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Laryngitis

Laryngitis is an inflammation of the larynx. Distinguish between ordinary (catarrhal) laryngitis, in which the mucous membrane is affected; submucosal (infiltrative) - submucosal tissue is also affected; laryngeal tonsillitis (mainly affected lymphoid tissue of the larynx); phlegmonous - abscess laryngitis - the entire larynx is affected.

Acute laryngitis occurs as an independent disease as a result of local or general cooling, voice overstrain or in case of common infectious diseases (influenza, acute catarrh of the respiratory tract, measles, etc.). Typical complaints are hoarseness, rarely aphonia (see), sometimes cough with a small amount of sputum. The general condition is almost not affected. When laryngoscopy (see) there is a hyperemia of the entire mucous membrane of the larynx, sometimes its individual sections, such as the vocal cords, a significant amount of mucus. Often (in children) there is mainly a lesion of the subglottic division of the larynx (see Croup).

With submucosal laryngitis, along with hyperemia, marked infiltration is observed, often edema.

When laryngeal sore throat is noted: dry throat, pain when swallowing, severe hoarseness, fever, swelling of lymph nodes, and sometimes difficulty breathing. With laryngoscopy there is swelling and swelling of the mucous membrane, sometimes there are inflamed follicles and small deposits similar to the follicular and lacunary angina (see).

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Phlegmonous laryngitis occurs with marked disorders of the general condition. Body temperature increased to 38 ° and above. Pronounced hoarseness up to full aphonia. When phonation and cough - a sharp pain in the throat. With the defeat of the upper parts of the larynx there is choking, severe pain when swallowing. The stenosis of a throat quite often develops (see. Laryngostenosis ). When laryngoscopy noted: severe infiltration and narrowing of the lumen of the entire larynx or its departments, hyperemia. During abscessing, purulent masses appear through the mucous membrane. Cervical lymph nodes are enlarged, painful on palpation .

Acute laryngitis (acute inflammation of the larynx) occurs as one of the manifestations of acute catarrh of the upper respiratory tract and is often associated with general or local hypothermia. The cause of this disease can also be inhalation of caustic vapors, highly dusty air, excessive smoking and alcohol abuse, as well as overstrain of the vocal cords. It is sometimes observed in some infectious diseases (influenza, measles, scarlet fever, typhoid fever).

In children, especially those suffering from exudative diathesis or other allergic diseases (bronchial asthma, etc.), at the age of 6–7 years, the inflammatory process with edema sometimes extends to the subglottic space and causes asthma attacks (false croup).

Acute laryngitis can also be of viral etiology. At the same time, the process sometimes extends to the trachea and is characterized by a stenotic course (laryngotracheitis is croupous, stenotic). This disease occurs mainly in children and is expressed in the development of the ulcerative-exudative process in the mucous membrane of the respiratory tract (even the bronchi) with the formation of films that clog the respiratory tract and cause asphyxiation (asphyxiation).

Symptoms of acute laryngitis. Hoarseness comes immediately or develops gradually over several hours or days. The pain is absent or is insignificant, even in very sensitive people. The cough, initially dry, is later accompanied by expectoration of the sputum. Sometimes he is strong, painful. Patients are worried about the feeling of constriction, congestion, tickling in the throat. The temperature increase is usually small, patients complain of poor health, general weakness. In acute laryngitis, patients with the flu sometimes experience hemorrhage in the mucous membrane of the pharynx and larynx.

The diagnosis is made on the basis of anamnesis, patient's complaints, pharyngoscopy and laryngoscopy, as well as bacteriological examination of discharge. Approximately it is necessary to take into account the epidemiological situation (the presence of other patients in the family, in particular diphtheria, etc.).

For lobar-viral stenosing laryngotracheitis is characterized by an acute onset, a general serious condition and a rapidly increasing laryngeal stenosis (asphyxiation). The signs of anxiety in a child who wakes at night, barking cough, difficulty breathing, lip cyanosis (false croup) can be characteristic signs. At the same time the pharynx is clean, there are no raids on the tonsils, the cervical lymph nodes are not enlarged and painless. Often there is a pronounced general intoxication of the body with severe lesions of parenchymal organs.

