Chronic laryngitis treatment. How chronic laryngitis manifests itself and its treatment. Hypertrophic chronic laryngitis is divided into two forms

Laryngitis is a fairly common disease; as a rule, it often accompanies the usual or. True, not everyone can accurately recognize it, especially when it comes to chronic laryngitis.

Many people notice that during downtime they gradually sit down, and their general condition becomes poor; they feel as if their throat is being squeezed. This is laryngitis.

To avoid the development of chronic laryngitis, which is much more difficult to treat than acute laryngitis, you need to know the main causes of its occurrence.

These include:

• Structural features, due to which the body, when harmful microbes and bacteria penetrate, is practically unable to resist them, and they settle on the mucous membrane, thereby causing its inflammation.
• Persistent infectious or viral diseases, as a result of which the mucous membrane of the pharynx not only becomes inflamed, but also does not have time to recover. And due to constant exposure to drugs and bacteria, the disease simply enters the chronic stage.
• Incorrect treatment of acute laryngitis. Most often, the cause of chronic laryngitis is improper treatment of its acute stage. This is especially true when it comes to ignoring the problem. Many people think that laryngitis can be treated the same as just being sick. In fact, this is not at all the case, because the nature of the disease is slightly different and requires a more intensive approach to treatment and the use of other medications.
• Smoking. In most smokers, after several years of continuous smoking, the mucous membrane gradually becomes inflamed due to exposure to tobacco smoke.
• Alcohol abuse. Moreover, we are not talking about a one-time intake of strong drinks, but about a constant one, when the mucous membrane is literally burned.
• The constant presence of bacteria in the body, which become more active over time.
• Caries. Many people think what caries has to do with chronic laryngitis. In fact, sometimes it's direct. Caries becomes a source of infection in the human body, and the mucous membrane of the throat is the first to be encountered by bacteria. And if caries is not treated for a long period of time, then more and more bacteria enter, and accordingly, the mucous membrane will be constantly inflamed.
• Breathing problems, which can occur for various reasons. Of course, the most common will be frequent rhinitis, but sometimes it can also be allergic reactions, especially in spring and summer, when the flowering period begins. For the most part, in this case, the reason for the occurrence of laryngitis lies in something slightly different. Due to the fact that a person’s nose does not breathe, he has to do it with his mouth, that is, cold air and chemicals directly enter the throat and irritate the mucous membrane.
• Great load on the vocal cords. As a rule, this problem plagues either singers or teachers who are forced to constantly talk, thereby straining not only the ligaments, but the entire larynx.
• Weak immunity, which becomes the cause of many diseases, since the body is not able to cope with the bacteria and microbes that enter it.

There are actually many reasons for the appearance of chronic laryngitis, but the main thing is different. It is necessary to know them exactly, as well as the main ones, in order to begin treatment on time and alleviate the course of the disease.

Symptoms of chronic laryngitis

In fact, the symptoms of chronic laryngitis are very obvious. And those who have suffered from it at least once know perfectly well how it begins.

Symptoms of chronic laryngitis include:

1. Swelling of the throat. Patients note that it feels as if a tight bandage has been applied to the neck. This sensation appears due to severe swelling, as a result of which it becomes difficult to breathe.
2. Hoarseness of voice, which occurs when a person tries to say something loudly, or simply speaks for a long time.
3. Unpleasant sensations when swallowing, especially with hot and cold foods.
4. Feeling of a foreign body in the throat. At this moment, a person has a desire to clear his throat. It seems to him that if he does this, the unpleasant feeling will go away. And as a result of this action, the throat becomes even more irritated, because it is simply impossible to clear the throat.
5. Disappearance of voice. Many people notice that after a slight hoarseness, literally the next day it disappears altogether, and any attempts to speak do not end in success, but only provoke even greater hoarseness.
6. Accumulation of mucus secretions in the throat. The patient feels as if mucus is draining from the nasal cavity. In fact, it is simply produced in large quantities and this interferes with a person, forcing him to constantly cough up.
7. Dry throat. Because of such dryness, it is painful for a person to speak, or rather, any attempts cause a severe attack, as well as a sore throat.
8. Difficulty coughing, which indicates that it has settled tightly on the ligaments and urgently needs to be liquefied and removed.

Some patients note that the mucus gradually changes color.

If in the first days of illness it is transparent when coughing, then after two or three days it acquires a yellow tint and acquires an unpleasant taste. This indicates a severe inflammatory process, gradually turning into a purulent one.

If any symptoms of laryngitis appear, you should immediately contact a specialist so that he can conduct an examination and prescribe the correct and effective treatment.

Treatment of chronic laryngitis

If with acute laryngitis everything is more or less clear. And you can cure it in a week, but in the case of a chronic one, you will have to pay much more attention to the disease and spend more time. But despite this, sometimes treatment is ineffective.

The most important thing is to establish the form of the disease, because the choice of a particular drug will depend on this.

Treatment for chronic laryngitis should only be prescribed by a doctor, since self-medication never leads to anything good.

Separately, it is necessary to consider the treatment of hypertrophic and catarrhal forms of chronic laryngitis.

The hypertrophic form will be as follows:

• Using hormonal drugs to remove swelling.
• Purpose, the action of which is aimed at destroying bacteria and microbes that cause inflammation of the mucous membrane.
• Prescribing drugs that have an active effect on the mucous membrane, while simultaneously reducing swelling and disinfecting it.
• Prescribing vitamins that will help the body recover faster.
• Prescribing vasoconstrictor drugs that will help relieve swelling a little.
• In addition, for the hypertrophic form of laryngitis, it is recommended to use, which will help thin the mucus and then remove it as quickly as possible.

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Banal chronic laryngitis is a superficial diffuse nonspecific inflammation of the mucous membrane of the larynx with a long course and periodic exacerbations in the form of catarrhal inflammation. In most cases, banal chronic laryngitis is combined with chronic inflammatory processes in the upper respiratory tract, covering both the nasopharyngeal spaces, the trachea and the bronchi.

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ICD-10 code

J37.0 Chronic laryngitis

Causes of chronic laryngitis

The causes and pathogenesis of banal chronic laryngitis are based on three factors:

1. individual predisposition to chronic inflammatory diseases of the upper respiratory tract, including individual anatomical features of the structure of the larynx;
2. risk factors (professional, household - smoking, alcoholism);
3. activation of opportunistic (vulgar) microbiota.

Banal chronic laryngitis is more common in adult men, who are more often exposed to occupational and household hazards. In childhood, banal chronic laryngitis occurs mainly after 4 years, especially with frequently recurring adenoamygdalitis.

Banal polymorphic microbiota indicates nonspecific inflammation in banal chronic laryngitis. Childhood infections (measles, whooping cough, diphtheria, as well as repeated sore throats and influenza infections) cause damage to the epithelium and lymphoid tissue of the larynx, which helps to reduce local immunity and activate the saprophytic microbiota and increase the pathogenic influence of exogenous risk factors. An important role in the pathogenesis of banal chronic laryngitis is played by descending infection in chronic rhinosinusitis, adenoiditis, tonsillitis, periodontitis, dental caries, which are foci of pathogenic microbiota, often causing chronic inflammatory processes in the larynx. The same role can be played by ascending infection in chronic tracheobronchitis, pulmonary tuberculosis, purulent diseases of the bronchopulmonary system (bronchiectasis), asthma, which, along with infection of the larynx with sputum and pus, cause irritation of its mucous membrane with prolonged bouts of coughing.

An important role in the occurrence of banal chronic laryngitis is played by impaired nasal breathing (rhinitis, polyps, deviated nasal septum), in which the patient is forced to constantly breathe through the mouth, which adversely affects the condition of the mucous membrane of the larynx (there is no hydration, warming or disinfection of the air). Particularly harmful effects on the condition of the larynx are impaired nasal breathing, unfavorable external climatic conditions (cold, heat, dryness, humidity, dust) and microclimatic conditions of human habitation and work.

The load on the larynx in people whose profession is related to vocal function or work in noisy production is often the main risk factor for the development of banal chronic laryngitis.

Endogenous factors play an important role in the occurrence of banal chronic laryngitis, causing a decrease in local immunity and trophism of the larynx, which, along with the own pathogenetic effect of these factors on the larynx, potentiates the harmful influence of external risk factors, transforming them into active causes of banal chronic laryngitis. Such endogenous factors may include chronic diseases of the digestive system, liver, cardiovascular and excretory systems, allergies, which often lead to circulatory, and therefore immune and trophic disorders of the mucous membrane of the upper respiratory tract. An important role in the occurrence of banal chronic laryngitis is played by endocrine disorders, in particular dysfunction of the thyroid and insular apparatus of the pancreas. Similar influences can be played by ischemic conditions due to various reasons, vitamin deficiency, a number of common chronic infections (syphilis) and some specific diseases of the upper respiratory tract (ozena, scleroma, lupus, etc.).

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Chronic catarrhal laryngitis

In chronic catarrhal laryngitis, hyperemia of the mucous membrane is noted, which is more stagnant in nature than inflammatory-paretic, characteristic of acute diffuse catarrhal laryngitis. Thickening of the mucous membrane occurs due to round cell infiltration, rather than serous infiltration. The squamous epithelium on the vocal folds is thickened; on the posterior wall of the pharynx, the ciliated epithelium is replaced by stratified squamous epithelium by metaplasia; The glands of the vestibular folds are enlarged and secrete more secretions. There is especially a lot of sputum in cases of similar damage to the trachea, which often manifests itself as a strong, sometimes convulsive cough, increasing irritation and inflammation of the vocal folds. The blood vessels of the submucosal layer are dilated, their walls are thinned, which is why pinpoint submucosal hemorrhages occur with a strong cough. Around the vessels there are foci of plasmacytic and round cell infiltration.

