Acute inflammation of the larynx. Treatment of acute laryngitis. Acute laryngitis: causes

Catad_tema Diseases of the ENT organs - articles

Acute laryngitis

Acute laryngitis

ICD 10: J04.0, J04.2, J05.0, J05.1, J38.6

Year of approval (revision frequency): 2016 (reviewed every 3 years)

ID: KR309

Professional associations:

• National Medical Association of Otolaryngologists

Approved

Chief freelance specialist otorhinolaryngologist of the Ministry of Health of Russia, Doctor of Medical Sciences, Professor N.A. Daikhes President of the National Medical Association of Otorhinolaryngologists Honored Doctor of Russia, Corresponding Member of the Russian Academy of Sciences Professor Yu.K. Yanov

Agreed

Scientific Council of the Ministry of Health Russian Federation __ __________201_

List of abbreviations

OL - acute laryngitis

ARVI - acute respiratory viral infection

Ultrasound - ultrasound examination

CT - computed tomography

ABP - antibacterial drugs

UHF - ultra high frequency

Terms and Definitions

Acute laryngitis – acute inflammation mucous membrane of the larynx.

1. Brief information

1.1 Definition

Acute laryngitis (AL) – acute inflammation of the mucous membrane of the larynx.

Abscess or phlegmonous laryngitis- acute laryngitis with the formation of an abscess, most often on the lingual surface of the epiglottis or on the aryepiglottic folds; manifests itself as sharp pain when swallowing and phonation, radiating to the ear, increased body temperature, and the presence of a dense infiltrate in the tissues of the larynx.

Acute chondroperichondritis of the larynx- acute inflammation of the cartilage of the larynx, i.e. chondritis, in which the inflammatory process involves the perichondrium and surrounding tissues.

1.2 Etiology and pathogenesis

Acute inflammation of the laryngeal mucosa may be a continuation catarrh mucous membrane of the nose or pharynx or occur with acute catarrh of the upper respiratory tract, respiratory viral infection, flu. Typically, acute laryngitis is a symptom complex of ARVI (influenza, parainfluenza, adenoviral infection), in which the mucous membrane of the nose and pharynx, and sometimes the lower respiratory tract (bronchi, lungs) is also involved in the inflammatory process. It is known that the microflora that colonizes non-sterile parts of the respiratory tract, including the larynx, is represented by saprophytic microorganisms that almost never cause diseases in humans and opportunistic bacteria that can cause purulent inflammation under unfavorable conditions for the microorganism.

In the pathogenesis of the development of acute laryngeal edema, an important role is played by the anatomical features of the structure of the mucous membrane of the larynx. Disruption of lymphatic drainage and local water metabolism is important. Swelling of the mucous membrane can occur in any part of the larynx and quickly spread to others, causing acute laryngeal stenosis and threatening the patient's life. The causes of acute inflammation of the mucous membrane of the larynx are varied: infectious and viral factors, external and internal trauma to the neck and larynx, including inhalation injuries, exposure to foreign body, allergies, gastroesophageal reflux. A large voice load is also important. The occurrence of inflammatory pathology of the larynx is facilitated by chronic diseases of the bronchopulmonary system, nose, paranasal sinuses, metabolic disorders in diabetes mellitus, hypothyroidism or diseases of the gastrointestinal tract, chronic renal failure, pathology of the separation function of the larynx, abuse of alcoholic beverages and tobacco, and previous radiation therapy.

It is possible to develop angioedema of the larynx of hereditary or allergic origin.

Non-inflammatory laryngeal edema can occur as a local manifestation of general hydrops of the body when various forms heart failure, liver disease, kidney disease, venous stagnation, tumors of the mediastinum.

Specific (secondary laryngitis develops with tuberculosis, syphilis, infectious (diphtheria), systemic diseases (Wegener's granulomatosis, rheumatoid arthritis, amyloidosis, sarcoidosis, polychondritis, etc.), as well as blood diseases).

1.3 Epidemiology

The exact prevalence of acute laryngitis is unknown, as many patients are often self-treated with medications or use folk remedies laryngitis treatment and do not seek medical help. Most often people from 18 to 40 years old become ill, but the disease can occur at any age.

The highest incidence of acute laryngitis was observed in children aged 6 months to 2 years. At this age, it is observed in 34% of children with acute respiratory disease.

1.4 Coding according to ICD 10

J04.0 - Acute laryngitis.

J04.2 - Acute laryngotracheitis.

J05.0- Acute obstructive laryngitis (croup).

J05.1 - Acute epiglotitis.

J38.6- Acute laryngeal stenosis.

1.5 Classification

1. According to the form of acute laryngitis:

catarrhal;

• phlegmonous (infiltrative-purulent):

Infiltrative;

Abscessing.

1. According to the nature of the pathogen:

bacterial;

viral;

fungal;

specific.

2. Diagnostics

2.1 Zha l routine and anamnesis

The main symptoms of acute laryngitis are sharp pain in the throat, hoarseness, cough, difficulty breathing, deterioration in general health. Acute forms are characterized by a sudden onset of the disease with general satisfactory condition or against the background of a slight malaise. Body temperature remains normal or rises to subfebrile levels with catarrhal acute laryngitis. Febrile temperature, as a rule, reflects the addition of inflammation of the lower respiratory tract or the transition of catarrhal inflammation of the larynx to phlegmonous. Infiltrative and abscess forms of acute laryngitis are characterized by severe pain in the throat, difficulty swallowing, including liquids, severe intoxication, and increasing symptoms of laryngeal stenosis. The severity of clinical manifestations directly correlates with the severity of inflammatory changes. General state the patient becomes ill. In the absence of adequate therapy, neck phlegmon, mediastinitis, sepsis, abscess pneumonia and laryngeal stenosis may develop. In these cases, regardless of the cause causing acute laryngeal stenosis, clinical picture it is of the same type and is determined by the degree of narrowing of the airways. Sharply expressed negative pressure in the mediastinum during intense inspiration and increasing oxygen starvation cause a symptom complex, which consists of the appearance of noisy breathing, a change in the breathing rhythm, retraction of the supraclavicular fossa and retraction intercostal spaces, forced position of the patient with his head thrown back, lowering of the larynx when inhaling and rising when exhaling.

