Chronic form of hyperplastic laryngitis. Clinical picture of the disease. Causes of the disease

Voice speech - the most important way communication for a person, its formation involves primarily the larynx with the vocal cords, and then other structures. Diseases of the larynx, including chronic atrophic laryngitis, lead to impaired vocal function.

What happens in the larynx during laryngitis

The exact translation of the term “laryngitis” means inflammatory disease larynx. In this case, the mucous membrane is the first to change, because it is the one that comes into contact with substances and microorganisms coming from outside. But the underlying layers are also involved in pathological reactions.

Laryngitis can be acute or chronic. They differ not only in terms of development, but also in the processes that occur, which is manifested by different symptoms.

The acute form of the disease most often occurs with a predominance of edema. In chronic disease, swelling also occurs, but changes in the structure of the laryngeal wall and circulatory disorders in it predominate.

The atrophic process develops over a long period of time. These are deep and irreversible changes that lead to thinning of the layers and disruption of the tissue structure. The mucous membrane, vein walls and glands change.

Initially, inflammatory infiltration appears in the outer layers of the laryngeal wall. The tissues gradually become denser and are replaced by connective tissue fibers.

The number of glands decreases, and the quality of the mucus they produce changes.

Since some vessels stop functioning, the saturation of tissues with oxygen and nutrients deteriorates. This supports ongoing processes.

Formation connective tissue makes atrophy irreversible. The changes that occur determine the symptoms of laryngitis.

Etiology of laryngitis

Atrophic laryngitis can have external and internal causes:

1. unfavorable factors environment;
2. infectious diseases of the respiratory tract;
3. diseases of other localization.

Long-term and regular contact with harmful substances and their inhalation has a local irritant effect and leads to damage to the mucous membrane. It may be gaseous chemical compounds, smoke, dust, mist, dry air. Tobacco smoke has a similar effect. Residents of hot countries with dust and sand storms are susceptible to this disease.

There is an opinion that the use of hot spices can have an irritating effect not only on the pharynx, but also on the larynx, creating a background for changes in its tissues.

Laryngitis often develops after suicide attempts with poisoning vinegar essence. Inhalation of vinegar vapor leads to a deep chemical burn of the larynx, lower and overlying sections respiratory system. Healing of such a lesion occurs with scars and atrophy.

TO external influences Radiation damage can also be attributed. The larynx is exposed to x-rays when treating tumors located in nearby organs.

Infections can lead to acute disorders and edema, the outcome of which will be scarring and atrophy of the mucosa. Some pathogens also affect the walls of blood vessels, disrupting tissue nutrition.

The same process occurs when systemic diseases. Therefore, atrophic laryngitis can develop as a result of amyloidosis, sarcoidosis, rheumatoid arthritis, granulomatosis.

Secondary laryngitis occurs with tuberculosis and syphilis. In this case, bacteria usually penetrate the wall of the larynx through the bloodstream. With these diseases, specific foci (tuberculosis and tertiary syphilis) or diffuse lesions of the mucous membrane (secondary syphilis) form near the vessels and under the mucous membrane.

Their ulceration followed by rough scarring leads to atrophy.

Damage to the larynx may be one of the symptoms of metabolic disorders due to diabetes mellitus and other endocrine pathologies, at renal failure, as well as for diseases of the heart, digestive system and frequent allergic manifestations.

Long-term reflux esophagitis may be accompanied by laryngitis. The acidic contents of the stomach irritate the esophagus and can travel to the back of the throat and into the larynx.

The presence of an atrophic process in the larynx requires identifying the cause not only among possible factors environment, but also a diagnostic search for internal organs.

Clinical picture

Atrophic laryngitis has external symptoms and signs detected during examination of the larynx. In addition, a general examination may reveal symptoms indicating damage to other organs. This may suggest the cause of laryngitis.

TO external manifestations manifested in the patient’s complaints include:

1. symptoms of dry mucous membranes;
2. cough;
3. voice changes.

Due to a decrease in mucus production and a change in its quality, dry mucous membranes are noted. Therefore, frequent complaints include tickling, coughing, feeling foreign body.

With atrophic laryngitis, in addition to coughing, there are coughing attacks. It is suffocating and unproductive.

The sputum produced is thick, viscous, and may be streaked with blood. Blood appears after the crusts are separated and when the mucous membrane is damaged during a hacking cough. This symptom requires clarification of the localization of the process so as not to miss lung diseases.

A mandatory symptom is a change in voice. It becomes hoarse, hoarse, the voice becomes fatigued, and its timbre changes.

Upon examination, the larynx space looks somewhat expanded. The vocal folds are thinned, symmetrical and loosely closed. The main symptom during laryngoscopy is specific changes in the mucous membrane.

It is thin, dull, rough, with translucent vessels, covered thick mucus, dry crusts.

And in places where the crusts separate, there may be minor hemorrhages and damage. If the cause of the disease was burns or some infections, then ulcers, uneven or deep scars may be visible, sometimes deforming the wall of the larynx.

When chronic atrophic laryngitis is detected, the doctor prescribes treatment and must try to identify the etiology.

If the disease is irreversible, then how to treat it?

The atrophic process cannot be reversed. But treatment is necessary to make you feel better and reduce the progression of atrophy.

To alleviate the patient’s condition, it is first necessary to identify and minimize as much as possible the factors that irritate the respiratory system. Elimination of occupational hazards, quitting smoking, use of protective equipment (respirators).

Gives a good effect spa treatment, with accommodation by the sea, in wooded or mountainous areas.

Treatment goals for atrophic laryngitis:

1. cleansing the mucous membrane from crusts;
2. healing of microdamages;
3. moisturizing the surface of the larynx;
4. stimulation of the glands;
5. treatment of the underlying disease that led to laryngitis;
6. for microbial etiology - the use of antibacterial agents.

Thus, treatment should be aimed at both relieving symptoms and correcting the cause of laryngitis. Monitoring blood sugar levels is mandatory.