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Chronic hypertrophic laryngitis

In chronic hypertrophic laryngitis, the epithelium and connective tissue of the submucosal layer hyperplasia; Infiltration of the internal muscles of the larynx also occurs, most often the muscle fibers that form the basis of the true vocal folds; proliferation of cells of the mucous glands and follicles of the ventricles of the larynx occurs.

Hyperplasia is understood as an excessive increase in the number of structural elements of tissues through their excessive neoplasm. Hyperplasia, which underlies hypertrophy, manifests itself in cell proliferation and the formation of new tissue structures. With rapidly occurring hyperplastic processes, a decrease in the volume of the multiplying cellular elements themselves is often observed. As noted by A. Strukov (1958), hyperplastic processes in the narrow sense are understood only as those associated with hypertrophy of tissues or organs, when it comes to the functional identity of newly formed and previous (“uterine”) tissues. However, in pathology, any proliferation of cells is often referred to as “hyperplasia.” The term proliferation is also used for cell reproduction in a broad sense. As a universal morphogenetic process, hyperplasia underlies all processes of pathological tissue formation (chronic inflammation, regeneration, tumors, etc.). In structurally complex organs, such as the larynx, the hyperplastic process can affect not only any one homogeneous tissue, but also all other tissue elements that form the morphological basis of the organ as a whole. Strictly speaking, this is the case with chronic hyperplastic laryngitis, when not only the epithelial cells of the ciliated epithelium, but also flat multilayered epithelium, cellular elements of the mucous glands, connective tissue, etc., undergo proliferation. Hence such a variety of forms of chronic hypertrophic laryngitis - from “singing nodules » to prolapse of the mucous membrane of the ventricles of the larynx and retention cysts.

Thickening of the vocal folds in chronic hypertrophic laryngitis is continuous, uniform along the entire length, then they acquire a fusiform shape with a rounded free edge, or limited, in the form of individual nodules, tubercles or slightly larger dense whitish formations (laryngitis chronica nodosa). Thus, more massive thickenings, formed by proliferation of squamous epithelium, are sometimes formed in the area of ​​the vocal fold at the vocal process of the arytenoid cartilage, where they look like a mushroom-shaped elevation on one side with a “kissing” depression on the opposite vocal fold or symmetrically located contact ulcers. Much more often, pachydermia occurs on the posterior wall of the larynx and in the interarytenoid space, where they acquire a lumpy grayish surface - pachydermia diffusa. In the same place, hyperplasia of the mucous membrane in the form of a pillow with a smooth red surface (laryngitis chronica posterior hyperplastica) can be observed. A hyperplastic process can develop in the ventricles of the larynx and lead to the formation of folds or ridges of the mucous membrane that extend beyond the ventricles and cover the vocal folds. Hyperplasia can also develop in the subglottic space, forming ridges parallel to the vocal folds (laryngitis chronica subglotica hyperplastica). In people whose professions involve voice strain (singers, teachers, actors), often symmetrically located cone-shaped nodules appear on the vocal folds, approximately in the middle, the basis of which is thickened epithelium and elastic tissue - the so-called singing nodules.

In chronic atrophic laryngitis, which occurs less frequently than chronic hypertrophic laryngitis, metaplasia of the columnar ciliated epithelium into keratinizing squamous epithelium is observed; capillaries, mucous glands and intralaryngeal muscles atrophy, and the interstitial connective tissue undergoes sclerosis, due to which the vocal folds become thinner, and the secretion of the mucous glands quickly dries out and covers them with dry crusts.

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Chronic atrophic laryngitis

Chronic atrophic laryngitis is much less common; more often it occurs in the form of a subatrophic process in the mucous membrane of the larynx, combined with systemic subatrophy of the mucous membrane of the upper respiratory tract.

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Causes of chronic atrophic laryngitis

Atrophy is understood as a pathological process characterized by a decrease in volume and size, as well as qualitative changes in cells, tissues and organs expressed to varying degrees, usually occurring during various diseases or as their consequence, differing in this from hypoplasia and hypogenesis (pathological atrophy). In contrast to the latter, a distinction is made between physiological (age-related) atrophy, which is caused by the natural aging of tissues, organs and the body as a whole and their hypofunction. An important role in the occurrence of physiological atrophy is played by the withering of the endocrine system, which is largely reflected in such hormone-dependent organs as the larynx, organs of hearing and vision. Pathological atrophy differs from physiological atrophy both in the reasons for its occurrence and in some qualitative features, for example, faster fading of the specific function of an organ or tissue during pathological atrophy. The basis of any type of atrophy is the predominance of dissimilation processes over assimilation processes. Depending on the reasons causing atrophy, there are:

1. tropho-neurotic atrophy;
2. functional atrophy;
3. hormonal atrophy;
4. nutritional atrophy;
5. professional atrophy resulting from the harmful effects of physical, chemical and mechanical factors.

In otorhinolaryngology, there are quite a lot of examples of the latter (occupational anosmia, hearing loss, atrophic rhinitis, pharyngitis and laryngitis, and many others). To the forms of atrophy listed above should be added atrophy caused by the consequences of acute or chronic infection, both banal and specific. However, this type of atrophy is also accompanied by pathological changes in tissues and organs, characterized by complete destruction or replacement of specific tissues by fibrous tissue. As for chronic atrophic laryngitis specifically, all of the above types of causes can take part in its pathogenesis to one degree or another, causing atrophy not only of the epithelium of the mucous membrane, but also of all its other elements (trophic and sensory nerve endings, blood and lymphatic vessels, connective tissue layer, etc.). On this basis, chronic atrophic laryngitis should be recognized as a systemic disease that requires an analytical approach for its study, as well as for the development of etiotropic and pathogenetic treatment.

Symptoms of atrophic laryngitis

With a pronounced clinical and pathological form, there is significant dryness of the mucous membrane, acquiring a reddish-gray tint, the vocal folds are hyperemic, covered with dry crusts of a yellow or greenish-dirty color, tightly fused to the underlying surface. After rejection, small hemorrhages and damage to the epithelial cover remain in their place. In general, the laryngeal cavity appears expanded, with a thinned mucous membrane, through which small convoluted blood vessels are visible. A similar picture is observed in the mucous membrane of the pharynx. Such patients constantly cough and attempt to remove crusts from the larynx using characteristic vocal sounds; their voice is constantly hoarse and gets tired quickly. In dry rooms these phenomena intensify and, on the contrary, in a humid environment they weaken.

Diagnosis of atrophic laryngitis

The diagnosis is established on the basis of anamnesis (long-term course, the presence of addictions and corresponding occupational hazards, chronic foci of infection in the neighborhood and at a distance, etc.), patient complaints, and a characteristic endoscopic picture. The variety of morphological disorders of just banal chronic inflammatory processes in the larynx, not counting those that occur during infectious and specific diseases, makes the diagnosis of chronic laryngitis a very responsible process, since many of the diseases noted above are regarded as precancerous, the degeneration of which into malignant neoplasms, including even sarcoma are not such a rare phenomenon, which was especially clearly demonstrated by official statistics at the end of the 20th century. When determining the nature of a particular chronic disease of the larynx, it should be borne in mind that almost always chronic hypertrophic laryngitis accompanies one or another malignant process or specific disease of the larynx and often masks the latter until both the first and the second reach their destructive forms. Therefore, in all cases of dysphonia and the presence of “plus tissue,” such a patient should be referred for a consultation to an ENT oncologist, where he will undergo a special examination, including a biopsy.

In doubtful cases, especially in hyperplastic chronic laryngitis, an X-ray examination of the patient is mandatory. Thus, in chronic hypertrophic laryngitis, the use of frontal tomography of the larynx allows one to visualize the following changes: 1) thickening of the vocal or vestibular folds; thickening of the ventricular fold; 2) its prolapse, as well as other changes without detecting defects in the internal walls and anatomical formations of the larynx.

An important differential diagnostic feature that testifies to the benign nature of the process is the symmetry of morphological changes in the larynx, while malignant neoplasms are always one-sided. If chronic hypertrophic laryngitis manifests itself as a unilateral “inflammatory process,” then an X-ray examination of the patient and a biopsy of suspicious “plus tissues” are always necessary. They differentiate banal chronic laryngitis from primary infiltrative tuberculosis of the larynx, tertiary syphilis and benign and malignant tumors, scleroma and papillomatosis of the larynx. In children, chronic hypertrophic laryngitis is differentiated from papillomatosis and unidentified foreign tissue of the larynx. Chronic atrophic laryngitis is differentiated from primary ozena of the larynx. Myogenic dysfunctions of the larynx, which often occur with banal chronic laryngitis, should be differentiated from neurogenic paralysis of the internal muscles of the larynx, which are characterized by specific symptoms.

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Symptoms of chronic laryngitis

Complaints of patients with banal chronic laryngitis do not differ in any significant features and depend solely on the pathoanatomical changes that occur, as well as on the degree of vocal load and the professional need for the voice apparatus. Almost all patients complain of hoarseness, rapid fatigue, sore throat, often dryness and constant cough.

The degree of vocal dysfunction can vary from mild hoarseness, which occurs after a night's sleep and during work, little bothering the patient and only reappearing in the evening, to severe constant hoarseness. Permanent dysphonia occurs in cases where banal chronic laryngitis and other chronic diseases of the larynx are accompanied by organic changes in the vocal folds and other anatomical formations, especially with proliferative keratotic processes. Dysphonia can significantly worsen under unfavorable weather conditions, during endocrine changes in women (menopause, menstruation, pregnancy, during exacerbation of the underlying inflammatory process in the larynx).

For professionals, even minor dysphonia is a factor of mental stress, aggravating the phonatory qualities of the voice function, often radically changing their social status and worsening their quality of life.

Violations of the sensitivity of the larynx (stingling, itching, burning, sensation of a foreign body or accumulated mucus or, on the contrary, dryness) force the patient to constantly cough, attempt to remove the “interfering” object by closing the vocal folds and vocal effort, lead to further fatigue of the vocal function, and sometimes to spastic contractures of the vocal muscles. Often these sensations contribute to the development of cancerophobia and other psychoneurotic conditions in patients.

