they almost never provoke any diseases in humans. In addition, a class of conditionally pathogenic microorganisms is present on the mucosa - under favorable conditions, these bacteria begin to multiply rapidly on the mucosa, and provoke the onset of inflammation.
Most often, acute laryngitis is provoked by S. pneumoniae and H. influenzae, Moraxella catarrhalis, Staphylococcus, Streptococcus. More rarely, representatives of corynebacteria and neisseria are found in bacposae. Atypical pathogens of ENT organs are mycoplasmas, ureaplasmas, chlamydia, which alter the course of the underlying disease, causing extensive inflammation.
Bacterial laryngitis can occur as a complication of tuberculosis, syphilis, larynx cancer. In such cases, the causative agent is streptococcus, pneumococcus or staphylococcus, less often a combination of a spindle-shaped stick and a pale spirochete.
The rarest and most dangerous forms of laryngitis that the Bac sticks cause. Anthracis and the bacterium Pseudomonas mallei are anthrax laryngitis and acute sap.
Bacterial forms of the disease are more common in children, as a rule, they develop as a complication of the viral form, when the immune response weakens against the background of the presence of a virus, and pathogenic bacterial activity joins the underlying disease.
The clinical picture of the symptoms of bacterial laryngitis:
- tickling and burning in the throat;
- dry cough;
- redness and swelling of the laryngeal mucosa;
- an increase in the vocal cords;
Syphilis is a chronic infectious disease of a systemic nature, which develops due to the defeat of the body by a pale spirochete (treponema). One of the dozens of its complications is laryngitis. Pathology is accompanied by the appearance of multiple ulcerations of the mucous tissue, plaques in the larynx. If syphilis passes into the third stage, scars appear on the vocal cords, as a result of which the voice changes irreversibly, and in difficult cases complete aphonia occurs.
The term “reflux” means the opposite of the flow of contents from one hollow organ to another. Most often used in relation to the human digestive system. Gastroesophageal reflux is characterized by the fact that the contents of the stomach is thrown back into the esophagus. In a healthy person, the lower esophageal sphincter works, which prevents food and gastric juice from rising up into the esophagus.
In fact, reflux is not a pathological process, since even in a healthy person, after a heavy meal, a reflux of food can occur. 2-3 such episodes per day are considered the norm, however, if a reflux occurs more frequently or continuously, with abundant outpouring of the contents of the stomach out, of course, we are talking about the disruption of the normal functioning of the digestive tract. Due to reflux, the mucous tissues of the esophagus and pharynx are constantly exposed to the aggressive effects of gastric juice, they become inflamed and may ulcerate. Against the background of gastroesophageal reflux disease (GERD), reflux laryngitis may also develop if the contents of the stomach constantly enter the hypopharynx.
The larynx and pharynx are organs that are very sensitive to the effects of gastric secretion; therefore, inflammation in the airways occurs in most cases of advanced GERD, even if the reflux episodes are short.
The patient complains of changes in voice, loss of its sonority, hoarseness and coarseness of timbre. Sometimes the voice can disappear altogether. There is constant tickling and dryness in the throat, a feeling of a lump in the throat. Almost immediately, a barking dry cough joins, gradually turning into a wet cough with the separation of mucous sputum. Severe inflammation causes problems with swallowing, whistling when breathing. Laryngitis on the background of GERD differs from other forms in that the patient is often tormented by heartburn, belching with air, increased separation of saliva during sleep, shortness of breath after eating, heaviness in the epigastric region.
Dysphonia or aphonia, developing with reflux-laryngitis, occurs when a direct irritant effect of the contents of the stomach on the larynx. Chronic reflux laryngitis leads to nodules on the ligaments, which also negatively affects the state of the voice.
In general, the picture of the manifestations of acute and chronic forms of laryngitis differ somewhat among themselves. The acute course is accompanied by a general deterioration of the patient’s condition, a rise in temperature.
Laboratory signs indicate a developing inflammation - we are talking about indicators of accelerated ESR, as well as an increase in the total number of leukocytes in the blood. If the pathological process predominantly captures the epiglottic region or the posterior laryngeal wall, the patient develops characteristic pains when swallowing.
Another typical sign of laryngitis is a change in voice, its hoarseness. The voice loses its power and depth, and with an acute form, no matter how hard the patient tries to strengthen it, speak louder, it does not work. In chronic course, the voice hoarse slightly, the patient tries to compensate for the loss of the volume of the conversation, excessively straining ligaments, because of which in the evening he felt a burning sensation and pain in the larynx.
If a spasm of the glottis occurs and a strong swelling of the mucous is formed, the patient feels difficulty breathing. Inhalation occurs with effort, exhalation is accompanied by whistling. In addition, the throat feels tingling, pain, increased dryness. A dry cough eventually goes into a wet cough with a small amount of sputum.
