Laryngitis - Causes, symptoms and treatment. MF.

Laryngitis is a common syndrome of respiratory tract infections and can cause serious life-threatening complications without proper medication.

Laryngitis is a clinical syndrome of laryngeal lesion caused by inflammatory changes in the mucous membrane due to the development of infection of viral or bacterial etiology or other causes, manifested as acute or chronic form.

Laryngitis

The risk factors for developing laryngitis are as follows:

1) decreased immunity due to frequent colds or concomitant chronic pathology;
2) supercooling( cold and windy weather conditions);
3) professional factors( in the risk group, persons with forced overstrain of vocal cords - singers, teachers - "laryngitis lecturer" and others, persons in harmful chemical industries);
4) children's age group( breathing through the mouth in the cold, clothes not in the weather);
5) bad habits( smoking - "smoker's laryngitis", alcohol abuse);
6) dusty air;
7) etiological factor( acute form of infection for acute laryngitis - ARVI, measles, whooping cough, scarlet fever and others, chronic bacterial foci - for the chronic form of laryngitis);

8) external allergens( food, vegetable, chemical).

Thus, laryngitis can be infectious, professional( the laryngitis of the lecturer), due to bad habits( smoker's laryngitis), allergic.

Causes of development of infectious laryngitis

Laryngitis pathogens are divided into two groups:

1) viruses( influenza virus, parainfluenza, measles and others);
2) bacteria( causative agent of scarlet fever, diphtheria, whooping cough, streptococci, staphylococcus, mycobacteria, treponema and others).

Source of infection is a sick person who becomes infectious from the time of the onset of the first symptoms of the disease.

The mechanism of infection with laryngitis is aerogenic, and the main path of is airborne, which is realized by sneezing and coughing a sick person within a radius of up to 3 meters. The susceptibility of the body is universal. In the risk group, the children's age group due to the massive incidence of ARVI.For laryngitis, especially its acute form, there is a winter-spring seasonality( season of colds).

Laryngitis can be: acute , which occurs suddenly after exposure to one of the above reasons, or chronic , which occurs as a result of acute laryngitis, the presence of a chronic foci in the nose and nasal sinuses, the pharynx, and as a consequence of the multiple effects of the damaging factorillness of teachers, singers, smokers, alcohol abusers).

Physiology and anatomy of the larynx

The larynx( Latin larynx) is the upper respiratory tract located between the pharynx( in most cases, the entrance gate of the infection) and the trachea. The larynx contains a voice apparatus. Located at the level of IV-VI cervical vertebra, it has a direct communication with the pharynx and trachea. The larynx consists of their cartilaginous hyaline frame, which includes unpaired or large cartilages( cricoid, epiglottis, thyroid) and paired or small( aryps, wedge-shaped, coroniform).The mobility of the organ is provided by two joints: a ring-toothed joint and a finger-thyroid joint. In the larynx is the human voice apparatus, which is represented by vocal cords attached to the thyroid and arytenoid cartilages. The formation of sounds occurs both on inhalation and exhalation by vibrating the vocal cords. Stretching them and changing the shape of the glottis occurs when the muscular apparatus of the larynx is shortened.

Laryngitis, larynx in profile

Laryngitis, laryngeal anatomy

Pathological changes in larynx with laryngitis

Infectious or other causes of inflammatory( or damaging) phenomena of the mucous membrane of the larynx: mucosal edema, plethora of vessels, infiltration of mucosal cells by inflammation( neutrophils, lymphocytes, macrophages).These changes lead to the appearance of a local reaction in the form of hyperemia( redness), edema( and as a consequence, narrowing the laryngeal lumen, narrowing the glottis, edema of ligaments), hemorrhagic eruptions( enanthema more often with influenza) can appear on the mucous membrane. The pathological process is accompanied by the effusion of an abundant amount of mucus. Often the process affects the epiglottis zone, and sometimes passes to the trachea, causing a combined damage( laryngotracheitis).