Cough is caused by irritation of the tactile receptors of the larynx, and with abundant sputum - by chronic inflammation of the mucous membrane of the trachea and bronchi. Cough is more pronounced in the morning, especially in smokers and workers whose professions are associated with hazardous production (foundry workers, chemists, welders, battery workers, etc.).

Of great importance in establishing the form of banal chronic laryngitis is laryngoscopic examination of the larynx, both with indirect and direct laryngoscopy, including microlaryngoscopy, which makes it possible to examine those parts of the larynx that are not visualized when using a conventional directoscope.

In chronic hypertrophic laryngitis, diffuse hyperemia of the mucous membrane is often observed, which is most pronounced in the area of ​​the vocal folds, while the mucous membrane is covered in places with a viscous mucous secretion. In chronic hypertrophic laryngitis, the vocal folds are diffusely thickened, swollen with uneven edges. In the interarytenoid space, papillary proliferation of the mucous membrane or pachydermia is observed, which with mirror laryngoscopy is clearly visible only in the Killian position. This pachydermia prevents the complete closure of the vocal folds, which is why the phonatory function of the larynx suffers: the voice becomes rough, rattling, and quickly gets tired. In some cases, there is also pronounced hyperplasia of the folds of the vestibule, which, with indirect laryngoscopy, cover the vocal folds, inspection of which in this case is possible only with direct laryngoscopy. During phonation, these hypertrophied folds come into contact with each other and, under the influence of exhaled air, give the voice a characteristic, almost pitchless, rough sound, which is sometimes used by pop singers, for example, the great American singer Loone Armstrong. In rare cases, hyperplasia of the mucous membrane occurs in the subglottic space, which takes the form of two elongated and thickened ridges located on both sides of the larynx, as if duplicating the vocal folds located above them and protruding from behind them, narrowing the lumen of the larynx. Exacerbation of the inflammatory process in this area or the occurrence of superinfection can lead to severe swelling of the subglottic space and threatening suffocation.

Two forms of chronic hypertrophic laryngitis deserve special attention - a contact ulcer and prolapse of the laryngeal ventricle (a paired formation located on the lateral wall of the larynx between the vestibule fold and the vocal fold).

Contact ulcer of the larynx

So called by the American authors Ch. Jackson and Lederer, it is nothing more than local symmetrically located pachydermia that forms on the mucous membrane covering the vocal processes of the arytenoid cartilages. Often the rest of the larynx has a normal appearance, although in essence these pachydermas indicate the presence of chronic hypertrophic laryngitis. Contact ulcers owe their origin to excessive vocal efforts in weakened individuals with a poorly developed subepithelial layer (N. Costinescu).

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Prolapse of the ventricle of the larynx

In fact, we are talking about excessive proliferation of the mucous membrane covering one of the ventricles of the larynx, which prolapses into the lumen of the larynx and can partially or completely cover the corresponding vocal fold. This hyperplastic formation is red in color, often has an edematous appearance and can be mistaken for a laryngeal tumor. Often, prolapse of the ventricles of the larynx is combined with a cyst of the ventricular fold, which occurs as a result of proliferation of the epithelium of the mucous gland and blockage of its excretory duct. However, such laryngeal cysts occur rarely; much more often, phoniatrists and general ENT specialists encounter the so-called false cyst of the vocal fold, in which in most cases a defect in the form of a contact ulcer forms symmetrically on the opposite fold. Often, false cysts are visually mistaken for polypous formations of the vocal folds, the distinctive feature of which is a lighter shade, which, in terms of color intensity, occupies an intermediate position between a false cyst and the so-called fusiform edema of the vocal folds. The described space-occupying formations significantly disrupt the function of the vocal folds, preventing their complete closure, which is clearly visualized using the stroboscopy method.

Polypous formations that appear on the vocal folds morphologically belong to the so-called mixed forms, consisting of fibrous and angiomatous tissue. Depending on the relationship between these morphologically different structures, these formations are called fibromas, angiofibromas and angiomas. As noted by D.M. Thomassin (2002), the red or angiomatous type of polyp can be a manifestation of “congenital pathological processes”, and its color depends on the fact that fibrinous exudate envelops the angiomatous elements, giving them a dark red tint.

Mucous retention cysts occur in both adults and children. In appearance, they are “yellowish humps that arise under the mucous membrane and deform the free edge of the vocal fold.” Morphologically, these formations are true cystic cavities located in the stroma of the mucous gland. The cyst develops as a result of blockage of the excretory duct of the gland under the influence of a chronic proliferative inflammatory process. The cavity of the gland is filled with secretion, and its walls undergo proliferation (multiplication of mucous and intercalated cells, thickening and increase in the size of the cyst wall). Unilateral and bilateral cysts, as well as polyps, prevent complete closure of the vocal folds and disrupt the phonatory function of the larynx.

A number of authors attach great importance in the occurrence of the pathological conditions of the vocal folds described above in chronic hypertrophic laryngitis to the so-called Reinke’s space, which forms part of the vocal fold. The bottom of Reinke's space forms a layer of fascia covering the vocal muscle, which thickens towards the free edge of the vocal fold and is woven into the vocal cord, which, in turn, in the caudal direction passes into the elastic cone and cricoid ligament, which provides attachment of the vocal fold to the process of the cricoid cartilage . The ceiling of Reinke's space forms a thin layer of squamous epithelium lying on a strong basement membrane covering the fascia of the vocalis muscle. According to special phoniatric, stroboscopic and model studies, it was found that Reinke's space plays an important role in the subtle modulation of the voice, which is an important acoustic mechanism that enriches the timbre of the singing voice and gives it a unique individuality, therefore one of the principles of modern microsurgery of the larynx is to preserve it in optimal condition structures of the Reinke space during surgical interventions for the pathological conditions of the vocal folds described above. One of the pathological manifestations of chronic hypertrophic laryngitis is swelling of the tissues that make up Reinke's space (Reinke's edema), which occurs in the presence of symptoms of chronic laryngitis and strong vocal tension of the phonatory function of the larynx. Occasionally, cyst-like formations form in Reinke's space, which some authors interpret as retention cysts arising from “stray” mucous glands, others as swelling of this space. The dispute is resolved by histological examination of the removed tissue. Often during prolonged mechanical ventilation, the endotracheal tube is the cause of the so-called endotracheal granuloma.

The variety of morphological changes in chronic hypertrophic laryngitis was mentioned above. Here we note several more forms of this disease, the final differences between which can only be established by microlaryngoscopy and histological examination. One of these forms is the so-called contact granuloma, which occurs, like a contact ulcer, with prolonged traumatic contact of the vocal folds, either of professional origin, or as a complication of a long-term inflammatory process.

Another rare special form of chronic hypertrophic laryngitis is pseudomyxoma of the larynx - a tumor, which may be based on ordinary tissue swelling with its transformation into a substance resembling mucus, but not containing mucin, which is a spindle-shaped infiltrate located on the vocal fold. Sometimes pseudomyxoma is bilateral with a developed network of blood vessels. Single papillomas (a benign tumor from the integumentary epithelium, which has a characteristic appearance of papillary growth protruding above the surface of the surrounding unchanged epithelium - exophytic growth; true papillomas can be difficult to distinguish from papillary growths of inflammatory origin, including productive manifestations of syphilis, gonorrhea, tuberculosis) are not uncommon. hyperkeratosis, occurring exclusively in adult men, having the form of a single outgrowth, a gray or whitish tubercle with a dense consistency. All of the above forms of chronic hypertrophic laryngitis need to be differentiated from laryngeal precancer or laryngeal carcinoma.

Types of chronic laryngitis

Inflammatory phenomena in banal chronic laryngitis are less severe and widespread than in acute catarrhal laryngitis. They develop mainly in the area of ​​the vocal folds and in the interarytenoid space. According to the predominant nature of the inflammatory process, chronic catarrhal laryngitis, chronic hypertrophic laryngitis and chronic atrophic laryngitis are distinguished.

Treatment of chronic laryngitis

Treatment of chronic laryngitis consists primarily of eliminating risk factors that contribute to the occurrence of this disease, which include addictions, occupational hazards, and foci of infection in the upper respiratory tract. The diet that patients must follow is essential (excluding hot and cold drinks, spicy foods, fatty and fried foods). The patient's diet should include fruits, vegetables, and easily digestible foods. In case of dysfunction of the gastrointestinal tract, excretory and endocrine systems, such patients should be referred to appropriate specialists.

Special treatment is divided into non-operative and surgical (microsurgical). Persons suffering from chronic catarrhal laryngitis, chronic atrophic laryngitis and some forms of chronic hypertrophic laryngitis are subject to non-operative treatment; surgical treatment is for chronic hypertrophic laryngitis.

Therapeutic treatment of chronic laryngitis

According to many laryngologists, from the point of view of the use of drugs, chronic catarrhal laryngitis and chronic hypertrophic laryngitis are not much different from each other. At the same time, it is important to emphasize two features of the treatment of these forms of the disease: treatment must be strictly individual, taking into account the patient’s sensitivity to the drugs used and the effect obtained; treatment should not activate proliferative processes, since precancerous conditions may be hidden behind the manifestations of chronic hypertrophic laryngitis. When individually selecting therapeutic measures (inhalations, installations, aerosol irrigations, etc.), it should be borne in mind that both chronic catarrhal laryngitis and chronic hypertrophic laryngitis have a tendency to exacerbations, in which dryness and the formation of viscous, difficult to separate sputum accumulating on the vocal folds, can be replaced by increased secretion of mucus (intensification of the mucous glands) and exudation (the result of activation of the inflammatory process in the mucous membrane). These changes determine the patient’s treatment tactics and the nature of the prescribed medications (emollients, astringents, cauterizers). During exacerbations, you can use the same remedies as for acute catarrhal laryngitis. The remedies used in the mid-20th century have not lost their healing value. Thus, emollients and anti-inflammatory drugs included a 1% oil solution of menthol, chlorobutanol for inhalation, sea buckthorn oil for infusion into the larynx, etc.