Drugs are used to cleanse and moisturize the mucous membranes. local action in the form of inhalations, lubrication, irrigation. These are alkaline solutions, mineral waters (carbon dioxide and hydrogen sulfide), oil inhalations, enzyme solutions (Trypsin, Chymotrypsin). An oil solution of menthol and Lugol's solution are suitable for lubrication.

To treat cough, it is necessary to improve sputum discharge with the help of mucolytics. Preparations based on carbocisteine ​​and Mucaltin are well suited.

Physiotherapy is used - UHF inductothermy, darsonval, mud applications.

Atrophic laryngitis does not threaten the patient’s life, but significantly worsens its quality. The cure will not be complete, although therapy helps to significantly alleviate the patient’s condition.

Hypertrophic laryngitis is not independent disease, develops after other diseases of the pharynx. With such inflammation, it infiltrates muscle throat, deformation occurs vocal cords. Epithelial tissue hypertrophies, thickening of the entire mucous membrane appears.

Depending on the nature of the ongoing processes, the disease can be diffuse and limited. In the first case, changes even affect the edges of the vocal cords. With a limited form, the mucous membrane does not change much, but symmetrical formations appear. IN in rare cases they only appear on one side. This is a prerequisite for further research for the presence of cancer.

Hypertrophic laryngitis: etiology

Most often, the disease occurs in people who are forced to frequently strain their vocal apparatus. These are singers, teachers, speakers.

Causes, provoking factors

There are several factors that influence the formation of the disease. One of the important prerequisites that influences not only the development of the disease, but also the occurrence of complications, is smoking. In addition, the following can lead to the development of the disease:

• Impaired immune function.
• Hormonal imbalance.
• Deviation of the nasal septum.
• Tracheal intubation.
• GERD.

Most often, the disease is diagnosed in men over 35 years of age, as well as in patients with a genetic predisposition, vocalists, artists, and teachers.

Symptoms

According to the first symptoms, this type of laryngitis is similar to. It is manifested by swelling of the mucous membrane. A distinctive feature is the complete absence of voice and severe hoarseness.

In adults

Difficulty intermittent breathing is noted. body pressure rarely rises, usually it reaches 37.4. Thick mucus accumulates in the larynx area. A sharp, barking and... appears. During the period of remission, a slight cough is possible. There is a sensation and complete loss of voice. These symptoms lead to disruption of the patient's quality of life.

In children

Breathing is usually very difficult due to... Possible appearance high temperature body and stenosis. A sign of the latter is cyanosis of the nasolabial triangle and respiratory failure. The appearance of such signs requires immediate medical attention.

Symptoms of laryngitis:

Diagnostics. Research methods

To make an accurate diagnosis, various procedures:

• allows you to detect swelling and changes in the vocal cords, and detects hemorrhages. Thanks to this method, the diagnostician has the opportunity to examine in detail the inner surface of the larynx.
• It is carried out with the help of special lighting. This method is considered one of the oldest.
• Rhinoscopy is used to examine the nasal cavity.

An accurate diagnosis of the disease is made after taking a general and urine sample. These studies reveal the presence of an inflammatory process in the body. To make treatment more effective, nasopharyngeal swabs are prescribed to detect pathogenic microflora.

Types of pharyngitis

Treatment

Treatment of the disease is not always successful. Changes in the mucosa can be considered a precancerous condition. Therefore, patients with this diagnosis should be registered at the dispensary.

Treatment of hypertrophic laryngitis is always a long process. At this time it is necessary:

1. Drink plenty of fluids.
2. Protect the body from hypothermia.
3. Do not smoke or drink alcohol.
4. Ventilate the room regularly.
5. Eat only warm foods, avoid spicy foods and carbonated drinks.

The treatment process always takes place under the supervision of a doctor. It is best if the temperature at home is maintained at 20 degrees and humidity at 55-60 percent. The presence of tobacco smoke in the apartment is unacceptable.

Medication

Drug therapy includes targeted shading of hypertrophic areas every 2-3 days until they disappear completely. To reduce inflammatory processes, an infusion into the larynx is prescribed, hormonal drugs. To speed up the healing process, an infusion with a syringe is prescribed. oil solution, silver nitrate, .

If the disease allows surgical intervention to be avoided, a course of drug therapy. It includes the use of antibiotics,...

If it appears against the background of the disease, drugs are prescribed that suppress it. This is especially true for dry barking cough. In addition, the course of treatment includes taking vitamins and medications to stimulate the immune system.

Appointed:

• Mucolytics and expectorants that thin and effectively remove mucus.
• Antihistamines to cope with swelling of the larynx.

However, antibiotics systemic action, as with, are often not prescribed, since the disease is more associated with overstrain of the vocal cords. Their purpose is relevant only when joining.

Folk remedies

There are several effective recipes:

• tea tree, With .
• beet juice. This method allows you to soothe, relieve pain and swelling of the mucous membrane.
• To restore the functioning of the vocal cords, take half a glass of anise seeds. They need to be filled with 2 glasses of water and boiled for 10-15 minutes. The broth is filtered, 2 tablespoons and 1 spoon of cognac are added to it. You need to drink 20 ml every 40 minutes.

Recipes for treating laryngitis with folk remedies:

Features of treatment during pregnancy

If a woman is carrying a child, the treatment is selected so as not to harm the fetus. Antibiotics that do not have teratogenic properties are used. Alkaline and drinking mineral water are actively prescribed.

All methods are selected only by a doctor. After delivery, if the disease has not disappeared, minimally invasive or surgical treatment can be used. It is important to strictly adhere to the course of therapy, bed and voice rest.

Physiotherapy

With this form of laryngitis, alkaline and oil inhalations are possible to soften the mucous membrane. As a result, sputum begins to separate better and the cough weakens. Amplipulse therapy is often prescribed. It improves blood supply and accelerates the healing process of the mucous membrane.

Prevention

Preventative measures include quitting smoking, alcohol, and observing respiratory protection measures. If in the course of your professional activity you are forced to constantly use your vocal cords, then you must undergo regular examinations by a phoniatrist and follow all his recommendations.

In addition to these measures, hardening should be carried out and throat diseases should be treated in a timely manner. In the presence of chronic forms It is useful to visit sanatoriums, resorts, and take oxygen cocktails.