Pathological changes can be different, which causes the emergence of various clinical forms of laryngitis.
Catarrhal laryngitis is manifested by mild inflammatory changes in the mucosa.
Hypertrophic laryngitis is characterized by proliferation of the mucous membrane with the formation of specific nodules 3-4 mm in diameter, including on the ligaments - the so-called "singer's knots", and envelope overgrowth can lead to irreversible deformation of the ligaments.
Atrophic laryngitis is manifested by thinning of the laryngeal mucosa due to food predilections( spicy and spicy food).
The diphtheritic laryngitis is characterized by the formation of dense fibrinous dirty-grayish deposits that tend to merge, in parallel the mucosal edema develops, which is especially dangerous in the vocal cords, because it leads to a pronounced narrowing of the glottis and can not quickly regress with standard therapy.
The tuberculous laryngitis is manifested by the formation of thickenings in the mucous membrane of the larynx in the form of nodules, tubercles, epiglottis, cartilage tissue.
With syphilitic laryngitis in the second stage ulcers and plaques are formed on the mucous membrane of the larynx, which in the 3rd stage are scarred, which leads to deformation of the ligament apparatus and the larynx itself.

Clinical symptoms of laryngitis

Acute laryngitis is characterized by a sharp onset of the disease, more often with fever to febrile numbers( up to 37.5-38º), symptoms of intoxication of varying severity( from slight weakness to weakness, from mild dizziness to headaches, from nauseabefore vomiting).The severity of symptoms depends on the type of infection or other cause that caused laryngitis. Some patients complain of pain when swallowing( in case of localization of the process in the region of the pharynx, posterior wall of the larynx and epiglottis).Patients are concerned about hoarseness of voice or hoarseness, dryness, perspiration, scratching sensation in the throat, dry "barking" cough. Subsequently, the cough becomes moist( sputum mucous, can be transparent in viral nature or greenish-yellow in bacterial laryngitis), gradually the voice coarsens and even disappears. With the progression of the process, breathing difficulties on inhalation may occur( due to narrowing of the glottis, its edema and spasm).In the absence of timely assistance, complications can develop( see below).When providing timely medication therapy, the duration of the disease is up to 7-10 days.

Laryngeal edema detected with laryngoscopy

Chronic laryngitis is lighter in severity, but has a longer duration. Chronic laryngitis is characterized by a feeling of perspiration in the throat, sadness, constant coughing, rapid fatigue of the voice, which is confirmed by the hoarseness and hoarseness of the voice. During the period of remission, these complaints become smaller and disappear, but when exacerbated, they appear again. Chronic laryngitis is fixed for a disease duration of more than 10 days, but the process can last for years.

Chronic laryngitis

Allocate clinical forms of laryngitis:

1) Catarrhal laryngitis - the patient has pershenia, hoarseness of voice, a feeling of sagging in the throat, cough inconstant, dry and little expressed. The flow is favorable and easy.
2) Hypertrophic laryngitis is characterized by a dry cough, a strong hoarseness in the voice, expressed by constant perspiration. A characteristic symptom is the so-called "nodules of the singer" on the ligaments, which give a hoarse voice. In far-reaching cases, there may be a deformation of the vocal cords, which is irreversible. Hypertrophic laryngitis is accompanied by a course of "laryngitis lecturer" or "laryngitis singer"( that is, professional laryngitis).
3) The atrophic laryngitis of is manifested by severe perspiration and dryness in the throat, constant
with a hoarse voice, an excruciating dry cough, at which sometimes bloody clots with crusts may leave. More often observed in adult patients with certain taste preferences( spicy and spicy food).
4) The diphtheria laryngitis is characterized by a descending process, that is, an isolated larynx is very rarely affected. Most pathological process comes from the oropharynx and descends into the larynx. Due to the spread of diphtheria raids and swelling in the patient, there is a pronounced sore throat, hoarseness, coughing, difficulty breathing. With diphtheria, the appearance of laryngitis is an unfavorable moment, as it entails the appearance of a formidable complication - "true croup"( see below).Associated symptoms of diphtheritic laryngitis - temperature, diphtheria angina with minor sore throat, characteristic local changes of the oropharynx.
5) TB laryngitis is a secondary clinical form that occurs after the spread of pulmonary tuberculosis. Against the backdrop of the pulmonary process, there is perspiration, hoarseness in the voice and coughing worse. Usually the process affects not only the mucous membrane, but also the cartilaginous tissue.
6) Syphilitic laryngitis is formed in the 2nd and 3rd stages of the disease, refers to the complications of syphilis. Patients present quite characteristic complaints for laryngitis, and due to specific changes in the mucosa during coughing purulent-bloody clots or mucocutaneous bloody inclusions can depart. A characteristic feature of the third stage is the irreversibility of deforming changes in the larynx, which is manifested by a permanent( lifelong) hoarseness.
7) Allergic laryngitis occurs in a patient with an allergic reaction( allergic rhinitis, pharyngitis and others).The reason - the allergic edema of the larynx, which manifests itself at night - barking cough, difficulty breathing, excitement of the patient. When the acute form appears suddenly, and when the chronic form of the disease - gradually.