As astringents and slightly cauterizing agents, we used a 1-3% solution of collargol, a 0.5% solution of resorcinol for infusion into the larynx 1-1.5 ml once a day, a 0.25% solution of silver nitrate - infusion of 0.5 ml every other day for hypersecretion; solution of tannin with glycerin, 0.5% solution of zinc sulfate (10 ml) in a mixture of ephedrine hydrochloride (0.2) for infusion into the larynx 1 ml, etc. To liquefy viscous sputum and crusts formed in the larynx, a solution of chymotrypsin or trypsin was used ( 0.05-0.1%) for infusion into the larynx 1.5-2 ml.

For nodular formations, along with other medications (infusion of menthol oil solutions into the larynx, lubrication with a 2% silver nitrate solution), various powdery substances were injected into the larynx, for example:

• Rp.: Aluminis 1.0
• Amyli Tritici 10.0 MX pulv. subtil.

• Rp.: Tannini
• Amyli tritici aa 5.0 M. G. pulv. subtil.

For electrophoresis in the larynx area, medications such as 2% calcium chloride solution, 0.25% zinc sulfate solution, 1% potassium iodide solution, lidase 0.1 (64 units) for the procedure for “singing nodules”, etc. were used.

Chronic atrophic laryngitis is usually part of a general systemic degenerative process that has developed in the upper respiratory tract, so isolated treatment of only the larynx without taking into account and treating other ENT organs is ineffective. As for the treatment tactics for chronic atrophic laryngitis and the means used, in a certain sense they are the complete opposite of those methods that are used for chronic catarrhal laryngitis and chronic hypertrophic laryngitis. If in the treatment of the latter astringents, cauterizing agents and agents are used that prevent proliferative (hyperplastic) processes and, as a consequence, hypersecretion and hyperkeratosis, then in the treatment of chronic atrophic laryngitis all measures are aimed at stimulating the natural factors of the “life activity” of the laryngeal mucosa.

Medicines for chronic laryngitis

Medicines used for chronic atrophic laryngitis should help thin the viscous mucus containing high concentrations of mucopolysaccharides (mucin), forming viscous aqueous solutions and drying into dense crusts, facilitate the separation of crusts, moisturize the mucous membrane of the larynx and, if possible, stimulate its proliferation " uterine" cellular elements and the function of the se glands. For this purpose, warm moist inhalations with alkaline mineral waters, as well as inhalations of medicines, are used.

The use of the above remedies, which have been used and are partially used at present, is mainly symptomatic in nature and is aimed at the pathogenesis of the disease in an indirect, not always clearly established way. For example, the use of astringents and cauterizing agents in some forms of chronic hypertrophic laryngitis cannot in any way be called pathogenetic, much less etiotropic, treatment, since these drugs are aimed only at reducing the severity of symptoms of the disease, but not at the primary mechanisms that cause the proliferation of cellular elements of the mucous membrane, goblet cells, connective tissue, etc. In this sense, some methods of treatment for chronic atrophic laryngitis are closer to pathogenetic treatment, since they are to one degree or another aimed at stimulating natural reparative processes by activating stimulating effects aimed at the replication of morphological elements of organs and tissues. Activation of these effects in chronic atrophic laryngitis can only be achieved with complex treatment, when the drugs used have a multidirectional effect, the sum of the effects of which, and often their mutual potentiation, approaches the natural harmony of those physiological processes that are involved in ensuring the trophic and morphological homeostasis of the tissue or organ. The effectiveness of such treatment increases many times if it is possible to establish the cause of atrophy and eliminate it, otherwise a kind of dynamic balance is established between reparative and destructive processes, in which “victory” will ultimately always be on the side of the latter.

It cannot be said with certainty that modern therapy for so-called banal chronic diseases of the larynx has achieved significant success; one can only say that this direction in acute laryngitis is one of the most urgent, especially in the context of pressing environmental problems facing humanity, and that this direction is fraught with great potential scientific opportunities. However, today it is possible to offer the practitioner a number of modern methods and drugs that, in combination with traditional remedies, can be used in the treatment of so-called banal chronic laryngitis.

The tendency of chronic non-atrophic laryngitis to proliferative processes in some cases determines a certain differentiation of methods in the treatment of some of their forms. Thus, during exacerbation of chronic catarrhal laryngitis caused by activation of saprophytic microbiota (acute respiratory infections, adenoviral infection, general and local hypothermia, etc.), the use of the composite drug Strepsils, which has an antiseptic and local anesthetic effect, is indicated. Usually a spray dispenser is used (1 bottle contains 20 ml of solution). When using a spray for treatment of exacerbation of chronic catarrhal laryngitis, when spraying the drug, it is necessary to direct the dose into the laryngopharynx while inhaling, simulating stridor breathing (contraction of the vocal folds). In this case, most of the dose is deposited on the vocal folds and walls of the larynx.

With frequent exacerbations of chronic catarrhal laryngitis, and in some cases of chronic hypertrophic laryngitis, the use of Broncho-Munal (for children Broncho-Munal BP), containing a lyophilized lysate of bacteria that most often cause respiratory tract infections (Str. pneumoniae, Str. Viridans, Str. Pyogenes, Staph. aureus, Moraxella catarrarhalis, Haemophylus influenzae, K. pneumoniae, K. ozaenae). The drug has an immunomodulatory effect: stimulates macrophages, increases the number of circulating T-lymphocytes and IgA, IgG and IgM antibodies (including on the mucous membrane of the respiratory tract), stimulates the body’s natural defense mechanisms against infection of the respiratory system, reduces the frequency and severity of respiratory diseases.

The drug of choice may be Bronchalis-Hel, which has anti-inflammatory, antispasmodic, antitussive and expectorant properties. It is indicated not only for chronic catarrhal laryngitis and its exacerbations, but also for obstructive and inflammatory diseases of the upper respiratory tract (smokers' catarrh, chronic bronchitis, bronchial asthma, etc.); It is also effective for exacerbations of the inflammatory nature of chronic hypertrophic laryngitis.

For chronic laryngitis of any of the three forms, accompanying immunodeficiency states of any origin, manifested in the form of chronic, sluggish and recurrent infectious and inflammatory processes not only in the upper respiratory tract, but also in other localizations, Lykopid is indicated - a semi-synthetic glycopeptide, which is the main structural fragment of the cell wall all known bacteria and has a broad immunomodulatory effect.

In case of chronic atrophic laryngitis and their exacerbations, occurring in the form of acute catarrhal laryngitis, accompanied by the release of viscous, quickly drying sputum with the formation of crusts, it is necessary to prescribe secretolytics and stimulants of motor function of the respiratory tract and mucociliary clearance. Among such drugs, Carbocisteine ​​has proven itself well, having mucolytic and expectorant properties due to the activation of sialic transferase, an enzyme of goblet cells of the mucous membrane of the upper respiratory tract and bronchi. Along with restoring the viscosity and elasticity of the mucus secreted by these cells, the drug promotes the regeneration of the mucous membrane and normalizes its structure. During atrophic processes, it increases the replication of goblet cells, and during their excessive proliferation, it regulates their number. The drug also restores the secretion of immunologically active IgA, which provides specific protection (local immunity) of the mucous membrane, and improves mucociliary clearance. It is important to note that the maximum concentration of the drug in the blood serum and in the mucous membrane of the respiratory tract is achieved 2 hours after taking it orally and remains for 8 hours, therefore the drug is indicated for immediate use in all diseases of the ENT organs without exception, especially in acute and banal chronic laryngitis, infectious laryngitis and as a prevention of complications in preparation for direct laryngoscopy and bronchoscopy.

Another effective mucoregulating drug is Flunfort (Carbocysteine ​​lysine salt), produced in the form of syrup or granulate for oral use. The drug normalizes the function of the glands of the respiratory tract: restores the physiological state of sialomucins and fucomucins, normalizes the rheological parameters (viscosity and elasticity) of the secretion of goblet cells and mucous gland cells, regardless of their initial pathological state, accelerates the mucociliary transport function of the ciliated epithelium, facilitates the restoration of damaged ciliated epithelium. Indicated for acute and chronic diseases of the respiratory tract and ENT organs, accompanied by impaired secretion (laryngitis, tracheitis, rhinitis, sinusitis, otitis media, bronchitis, bronchiectasis, etc.).

For severe exacerbations of banal chronic laryngitis and their complications of a pyogenic nature, as well as for their prevention, antibiotics from the groups of cephalosporins (Ceftriaxone, Tercef, Cefuroxime, Supero), macrolides (Azithromycin, Sumazid) and fluoroquinolines (Ofloxacin, Toriferide) are used.

In the pathogenesis of chronic atrophic laryngitis, local secondary nutritional deficiency, hypovitaminosis and tissue hypoxia play a significant negative role. To combat these factors that enhance the underlying pathological process, vitamins C, thiamine, riboflavin, folic, para-aminobenzoic, pantothenic acids, vitamins B1, B6, B12 and PP, glucose, ATP, sodium bromide with caffeine are recommended.