2.2 Physical examination

In a limited form, changes are observed mainly on the vocal folds, in the interarytenoid or subglottic space. Against the background of the hyperemic mucous membrane of the larynx and vocal folds, expanded superficial blood vessels and mucous or mucopurulent secretion. In the diffuse form of acute laryngitis, continuous hyperemia and swelling of the entire mucous membrane of the larynx of varying degrees of severity are determined. During phonation, incomplete closure of the vocal folds is observed, and the glottis has a linear or oval shape. In acute laryngitis, which develops against the background of influenza or ARVI, laryngoscopy reveals hemorrhages in the mucous membrane of the larynx: from petechial to small hematomas (so-called hemorrhagic laryngitis).

The appearance of white and whitish-yellow fibrinous plaque in the larynx is a sign of the disease transitioning to a more severe form - fibrinous laryngitis, and gray or brown plaque may be a sign of diphtheria.

The main symptom of acute respiratory failure is shortness of breath. Depending on the severity of shortness of breath, the following degrees are distinguished:
I degree of respiratory failure – shortness of breath occurs during physical exertion;
II degree – shortness of breath occurs with little physical activity (slowly walking, washing, dressing);

III degree – shortness of breath at rest.

By clinical course and the size of the airway lumen, four degrees of laryngeal stenosis are distinguished:

The stage of compensation, which is characterized by slowing and deepening of breathing, shortening or loss of pauses between inhalation and exhalation, and slowing of the heartbeat. The lumen of the glottis is 6-8 mm or the narrowing of the tracheal lumen by 1/3. At rest there is no lack of breathing; shortness of breath appears when walking.

Stage of subcompensation - in this case, inspiratory shortness of breath appears with the inclusion of auxiliary muscles in the act of breathing during physical activity, there is retraction of the intercostal spaces, soft tissues of the jugular and supraclavicular fossae, stridorous (noisy) breathing, pallor of the skin, blood pressure remains normal or elevated, glottis 3-4 mm, the tracheal lumen is narrowed by? and more.

Stage of decompensation. Breathing is shallow, frequent, and stridor is pronounced. Forced position sitting. The larynx makes maximum excursions. The face becomes pale and bluish, there is increased sweating, acrocyanosis, rapid and thready pulse, and decreased blood pressure. The glottis is 2-3 mm, the trachea has a slit-like lumen.

Asphyxia - breathing is intermittent or stops completely. The glottis and/or tracheal lumen is 1 mm. Sharp depression of cardiac activity. The pulse is frequent, thread-like, and often cannot be felt. The skin is pale gray due to spasm of small arteries. There is loss of consciousness, exophthalmos, involuntary urination

The acute onset of the disease with rapid progression of stenosis symptoms aggravates the severity of the patient’s condition, since compensatory mechanisms do not have time to develop in a short time. This must be taken into account when determining indications for emergency surgical treatment. Narrowing of the lumen of the upper respiratory tract in acute stenosing laryngotracheitis occurs sequentially, stage by stage over a short period of time. With incomplete obstruction of the larynx, noisy breathing occurs - stridor, caused by vibrations of the epiglottis, arytenoid cartilages, partly vocal cords with intense turbulent passage of air through narrowed airways according to Bernoulli's law. When swelling of the laryngeal tissues dominates, a whistling sound is observed; when hypersecretion increases, hoarse, bubbling, noisy breathing is observed. In the terminal stage of stenosis, breathing becomes less and less noisy due to a decrease in tidal volume.

The inspiratory nature of shortness of breath occurs when the larynx narrows in the area of ​​the vocal folds or above them and is characterized noisy breath with retraction of pliable places chest. Stenoses below the level of the vocal folds are characterized by expiratory shortness of breath with the participation of auxiliary muscles in breathing. Laryngeal stenosis in the subglottic area usually manifests as mixed shortness of breath.

In patients with obstruction of the larynx with inflammatory infiltrate due to an abscess of the epiglottis against the background of acute pain symptom The first to appear are complaints about the inability to swallow, which is associated with limited mobility of the epiglottis and swelling of the posterior wall of the larynx, then as the disease progresses, difficulty breathing appears. Obstruction of the glottis can occur very quickly, which requires the doctor to take emergency measures to save the patient’s life.

2.3 Laboratory diagnostics

It is recommended to conduct a general clinical examination, including clinical analysis blood, general urine test, blood test for RW, HBS and HCV antigens, HIV, biochemical analysis blood, coagulogram; is performed at the preoperative stage in all patients with OA entering for surgery.

Comments:Standard laboratory examination during hospitalization.

Comments:The ciliated epithelium loses cilia or is rejected, the deeper layers of cells are preserved (they serve as a matrix for epithelial regeneration). With a pronounced inflammatory process, metaplasia of the ciliated columnar epithelium into squamous epithelium can occur. Infiltration of the mucous membrane is unevenly expressed, the blood vessels are tortuous, dilated, and overflowing with blood. In some cases, their subepithelial breaks are determined (usually in the area of ​​the vocal folds).

2.4 Instrumental diagnostics

Comments:The study allows us to determine the nature of the pathological process, its localization, level, extent and degree of narrowing of the airway lumen.