Complications of laryngitis

1) Stenosis of larynx or croup ( in combination with laryngospasm), which can be of two kinds:
"false groats" and "true croup".Most often occurs in the children's age group, which is associated with a special funnel-shaped form of the larynx and its small size. Stenosis of the larynx is a narrowing of the larynx and glottis gap due to mucosal edema, inflammatory phenomena and spasm of the muscular apparatus.

Croup with laryngitis

False groats ( stenosing laryngitis, nocturnal complication) occurs in children on the background of acute respiratory viral infection( usually parainfluenza, influenza, less often adenovirus infection, measles, whooping cough, hemophilia, strep infection) and develops suddenly. Against the background of the main symptoms of the disease on the 2nd-3rd day of the illness, a small patient develops a barking coughing, breathing disorder( noisy breathing or stridor), suddenly the baby starts to gasp( inspiratory shortness or difficulty of inspiration) at night. The child becomes nervous, restless. Upon examination, dry whistling hipes are heard. Complete loss of voice does not happen!

There are 4 stages of stenosis, already at the 2nd stage the skin becomes cyanotic( hypoxia).The third stage is characterized by tachycardia, loss of voice, shortness of breath already mixed( difficulty breathing and inhaling), and stage 4 is dangerous due to the appearance of seizures and a sharp drop in blood pressure. The stages of stenosis develop very quickly - the first hours. In the absence of medical assistance, stenosis can end fatal. When the first symptoms of stenosis appear, it is urgent to call a doctor at home!

Laryngeal stenosis with laryngitis

The true croup ( stenosing laryngitis in diphtheria) is a formidable complication of diphtheria and develops at the end of the first and beginning of the second week of the disease. The true croup develops gradually. The patient has hoarseness, barking cough, difficulty breathing. A few hours later, the voice disappears( right up to the full aphonia), dyspnea becomes more palpable, cyanosis appears. There are also 4 stages of croup, but when the first symptoms appear, you need to act without delay, otherwise the patient can not be saved. Urgent medical specialized help!

2) Cicatricial deformation of the larynx due to chronic laryngitis or an acute process with protracted flow in case of cartilage damage. Clinically deformity is accompanied by a constant hoarseness of the voice, coughing, and breathing disorders.