Surgical treatment of chronic laryngitis

Surgical treatment for chronic hypertrophic laryngitis is resorted to in cases where the ineffectiveness of non-operative treatment becomes obvious and it is necessary to eliminate any space-occupying formation that is not subject to non-surgical treatment (cyst, papilloma, fibroma, prolapse of the ventricle of the larynx, etc.) that is interfering with the functions of the larynx. The development of endolaryngeal surgery began after the invention of indirect laryngoscopy in 1854 by M. Garcia, and by the end of the 19th century. Many surgical instruments for endosurgical intervention on the larynx were invented, which were adapted specifically for this method of endoscopy. However, an obstacle to the development of laryngeal endosurgery was the inconvenience associated with the flow of blood and mucus into the trachea during attempts at more radical surgical intervention. The use of suction made the surgeon’s task somewhat easier, but not so much that it was possible to operate in a “dry field.” With the invention of tracheal intubation for endotracheal administration of narcotic gas substances by the Scottish physician W. Macewen in 1880, the development of endolaryngeal surgery accelerated. In the 20th century In connection with the development of fiber optics, the method of video endoscopy and the improvement of microsurgical instruments, the method of endolaryngeal microsurgery arose and reached perfection. For this purpose, Professor of the University of Marburg Oskar Kleinsasser, in collaboration with the Karl Storz company, developed and introduced into practice in most countries original models of laryngoscopes and a wide variety of types of surgical instruments, allowing under high magnification using an operating microscope to carry out the finest surgical operations in almost all types of the above. above hyperplastic processes in the larynx.

The author recommends first of all operating with two hands using two instruments. In most cases, forceps are combined with scissors or a coagulator with suction. Tweezers are intended only for fixing the object being removed and in no case for tearing or biting the fabric. “Stipping,” i.e. tearing off a polyp or tearing off Reinke's edema, is a serious surgical mistake, since it can cause injury to the tissue that needs to be preserved, which can subsequently lead to voice impairment and the formation of unwanted scars. Therefore, smooth cutting of the tissue to be removed using sharp scissors or a special scalpel should be a strictly followed rule.

To comply with the gentle principle, which is basic for endolaryngeal microsurgery, especially on the vocal folds, O. Kleinsasser recommends that novice surgeons have a clear understanding of the subtle anatomical structures of the larynx and study in detail the main pathological changes to differentiate them from healthy tissues that need to be preserved. When intervening on the vocal fold, it is necessary to take into account the fact that the squamous epithelium is not fixed to the underlying substrate only above the body of the vocal fold; in the remaining part it is attached above and below to the arcuate lines, dorsally to the vocal process, and ventrally to the anterior commissure. The structure of Reinke space should also be taken into account; Therefore, defects in the epithelium of the vocal fold, formed after the removal of polyps, nodules and varices, should remain as small as possible so that they are quickly covered with a new epithelial cover, and the Reinke's space is closed again. When removing small pathological formations, such as polyps, nodules and small cysts adhering to the epithelium, they should not be grabbed at the very base, but fixed with tweezers at the very edge of the fold of the mucous membrane, pulled to the middle of the glottis and cut off at their very base.

With Reinke's edema, as noted by O. Kleinsasser, suction of mucus, curettage and resection of remnants of the mucous membrane in most cases do not lead to the desired result. The author warns against the often recommended method of “stripping,” in which a strip of epithelium is simply torn from the vocal fold with tweezers. In this pathological condition, the author recommends that you first make an even cut with scissors around the tissue around the strip of epithelium to be removed, and only after this the removed “preparation” with the viscous edematous fluid attached to it can be “pulled off” entirely, without damaging the underlying tissue. The thick secretion remaining on the vocal fold is removed using suction. In case of large Reinke's edema, in order to avoid excessive impairment of vocal function, it is recommended to perform only partial removal of the pathological tissue during the first operation, and then, with an interval of 5-6 weeks, complete surgical treatment with two more similar surgical interventions.

In case of advanced chronic hypertrophic laryngitis with thickening of the vocal folds, it is advisable to excise narrow strips of the most thickened epithelial layer and inflamed submucosal tissue so that in the future it is possible to remodel the shape of the vocal folds at the expense of the remaining epithelial layer.

For juvenile papillomas, it is advisable to use the method of diathermocoagulation with suction of destroyed papillomatous tissue. This method is the fastest, gentlest and almost bloodless, ensuring satisfactory function of the vocal folds. Destruction is carried out by touching the microcoagulator to the most protruding part of the tissue being removed, while the current is set at a low level so that the tissue does not burn during coagulation, but becomes soft (“boiled”) and white and is easily removed without bleeding using suction. This technique does not allow current to be applied to an unacceptable depth and ensures coagulation of only the layer that needs to be removed. Due to the small return of thermal energy, there is no large postoperative edema.

For precancerous tissue changes and small carcinomas, currently, as a rule, an excisional biopsy is performed, and not only small biopsies are taken: the healthy-looking epithelium of the affected part of the vocal fold is cut and this part is separated within the healthy tissue to its very base and removed en masse . Keratoses, as well as preinvasive and microinvasive carcinomas, are usually removed without technical difficulties and without damaging the submucosal structures of the vocal folds. But when determining whether the tumor has penetrated deep into the vocal muscle, it should also be resected within healthy tissue.

As O. Kleinsasser notes, endolaryngeal chordectomy in the clinic he runs is carried out only when only the superficial muscle layer is affected by the tumor. In case of more significant damage to the vocal fold, the author recommends performing the operation from an external approach, which provides a good overview and immediate restoration of the vocal fold and thereby preserves the fullness of the vocal function.

In the last decade, significant advances have been made in laser microsurgery of the larynx (M.S. Pluzhnikov, W. Steiner, J. Werner, etc.) using a carbon dioxide laser (G. Jako).

Form of the disease

The question of what chronic laryngitis is and how it differs from the acute form of the disease interests many patients who have been diagnosed with this. Experts always note the fact that the main feature of this type of disease is its asymptomatic course. A person who has recurrent swelling in the throat area may not be aware of it for a long time, since the main negative symptoms will appear only during an exacerbation.

Chronic laryngitis of the larynx in many patients is discovered only during a routine visit to the otolaryngologist during laryngoscopy. This “closed nature” of the course of the disease is due to the fact that it rarely becomes a consequence of an acute form of the disease. For the most part, the development of the pathological process in the laryngeal region occurs unnoticed over several years, due to the regular influence of certain negative factors on a person.

At the same time, people susceptible to its development experience some vocal disturbances, such as dysphonia, that is, changes in timbre and sound, and rapid fatigue of the vocal cords. But these negative sensations are usually not given special attention due to their weakness and the complete absence of any discomfort in a person. A disease that cannot be completely cured and constantly recurs is noticed only when an exacerbation begins.

The reasons for its occurrence

In order to prevent the development of swelling in the laryngeal area, which occurs with regular alternating periods of exacerbations and subsidence, which is not completely possible to cure, it is necessary to study the basic prerequisites that can provoke the development of the disease. The causes of chronic laryngitis, according to all leading otolaryngologists, lie in the following negative factors that have a direct impact on a person:

• genetic features of the structure of the pharynx, which cannot prevent the penetration of pathogenic microorganisms and bacteria into the body. They settle in large quantities on its mucous surface, thereby provoking the development of inflammation on it;
• a person’s exposure to frequent infectious diseases of a viral or bacterial nature, under the influence of which the regularly inflamed mucous membrane of the larynx simply does not have time to recover and is constantly in a state of hyperemia;
• a therapeutic course that is incorrectly selected or carried out with serious errors, which is intended to stop. Ignoring treatment measures is considered especially dangerous and always provokes the transition of pathology to a regularly relapsing stage;
• exposure to harmful habits, such as prolonged and excessive consumption of alcohol, which literally burns the mucous membrane of the larynx, and smoking, which causes the development of an inflammatory process in it;
• untreated caries, which is a source of penetration of pathogenic microorganisms into the body, most of which settle on the surface of the pharynx and begin to become active over time;
• problems in respiratory function that arise for various reasons - polyps in the nasopharynx, frequent rhinitis, . In these cases, the listed prerequisites are not the direct factor causing this type of pathological swelling of the larynx. Their negative role lies in the fact that due to the inability to breathe through the nose, a person carries out this action with the mouth, thereby chilling the throat;
• increased load on the vocal cords, which is always present among teachers, actors and singers, as well as those people who express their emotions with their voices, excessively straining the entire larynx;
• disorders in the immune system, since with reduced immunity the body is defenseless against pathogenic microbes that enter it.

This pathology of the throat and, directly, the vocal cords, such as chronic laryngitis, has numerous causes that determine its occurrence. That is why attending physicians always advise their patients to know not only them, but also the possible symptoms of this form of ENT disease as accurately as possible, since only this will contribute to the beginning of adequate treatment, which can lead to a long period of remission in the shortest possible time.

Types of chronic laryngitis: hypertrophic, catarrhal, atrophic

A constantly recurring type of throat disease that impairs the functioning of the vocal cords can be of several types. Everyone needs to know the forms of chronic laryngitis, as well as their distinctive features. This especially applies to those people who are at risk for developing this pathology. This disease is divided into the following subtypes:

• . It is an inevitable consequence of acute inflammatory processes of an infectious nature repeatedly suffered by a person. At risk for its development, for the most part, are those people who, due to their professional activities, are subject to regular overstrain of the vocal cords;
• is a type of disease in which there is a pronounced thickening and enlargement of the laryngeal mucosa, accompanied by its inflammation. In addition, with this form, the formation of pathological growths in the form of nodules is observed on its surface. It is they that lead to the appearance of pronounced hoarseness in the voice, which is the most obvious sign. This type of disease is considered the most dangerous, as it is a precancerous condition;
• atrophic laryngitis is directly related to atrophy (excessive thinning) of the pharyngeal mucosa. With this form of the disease, the process of malignancy of the laryngeal mucosa also begins quite quickly. This type of disease occurs as a result of regular alcohol abuse, long-term smoking, and a love of spicy food. This type of disease is completely unusual for the younger age category of patients; it is diagnosed mainly in people over 40 years of age.

A separate group includes specific forms of swelling of the larynx, which include pachydermia (the formation of warty growths on significantly thickened vocal cords).

Symptoms and manifestations of chronic laryngitis

The clinical picture of this disease is not particularly pronounced, which is considered by doctors to be very dangerous. The immediate threat in this situation is the fact that a person who is not experiencing any discomfort or pain is in no hurry to visit a doctor. This is fraught with constant progression of the disease and, as a result, irreversible processes occurring in the larynx area.