The picture of acute laryngitis is characterized by hyperemia, swelling of the laryngeal mucosa, and increased vascular pattern. The vocal folds are usually pink or bright red, thickened, and the glottis during phonation is oval or linear with accumulation of mucus. In acute laryngitis, the mucous membrane of the subglottic part of the larynx may be involved in the inflammatory process. With subglottic laryngitis, a roller-like thickening of the mucous membrane of the subglottic part of the larynx is diagnosed. If the process is not associated with intubation trauma, its detection in adults requires urgent differential diagnosis with systemic diseases and tuberculosis. With infiltrative laryngitis, significant infiltration, hyperemia, an increase in volume and impaired mobility of the affected part of the larynx are determined. Fibrinous deposits are often visible, and purulent contents are visible at the site of abscess formation. Severe forms of laryngitis and chondroperichondritis of the larynx are characterized by pain on palpation, impaired mobility of the cartilage of the larynx, possible infiltration and hyperemia of the skin in the projection of the larynx, against the background of pain and general clinical symptoms. purulent infection. An abscess of the epiglottis looks like a spherical formation on its lingual surface with translucent purulent contents with pronounced pain syndrome and swallowing disorders.

3. Treatment

3.1 Conservative treatment

Systemic antibacterial therapy is recommended for severe intoxication and the presence of significant inflammation in the larynx ( diffuse edema mucous membrane of the larynx, the presence of infiltration) and regional lymphadenitis.

Comments: Systemic antibacterial therapy for acute laryngitis is also prescribed in the absence of effect from local antibacterial and anti-inflammatory therapy for 4–5 days, with the addition of purulent exudation and inflammation of the lower respiratory tract.

Carrying out antibiotic therapy on an outpatient basis is not an easy task, since the irrational choice of the “starting” antibiotic prolongs the course of a purulent infection and leads to the development of purulent complications. Antimicrobial therapy of acute laryngitis with severe inflammatory phenomena prescribed empirically - amoxicillin + clavulanic acid**, macrolides, fluoroquinolones.

Comments:Local antimicrobial therapy includes endolaryngeal infusions with hydrocortisone emulsion**, peach oil and an antibacterial drug (you can use erythromycin, gramicidin C, streptomycin, amoxicillin + clavulanic acid**).

Comments:In the allergic form of angioedema of the larynx, it is quite easily removed with injections antihistamines, acting on both H1 receptors (diphenhydramine**, clemastine, chloropyramine**) and H2 receptors (cimetidine, histodil (not registered and not used in the Russian Federation) 200 ml IV) with the addition of glucocorticosteroids (60 -90 mg prednisolone** or 8-16 mg dexamethasone** IV)

Comments:Inhalations with corticosteroids, antibiotics, mucolytics, herbal preparations with anti-inflammatory and antiseptic effects are used, as well as alkaline inhalations to eliminate dryness of the laryngeal mucosa. The duration of inhalation is usually 10 minutes 3 times a day. Alkaline inhalations can be used several times a day to moisten the lining of the respiratory tract.

3.2. Surgery

Comments:In case of complications such as phlegmon of the neck or mediastinitis, combined surgical treatment is performed using external and endolaryngeal access.

It is recommended to perform tracheostomy or instrumental conicotomy in case of clinical picture of acute edematous-infiltrative laryngitis, epiglottitis, abscess of the lateral wall of the pharynx, lack of effect from conservative treatment and increasing symptoms of laryngeal stenosis (the method of tracheostomy is presented in Appendix D).

3.3 Other treatment

Comments:Good therapeutic effect Laser therapy provides laser radiation in the visible red range of the spectrum (0.63-0.65 microns) in continuous mode with a mirror attachment D 50 mm (mirror-contact method of exposure).

Superphonoelectrophoresis according to Kryukov-Podmazov is highly effective.

Comments:It is also necessary to remember that for any inflammatory disease of the larynx it is necessary to create a protective mode (voice mode), recommend that the patient speak a little and in a quiet voice, but not in a whisper, when the tension of the larynx muscles increases. It is also necessary to stop eating spicy, salty, hot, cold foods, alcoholic beverages, and smoking. In the stage of convalescence and in cases where intense phonation is one of the etiopathogenetic factors in the development of hypotonic disorders of vocal function as a result of inflammation, phonopedia and stimulating therapy are indicated.

4. Rehabilitation

Comments:Patients who have undergone surgical interventions are observed until the clinical and functional state of the larynx is completely restored for an average of 3 months, with examinations occurring once a week in the first month and once every 2 weeks, starting from the second month.

The period of incapacity for work depends on the patient’s profession: for people in vocal professions, they are extended until voice function is restored. Uncomplicated acute laryngitis resolves within 7-14 days; infiltrative forms - about 14 days.

5. Prevention and clinical observation

Prevention of chronicity inflammatory process larynx is the timely treatment of acute laryngitis, increasing the body's resistance, treating gastroesophageal reflux disease, infectious diseases of the upper and lower respiratory tract, quitting smoking, and maintaining a voice regime.

6. Additional information affecting the course and outcome of the disease

In uncomplicated forms of laryngitis, the prognosis is favorable; in complicated forms with the development of laryngeal stenosis, timely specialized care and surgical treatment will help save the patient’s life.

Criteria for assessing the quality of medical care

Bibliography

Vasilenko Yu.S. Diagnosis and treatment of laryngitis associated with gastroesophageal reflux / Ros. otorhinolaryngology. 2002. - No. 1. - P.95-96.

Daynyak L. B. Special forms of acute and chronic laryngitis / Bulletin of Otorhinolaryngology. 1997. - No. 5. - P.45.

Vasilenko Yu.S., Pavlikhin O.G., Romanenko S.G. Features of the clinical course and therapeutic tactics for acute laryngitis in voice professionals. / Science and practice in otorhinolaryngology: Materials III Russian scientific and practical conference. M., 2004. - P.122-123.

Otorhinolaryngology. National leadership. Brief edition / ed. V.T. Palchuna. M.: GEOTAR-Media, 2012. 656 p.

Carding P. N., Sellars C., Deary I. J. et al. Characterization of effective primary voice therapy for dysphonia / J. Laryngol. Otol. 2002. - Vol. 116, No. 12. - P. 1014-1018.