Diagnosis of laryngitis

1) Clinical data: symptoms of laryngitis are quite specific - rough barking
cough, hoarseness and hoarseness, a feeling of sore throat, dry mouth and throat, voice change from dysphonia( rudeness) to aphonia( lossvoices), breathing disorders( difficulty breathing or inspiratory shortness of breath).
2) Collection of epidemiological history and history of life( identification of contacts with infectious
Patients, presence of chronic foci of infection, presence of occupational hazards and factors, bad habits, allergic anamnesis).
3) Laboratory data:
- changes in the general blood test depending on the cause that caused laryngitis may be leukocytosis, increased ESR, eosinophilia, lymphocytosis;
- specific assays for infection( smears from the nasopharyngeal and oropharyngeal viruses, smear from the pharynx to the BL - causative agent of diphtheria, sputum on the MBT - the causative agent of tuberculosis, blood for antibodies to the causative agent of syphilis, and so on);
- allergic examination for suspected allergic laryngitis.
4) Instrumental examination - direct laryngoscopy( larynx examination with
flexible endoscope to study the nature and extent of changes in the mucous membrane of the larynx, ligaments) or indirect laryngoscopy( examination of the larynx using a special mirror).In the process of this study, tissue can be taken for biopsy( excluding oncological processes and other diseases).

Direct laryngoscopy

Indirect laryngoscopy

Treatment of laryngitis

1) Regimen-protective measures - home treatment with outpatient treatment and in severe forms - inpatient treatment. Immediate hospitalization is required for patients with diphtheria process and stenosis of the larynx. Full peace of voice for 5-7 days. Special diet - the exclusion of spices, spicy and salty foods, too hot and cold dishes. Exclusion of bad habits. The abundant warm drink( milk with honey, mineral water without gas), heat on the neck, warm steam inhalations are shown.

2) Treatment of the underlying disease( cold and other infections)

3) Etiotropic therapy is prescribed depending on the cause of the laryngitis: antiviral( arbidol, isoprinosine, cycloferon and other drugs in the viral nature of the disease) or antibacterial treatment( beta-lactams, macrolides,fluoroquinolones, the choice of the drug remains only for the doctor), the introduction of specific drugs( PDS - ptyvodipteriynaya serum for diphtheria laryngitis), if necessary, antituberculous therapy, antisyphilitic drugsparaty.

4) Local therapy with anti-inflammatory and antimicrobial sprays.

Sore throat always indicates the activity of pathogenic microorganisms, which will help to destroy the procedures of irrigation of the nasopharyngeal mucosa with a drug with antibacterial action. Such a means can be a Bioparox aerosol containing an antibiotic of natural origin, fusafungin, which reduces inflammation and accelerates the healing process. The drug will stop the reproduction of harmful bacteria and help to cope with the pain in the throat.

5) Antihistamines( loratadine, zirtek, cetrine, claritin, erius and others).

6) Treatment of stenosis of the larynx: urgent call of an ambulance;while waiting for distraction therapy( mustard on the larynx, thorax, gastrocnemius muscles, hot foot bath for 7-10 minutes, warm milk or mineral water);patient to seat or put under the back of the pillow, to achieve a semi-sitting position;glucocorticosteroids parenterally, antihistamines parenterally, nebulizer inhalation with euphyllin in a hospital environment, sedative therapy, with diphtheria stenosis - intubation is possible, constant observation of the doctor until relief is relieved.

7) Inhalation therapy can be with the help of steam inhalations with herbs( chamomile, oregano, sage and others), potato steam, alkaline inhalations. It can be inhalation with the help of a nebulizer( with mineral water or medications prescribed by a doctor).Inhalation is carried out 3 to 7 times a day.

Laryngitis, inhalation

8) The folk remedies for laryngitis include the use of decoctions and infusions of chamomile, oregano, sage, plantain, potato vapors, boiled beet juice, dill seed infusion, carrot juice, honey, warm milk. The initial symptoms of laryngitis can cope with the infusion of willow bark.

9) Surgical treatment for cicatricial deformation of the larynx.

Prophylaxis of laryngitis

- Hardening of the body, starting from childhood.
- Timely treatment of cold infections and chronic bacterial foci.
- If you have ARI or ARVI, adhere to the regime( home mode, warm abundant drink, shake voice - speak quietly or in a whisper, do not get nervous, do not walk, exclude physical activity).
- Fighting bad habits( smoking, alcohol).
- Sport activities.

Voach infectionist Bykova N.I.