A rise in temperature is a sign more characteristic of children than adults. Usually the temperature reaches subfebrile values, not more than 37.5 degrees.
A specific symptom characteristic of the course of the disease in children is false croup or laryngeal stenosis. In this case, the disease causes a strong reduction in the larynx, its edema, due to which access of air to the respiratory organs is difficult.
Chronic type of the disease is accompanied by stable voice fatigue, hoarseness, sore throat and raw throat, discomfort when swallowing. Sharp pains are usually absent, and in general, symptoms appear blurry. Cough, often light, dry.
The first stage in the development of acute laryngitis is an incubation period. With viral and bacterial infection, the disease “ripens” in the body from a day to a week. In this case, there may be a general decrease in performance, weakness. Allergic form usually develops within a week or two, sometimes up to a month. If the pathology is due to mechanical stress, the duration of the incubation period depends on the nature of the injury, burn or damage, on their intensity.
The next stage is characterized by changes in the voice, its hoarseness and hardening. During this period, the pathological changes in the larynx are already so pronounced that the patient feels discomfort, he periodically coughs, and in the mornings he has a very sore and dry throat.
Further, there are more acute signs of the disease - fever, pain in the larynx and throat, dry barking cough. The transition from dry to wet cough with sputum can be partly considered the beginning of the healing process, but only on condition that the patient is treated and follows all the recommendations of the doctor. If this does not happen, the next step is to move the inflammation down to the upper respiratory tract.
As for the stages of chronic laryngitis, physicians correlate them with catarrhal, hypertrophic and atrophic forms. It is believed that the first stage, the onset of the disease manifests itself as catarrhal, the least dangerous type of laryngitis. Without proper treatment, respectively, the disease becomes hypertrophic, when the mucosa begins to grow, and atrophic, when the tissue is depleted and begins to die locally.
Complications and consequences
The acute and chronic type of the disease has a different course and various complications. Especially they are associated with the lack of adequate treatment, so that the sick does not seek medical help. In the acute form, laryngitis is accompanied by a dry cough, pain when swallowing, swelling of the mucous membrane, inflammation of the ligaments. Complications of this form are:
- temporary loss of voice;
- transition of the inflammatory process down into the respiratory tract (development of tracheitis, bronchitis, pneumonia);
- false croup (most often in children);
- the transition of the disease to the chronic form.
Purulent phlegmonous laryngitis is especially dangerous in that it can give impetus to the development of mediastinitis (inflammation of the space of the middle parts of the chest cavity), lung abscess, sepsis or neck phlegmon (purulent inflammation of the cervical tissues).
Complications characteristic of childhood:
- subglottic laryngitis;
- diffuse laryngitis.
The chronic form is even more dangerous, since, for example, hypertrophic laryngitis is considered a precancerous condition. Against the background of the chronicle, the following complications may develop in an adult or small patient:
- malignant tumors of the larynx;
- benign neoplasms in the larynx, for example, fibromas, papillomas, angiomas;
- laryngeal stenosis;
- tumor-like formations: cysts, polyps, vocal cords granulomas;
- mobility of the larynx, paresis of ligaments.
The duration of the disease depends on several factors, including:
- from the form of the flow;
- from the state of the body;
- the degree of neglect of the disease (when the patient went to the doctor, and if he turned at all);
- from the cause of the disease.
Acute viral type laryngitis, with adequate therapy, passes after 4-6 days. A disease without adequate therapy in 10-14 days ceases to give active signs of its presence. Allergic laryngitis lasts as long as the active contact of the patient with the allergen continues. Of course, taking antihistamines drowns out its manifestations, but full recovery is possible only if the patient is isolated from the stimulus. Laryngitis associated with trauma or mechanical stress usually disappears in 7-14 days.
The chronic form of the course is more prolonged, and due to the fact that it does not manifest itself too brightly, the patient may not seek medical help for months, all the time being unhealthy. Treatment of chronic laryngitis in neglected forms takes up to six months, sometimes longer, and rehabilitation, sometimes even several years.
To make a diagnosis of “laryngitis,” the attending physician needs to clarify the patient's list of his complaints, as well as to carry out laryngoscopy, that is, a direct examination. On examination of the patient, the doctor draws attention to the state of the vocal cords, the presence of structural changes, inflammation, and neoplasms on them. Hyperemia of the mucous membrane of the larynx and ligaments is noticeable, dilated blood vessels, the presence of secretions of the mucous membrane or mucopurulent structure are visible.