Kryukov A.I., Romanenko S.G., Palikhin O.G., Eliseev O.V. The use of inhalation therapy for inflammatory diseases of the larynx. Guidelines. M., 2007. 19 p.

Romanenko S.G. Spicy and chronic laryngitis", "Otorhinolaryngology. National leadership. Brief edition / ed. V.T. Palchuna. - M. - :GEOTAR-Media, 2012 – P. 541-547.

Strachunsky L.S., Belousov Yu.B., Kozlov S.N. Practical guide on anti-infective chemotherapy. – M.: Borges, 2002: 211-219.

Klassen T.P., Craig W.R., Moher D., Osmond M.H., Pasterkamp H., Sutcliffe T. et al. Nebulized budesonide and oral dexamethasone for treatment of croup: a randomized controlled trial // JAMA. – 1998; 279:1629–1632.

Daikhes N.A., Bykova V.P., Ponomarev A.B., Davudov Kh.Sh. Clinical pathology of the larynx. Atlas Guide. - M. - Medical information agency. 2009.- P.160.

Lesperance M.M. Zaezal G.H. Assessment and management of laryngotracheal stenosis. / Pediatric Clinics of North Amrica.-1996.-Vol.43, No. 6. P. 1413-1427.

Appendix A1. Composition of the working group

Ryazantsev S.V.,

Karneeva O.V., Doctor of Medical Sciences, Professor, Member of the National medical association otorhinolaryngologists, no conflict of interest;

Garashchenko T.I., Doctor of Medical Sciences, Professor, member of the National Medical Association of Otorhinolaryngologists, no conflict of interest;

Gurov A.V.,

Svistushkin V.M., Doctor of Medical Sciences, Professor, Member of the National Medical Association of Otorhinolaryngologists, no conflict of interest;

Abdulkerimov Kh.T., Doctor of Medical Sciences, Professor, Member of the National Medical Association of Otorhinolaryngologists, no conflict of interest;

Polyakov D.P., Candidate of Medical Sciences, member of the National Medical Association of Otolaryngologists, no conflict of interest;

Sapova K.I., Member of the National Medical Association of Otorhinolaryngologists, no conflict of interest;

Otorhinolaryngologists.

General practitioners.

Pediatricians.

General practitioners (family doctors).

Table P1. Levels of evidence used

Table P2 - Recommendation strength levels used

Appendix A3. Related documents

Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 905n “On approval of the procedure for providing medical care to the population in the field of otorhinolaryngology.

Order of the Ministry of Health of the Russian Federation dated December 28, 2012 No. 1654n “On approval of the standard of primary health care for acute nasopharyngitis, laryngitis, tracheitis and acute infections upper respiratory tract mild degree heaviness."

Order of the Ministry of Health of the Russian Federation dated November 9, 2012 No. 798n “On approval of the standard of specialized medical care for children with acute respiratory diseases moderate severity."

Appendix B. Patient management algorithms

Appendix B: Patient Information

With the development of acute laryngitis, it is necessary to limit the vocal load. It is prohibited to take hot, cold and spicy food, alcoholic drinks, smoking, steam inhalations. Constant humidification of the air in the room using special humidifiers and taking antiviral drugs are recommended.

Appendix D

Urgent tracheostomy should be performed with careful adherence to surgical technique and comply with the principles of maximum preservation of tracheal elements. The operation is performed under local anesthesia with 20-30 ml of 0.5% novocaine or 10-15 ml of 1% lidocaine under the skin of the neck. Standard styling with a cushion under the shoulders is not always possible due to severe difficulty breathing. In these cases, the operation is performed in a semi-sitting position. A median longitudinal incision is used to dissect the skin and subcutaneous fatty tissue from the level of the arch of the cricoid cartilage to the jugular notch of the sternum. Layer by layer strictly according to midline The superficial fascia of the neck is incised. The sternohyoid muscles are pushed apart bluntly along the midline (linea alba of the neck). The cricoid cartilage and isthmus are exposed thyroid gland, which, depending on the size, moves up or down. After this, the anterior wall of the trachea is isolated. The trachea should not be isolated over a large area, especially its side walls, because in this case, there is a possibility of disruption of the blood supply to this section of the trachea and damage to the recurrent nerves. In patients with normal neck anatomy, the thyroid isthmus is usually displaced superiorly. In patients with thick short neck and the retrosternal location of the thyroid gland, the isthmus is mobilized and displaced downwards behind the sternum by transverse dissection of the dense fascia at the lower edge of the cricoid cartilage arch. If it is impossible to displace the isthmus of the thyroid gland, it is intersected between two clamps and sutured with synthetic absorbable threads on an atraumatic needle. The trachea is opened with a longitudinal incision from 2 to 4 half rings of the trachea after anesthesia of the tracheal mucosa with 1-2 ml of 10% lidocaine solution and a test with a syringe (free passage of air through the needle). If the situation allows, then a permanent tracheostomy is formed at the level of 2 - 4 half rings of the trachea. The size of the tracheal incision should correspond to the size of the tracheostomy cannula. Increasing the length of the incision can lead to the development of subcutaneous emphysema, and decreasing it can lead to necrosis of the mucous membrane and adjacent tracheal cartilage. A tracheostomy cannula is inserted into the tracheal lumen. It is preferable to use tracheostomy tubes made of thermoplastic materials. The main difference between these tubes is that the anatomical bend of the tube makes it possible to minimize the risk of complications associated with irritation caused by contact of the distal end of the tube with the tracheal wall. The tracheostomy remains until breathing is restored through natural pathways.

Immediately after the end of the operation, sanitary fibrobronchoscopy is performed to avoid obstruction of the lumen of the trachea and bronchi with blood clots that got there during the operation.