Forecast

With hypertrophic laryngitis, complete recovery does not occur. Therefore, treatment and lifestyle should be aimed at creating long-term remission. At proper treatment the risk of developing cancer is reduced.

Hyperplastic laryngitis is one of the types chronic inflammation laryngeal mucosa. The classification of laryngitis is very broad. The treatment tactics for this disease in each individual case are chosen depending on the specific type it belongs to.

Types of laryngitis

The classification of inflammation of the larynx is based on several criteria.

First of all, it can be acute or chronic.

Acute catarrhal and phlegmous (purulent) inflammatory processes of the laryngeal mucosa occur.

At catarrhal form a disease, a type of which is stenosing laryngitis, in which only the mucous membrane of the larynx is inflamed.

Stenosing laryngitis (or false croup) is diagnosed if, due to the proliferation of the mucous membrane, a narrowing of the lumen of the larynx occurs, which causes suffocation. Often inflammatory process invades the trachea and even the bronchi.

Narrowing of the lumen of the larynx with false croup

Stenosing laryngitis develops for the following reasons:

• complications after ARVI, addition of a bacterial infection;
• allergic reactions in children who have a physiologically narrow lumen of the larynx, therefore, the consequence of swelling and inflammation of the mucous membrane is difficulty and spasm of breathing.

Stenosing laryngitis is characterized by an acute onset, especially in children. False croup most often occurs at night. The severity of the patient's condition depends on the degree of stenosis, there are only four of them. The first is difficulty breathing for a few seconds or longer. The second and third stages are characterized by increased cough, worsening of the patient’s condition, pallor skin, cyanosis (blue lips and limbs), adynamia, hypoxemia, increasing heart failure. The fourth degree is asphyxia.

Stenosing laryngitis is diagnosed based on examination and symptoms, suggesting the exclusion of getting into Airways foreign body and respiratory allergosis.

Symptoms:

• nonproductive barking cough;
• sore throat;
• hoarse voice;
• labored breathing.

Treatment depends on the stage:

• distraction therapy (mustard plasters on calves, hot foot baths);
• steam inhalations with alkaline mineral waters (Borjomi, Narzan, Polyana Kvasova) or solutions;
• frequent warm drinks;
• inhalations with aminophylline and hydrocortesone;
• antispastic medicines;
• antihistamines;
• hyposensitizing drugs;
• vitamins and immunostimulants.

Treatment with drugs as for stage 1, plus antibiotics, hormones (hydrocortisone, prednisolone), cardiac and hypertensive drugs, humidified oxygen. Diuretics and neuroleptic drugs.

This extensive treatment is carried out in a hospital.

With stage 3 and diagnosis of stage 4, the patient is in the hospital, where, in addition to drug treatment According to indications, laryngoscopy and bronchoscopy are used, and there is also a willingness to perform tracheostomy.

Phlegmous laryngitis is diagnosed if the inflammatory process involves the submucosa, muscles and ligaments, as well as the perichondrium of the laryngeal cartilage. If joins bacterial infection, the disease becomes purulent in nature.

Chronic inflammation of the laryngeal mucosa can be catarrhal, hyperplastic and atrophic. Chronic hyperplastic laryngitis is especially difficult; to cure it, 5-10 days are no longer enough, as for acute form diseases. You need to be prepared for the recovery process to take three weeks or more.

How to identify and treat hyperplastic inflammation of the larynx

Hyperplastic laryngitis is an inflammatory process of the laryngeal mucosa, consisting of hyperplasia (increase in the number) of cells of the laryngeal mucosa. As a result, folds and blockages form on the vocal cords, a violation of the closure of the vocal cords, which manifests itself in such an obvious symptom of the disease as hoarseness of the voice and a single dry, irritating cough (a limited form of the disease).

Hyperplastic laryngitis (pachydermia of the posterior wall of the larynx and vocal processes) with an area of ​​ulceration on the left.

The hyperplastic process can occur in a diffuse form when most of the laryngeal mucosa is affected. As a result, it appears copious mucus, which accumulates on the vocal cords and interferes with their normal functioning.

Chronic hyperplastic laryngitis can be a consequence of frequent or untreated acute laryngitis, and it can also develop as an independent pathology. It is classified as a precancerous disease, so regular medical examinations are necessary.

In chronic hyperplastic laryngitis, vascular congestion occurs, blockage occurs excretory ducts glands of the mucous membrane and metaplasia (replacement) of the ciliated epithelium (normal) of the mucous membrane with multilayered squamous epithelium is formed.

Causes hyperplastic laryngitis:

• ARVI;
• external irritating factors (occupational stress on the vocal cords of actors, lecturers; smoking; mechanical damage);
• anatomical and physiological individual characteristics;
• hypovitaminosis;
• allergy.

Symptoms of hyperplastic laryngitis:

• hoarse voice;
• sore throat and constant desire clear throat;
• irritating intermittent dry cough;
• aphonia is possible.

The examination reveals hyperemia, infiltration and swelling of the mucous membrane of the larynx and true and vestibular vocal cords. CT scan and tissue biopsy confirms the hyperplastic process.

Unfortunately, treatment of hyperplastic laryngitis is long and complex.

Applicable:

• anti-inflammatory therapy;
• antibiotics;
• treatment with corticosteroids;
• treatment with antihistamines.

IN certain cases it will be necessary to use antispastic therapy and hyposensitizing drugs and novocaine blockade

Also necessary is a local effect on the larynx, which consists of injecting astringent solutions into it. Among them are 0.25% zinc sulfate solution, hydrocortisone solutions and 20% albucid solution.

Inhalations of Sofradex, corticosteroids, and streptomycin are used. Electrophoresis with potassium iodide is also prescribed

Voice rest and elimination will be important in treatment. irritating factors. It is also necessary to follow a diet consisting of avoiding too hot and cold foods, spicy and salty foods. Quitting alcohol and smoking is required.