In the diffuse form of the disease, the hyperemia is continuous, the edema of the mucous is uneven. During sound extraction, the incomplete closure of the vocal cords is noticeable, with the glottis becoming oval or sharply elongated. If laryngitis has developed against the background of an acute respiratory viral infection or flu, during the examination the doctor sees hemorrhages in the mucous tissue of the larynx - they can be small or large, like a hematoma. In the presence of a fibrinous plaque of yellowish or white color, it is possible to speak about the transition of the disease into a fibrinous form. Plaque brown or gray color gives reason to suspect diphtheria.
Usually, this data is enough for a physician to make a diagnosis, but in some cases it is necessary to undergo additional examinations, for example, to undergo a complete blood count, PCR tests for specific viruses, pharyngeal bacposi.
The complexity of the differential diagnosis is to determine the true cause of the development of the disease, to distinguish acute or chronic catarrhal laryngitis associated with professional activity, from the disease caused by hypothermia, SARS or influenza. In addition, laryngitis should be distinguished from erysipelas, the initial stage of tuberculosis, syphilitic erythema, the prodromal period of measles and diphtheria, amyloidosis, and Wegener's granulomatosis.
Treatment and Prevention
After determining the diagnosis, identifying the source of the problem, the doctor prescribes appropriate treatment, which is aimed at the specific cause of the development of laryngitis in the patient.
A limited inflammatory process in the absence of signs of intoxication is stopped by local antibacterial therapy, the use of anti-inflammatory medications, and symptomatic therapy is also prescribed. It is prescribed the use of local combination drugs in the form of tablets, lozenges and aerosols, and complex anti-inflammatory drugs based on paracetamol. If the patient complains of severe pain, the appointment of non-steroidal anti-inflammatory drugs is allowed. At the same time dry heat is recommended for the laryngeal zone, plentiful warm drink.
To influence the pronounced local inflammatory processes, it is advisable to use inhalation, use a nebulizer. Miramistin, dioxidine, as well as decongestants are prescribed for this purpose. If a patient has viscous sputum and crusts that are poorly separated, he is given inhalations with alkaline mineral waters, mucolytics and combination drugs of the “antibiotic-mucolytic” type.
In addition, for patients without obvious contraindications, physiotherapy is effective, including UHF, laryngeal electrophonophoresis and DDT in the larynx.
When the viral nature of the disease is detected, anti-inflammatory and symptomatic therapy is prescribed to the patient along with the treatment of the viral infection itself with antiviral drugs.
Allergic laryngitis, in addition to local symptomatic treatment, requires the appointment of antihistamines and sorbents.
In addition to traditional medicines, in agreement with your doctor, you can add to the scheme of therapy some folk remedies and recipes.
Such treatment at home is aimed at local manifestations of the disease, designed to somewhat alleviate the symptoms of laryngitis, to help the body cope with inflammation. Onions, milk, oranges and lemons, carrots, apples, chamomile, and even table horseradish are used against the disease. It is important to remember to keep to a diet and that any irritating products are prohibited for the inflamed larynx, so onions or horseradish in their pure form do not apply.
So, to alleviate the condition of acute laryngitis, you can make onion-milk tincture: rub the onion on a grater, boil the onion gruel in 500 ml of milk, not bringing to a boil, filter and drink the tincture warm before bedtime. Fresh cabbage juice can gargle with aphonia. When hoarseness is useful to drink a decoction of dried apples with honey, half a glass 1-2 times a day.
Chamomile decoction is used for rinsing and inhalation at the initial stage of the disease. It is useful to take a chamomile bath, which also has an inhalation effect. For its preparation, take 400 grams of dried flowers, pour in a bucket of boiling water, insist an hour and a half. After filtering, poured into the bath, prepare water with a temperature of 38-39 degrees. The procedure lasts 10-15 minutes. At strongly elevated body temperature is not recommended.
Professional singers and lecturers recommend this remedy against throat diseases: they take half a glass of anise fruit, 50 grams of linden honey and 2 tablespoons of brandy for a glass of water. Water is poured into the pan, anise is poured out and boiled for 15 minutes over low heat, then the broth is filtered and boiled together with cognac and honey. The cooled tool is ready for use, 1 tablespoon every half hour. The tincture is suitable for both treatment and prevention of lesions of the larynx and ligaments.
For gargling they prepare a mixture of a glass of boiling water and a teaspoon of honey, as well as a gargle of apple cider vinegar diluted with water and honey.
Specific prevention measures for adults and children do not exist, as infectious or viral laryngitis can develop in any person. However, the body's defenses, its immunity directly affects the course of the disease, so the main task of prevention is to strengthen the body overall. Hardening is useful, which you need to learn gradually, slowly. Sports, walking in the fresh air, a healthy diet with lots of vitamins and useful elements - all this develops the ability of the immunity to actively resist the development of the disease.