In urgent situations, when the stenosis is decompensated, the patient undergoes an emergency conicotomy to ensure breathing. The patient lies on his back, a cushion is placed under the shoulder blades, and the head is tilted back. Palpable is the conical ligament, located between the thyroid and cricoid cartilages. Under aseptic conditions, after local anesthesia, a small skin incision is made above the conical ligament, then the conical ligament is pierced with a conicotome, the mandrel is removed, and the tracheostomy tube remaining in the wound is fixed by any available method.

In the absence of special instruments and severe obstruction of the larynx at the level of the vocal folds, it is justified to insert 1-2 thick needles with a diameter of about 2 mm (from the infusion system) into the palpable part of the cervical trachea at the level of 2-3 tracheal rings strictly along the midline. This air gap is enough to save the patient from asphyxia and guarantee his transportation to the hospital.

Acute laryngitis is one of the most common diseases of the upper respiratory tract, characterized by inflammation of the vocal apparatus and larynx.

This disease rarely occurs as a separate pathology and is often accompanied by concomitant diseases of the nasopharynx and lower respiratory system.

Treatment of laryngitis involves symptomatic therapy, which includes medications and inhalation to alleviate the patient's condition.

Acute laryngitis, unlike chronic laryngitis, is temporary, the symptoms of the disease disappear immediately after the main cause is eliminated, in standard cases treatment before full recovery lasts about two weeks.

Acute laryngitis, as a rule, develops against the background of hypothermia, a viral or bacterial infection (measles, whooping cough, scarlet fever), as well as a weakened immune system.

Besides, auxiliary reasons Acute laryngitis may be caused by the following factors:

• prolonged overstrain of the vocal apparatus (loud conversations, screaming, crying);
• burns and injuries of the larynx;
• unfavorable climatic conditions residence, systematic inhalation of dry, cold or hot air;
• work in a dusty room, in a hazardous workplace, with constant interaction with chemical irritants;
• bad habits: smoking and alcohol;
• impaired nasal breathing;
• allergic reactions, long-term drug treatment;
• inflammatory processes in the nasopharynx, nasal cavity or mouth;
• diseases of the gastrointestinal tract, in which aggressive stomach contents enter the esophagus and larynx.

An attack of laryngitis can be triggered by spicy or salty foods, hot or cold foods, and carbonated drinks.

Symptoms of the disease

Acute laryngitis is characterized by an unexpected sharp onset of the inflammatory process in the larynx.

The most common symptoms of the disease are hoarseness, painful swallowing, and discomfort in the throat in the form of soreness or dryness.

To the listed signs of laryngitis, symptoms of cyanosis, difficulty breathing and a dry cough may be added; upon examination, redness of the mucous surface of the larynx is noted.

General clinical picture

Acute pharyngitis has the following symptoms:

• symptoms of general malaise, weakness, elevated temperature. Before prescribing treatment, the doctor performs diagnostics, including a blood test;
• the patient experiences discomfort and painful sensations when swallowing. These symptoms often appear if the inflammation is concentrated on the back of the larynx;
• breathing becomes difficult, the voice becomes hoarse, due to a decrease in the vocal passage and an increase in the inflammatory process;
• the patient experiences dryness, rawness and soreness in the larynx;
• At the initial stage of acute laryngitis, a cough appears, which, as the disease progresses, turns into a wet one. In this case, medications are prescribed to relieve cough symptoms; inhalations and sprays with a bronchodilator (for example, Berodual) are considered the most optimal means;
• Over time, the pain in the throat becomes more intense, a headache is added to it, and the temperature continues to remain high.

In addition to the listed symptoms, other signs may begin to appear.

Temperature increase

A high temperature with laryngitis is observed when the disease has an infectious etiology or occurs against the background of diphtheria, syphilis or tuberculosis, and the patient experiences symptoms such as chills and pain in the larynx.

High fever with laryngitis in children is usually accompanied by symptoms of a common cold, such as cough, runny nose and conjunctivitis.

The temperature in tuberculous laryngitis increases as a result of the inflammatory process spreading from the lungs to the larynx, in diphtheria form infectious agents pass from the tonsils to the mucous surface of the larynx, covering it with a white membrane.

Laryngitis bacterial etiology is also accompanied by an increase in temperature, which characterizes the process of the body fighting infection.

Adequate treatment relieves swelling of the mucous membrane, after which the temperature immediately returns to normal.

How is the disease treated?

Laryngitis, as a rule, has a favorable prognosis, adequate competent treatment leads to complete cure within 7-14 days.

IN otherwise the disease can develop into more serious forms, for example, laryngotracheitis or stenosing laryngitis, in which the patient may experience attacks of suffocation.

In this case, the patient requires treatment in inpatient conditions. General recommendations for the treatment of laryngitis

In the early stages of the disease and in mild cases of acute laryngitis, the following measures are recommended:

• gargle regularly at least 3 times a day, for this purpose use herbal infusions from chamomile, sage, eucalyptus;
• limit the load on the vocal cords: do not talk loudly, do not shout, do not whisper;
• give up spicy foods, cold and hot foods, alcohol and smoking;
• drink a lot of warm liquid (fruit drinks, tea, compotes, mineral water);
• perform alkaline or herbal inhalations. Warm, humid air is considered the main enemy of laryngitis, so effective treatment provide oil-alkaline inhalations, which must be done every three hours;
• put a humidifier in the patient’s room or let him breathe steam in the bathroom (this method has quick help with spasm of the larynx);
• do warm compresses on the throat (honey mustard).

The listed measures help relieve the symptoms of laryngitis and improve the patient’s condition, however complex treatment must necessarily include drugs that eliminate the root cause of the disease.

Inhalations as the basis of therapy

Acute laryngitis is characterized by a systematic dry cough, to eliminate which inhalations with bronchodilators are often prescribed, one of the most effective means Today, inhalations with a nebulizer are considered.

Bronchodilators include components that relax smooth muscles and eliminate spasms.