Observation by a doctor will reveal positive dynamics in eliminating the inflammatory process with effective treatment. However, the question of endolaryngeal surgery and subsequent tissue histology will become possible. Among endolaryngeal methods, the following are effectively used:

• cryodestruction;
• laser therapy;
• radiotherapy.

The prognosis for a disease detected on time is favorable, and with proper treatment the patient recovers. If this form of laryngitis is neglected, it may degenerate into laryngeal cancer.

Chronic laryngitis is an inflammation of the mucous membrane of the larynx lasting more than 3 weeks. Timely diagnosis and adequate treatment of this pathology are extremely important, since it is social problem, leading to disability of persons in voice-speech professions - vocalists, actors, teachers, tour guides. It may occur, that is, their degeneration into a cancerous tumor.

Causes of chronic laryngitis

A role in the development of chronic inflammatory process in the larynx is played by:

• frequent;
• chronic foci of infection of other localization (sinusitis, caries);
• opportunistic microflora of the oral cavity;
• accompanying somatic pathology, in particular GERD (with this disease, the acidic contents of the patient’s stomach are thrown into the esophagus, burning the mucous membrane, which creates favorable conditions for the proliferation of microorganisms in this area);
• metabolic diseases (in particular, diabetes mellitus);
• dust, food, chemical allergens;
• regular excessive load on the vocal apparatus;
• working or living in conditions of severe air pollution with dust or chemicals;
• sudden changes in temperature;
• smoking and drinking alcohol;
• decrease in the body's overall resistance.

Chronic laryngitis: symptoms and diagnosis

The leading symptom of chronic inflammation of the larynx is a change in the timbre of the voice, its hoarseness. The disease may manifest itself constant feeling, a feeling of the presence of a foreign body or coma in it. Patients are worried about constant coughing to a paroxysmal painful cough. During the period of remission, the above symptoms are mildly expressed, and during exacerbation their intensity increases, body temperature rises to subfebrile levels, and complaints of weakness, fatigue and headache may appear.

Diagnosis acute laryngitis is set on the basis of the patient’s complaints, taking into account data from the medical history and life, and is confirmed during laryngeal or video endoscopy - a simple examination of the larynx area or examination of it using a video endoscope device. In some cases, for the purpose accurate diagnosis microlaryngoscopy is used (examination of the laryngeal mucosa under a microscope). If a malignancy of the process is suspected, a puncture biopsy is performed during a laryngoscopic examination - sampling of the affected cells with a special needle for subsequent histological examination.

Depending on the morphological changes in the laryngeal mucosa and the predominant symptoms of the disease, acute laryngitis is usually divided into 3 forms: catarrhal, hypertrophic and atrophic.

With catarrhal form chronic laryngitis the mucous membrane of the larynx is diffusely thickened, moderately hyperemic, blood vessels are visualized on the swollen vocal folds. During phonation, the glottis does not close completely. This form of the disease is manifested by constant hoarseness, a sore throat, fatigue vote. In addition, patients are occasionally bothered by a moderately intense cough with clear or whitish sputum.

Chronic hypertrophic laryngitis can be diffuse or limited. In the diffuse form, the mucous membrane of the larynx is uniformly swollen; in the limited form, symmetrically located connective tissue tubercles are visualized in the area of ​​the vocal folds (singers’ nodules in adults, screamers’ nodules in children). A characteristic clinical sign of hypertrophic laryngitis is severe hoarseness of the voice, up to its complete absence - aphonia.

In the atrophic form of chronic inflammation of the larynx, its mucous membrane is dry, thinned, covered with thick mucus and crusts. Clinically, the disease is manifested by a constant feeling of soreness and dryness in the throat, in which crusts streaked with blood come off. Hoarseness during the day is expressed differently: in the morning it is stronger, after clearing the throat it decreases.

Chronic laryngitis: treatment

Unfortunately, it is impossible to completely get rid of this disease, so the goal should be to reduce its manifestations and improve the patient’s quality of life.

Non-drug methods are of great importance in the treatment of chronic inflammation of the larynx:

• to give up smoking;
• voice rest;
• gentle nutrition (warm, soft, neutral-tasting food, exclusion of spicy, hot and cold foods, carbonated drinks);
• drinking plenty of fluids(alkaline mineral waters (“Naftusya”, Borjomi), warm milk with honey);
• prevention of hypothermia;
• ventilate the room in which the patient lives for 10 minutes every hour;
• adequate microclimate (temperature and humidity) in the room.

An important component of the treatment of chronic laryngitis is timely treatment of the accompanying pathology (sanitation chronic foci infections, correction of blood glucose levels, treatment of GERD).

Further aspects of therapy are different for different forms diseases, so we will consider each of them separately.

Treatment of chronic catarrhal laryngitis

This form of the disease is very treatable. In addition to the above non-drug measures, drug therapy is also used:

• antiviral drugs (interferon inducers, Groprinosin);
• if necessary, systemic antibiotics (Amoxiclav, Moexipril);
• oil and alkaline inhalations;
• antitussives (Codeine);
• expectorants (preparations of marshmallow, ivy, plantain) and mucolytic (Acetyl-, Carbocysteine, Ambroxol, Bromhexine) agents;
• local anti-inflammatory and analgesic drugs (Isla lozenges, Neo-angin, Decatylene, Angilex sprays, Tera-flu, Ingalipt);
• local antibacterial drugs(Bioparox);
• multivitamin preparations (Duovit, Multitabs);
• immunomodulators (Respibron, Ribomunil);
• preparations containing bacterial lysates (IRS-19).

In a hospital setting, infusions of medications into the larynx using a special laryngeal syringe are also prescribed - so-called instillations.

When the symptoms of an exacerbation regress, the use of physiotherapeutic methods of treatment is recommended:

• novocaine electrophoresis;

Treatment of chronic atrophic laryngitis

If appropriate symptoms are present, the same remedies are used that are recommended for the treatment of the catarrhal form of the disease. A feature of the treatment of atrophic laryngitis is inhalation of proteolytic enzymes (Chymotrypsin, Trypsin) in the form of aerosols.

