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Laryngostenosis

Laryngostenosis is a narrowing of the lumen of the larynx until it is completely closed. Distinguish between laryngostenosis congenital (less often) and acquired (more often), acute and chronic. Causes of laryngostenosis are different: inflammatory and non-inflammatory processes (subglossal laryngitis , allergic edema, etc.), foreign bodies, infections (influenza, measles, scarlet fever , diphtheria, etc.), laryngeal injuries (mechanical, thermal, chemical), neoplasms, pathological processes in the tissues adjacent to the larynx and trachea , malformations (congenital membranes or cysts of the larynx), infectious granulomas ( tuberculosis , syphilis ), etc.

In acute laryngostenoses, asphyxiation develops quickly (more often in children), and in chronic, slowly. However, if inflammation or hemorrhage occurs in the area of stenosis, chronic laryngostenosis can quickly increase and lead to asphyxiation.

There are three stages of laryngostenosis: compensated, decompensated and asphyxial. Stage I is characterized by increased activity of the respiratory muscles, the pause between inhalation and exhalation disappears, breathing becomes deeper and slower. There is hoarseness, noisy breathing (stenosis noise). In stage II, cyanosis of the skin and mucous membranes is observed, turning into pallor with increasing stenosis. Patients are restless, covered with cold sweat. The auxiliary respiratory muscles come into play, which leads to the intercostal spaces, supra- and infraclavicular fossae being drawn in. Noise stenosis is heard at a considerable distance. In stage III, persistent respiratory arrest develops (see Asphyxia ).

In all cases of possible development of asphyxia in any pathological condition of the larynx, an urgent hospitalization of the patient and the adoption of measures to prevent asphyxia are indicated.

Treatment of acute laryngostenosis begins with the treatment of the underlying disease. For inflammations, distraction agents (mustard plasters on the neck, hot foot baths), alkaline inhalations are recommended.

For removal of edema - dehydration therapy (intravenous administration of hypertonic solutions of glucose, calcium ). Allergic edema is removed by intravenous administration of corticosteroids and antihistamines such as dimedrol and pipolfen. To reduce hypoxia (oxygen starvation of tissues), inhalation of oxygen is recommended. To excite the respiratory center, lobeline is injected (0.3-0.5 ml of a 1% solution intravenously). With low effectiveness of these measures, they switch to intubation (see) or tracheotomy (see).

In chronic laryngostenoses, treatment is directed, in addition to the underlying disease, to the removal of structures that narrow the lumen of the larynx.