Berodual, as one of the most effective bronchodilators, contains fenoterol and ipratropium, the combination of which successfully stops coughing attacks or completely eliminates it.

Berodual is produced in the form of a solution for inhalation or as a spray, reduces the volume of mucous sputum in the upper respiratory tract, and also protects the bronchi and blood vessels from exposure to cold air, allergic agents, and prevents the formation of methacholine and histamine.

Immediately after introduction into the body, Berodual is able to block the places where the inflammatory process develops.

Treatment of laryngitis becomes more effective if the drug Berodual is used for inhalation with a nebulizer.

The nebulizer divides each drop of the drug into microparticles and distributes it over the entire surface of the affected larynx.

It is advisable to carry out the first inhalations with a nebulizer under the supervision of a doctor, since correct technique execution is an important factor for achieving results.

It should be noted that inhalations with the drug Berodual are contraindicated in pregnant women, as well as patients suffering from tachycardia and cardiomyopathy.

Antibiotics in the treatment of disease

Acute laryngitis very often develops due to viral infectious diseases, which may also involve a bacterial process; in this case, therapy should include antibacterial drugs.

To treat acute laryngitis, antibiotics from the penicillin group, semisynthetic penicillins, fluoroquinolones, cephalosporins and macrolides are used.

Antibiotics are prescribed by a doctor after complex diagnostics and examination, independent choice of drugs may not only not bring positive dynamics, but also cause complications of the disease.

If acute laryngitis is of a viral nature without the addition of a bacterial infection, antibiotics are not prescribed, as they will not bring any result.

The presence of a bacterial infection, as a rule, can be determined by the following symptoms: chills, increased body temperature, and the release of mucopurulent sputum.

Preventive actions

Despite the fact that in most cases laryngitis has favorable prognosis, at Not timely treatment he can take chronic form, characterized by frequent exacerbations and a sluggish course.

Therefore, to prevent laryngitis and its possible complications, it is recommended to follow some recommendations:

• engage in regular physical exercise, strengthen the body, walk in the fresh air;
• avoid contact with people suffering from ARVI;
• limit your stay in crowded places during periods of exacerbation of acute respiratory infections and influenza;
• avoid hypothermia, limit inhalation of frosty cold air if possible;
• carry out regular cleaning of the living space;
• when working with harmful chemicals use a protective mask;
• carry out preventive inhalations if there is a real threat or the first signs of laryngitis appear.

Prevention of the disease is the best way to combat it.

Acute laryngitis is an inflammation of the mucous membrane of the larynx, submucosal layer, as well as internal muscles, most often of an infectious nature. Typically, acute laryngitis in adults and children occurs in conjunction with a viral or bacterial infection. If the pathology also affects the initial parts of the trachea, the disease is called laryngotracheitis.

In children, the disease often develops in infancy and early preschool age, accompanying up to a third of all inflammatory and infectious diseases. In adults, acute laryngitis can occur in several forms:

1. Catarrhal laryngitis. Light form pathology, causes redness and slight pain in the throat.

2. Hemorrhagic laryngitis. The specificity of the disease is small hemorrhages in the area of ​​the mucous membrane of the larynx and in the vocal folds.

3. Phlegmonous laryngitis. Inflammation of the laryngeal mucosa is purulent in nature. This type of pathology is very rare and is more often associated with trauma to the larynx.

4. Stenosing laryngitis. The disease leads to swelling of the larynx (especially its subglottic region), against which the lumen narrows. In addition to laryngeal stenosis, narrowing of the tracheal lumen may occur, which is fraught with serious complications.

Stenosing (subglottic) laryngitis often develops in children and is called false croup. Obstruction of the larynx in young patients occurs due to its small size and increased looseness of connective tissue. As a result, swelling quickly covers the subglottic space and can lead to a lack of oxygen.

Due to the appearance of acute laryngitis, it occurs:

• Bacterial,
• Viral
• Professional,
• Tuberculosis,
• Diphtheria,
• Syphilitic,

According to the degree of narrowing of the larynx, stenosing laryngitis can be:

• compensated,
• Subcompensated,
• Decompensated
• Terminal stage

At the last stage, it is possible to save the patient in rare cases. All other forms of stenosing laryngitis in adults and children have a favorable prognosis if they seek help in a timely manner.

Why does acute laryngitis develop?

The causes of the disease may be associated with injury to the mucous membrane of the larynx, for example, due to severe voice strain or due to a cold (hypothermia). This causes increased proliferation of bacteria inhabiting the mucous membrane, resulting in the development of symptoms of pathology. Acute laryngitis can be an occupational disease of singers and lecturers, but in this case it is often chronic.

And yet, in most cases, acute laryngitis in children and adults is a complication associated with an infectious disease. The disease can be caused by:

• Influenza viruses, adenoviruses, parainfluenza, measles virus, herpes (respiratory viruses cause up to 70% of cases of acute laryngitis);
• Bacteria specific (tuberculosis, diphtheria, chlamydia) and nonspecific (staphylococci, streptococci, hemophilus influenzae)

Symptoms of laryngitis may appear after a burn to the larynx, after the introduction of a foreign body or other damage to the mucous membrane. In addition, there are a number of factors that provoke acute laryngitis, the influence of which is more likely to lead to the development of this disease:

• Frequent hypothermia, for example, working outdoors;
• Unfavorable ecology in the place of residence;
• Smoking;
• The presence of chronic diseases of the pharynx and sinuses;
• Tendency to food or drug allergies;
• Conditions labor activity, involving work with poisons, chemicals, etc.

False croup in children almost always develops as a complication of influenza, nasopharyngitis, measles, chickenpox, etc. In infancy, acute laryngitis is diagnosed much less frequently in babies who have received full breastfeeding.