Treatment of chronic hypertrophic laryngitis

Depending on the patient’s condition, treatment can be conservative (include all or some drugs from the above groups) or surgical. The essence of the latter is that under local anesthesia under the control of a microscope, an ENT surgeon removes hyperplastic tissue. An equally popular method of surgical intervention is the removal of growths from the vocal folds using a cold plasma beam - coblation.

After the operation, the patient must follow the following recommendations:

• do not eat for 2 hours after leaving the operating room;
• do not cough (to avoid mechanical injury postoperative wound);
• complete vocal rest for the next 5–7 days;
• sharp limitation of physical activity in the next 7–8 days.
• gentle diet;
• avoid contact with tobacco smoke, quit smoking.

Prevention of chronic laryngitis

Main preventive measures are:

• timely and adequate treatment of acute and chronic infectious diseases and somatic pathology;
• maintaining an adequate voice regime (avoiding overload of the vocal apparatus);
• regular observation of people in voice-speech professions by a phoniatrist;
• refusal of active and passive smoking, drinking alcohol;
• strengthening common protective forces body (walks on fresh air, dosed physical exercise, cold water rubdowns, foot baths and other activities).

About the treatment of laryngitis and how to distinguish it from similar diseases, in the program “Dr. Komarovsky’s School”:

Laryngitis– a disease of the respiratory system that affects the mucous membrane of the larynx. The disease is accompanied by a change in voice, even total loss, cough, breathing problems. The most severe complication of laryngitis is complete occlusion of the upper respiratory tract (larynx stenosis), which most often occurs in children.

What are the larynx and vocal cords?

The framework of the larynx is created by cartilages: 3 paired (arytenoid, sphenoid and corniculate) and 3 unpaired (thyroid, epiglottis and cricoid).

All cartilages are connected to each other by strong ligaments and joints. The largest and most clinically significant of them are: the conical ligament (connects the cricoid and thyroid cartilages) and the thyrohyoid ligament (connects the hyoid bone and thyroid cartilage).

Two paired joints, the cricothyroid and cricoarytenoid, help the larynx perform active movements. Thus, the cricothyroid joint allows the thyroid cartilage to tilt forward and backward, which helps to tighten or relax the vocal cords. Movements in the cricoarytenoid joints make it possible to narrow and expand the glottis (convergence and divergence of the vocal folds).
In implementation motor activity larynx The main role is played by the muscles of the larynx.

There are the following groups of muscles of the larynx: external and internal.

External(sternothyroid, thyrohyoid) muscles help raise and lower the larynx. Due to the contraction of the internal muscles, the cartilage of the larynx moves, which in turn changes the width of the glottis. There are muscles that help expand the glottis and muscles that narrow it. Glottis dilators: paired posterior cricoarytenoid muscle, which moves the arytenoid cartilages along with the vocal folds.

Muscles that narrow the glottis: 1) lateral cricoarytenoid, 2) transverse interarytenoid, 3) arytenoid oblique muscle, 4) cricothyroid muscle, 5) vocalis muscle. The internal muscles also include the muscles that elevate and depress the epiglottis (the thyroepiglottic and aryepiglottic muscles).

The cavity of the larynx is narrowed in the middle section and expanded upward and downward, thus resembling an hourglass in shape. The mucous membrane lining the inside of the larynx is a continuation of the mucous membrane of the nose and pharynx. There are sections of the larynx where under the mucous membrane there is a layer of loose fiber (folds of the vestibule, subglottic space, lingual surface of the epiglottis). If inflammation and swelling develop in such places, this leads to difficulty breathing (stenosis), up to complete closure of the airways (obstruction). Between the folds of the vestibule and the vocal folds is the ventricle of the larynx. This ventricle contains lymphatic tissue and when it becomes inflamed, “laryngeal sore throat” develops.

Vocal cords. Speech therapists use the term “vocal cords” more often in professional vocabulary than vocal folds. However, the "vocal cords" are folds of mucous membrane that project into the laryngeal cavity, containing the vocal cord and vocal muscle. The muscle bundles in the vocal folds are located in a special way in different mutually opposite directions. This unique structure of the vocal folds allows them to vibrate not only with their entire mass, but also with one part, for example, the edges, half, third, etc.

Why can the laryngeal mucosa become inflamed?

• Infection. The laryngeal mucosa can be affected primarily after direct entry of an infectious agent into the body and onto the laryngeal mucosa. And be affected secondarily as a result of the spread of infection from foci of long-standing chronic infection(sinusitis, tonsillitis, bronchitis, etc.). When an infectious agent (bacterium, etc.) gets on the mucous membrane, it releases a number of toxic substances, which disrupts the integrity of the protective barriers and destroys the cells of the mucous membrane. In response to this, an inflammatory reaction is launched and immune defense cells are attracted in order to limit infectious process and eliminate the causative agent of the disease. In this case, there is a sharp reddening of the mucous membrane, vasodilation, accumulation of leukocytes, and swelling. Laryngitis is most often caused by a nonspecific infection (bacteria, viruses, fungi), less often by a specific infection (tuberculosis, syphilis, etc.). The most common causative agents of laryngitis:

• Viruses: influenza virus, Haemophilus influenza, parainfluenza, microviruses, adenoviruses (1,2,3,4,5), rhinoviruses, coronavirus, Coxsackie viruses, measles virus.
• Bacteria: Staphylococcus aureus, Klebsiela pneumonia, Branhomella cataralis, Streptococcus viridans, Streptococcus pneumonia, etc.
• Fungal infection most often develops in people suffering from immunodeficiency or after long-term antibiotic therapy.