Chronic laryngitis, like any other disease, may have some mild symptoms. Such manifestations of the disease should be known in order to promptly suspect the occurrence of a dangerous scourge. Otolaryngologists recommend that all people at risk for developing this disease study all possible manifestations of each of its forms and do not neglect visiting a doctor even if minimal alarming symptoms appear.

How does the catarrhal type of the disease manifest itself?

This type of disease, also called banal, does not have any special manifestations. Chronic catarrhal laryngitis is detected mainly during routine laryngoscopy. It is a visual review that helps to detect not too active hyperemia that has appeared in the larynx area. The color of the mucous membrane in this disease becomes gray-red and is mostly local in nature, although it can be observed on its entire surface. The main manifestations of chronic laryngitis of the catarrhal type are as follows:

• constant dryness, soreness and tickling in the throat;
• the appearance of hoarseness in the voice during long conversations or in the evening;
• a feeling that there is a foreign object in the larynx;
• frequent occurrence of slight pain accompanying the swallowing reflex.

But cough with chronic laryngitis of this type is rare. Usually it occurs only when the back wall of the pharynx is exposed to inflammation. A distinctive feature of cough syndrome is that it, although mildly expressed, can be accompanied by copious mucus secretion. Adequate therapeutic measures in this case quickly lead to remission of the pathology.

Hypertrophic chronic form of the disease

All symptoms of this type of laryngeal disease appear evenly on both sides. Patients with this disease try to compensate for the strength of their voice by strengthening it, and this leads to the development of even greater irritation. The main symptoms accompanying this form of the disease are usually as follows:

• dryness and a sore throat, causing a dry cough;
• constant presence of thick mucus in the throat area;
• hoarseness or complete loss of voice;
• frequent manifestations of shortness of breath against the background of constant difficulty breathing;
• low-grade fever within 37.1-37.5°C.

These signs of chronic hyperplastic laryngitis, although they do not cause serious problems for a person, pose a serious danger. Experts note the fact that the overgrown epithelium of the larynx can almost never be completely cured. This process is considered irreversible, since when normal tissues are replaced by connective tissues, carcinoma occurs, which is a malignant neoplasm. Typically, patients with such symptoms, after undergoing diagnosis and confirmation of the suspected diagnosis, are registered with an otolaryngologist and oncologist in order to avoid the development of laryngeal cancer.

Signs of atrophic pathology of the larynx

This type of disease has one distinctive feature. In addition to the general symptoms and clinical signs detected during visual examination, there are also manifestations indicating lesions that have arisen in other organs, which had a direct impact on the development of the disease. According to most leading otolaryngologists, if a person develops mucosal atrophy in the larynx, causing chronic laryngitis, the symptoms will indicate its immediate root cause. You can suspect the onset of a destructive process in the larynx area based on the following alarming symptoms:

• syndrome of constant dryness in the throat with a simultaneous sensation of viscous exudate (mucus accumulation);
• almost non-stop barking cough;
• a pronounced change in the timbre and sonority of the voice.

Due to the fact that atrophy provokes a disturbance in the production of mucus, the inner surface of the throat becomes very dry, which causes the patient to experience unpleasant sensations reminiscent of the presence of a foreign body in the larynx that interferes with the swallowing reflex.
Experts always warn people who come to them with similar symptoms that this form of the disease is no less dangerous than the hypertrophic one, since it can also provoke the development of a malignant neoplasm in the pharynx. That is why, immediately after minor symptoms of chronic laryngitis appear in adults, it is necessary to urgently consult a doctor and undergo appropriate research to establish an accurate diagnosis.

Diagnosis of the disease

Diagnosis of the disease

Doctors involved in treatment strongly advise anyone who has discovered at least one of the above symptoms to urgently consult a specialist. This will help to timely determine the form of the pathological inflammatory process occurring in the larynx and take adequate measures to stop it. Also, correct diagnosis of chronic laryngitis allows one to identify both unilateral and bilateral types of the disease, which is an important factor in determining malignancy. The main methods used to determine the type of disease are the following:

1. a survey of the patient, during which the specialist is able to establish which form of pathology, chronic or acute, is developing in the person. Also, when collecting anamnesis, it is possible to identify those factors that were the root cause of the recurrent type of illness;
2. laryngoscopy, which gives the doctor the opportunity to visually examine the surface of the pharyngeal mucosa and, by its texture, determine the type of destructive process that has affected the larynx;
3. biopsy. This procedure is necessary when nodular growths are found on the surface of the mucous membrane covering the throat, and the vocal cords look excessively thickened.

Chronic laryngitis: treatment

Many people mistakenly believe that treatment for often recurrent laryngeal edema is as easy and simple as with ordinary sore throat. This opinion is completely untrue. In fact, if a person has developed chronic laryngitis, more serious treatment will be required, using completely different groups of medications and a special approach.

Due to the fact that it is almost never possible to completely eliminate this disease, the main goal of therapeutic measures is to improve the general condition of a person by relieving the main symptoms. The treatment regimen prescribed by a specialist is carried out in conjunction with the observance of certain rules to make it more effective. A patient undergoing therapy is required to adjust his diet, ensure maximum rest for the vocal cords, and give up bad habits.

Medicinal methods of therapy

Treatment of chronic laryngitis always has a direct dependence on its type. Moreover, all therapeutic measures should be prescribed exclusively by a specialist. Conducting the selected course also involves its direct control. Drugs are prescribed depending on the identified form of the disease. For the most part, all therapeutic measures are performed by the patient at home. Hospitalization is required only if the medications prescribed by the doctor for chronic laryngitis of any kind do not bring any relief.

Typically, the general course of drug treatment is similar to the treatment of pharyngitis.

So, how to treat chronic laryngitis at home:

• Antibiotics are used for systemic therapy. For chronic laryngitis, Moexipril or is most often recommended, and Groprinosin is used to localize viral foci formed on the surface of the larynx.
• Local treatment is carried out using Bioparox and Ingalipt sprays, as well as Decatylene lozenges.
• Irrigation of the constantly drying mucosa involves constant inhalation. For chronic laryngitis, Interferon powder, Acetylcysteine ​​or Eufillin dissolved in water helps well, but these drugs should only be prescribed by the attending physician.
• It is possible to localize a cough with the help of mucolytics, the most effective of which is Ambroxol. Expectorant drugs with herbal components are also used, such as: Prospan, Gerbion, Pectolvan.

Also, for the treatment of certain pathological conditions of the larynx, doctors recommend specific drug procedures. Treatment of ataral laryngitis involves the use of medicinal substances with an astringent, anti-inflammatory and emollient effect. To extinguish and reduce clinical manifestations associated with hypertrophy of the superficial layer of the pharynx, gargling with silver nitrate is also recommended.

If a person is diagnosed with atrophic laryngitis, treatment involves the use of medicinal substances that not only moisturize the mucous membrane, but also help soften the crusts that have formed on it. In this case, stimulation of cells that produce glandular enzyme is also necessary. It is carried out using proteolytic enzymes. Drug treatment of atrophic laryngitis also includes the elimination of concomitant pathologies. Such therapeutic measures are prescribed by a doctor only after receiving the results of a diagnostic study.

When and how to treat chronic laryngitis with surgery?

The treatment methods listed above may not always be effective. In some cases, drug therapy does not produce positive results. Typically, this situation occurs in the hypertrophic form of the disease. In this situation, surgical intervention may not be possible. Surgery for chronic laryngitis is performed to remove neoplasms found in the pharynx, or overgrown submucosal tissue that interferes with the complete restoration of the functioning of the pharynx. The most modern methods of radically solving the problem are:

• endolaryngeal microscopic removal of benign neoplasms from the surface of the larynx;
• laser cauterization of pathologically overgrown cells of the pharynx;
• radio wave effects on abnormal mucosal hyperplasia.

During any of the treatment courses chosen by the specialist, the patient is recommended to follow a gentle regime for the ligamentous apparatus. Basically, it consists of following a diet with the exclusion of too spicy, hot or cold foods from the daily diet.

Traditional treatment of chronic laryngitis

Treatment using folk remedies

Along with traditional therapy methods, experts recommend using remedies prepared according to folk wisdom recipes. But you must always remember that folk treatment of chronic laryngitis is permissible only as an addition to the main complex. Despite the fact that all infusions and decoctions for the preparation of which medicinal herbs were used are highly effective, they are not able to cope with a constantly recurring illness on their own.

We should also not forget that after chronic laryngitis is diagnosed, it should only be prescribed by an otolaryngologist. Only the attending physician, who has a direct understanding of the clinical condition of the patient’s larynx, will be able to select the most effective herbal remedies for cough, dryness and swelling of the mucous membrane or herbal infusions that help restore the voice. If you need to treat chronic laryngitis at home, you can use the following popular recipes:

• two teaspoons of a mixture of oregano, chamomile flowers and coltsfoot leaves, taken in a 1:2:2 ratio, are poured with half a liter of boiling water. This composition should be infused for 6 hours, and then taken 4 times a day, half a glass;
• Black elderberry flowers, pine buds, licorice root and plantain and sage leaves are mixed in equal quantities. 2 tablespoons of the resulting composition should be poured with a glass of boiling water and kept in a water bath for half an hour. This remedy is taken 2 tablespoons 6 times a day at equal time intervals.

Treatment of chronic laryngitis at home involves the use of inhalations, for which it is best to use peppermint, calendula and eucalyptus. Moreover, to carry out the procedure, these plants can be taken either separately or together.

Complications of chronic laryngitis in adults

This form of the disease, according to all specialists without exception, is very dangerous. Most often, when its course is advanced, pathological conditions such as frequent airway obstruction and constant aphonia can develop. But the worst complications of chronic laryngitis are those that are associated with malignancy of the laryngeal mucosa and the development of carcinoma on it. There are also frequent cases of complete paralysis of the vocal cords with this pathology.