Observation from practice:
Patient P., 2.5 years old, was taken to the feldsher-obstetric point 21 / III of 1964 for shortness of breath, barking cough. From 17 / III 1964 he had the flu. The condition of a child of moderate severity, rough barking cough, hoarse voice (stenosis of I degree). The pharynx is clean, there are no raids on the tonsils. With a diagnosis of acute stenosing laryngotracheitis after the flu, the paramedic sent the child in urgent order to the department of the ear, nose, and throat of the district hospital. On the night of 24 / III, the condition worsened, stenosis of the larynx increased, and therefore a tracheotomy was performed. Conducted treatment with antibiotics and symptomatic agents. A large amount of purulent sputum began to stand out through the tracheostomy. On the radiograph - a picture of bilateral pneumonia, right-sided pleurisy. Condition for a long time is difficult. 8 / IV patient was decanted. 15 / V 1964, the patient was discharged on recovery.

Features of observation: the disease began after the flu; acute laryngotracheitis in a weakened child was characterized by a severe course, timely hospitalization, tracheotomy and complex therapy led to recovery.

First aid and treatment. In acute laryngitis, it is necessary to give complete peace of the larynx, and for persons whose voice is professional (teachers, singers, etc.), they must be released from work. A warming compress on the neck, UHF, diathermy in the larynx area, inhalation of penicillin aerosols and alkaline inhalations are recommended.

At elevated temperatures and cough, antipyretic drugs are prescribed, as well as expectorant drugs. If there are signs of acute inflammatory edema of the larynx, emergency hospitalization is indicated in the otorhinolaryngological hospital or in the nearest surgical department due to the possible need for a tracheotomy.

Before hospitalization, antiedematous and anti-inflammatory therapy should be provided (administration of glucose, calcium chloride, antibiotics, inhalation, etc.).

When false croup shows bed rest, distracting means in the form of mustard plaster or cans, hot foot baths. In a choking attack, you can stop it by causing a pharyngeal reflex (touching the back wall of the pharynx with a spatula). In case of acute laryngotracheobronchitis, in addition to the above treatment, sputum suction is shown, giving oxygen with an admixture of 7% carbon dioxide, antibiotics are prescribed. Hospitalization is shown in order of urgency.

Treatment . Silence mode. In acute laryngitis, it is recommended to speak in a whisper and only when necessary.

Inhalations with alkaline solutions, menthol vapors, eucalyptus, antibiotic aerosols; warming compresses on the neck; infusion (doctor) drugs in the larynx. When infiltrative and phlegmonous laryngitis, guttural angina, in addition, prescribe antibiotics and sulfonamides. Laryngeal abscesses open endolaryngeal. When stenosis of the larynx produce a tracheotomy (see).

laryngitis
Acute (left) and chronic laryngitis

Chronic laryngitis . There are catarrhal, hyperplastic and atrophic forms. The main complaints are hoarseness, fatigue of voice. In atrophic laryngitis, in addition, dry throat. Chronic laryngitis develops as a result of an acute process that does not end (more often if the silence regime is not followed), with prolonged disturbance of nasal breathing, as a result of occupational injuries.

Changes in the larynx correspond to the shape of the process. With catarrhal - catarrhal changes predominate, with hyperplastic - hyperplasia of the entire mucosa or its individual sections. In atrophic laryngitis - pallor of the mucous membrane, mucus, crusts.

Treatment . Voice mode, the exclusion of factors contributing to the disease; inhalation of antibiotic aerosols, alkaline oil solutions; UHF , iono-galvanization, diathermy on the laryngeal area. Infusion (by a doctor) of a 1-2% solution of menthol in oil into the larynx, lubrication with astringent and cauterizing agents; in atrophic laryngitis - lubrication of the larynx with a solution of Lugol in glycerin. When laryngitis is recommended to refrain from smoking, drinking alcohol and irritating foods (sour, salty and peppered).