• Physical reasons. General and local hypothermia, eating irritating food (usually very cold), cold drinking, breathing through the mouth, occupational hazards (dust, smoke, etc.), excessive vocal stress (long, loud conversation, singing, screaming) - all this leads to a violation local defense systems, damage to the cellular structures of the mucous membrane and the development of the inflammatory process. In the future, infection may occur.
• Allergic causes . Inflammation in the larynx can also occur if an allergic reaction develops. More often, the triggering factors of allergies are: various chemical powders that get on the mucous membrane of the larynx, dust, smoke, ingestion of a number of food products (chocolate, eggs, milk, citrus fruits, etc.). With the development of inflammation as a result of an allergic reaction, edema may develop, which sometimes threatens the patient’s life.
• Autoimmune causes. In rare cases, inflammation of the larynx can develop as a result of a violation of the immune defense mechanisms. When your own tissues, and in particular the mucous membrane of the larynx, are attacked by your own immune defense cells. More often, autoimmune laryngitis develops against the background of systemic autoimmune diseases such as: Wegener's granulomatosis, amyloidosis, relapsing polychondritis, systemic lupus erythematosus, etc.
• Other reasons. Laryngitis can develop if stomach contents enter the larynx (gastroesophageal reflux). This condition can develop in case of weakness of the esophageal sphincters, which normally prevent gastric contents from entering the esophagus, pharynx, and larynx.

What are the symptoms of laryngitis?

• Voice change. The voice coarsens, becomes hoarse, hoarse, and may lose sonority until it is completely absent (aphonia).
• Burning sensation, dryness, sensation of a foreign body in the larynx (soreness), possible pain during inhalation and exhalation.
• Painful cough with sputum discharge. Laryngitis often occurs together with other diseases of the respiratory system (bronchitis, tracheitis, etc.)
• General state moderately impaired, body temperature increased, chills possible.

• Persistent voice disorder. Voice weakness, hoarseness, loss of voice sonority. During the day, the voice can change its character, sometimes the patient speaks only in a whisper and with tension.
• , burning, itching, pain when swallowing
• Cough is dry and produces sputum, a painful cough is possible in the morning, especially in heavy smokers
• General state practically undisturbed

• Sudden development, after contact with an allergic agent (dust, smoke, chemical, etc.).
• Labored breathing, severe lack of air, asthma attack
• Persistent cough, while the voice usually does not change (acute laryngitis)
• In chronic allergic laryngitis, the symptoms are the same as in ordinary chronic laryngitis (change in voice, sore throat, coughing, etc.), but there is allergic factor causing disease (dust, chemical substances, smoke, etc.).

• Voice disorder. The voice is rough, wheezing, sometimes turning into falsetto, sonority is reduced until it is completely absent.
• Sensation of a foreign body in the throat, rawness, cough.
• The disease mainly occurs in smokers who produce copious amounts of sputum in the morning and experience a painful cough.
• IN severe cases Possible breathing problems.

What are the symptoms of laryngitis in children?

Laryngitis in children is characterized by a number of features, such as:

• As a rule, develops against the background of acute respiratory viral infection or influenza
• Severe swelling of the larynx
• High probability development of airway spasm
• High risk of developing acute shortness of breath with severe complications (respiratory failure)
• Swallowing problems, pain when swallowing
• Often develops suddenly during sleep (child in a supine position).
• An attack of suffocation occurs, the child wakes up from a sudden lack of air, blue lips
• The attack is accompanied by a convulsive barking cough, the voice is often unchanged
• The attack may be repeated within 15-20 minutes
• It is possible that the attack will stop on its own
• In most cases, acute laryngitis requires hospitalization of the child

What is chronic laryngitis?

Select 3 clinical forms chronic laryngitis: catarrhal (normal), hyperplastic (hypertrophic) and atrophic. In general, these forms of laryngitis have similar symptoms (change in voice, cough, discomfort in the throat), but there are some individual characteristics for each of the forms.
For example atrophic laryngitis characterized by painful dryness in the throat and larynx, as well as significant impairment of voice formation. As a result of a long-term inflammatory process with atrophic laryngitis, the vocal cords become thinner, which leads to the impossibility of their complete closure. In addition, a viscous secretion accumulates in the larynx, crusts form, which causes a sensation of a foreign body in the throat and frequent attacks cough. With atrophic laryngitis, breathing is difficult. Atrophic laryngitis is the most complex and difficult to treat form of chronic laryngitis.

Another form of chronic laryngitis such as hypertrophic laryngitis, unlike atrophic laryngitis, is characterized by thickening of the laryngeal mucosa. Excessively thickened areas of the larynx, in the form of whitish or transparent elevations, can become so large that they interfere with the closure of the vocal cords. Also, with this form of laryngitis, deformation of the vocal folds occurs, which is accompanied by a violation of voice formation (a wheezing, rough, dull voice). This form of laryngitis, like atrophic laryngitis, is accompanied by difficulty breathing.
At usual form (catarrhal) Laryngitis does not cause breathing problems. This form is characterized by persistent voice impairment, hoarseness and cough with sputum production. The voice can change its character during the day, sometimes there are periods when the patient can only speak in a whisper. In the catarrhal form of laryngitis, the laryngeal mucosa looks like classic inflammation (redness, swelling, slightly thickened).

How to treat laryngitis at home?

• Compliance with the regime. First of all, you should follow the voice mode. Talk as little as possible, and it is better to remain completely silent. Under such conditions, the processes of restoration and healing of the laryngeal mucosa proceed much faster. Under no circumstances should you speak in a whisper. With this type of conversation, the tension and trauma to the vocal cords is several times greater than with normal speech.

• Environment. It is necessary to maintain a favorable indoor microclimate. The room should be well ventilated, maintain an optimal temperature of 20°-26 °C, and monitor the air humidity level (50% - 60%). Since dry air contributes to microdamage to the laryngeal mucosa, this aggravates the course of the disease and slows down the recovery process. You should keep your throat warm, for this it is better to wrap your neck with a warm scarf or make warm compresses. Avoiding going outside, especially in cold weather, can make the situation significantly worse.

• Water or drinking regime . The patient needs to drink plenty of fluids in order to quickly remove toxins from the body, as well as in order to reduce the viscosity of sputum and maintain the necessary moisture in the laryngeal mucosa. Moisturized vocal folds are not as susceptible to trauma and the processes of restoration of damaged tissue are more likely to occur in them. You should drink up to 2-3 liters of fluid per day. It is better to consume the liquid in the form of warm herbal teas(chamomile, lemon balm, thyme, sage, etc.), berry fruit drinks. Warm milk with mineral water (Borjomi, Essentuki, etc.) helps well in liquefying and removing phlegm.