Clinical picture of acute laryngitis

Typically, symptoms of laryngitis appear 2-5 days after the onset of the primary infectious disease. If you examine the patient's throat, it appears swollen and bright red. Swelling in the folds of the vestibule of the pharynx is especially clearly visible. Sometimes when severe course acute laryngitis causes small hemorrhages from affected and dilated vessels, which look like red or burgundy dots. If inflammation covers the trachea, a cough occurs (dry, later wet, with sputum discharge). Subjective signs of the disease are represented by the following symptom complex:

• Malaise, symptoms of body intoxication;
• Increased temperature (in adults it is rarely higher than 37.5 degrees, in children - up to 38.5 degrees);
• Sore throat that gets worse when swallowing;
• Feeling of throat distension, sore throat, presence of a foreign body;
• Severe hoarseness of voice;
• Wheezing when breathing;
• Feelings of difficulty in breathing and swallowing.

If a patient develops laryngotracheitis, symptoms include cough. Usually it is very dry, “barking”, and the patient’s voice may completely disappear. If treatment is started at this stage, the cough quickly turns into a wet one, and the symptoms reduce in intensity.

In children under 7 years of age, acute laryngitis can occur in a completely different scenario. If the disease progresses to false croup, then the swelling covers a significant part of the larynx and is externally manifested by periodic attacks. Symptoms of an attack with false croup:

• Violent, rough cough;
• Blue lips, pale face;
• Increased sweating;
• Hoarse, uneven breathing with whistling sounds;
• Fear, anxiety of the child;
• Shortness of breath, lack of air.

Treatment of false croup must be urgent, because acute laryngitis and its symptoms in this case can lead to dire consequences. Usually severe attacks occur at night, which requires special attention from parents to the child’s condition. In addition to possible suffocation, there is a risk of developing cardiac collapse due to the high load on the myocardium.

Diagnostics

Diagnosis and treatment of acute laryngitis is the task of an otolaryngologist. For stenosing laryngitis, direct laryngoscopy is performed. For other forms of pathology, it is often sufficient to collect an anamnesis and external examination of the patient’s throat. Acute laryngitis is differentiated from diphtheria, a retropharyngeal abscess, and in children - from malformations of the larynx.

Treatment of acute laryngitis

For treatment to be successful and quick, some restrictions on diet and daily routine must be introduced in children and adults. It is advisable for the patient to comply bed rest, ensure vocal peace, give up bad habits. The diet should exclude spicy, too salty, cold, and hot foods. You should drink as much warm mineral water, herbal teas, and warm milk as possible.

Drug treatment of pathology such as acute laryngitis in children and adults includes:

1. Antibacterial therapy. Treatment is usually prescribed if laryngitis becomes protracted course or purulent character. In addition to antibiotics, the patient is prescribed sulfonamide drugs.

2. Cough medications (inhibiting the cough center - for a non-productive cough, expectorants and thinning mucus - for a wet cough).

3. Prelytic enzymes are prescribed in the presence of sputum that is too viscous and difficult to separate.

4. Vitamins, restoratives, immunostimulants.

5. Antihistamines (if you are prone to edema).

6. Antiviral agents (if).

7. Anti-inflammatory, antipyretic drugs for high temperature and severe pain in the throat.

Acute laryngitis in adults and children goes away faster if local treatment is used:

• Inhalations with antibiotic solutions;
• Irrigation of the throat with local antiseptics, antibiotics (for example, Bioparox, Hexoral);
• Instillations into the larynx oil solutions together with antibiotics, anti-inflammatory drugs, glucocorticosteroids (according to indications);
• Lozenges and lozenges to relieve symptoms of the disease (for example, Septolete, Faringosept)

Non-drug treatment includes:

1. Steam inhalations with mineral water to relieve dryness and tickling.

2. Warm compresses.

3. Mustard plasters, warming the feet with mustard powder.

4. After acute symptoms have been relieved, treatment may include physiotherapy (UHF, microcurrents, electrophoresis).

An acute attack of stenosing laryngitis in a child requires an urgent call to an ambulance.

If signs of false croup develop in children or with severe swelling of the larynx in adults, the emergency treatment program includes intravenous administration of antihistamines, glucocorticosteroids, antispastic agents, sedatives, as well as instillation of adrenaline. The ineffectiveness of therapy sometimes leads to the need for surgical treatment - tracheostomy and tracheal intubation.

Treatment of laryngitis with traditional methods

Traditional methods are allowed for use in uncomplicated laryngitis in adults. IN childhood the course of treatment should contain only medications recommended by the doctor. The most effective recipes:

1. Rub a cotton cloth laundry soap, tie to the throat area and leave overnight. Repeat every evening for 5-6 days.

2. Every day for 2 weeks, take a spoonful of honey combined with 10 drops of aloe juice. Repeat the procedure twice a day.

3. Take 100 ml. a mixture of carrot juice and potato juice in equal parts, which was slightly warmed up. Continue treatment until recovery.

4. Add 30 ml to warm milk (glass). radish juice, drink in small sips. Repeat 2 times a day for at least a week.

Because the specific methods There is no prevention of laryngitis, you should protect yourself and your child as much as possible from contact with sources of infection, stop smoking, avoid damage to the larynx and hypothermia, because preventing the disease is much easier than curing it!

– acute or chronic inflammatory process in the mucous membrane of the larynx and vocal cords, most often viral nature. It manifests itself as a feeling of dryness, scratching in the throat, hoarseness or lack of voice, and a “barking” cough. In young children, there is a danger of developing false croup - swelling of the laryngeal mucosa, blocking the flow of air. The prognosis is generally favorable; the acute form of the disease may transition to chronic.

General information

– acute or chronic inflammatory process in the mucous membrane of the larynx and vocal cords, most often of a viral nature. It manifests itself as a feeling of dryness, scratching in the throat, hoarseness or lack of voice, and a “barking” cough. In young children, there is a danger of developing false croup - swelling of the larynx, blocking the flow of air. The prognosis is generally favorable; the acute form of the disease may transition to chronic.