All this can be avoided only if the patient does not ignore the therapeutic measures prescribed by the doctor. It should also be borne in mind that when an exacerbation of chronic laryngitis is completely stopped, the patient needs subsequent rehabilitation. It is as follows:

• normalization of respiratory functions. For this purpose, specialized exercise therapy classes are conducted;
• voice restoration requires the direct assistance of a speech therapist;
• complete recovery of the body. Strengthening the immune system helps achieve this.

Only after these consequences of chronic laryngitis are eliminated will the patient be able to return to their usual lifestyle, in which there is no constant discomfort from the larynx. To avoid new relapses of the disease or the occurrence of any serious, often irreversible complication, you should follow certain rules of behavior recommended by your doctor.

Prevention of chronic laryngitis

All types of chronic laryngitis without appropriate preventive measures are prone to frequent recurrence. In people with this diagnosis, the frequency of periods of increased symptoms reaches 2-3 times a year. Typically, the onset of a negative state is characterized by a person experiencing a voice disorder. In chronic laryngitis, this is the main sign of relapse of the disease. In addition, a severe cough and shortness of breath may appear, significantly affecting people’s quality of life.

To avoid exacerbation of chronic laryngitis, treatment of pathological swelling of the larynx should be accompanied by preventive measures. They are usually prescribed by a specialist, but there are several publicly available methods that can prevent the development of the disease.

This prevention of chronic laryngitis is as follows:

1. correction of nutrition with complete exclusion from the daily menu of dishes and products that irritate the mucous membrane;
2. giving up existing bad habits;
3. increasing physical activity and constantly carrying out hardening procedures;
4. increasing time spent in fresh air;
5. normalization of work and rest schedules;
6. avoidance of stressful situations.

Relapse can be completely avoided only if all activities are carried out regularly. You should not neglect taking immunomodulators, which help maintain normal immunity.

Informative video

Catad_tema Diseases of the ENT organs - articles

ICD 10: J37.0, J37.1

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

ID: KR321

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. DykhesPresident 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 of the Russian Federation__ __________201_

chronic hyperplastic laryngitis

chronic edematous polyposis laryngitis

List of abbreviations

GERD – gastroesophageal reflux disease.

CHL – chronic hyperplastic laryngitis

CL – chronic laryngitis

COPL – chronic edematous polyposis laryngitis

Terms and Definitions

Chronic hyperplastic laryngitis (CHL) (l. chronica hyperplastica) - a type of chronic laryngitis characterized by diffuse hyperplasia of the laryngeal mucosa or limited hyperplasia in the form of nodules, mushroom-shaped elevations, folds or ridges.

Chronic edematous polyposis laryngitis (COPL) - Reinke-Hajek disease (Reinkae edema)- chronic laryngitis, characterized by polypoid growth of the mucous membrane of the vocal folds.

Gastroesophageal reflux disease (GERD) - morphological changes and symptom complex that develop as a result of the reflux of the contents of the stomach and duodenum into the esophagus.

1. Brief information

1.1. Definition

Chronic laryngitis (CL) is a chronic inflammatory disease of the laryngeal mucosa lasting more than 3 weeks.

1.2. Etiology and pathogenesis

Almost all chronic laryngitis are precancerous diseases. Chronic hyperplastic laryngitis (CHL) is characterized by hyperplasia of the epithelium of the laryngeal mucosa. The pathogenesis of the disease is not fully known. The pathogenesis of chronic edematous polyposis laryngitis (COPL) is better known. The course of the disease is associated with the anatomical features of Reinke's space. Immunohistochemical examination and electron microscopy of remote sections of the vocal fold mucosa in patients with Reinecke's disease reveal increased subepithelial vascularization with a large number of dilated vessels. The walls of the blood vessels are thinned, and capillaries are fragile. Fragility and changes in the vascular pattern in Reinecke's space are the cause of edema in this area and contribute to the progression of the disease. This can also explain the occurrence of hemorrhages in the vocal folds in the initial stage of the disease with a sharp increase in vocal loads. In addition, disruption of lymphatic drainage is of great importance.

1.3. Epidemiology

Chronic laryngitis accounts for 8.4% - 10% of all pathologies of the ENT organs. Reinke-Hajek COPL accounts for 5.5 - 7.7% of all diseases of the larynx leading to voice impairment. CGL is more common in men aged 40-60 years, and Reinke-Hajek COPL is more common in women.

1.4. Coding according to ICD-10

J37.0- Chronic laryngitis;

J37.1- Chronic laryngotracheitis.

1.5. Classification

Chronic laryngitis is divided into catarrhal, hyperplastic, atrophic and edematous-polyposis (Reinke-Hajek disease). Specific laryngitis is distinguished separately and, by some authors, pachyderma of the larynx is separately defined. There are limited and diffuse forms of hyperplastic laryngitis. Vocal fold nodules, according to some authors, are a form of hyperplastic laryngitis, but most authors tend to define this pathology as independent. Chronic laryngitis is also divided into specific and nonspecific.

2. Diagnostics

2.1. Complaints and anamnesis

In HL, the leading complaint is persistent impairment of vocal function, sometimes cough, sore throat with vocal stress, paresthesia in the projection of the larynx, and sometimes shortness of breath. Changes in vocal function are different in different forms of laryngitis. Chronic hyperplastic laryngitis is characterized by constant hoarseness with a deepening of the voice and the presence of many overtones. In chronic edematous polyposis laryngitis, the leading symptom is persistent hoarseness, which is characterized by a gradual shift in voice timbre to the low frequencies of a male timbre. Atrophic laryngitis is more characterized by decreased tolerance to vocal stress, the appearance of cough and pain when trying to improve voice volume, and hoarseness. In patients with catarrhal laryngitis, complaints of various paresthesias in the projection of the larynx and hoarseness, which increases during vocal stress, and decreased vocal endurance come to the fore. With edematous-polyposis laryngitis, respiratory failure may develop to grade 3 laryngeal stenosis. The appearance of patients suffering from Reinecke's edema is characteristic: symptoms of hirsutism in women, a tendency to facial swelling. With long-term laryngitis, in some cases, hypertrophy of the vestibular part of the larynx develops due to the formation of vestibular-fold phonation. Cough is not a constant symptom of laryngitis. If the patient complains of cough, further examination is necessary to determine the cause of the cough.

When collecting anamnesis, attention is paid to screening for etiopathogenetic factors in the development of the disease and the frequency of relapses. An anamnesis of the voice disorder is important (the nature of the voice dysfunction, its duration, the patient’s need for vocal stress), as this allows not only to carry out an initial differential diagnosis of the disease and determine its duration, but also to build the correct system of staged voice restoration treatment.

2.2. Physical examination

During a physical examination of a patient with chronic laryngitis, attention should be paid to the external contours of the neck and larynx, the mobility of the laryngeal skeleton by palpation and during swallowing, and the participation of the neck muscles in phonation. With intense phonation, the tension in the external muscles of the neck is clearly visible. Regional lymph nodes are assessed; their enlargement may indicate the degeneration of a precancerous process. The size of the thyroid gland is determined, which is especially important for patients with COPD. At the same time, a subjective assessment of voice quality, articulation and individual speech characteristics is carried out.

2.3. Laboratory diagnostics

A comprehensive general clinical examination of a patient with HL is recommended with the involvement of doctors of other specialties (gastroenterologist, endocrinologist, pulmonologist, neurologist, rheumatologist, infectious disease specialist, dermatologist, etc.).

Comments: is carried out to clarify the etiological factors in the development of the inflammatory process and concomitant pathology.

Comments: It is preferable to take cultures from the mucous membrane of the hypopharynx without anesthesia or from the vocal folds under local anesthesia. The most common causative agents of laryngitis are: Streptococcus pneumonia, Haemophilus influenza, S. aureus, Mycoplasma spp., Actinomyces diphteriae, Mycoplasma pneumonia, Chlamiophila pneumonia. Chronic hyperplastic laryngitis is characterized by associations of microorganisms, among which the most common are Staphylococcus aureus and epidermidis. It has been established that the causative agents of laryngomycosis in 97% of cases are yeast-like fungi of the genus Candida, most often Candida albicans and Candida spp., other species are less common - C.tropicalis, C.krusei, C.pseudotropicalis, C.glabrata.

Comments: Taking a biopsy in the larynx can be carried out during fibrolaryngoscopy, during indirect microlaryngoscopy, during direct microlaryngoscopy by an otolaryngologist or an endoscopist or an oncologist with the necessary surgical skills.

The microscopic picture of CGL is a combination of reactive changes in the surface epithelium and inflammatory, reparative and sclerotic changes in the lamina propria of the mucous membrane. The inflammatory infiltrate is characterized by a predominance of mononuclear elements and plasma cells over segmented leukocytes. The predominance of cells from the productive phase of inflammation is the main distinguishing feature of chronic inflammation. The second morphological component is reactive changes in the integumentary and glandular epithelium in the form of hyperplasia, acanthosis and keratinization disorders, dysplasia of the respiratory epithelium - in the form of basal cell hyperplasia, an increase in the number of goblet cells and squamous metaplasia. Severe acanthosis of the stratified squamous epithelium is the main pachyderma. With COPD, it is not the signs of inflammatory infiltration that come to the fore, but pronounced interstitial edema, often with stromal myxomatosis, disruption of the vascular wall, and thickening of the basement membrane of the integumentary epithelium. Morphological examination for specific laryngitis and laryngomycosis, although it has its own characteristics, is only part of the diagnosis; the entire clinical picture of the disease and data from other examination methods are of great importance. Histological examination in these cases is not always informative.