• Diet for laryngitis. The patient should avoid excessively cold, hot, spicy, and salty foods. All this can injure the laryngeal mucosa and reduce the body's resistance. In addition, foods that help relax the lower esophageal sphincter (chocolate, caffeine, alcohol, fried foods, mint, etc.) should be excluded from the diet. This diet should be followed especially strictly by patients with so-called “chemical” laryngitis, which occurs due to gastric juice entering the larynx. This occurs when the lower esophageal sphincter is unable to properly close the esophagus and prevent stomach contents from entering it. In this case, gastric juice from the esophagus enters the pharynx, and then into the larynx, burning its mucous membrane, thereby causing inflammation (laryngitis).

• Eliminate smoking and alcohol. Smoke entering the laryngeal mucosa significantly reduces its protective and restorative abilities.

• Hot foot baths, mustard plasters on the calf muscles help reduce swelling of the laryngeal mucosa and make you feel better. This effect is mainly achieved due to the redistribution of blood from the upper part of the body to the lower.

• Rinse. Another effective way to treat laryngitis at home. Frequent rinsing at least 5-7 times a day reduces swelling, reduces inflammation, and accelerates healing processes. Recommended rinses:
  • Sea salt solution (1-1.5 tsp per 500 ml)
  • Soda solution (1 teaspoon per 200 ml),
  • Herbal infusions(chamomile, sage, linden, calamus rhizomes, raspberries, eucalyptus leaves,
  • Beet juice, juice fresh potatoes dilute with warm water,
  • Warm milk with carrots (boil 1 carrot in 500 ml of milk, then rinse with this milk),
  • Decoction onion peel and etc.

• Inhalations An excellent method for treating laryngitis at home. This does not require complex devices or expensive medications. An ordinary teapot can be used as an inhaler, with a long funnel made of thick paper attached to the neck, through which the healing process is carried out. Of course, you can just cover yourself with a towel and breathe over the pan. You should breathe through the pores at least 10 minutes after the water has boiled. It is important to ensure that the procedure is as comfortable as possible and does not cause pain. Do not allow the pores to burn the mucous membrane of the larynx under any circumstances. The following can be used as solutions for inhalation:
  • Alkaline soda solution
  • Mineral water (Borjomi, Essentuki, etc.)
  • Herbal infusions (chamomile, mint, thyme, sage, calamus, etc.)
  • A few drops of essential oil added to water for inhalation (menthol, eucalyptus, etc.)

• When treating, and especially at home, it is important to listen to your body! If you experience significant discomfort and worsening symptoms, it is better not to tempt fate and change the treatment method to a more proven one. Or better yet, you should contact a specialist for qualified help.

How to treat laryngitis with inhalations?

• The duration of the procedure is 10-15 no less and no more
• It is better to carry out 2 inhalations in the morning and 2 in the evening
• It is better not to inhale after eating; you should wait at least 30-50 minutes
• You cannot talk during inhalation and for another 30 minutes after the procedure.
• The procedure for inhalation medicines: 1) bronchodilators, 2) expectorants (15 after the previous one), 3) after sputum discharge, antiseptic and anti-inflammatory drugs

Traditional methods of treating laryngitis

Treatment of laryngitis at home

Do I need to use antibiotics to treat laryngitis?

If you do not want to harm yourself, and especially your child, antibiotics should be prescribed only by your doctor and after a series of additional studies. Since there are a number of features that only a doctor knows. Firstly, for effective treatment with antibiotics, it is necessary to take material for research from the laryngeal mucosa, determine the causative agent of the disease and determine how sensitive the microorganism is to a particular antibiotic. Often a situation arises when a patient takes an expensive and not entirely harmless drug, but there is no result or something else worse result there is, but not entirely positive, the functioning of the liver, kidneys and other organs is disrupted. Unfortunately, in most cases, laryngitis must be treated with antibiotics. But when the right approach treatment, you can avoid unpleasant consequences and quickly achieve the desired recovery.

• Do bacteriological examination, determine the causative agent of the disease and its sensitivity to antibiotics (antibioticogram)
• If after 3 days of antibiotic treatment the temperature does not decrease and the condition does not improve, the antibiotic should be replaced or the cause of the disease should be reconsidered
• After long-term use of antibiotics (7-10 or more days), you should take antifungal drugs so that fungal laryngitis or other fungal diseases(candidiasis, etc.)

• Duration of treatment 7-10 days
• Amoxicillin 1 gram 4 times a day, intramuscularly
• Amoxicillin + clavulanic acid 1.2 grams 2 times a day intravenously
• Cefuroxime 1 gram or Ceftriaxone 1 gram or Cefaclor 1 gram + lidocaine solution 1%-1 ml 2 times a day, intramuscularly
• Ciprofloxacin 100 mg/10 ml - 200 mg with 200 ml saline intravenously 2 times a day
• Metronidazole 200 ml 3 times a day, intravenously

What is allergic laryngitis?

Depending on the sensitivity of the body, the amount of the allergic factor and the time of its exposure to the body, acute or chronic allergic laryngitis may develop. In case of acute allergic laryngitis, emergency care is required. Because this type laryngitis is accompanied by rapidly increasing swelling of the larynx varying degrees, leading to difficulty breathing and often threatening the patient’s life.

Chronic allergic laryngitis does not develop so rapidly and dramatically, but it does cause a number of unpleasant symptoms. Typically, patients complain of discomfort, soreness in the larynx, cough, and impaired voice production (hoarseness, hoarseness, loss of voice sonority, etc.). The main feature of chronic laryngitis is that it exists as long as there is an allergic factor. Once contact with the allergen is eliminated, the patient will recover on his own.

How to treat laryngitis during pregnancy?