Acute laryngitis

Acute laryngitis rarely develops as an independent disease. Usually it is one of the manifestations of ARVI, measles, influenza, whooping cough, scarlet fever and a number of other diseases. It is seasonal.

The risk of developing acute laryngitis increases with general or local hypothermia, inhalation of dusty air and irritating substances, overstrain of the vocal cords, smoking, gastroesophageal reflux, and alcohol abuse. Risk factors may include age-related changes larynx (deformation of the vocal cords, insufficient hydration of the mucous membrane, muscle atrophy).

Classification

Depending on the nature and depth of the lesion, two forms of acute laryngitis are distinguished:

• Acute catarrhal laryngitis. The process involves the mucous membrane, submucosal layer and internal muscles of the larynx.
• Acute phlegmonous laryngitis. Purulent lesion surface layers, muscles and ligaments of the larynx. Sometimes cartilage and periosteum are affected.

Symptoms

The disease begins acutely against the background of complete health or slight malaise. Patients complain of dryness, burning, tickling, and scratching in the larynx. Sometimes there is a sensation of a foreign body, a convulsive superficial cough or pain when swallowing. The voice “sits down”, becomes rough and hoarse.

It is possible to develop aphonia, in which the patient can only speak in a whisper. Body temperature is normal or subfebrile. After some time, the cough becomes wet and separates when coughing. a large number of mucous or mucopurulent sputum. The duration of acute laryngitis is 7-10 days. In most cases, recovery occurs. Transition to subacute or chronic laryngitis is possible.

Complications

When the inflammatory process spreads to the subglottic space, acute laryngeal stenosis develops. In young children, acute laryngitis is sometimes accompanied by pronounced edema mucous membrane of the larynx (false croup). Air access becomes difficult, the child suffocates, worries, and cries. In severe cases, brain function may be disrupted due to hypoxia. Loss of consciousness and even coma are possible. Symptoms of false croup are an indication for urgent hospitalization.

Diagnostics

The diagnosis of acute laryngitis is established by an otolaryngologist based on the characteristic clinical picture and the results of a laryngoscopic examination. Laryngoscopy reveals swelling and diffuse hyperemia of the laryngeal mucosa, thickening and hyperemia of the vocal folds. There are pieces of sputum on the surface of the vocal cords. With the flu, hemorrhages sometimes appear in the mucous membrane.

IN general analysis leukocytosis is determined in the blood. If the bacterial nature of the infectious agent is suspected, a bacteriological examination discharge and washings from the oropharynx.

Treatment

Treatment of acute laryngitis is carried out on an outpatient basis. In case of acute laryngitis that occurs against the background of ARVI, the patient is prescribed bed rest. In other cases, exemption from work is issued only to persons whose work requires constant performances (presenters, artists, teachers, lecturers, etc.).

Patients with acute laryngitis are advised not to talk if possible. When speaking, you should speak as quietly as possible, but not in a whisper, pronouncing the words as you exhale. Spicy, cold and hot foods are excluded from the diet. Smoking or drinking alcohol is prohibited. For thick, viscous sputum, expectorants (liquid thyme extract, potassium bromide, marshmallow root extract) and sputum thinners (ambroxlol, bromhexine, acetylcysteine) are prescribed. It is recommended to drink warm alkaline water. To reduce inflammation, steam inhalations and warming semi-alcohol compresses are used on the neck area. Aerosol antibiotics are used locally. Perform distracting procedures (mustard plasters, moderately hot foot baths). If acute laryngitis lasts for a long time and treatment is ineffective, antibiotic therapy is performed.

The prognosis is favorable. IN in some cases transition from acute laryngitis to chronic is possible.

Chronic laryngitis

Chronic laryngitis can result from acute laryngitis or develop as a result of prolonged exposure irritating factors(dust in the air, inhalation of irritating substances, smoking, etc.). In people of certain professions (speakers, lecturers, artists), laryngitis occurs as a result of constant overstrain of the muscles and ligaments of the larynx.

Classification

Based on the nature of the lesion, catarrhal, hyperplastic (limited or diffuse) and atrophic chronic laryngitis are distinguished. People in vocal professions develop limited hyperplastic laryngitis (vocal cord nodules, also called singers' nodules or screamers' nodules).

Symptoms

The general condition is not disturbed. Patients note hoarseness, a feeling of rawness and soreness in the throat, and rapid voice fatigue. Cough with sputum appears periodically. Symptoms intensify as the process worsens.

Diagnostics

The basis for the diagnosis of “chronic laryngitis” is the clinical picture and laryngoscopic examination data. Laryngoscopy of a patient with chronic catarrhal laryngitis reveals congestive edema and hyperemia of the laryngeal mucosa.

The characteristic laryngoscopic picture of diffuse hyperplastic laryngitis includes swelling, hyperemia, thickening of the mucous membrane, fusiform thickening of the free edges of the vocal cords. With limited hypertrophic laryngitis symmetrical nodular formations are observed. The lumen of the larynx is filled thick mucus.

A laryngososcopic examination of a patient with chronic atrophic laryngitis reveals dryness and thinning of the laryngeal mucosa. The larynx is covered with thick mucus that forms crusts.

Treatment

Factors that support inflammation should be excluded and the correct voice mode should be observed. Patients are advised to give up smoking, drinking alcohol, spicy, hot and cold foods. Warm drinks, physiotherapy (quartz, UHF, magnetic therapy), alkaline and oil inhalations are prescribed.

Areas of hypertrophy in chronic hypertrophic laryngitis are cauterized with 5% silver nitrate, large nodules are removed surgically. Surgery is performed to remove excess vocal fold tissue. Patients suffering from chronic atrophic laryngitis are recommended to lubricate the larynx daily with Lugol's glycerin solution. To soften the crusts and facilitate the process of their removal, aerosol preparations of proteolytic enzymes (chymotrypsin, chymopsin) are prescribed.