Also important is the microclimate in the living room. The rooms should be fresh, the temperature above 27 degrees is harmful to ligaments. Also, the air should not be too humid or dry. For people working in hazardous industries with highly dusty and polluted air, wearing a protective mask is mandatory.
Recommendations to patients
It is important to understand that the treatment of laryngitis is not limited to medical therapy or the use of traditional medicines. Doctors draw the attention of patients to the importance of compliance with the recommendations on the treatment and protection regime. A sparing diet is developed for the patient, any irritating food, hot or cold, alcoholic and carbonated drinks is contraindicated.
If the patient has a fever, bed rest is necessary, you can not tolerate the disease on his feet. For people of the so-called vocal speech professions, exemption from work is shown, even in the absence of fever.
In acute catarrhal laryngitis, voice load restriction is prescribed, in some cases its absence is temporarily prescribed, it is impossible to speak in a whisper.
First of all, it is important to follow the recommendations on nutrition for laryngitis, because food and beverages directly affect the state of the larynx. Do not eat spices, spices, seasonings, as they irritate the mucous membranes and can cause coughing. Too hot or cold drinks and dishes are prohibited, you can not eat ice cream. Food should be warm, liquid or ground to avoid mechanical injury to an already inflamed mucosa. Vegetables and fruits, it is desirable to eat in the form of mashed potatoes.
It is very useful to drink warm chicken broth, jelly, tea with honey when laryngitis. Useful vegetable oils that envelop the mucous membranes, for example, olive or sea buckthorn.
Especially important is the diet for reflux laryngitis, since its immediate cause is a malfunction of the gastrointestinal tract. It is necessary to exclude from the diet any foods that relax the lower esophageal sphincter. These patients need to be fed, excluding from the menu:
- sour and rich broths, soups on fish, meat and mushroom broths;
- fatty meats and fish, canned meat, rolls, sausages;
- spicy cheese, fatty and sour dairy products;
- fried, spicy, smoked and marinated dishes, pickles;
- for the period of exacerbation of reflux - fresh fruits and vegetables;
- raw onions and garlic;
- tomatoes in any form;
- chocolate, honey, jam, candy, ice cream.
It is prescribed fractional meals - 5-6 times a day, in small portions.
In addition to voice restrictions, for patients with different forms of laryngitis, there are other recommendations, contraindications, prohibitions and useful tips. For example, doctors with chronic forms of the disease doctors recommend visiting the bath from time to time. It is better to bathe with a broom collected from juniper branches. Such a procedure, firstly, activates the work of the immune system, secondly, it enhances the process of expectoration of sputum.If a person has an acute form with a strong cough and high temperature, of course, you can not steam in a bath.
Heat treatment, in general, is used for laryngitis, for example, for acute currents, it is shown to warm the larynx area with dry heat, and also to soak feet before bedtime in hot water with the addition of mustard powder.
The actual question for parents is whether it is possible to walk with the child if he has laryngitis? In acute course, if the baby feels bad, you should not go outside with him, so as not to provoke a rise in temperature and even greater weakening of the body. However, if the body is recovering and the symptoms of the disease recede, 3-4 days after the onset of the disease, short walks in the fresh air can begin. It is necessary to make an amendment to the weather - if it is rainy and damp, or severe frost, it is better to postpone the walk.
Visiting the beach with laryngitis can be useful if you plan a sea vacation for the time after dinner, when the sun becomes less active. Sunbathing and swimming in the sea with acute laryngitis is undesirable, but breathing the sea air is useful for the lungs, especially with a dry cough.
Similar recommendations relate to attendance at workouts - it is better to tolerate acute laryngitis in bed and not in the gym, since exercise in such a state undermines the body's defenses. If there are signs of recovery and improvement of well-being, you can start playing sports little by little, with light workouts, gradually increasing your pace.
Smoking during laryngitis is strictly prohibited.
Acute and chronic laryngitis is an inflammatory disease that affects the laryngeal mucous tissue and vocal cords. At the same time, a person may hoarse slightly, or even lose his voice, he may even have life-threatening complications in the form of false croup or sepsis. Therefore, the treatment of laryngitis is best done in a timely manner and with the involvement of a qualified physician.
Specialty: pediatrician, infectious diseases specialist, allergist-immunologist.
Total experience: 7 years.
Education: 2010, SSMU, pediatric, pediatrics.
Experience infectious diseases more than 3 years.
He has a patent on the topic “A method for predicting a high risk of the formation of a chronic pathology of the adeno-tonsillar system in frequently ill children”. As well as the author of publications in the journals of the Higher Attestation Commission.