An excellent way to remove sticky mucus are inhalations based on slightly alkaline mineral waters(Borjomi, Essentuki, etc.). Rinse and inhalation procedures should be at least 3-5 times a day. Traditional methods of treating laryngitis during pregnancy can come in handy. When choosing the appropriate method, be sure to consult your doctor. To remove toxins and better discharge of sputum, it is necessary to take a sufficient amount of fluid. Drink more juices, fruit drinks, herbal teas (chamomile, thyme, mint, etc.). Honey and milk will do the same good helpers in treatment. Nutrition should be rich in vitamins and minerals. During illness, you should not overload the digestive tract with heavy food. Since this takes away energy that should be aimed at fighting the disease.

An important part of treatment is the voice mode, talking as little as possible, or better yet, being silent for a while. Do not go outside, especially during the cold season. Keep your throat warm (wrap your neck with a scarf). The above measures should help with mild to moderate laryngitis. However, laryngitis is a disease that should not be underestimated, especially during pregnancy. Therefore, at the first symptoms of the disease, you should contact experienced specialist, who will competently assess the severity of the disease and prescribe effective treatment without undesirable consequences.

Hyperplastic laryngitis - what is it?

With hypertrophic laryngitis, the vocal cords become flabby, increase in size, and their free edge thickens. All this leads to significant changes in voice production. Patients mainly complain of a wheezing, rough, dull voice, cough and discomfort in the throat.
In most cases this form Laryngitis is observed in smokers who produce a significant amount of sputum and experience a painful cough. Often the disease occurs together with diseases such as chronic sinusitis, tonsillitis, bronchitis. The cause of hypertrophic laryngitis can be any of the unfavorable factors that act for a long time on the laryngeal mucosa (see “Why can the laryngeal mucosa become inflamed?”).

Adverse factors reduce local and general immunity, activity increases pathogenic microorganisms, which leads to the development of a chronic inflammatory process. Final diagnosis“hypertrophic laryngitis”, the ENT doctor diagnoses it based on a survey of the patient (complaints, medical history, etc.), examination (laryngoscopy), and additional instrumental studies(tomography of the larynx, laryngeal fiberoscopy, videolaryngostroboscopy, etc.), laboratory research (general analysis blood, bacteriological examination, and, if necessary, biopsy of the larynx).

Treatment of hyperplastic laryngitis primarily involves eliminating the cause that caused the disease and sanitizing chronic foci of infection. In addition, it is necessary to maintain a voice regime (reduce vocal stress), stop smoking and drinking alcohol. Oil, soda and corticosteroid inhalations can relieve swelling and alleviate the condition. In most cases, hypertrophic laryngitis requires radical treatment, microsurgical intervention with removal of areas of excessively enlarged mucous membrane.

Available about laryngitis

How does laryngitis occur in infants?

The most common cause of laryngitis in children under 1 year of age is viral infections, especially parainfluenza virus , which is common among the population in the spring and autumn periods. In addition, children with atopic or allergic reactions may develop allergic laryngitis. Bacteria and fungi rarely cause laryngitis in infants.

The development of laryngitis and its complications is facilitated by the following features of infancy:

1. Age anatomical feature structures of the larynx:

• narrow opening in the larynx area, only 4-5 mm;
• thin and shortened vocal cords;
• anatomically higher location of the larynx, which makes it easier for infections and allergens to enter;
• a large number of nerve receptors in the muscles of the larynx, that is, their increased excitability;
• predisposition to the rapid development of submucosal edema.

• still unformed immunity;
• a tendency to develop atopic (allergic) reactions when encountering new foods and other foreign proteins coming from outside.

• the disease develops acutely, sometimes within a few hours, during or even a week after ARVI;
• increase in body temperature noted only in half of the cases;
• restless child, sleep disturbance, refuses to eat;
• the child's voice changes, the cry becomes hoarse, rough, in rare cases there is a loss of voice;
• Laryngitis in infants is almost always accompanied by respiratory failure and hypoxia(due to disruption of the passage of air through the narrowed larynx), this manifests itself noisy breathing , may be accompanied by a whistle, breathing quickens, against this background you can see cyanosis(cyanosis) of the nasolabial triangle, limb tremors;
• cough with laryngitis, the baby always has paroxysmal, sometimes painful attacks; attacks often develop against the background of screaming; many compare this cough to the barking of a dog (barking cough).

Development false croup Various factors may predispose:

5. Eliminate factors affecting the voice(smoking, alcohol, temperature changes, and so on).

6. Peppermint candies, lozenges, chewing gum help improve the condition of the vocal cords.

2. Formation of various tumors, including cancer. Any chronic process contributes to a failure in cell division and mutation. Therefore, they can form various neoplasms larynx.

3. Vocal cord paralysis, as a result - permanent loss of voice. This complication occurs when the laryngeal nerves are involved in the inflammatory process - neuritis. This condition can lead not only to aphonia (loss of voice), but also to breathing problems and suffocation. If breathing is impaired, tracheal intubation (tracheostomy) is required - a tube is inserted into the trachea through the skin, and air enters the lungs not through the upper respiratory tract, but through the tracheostomy. After drug treatment, nerve function is gradually restored, and the voice may also be restored, partially or completely. In some cases, surgery is required.

Laryngitis, like any other disease, must be treated promptly and correctly, since self-medication and lack of treatment can lead to serious consequences.

Prevention of laryngitis and its consequences, how to prevent the development of chronic and hyperplastic laryngitis?

• healthy balanced diet , rich in vitamins, amino acids, unsaturated fatty acids;
• rejection of bad habits , smoking especially predisposes to the development of laryngitis and its complications, negatively affects the vocal cords;
• hardening - this is the most effective method of preventing all diseases, including exacerbations of chronic laryngitis, this is especially important in childhood;
• physical activity , Movement is life;
• frequent walks in the fresh air, it is especially useful to take a walk near bodies of water;
• normal mode work, sleep and rest;
• if possible avoid nervous stress .

• avoid contact with sick people and staying in in public places during the flu period;
• vaccination against flu in the autumn season;
• if ARVI starts , it is necessary to start treatment in a timely manner, any flu also needs to be treated.

• smoking;
• voice loads;
• hot and too cold food or drinks;
• food that irritates the larynx;
• tall and low temperatures air, as well as high and low humidity;
• other factors.

It is easier to prevent any disease than to treat it later, and you will be healthy.