2.4. Instrumental diagnostics

Comments: It is optimal if the examination is recorded on video, as this will make it possible to fully monitor the patient with a precancerous process. If it is not possible to perform microlaryngoscopy, the patient should be sent for consultation to those institutions where this diagnostic method exists. Microlaryngoscopy picture of CL diverse. In the vast majority of cases, the pathology is bilateral. Chronic catarrhal laryngitis is characterized by an increase in the vascular pattern of the vocal folds, their hyperemia, and dryness of the mucous membrane. In chronic edematous-polyposis laryngitis, polypoid degeneration of the mucous membrane can be different: from a mild fusiform-vitreous tumor that looks like an “abdomen” to a severe floating, polypoid, translucent or gray, gray-pink gelatinous thickening that stenoses the lumen of the larynx. With atrophic laryngitis, the mucous membrane of the vocal folds looks dull, there may be viscous sputum, there is hypotonia of the vocal folds and non-closure during phonation.

In the diffuse form of CGL, infiltration of the vocal folds is observed, foci of keratosis are visible, hyperemia of the laryngeal mucosa, the presence of fibrinous deposits, and accumulation of viscous or purulent sputum are possible. Keratosis is a pathological keratinization of the epithelium of the laryngeal mucosa, which can manifest itself in the form of pachyderma (thickening of the mucous membrane in the interarytenoid region), leukoplakia (white smoky formation), hyperkeratosis (lumpy formation) located on the vocal folds.

In all forms of laryngomycosis, a common microlaryngoscopic sign was noted - the presence in all patients of whitish deposits or accumulation of thick sputum in various parts of the larynx. The diagnosis of laryngomycosis can be made only after verification of the pathogen.

The endovideolaryngostroboscopic picture in the catarrhal form of laryngitis shows minor changes in the vibrator cycle; there is a decrease in the amplitude of vibration of the vocal folds and mucous waves. The subatrophic form of chronic laryngitis is characterized by a symmetrical decrease in the amplitude of vibrations of the vocal folds, a decrease in the mucous wave and the absence of the closure phase. With edematous-polyposis laryngitis, the closure phase is complete, the vibrations of the vocal folds are asymmetrical and irregular, the amplitude of vibrations of the vocal folds is reduced, and the mucous wave, on the contrary, is sharply increased. In the hyperplastic form of laryngitis, pronounced disturbances in the vibrator cycle are determined. They are determined by a decrease in the amplitude of vibrations of the vocal folds (along the entire length or in a separate area), the mucous wave is reduced or absent, non-vibrating areas of the mucous membrane are determined, an asymmetrical and uneven change in the amplitude of vibrations and the mucous wave is noted. Video laryngoscopy is indicated for patients with limited keratosis. There are superficially located keratosis and fused with the underlying layers. Adhesive keratosis is especially suspicious for cancer and is an absolute indication for surgical treatment.

Comments: at hastily used and other , based on the analysis of the vascular pattern of the affected areas of the mucous membrane, it is also possible to use contact endoscopy, which is an intravital morphological study of the mucous membrane.

Comments: the study helps in later stages of therapy to determine the quality and nature of phonation for each individual patient in order to build the correct system of voice restoration treatment.

Computed tomography of the neck organs is recommended if differential diagnosis is necessary, and pulmonary function testing is indicated for patients with COPD to verify symptoms of latent respiratory failure in laryngeal stenosis.

Comments: consultation is indicated to identify etiopathogenetic factors in the development of the inflammatory process in the larynx.

2.5. Differential diagnosis

Comments: The differential diagnosis of CGL and laryngeal cancer is often very difficult. With indirect microlaryngoscopy, attention is paid to the nature of the vascular pattern. Laryngeal cancer is characterized by atypia of capillaries: an increase in their number, their convoluted shape in the form of a corkscrew and uneven dilation of blood vessels, pinpoint hemorrhages. In general, the vascular pattern of the vocal fold is chaotic. Impaired mobility of the vocal fold, the unilateral nature of the process is alarming in terms of malignancy of chronic laryngitis. Other changes in the vocal fold also attract attention: severe dysplasia, infiltration of the mucosa, foci of dense keratosis adhered to the underlying tissues, and others. The final differential diagnosis for HL is made as a result of histological examination.

Comments: Involvement of the larynx in the pathological process with Wegener's granulomatosis occurs in 6-25% of cases in the form of subglottic laryngitis, accompanied by subglottic stenosis. Isolated damage to the larynx with scleroma is observed in 4.5% of cases, more often the nose, nasopharynx and larynx are involved in the process. Pale pink lumpy infiltrates form in the subglottic space. The process can spread into the trachea or upward to other parts of the larynx. There is primary amylodyosis of the larynx, nodular or diffuse-infiltrative forms, and secondary - against the background of chronic inflammatory systemic diseases (Crohn's disease, rheumatoid arthritis, tuberculosis, etc.). Most often, the damage is diffuse in nature with intact mucosa, sometimes spreading to the tracheobronchial tree. Amyloid deposits are localized mainly in the supraglottic part of the larynx, sometimes in the form of subglottic laryngitis. Sarcoidosis occurs in the larynx in 6% of cases in the form of epiglotitis and granulomas. The vocal folds are rarely affected. With rheumatoid arthritis, laryngeal pathology is diagnosed in 25-30% of patients. Clinically, the disease manifests itself as arthritis of the cricoarytenoid joint. Differential diagnosis is carried out on the basis of general clinical, serological examination and biopsy. Laryngeal tuberculosis is characterized by polymorphism of changes. The formation of miliary nodules and infiltrates is noted, which undergo decay with the formation of granulations, ulcers and scarring. Tuberculomas and chondroperichondritis often form. Syphilis of the larynx manifests itself in the form of erythema, papules and condylomas. Ulcers often form, covered with a grayish-white coating.

3. Treatment

The purpose of treatment is to eliminate the inflammatory process in the larynx, restore a sonorous voice, and prevent the degeneration of the inflammatory process into a malignant formation.

Indications for hospitalization. Patients who are scheduled for surgical treatment are hospitalized.

3.1. Conservative treatment

Antibacterial therapy is recommended for exacerbation of HL, and it is prescribed empirically using broad-spectrum drugs (amoxicillin + clavulanic acid, respiratory fluoroquinolones, macrolides).

Comments: in case of severe inflammatory phenomena with the addition of purulent exudation. Perioperative antibiotic therapy is prescribed for surgical intervention with direct microlaryngoscopy, implantation methods of surgical correction, and a large volume of surgical intervention. When diagnosing a fungal infection, antimycotic drugs are prescribed. The use of specific therapy in the diagnosis of specific laryngitis does not exclude the use of local and general anti-inflammatory therapy.

Comments: indicated for exacerbation of hyperplastic and edematous-polypous laryngitis, when indicating a history of allergies and in some cases of laryngomycosis. The use of antihistamines should be avoided for catarrhal and subatrophic forms of laryngitis, as these drugs cause dryness of the laryngeal mucosa.

Decongestant therapy with systemic corticosteroids is recommended, which is indicated for patients after surgical interventions, if decortication of the vocal folds has not been performed, as well as for stenosis of the upper respiratory tract caused by exacerbation of a chronic inflammatory process, and cannot be used as monotherapy.

Comments: locally – in the form of inhalations. Local and systemic mucolytics can be prescribed simultaneously. The indication for the use of mucolytics is the visualization of sputum and crusts in various parts of the larynx. It is possible to use long courses (up to 14 days) of preparations of plant origin or containing essential oils in the presence of dry crusts, including in patients with laryngomycosis. When choosing a mucolytic, it should be remembered that one of the etiological factors of HL is the pathology of the gastrointestinal tract, and therefore preference should be given to drugs that do not have side effects that affect gastric function.

A good clinical effect in patients with hyperplastic and edematous-polyposis laryngitis is achieved by using complex enzyme preparations for at least 14 days. These drugs are able to reduce inflammatory infiltration, local swelling, and affect cellular and humoral immunity.

Comments: For inhalation, antibacterial drugs, mucolytic, hormonal agents, herbal preparations with anti-inflammatory and antiseptic effects, as well as mineral water are used. The choice of drug for inhalation depends on the form of inflammation: if edema predominates, inhalation with corticosteroids; in case of severe inflammation - inhalation with antiseptics and antimycotic drugs. Inhalation of antibiotics is not currently carried out. Exceptions are the drug Thiamphenicol glycinate acetylcysteinate, which contains an antibiotic and mucolytic and an antimicrobial drug hydroxymethylquinoxaline dioxide. It is better to start the inhalation procedure with inhalation of mucolytic drugs and only after that, after 20 minutes, prescribe aerosols of other drugs. After inhalation of a corticosteroid and/or antiseptic, 20 minutes later you can inhale mineral water to moisturize the mucous membrane. Such inhalation procedures are carried out 1-2 times a day. The course of treatment is no more than 10 days.

Comments: in order to create conditions for physiological phonation and moisturizing the mucous membrane, inhalations with mineral water can be prescribed for long periods, for example, 1 month.

It is recommended to use physiotherapeutic methods of treatment: electrophoresis of 1% potassium iodide, hyaluronidase or calcium chloride on the larynx, therapeutic laser, microwaves; phonophoresis, including endolaryngeal.

Comments: For the treatment of patients with chronic edematous polyposis laryngitis, especially in the initial stages of the disease, injections of corticosteroid drugs into the vocal folds are also used. This procedure is performed with indirect, less often with direct microlaryngoscopy.

3.2 Surgical treatment

Comments: When performing a biopsy, it is necessary to take a sufficient amount of material for examination. The main errors in diagnosing laryngeal cancer are associated with an incorrectly selected area for biopsy and insufficient material for research. Despite the fact that the main purpose of surgical intervention is to verify the diagnosis and remove areas of hyperplastic mucous membrane, you should be gentle with the mucous membrane of the vocal folds, avoiding, if possible, additional deterioration of vocal function. It is better to plan surgical intervention after anti-inflammatory therapy, so that the location for the biopsy can be more accurately determined. The purpose of surgical intervention for COPD is to improve voice function and prevent complications - laryngeal stenosis. Histological examination of the removed mucous membrane is mandatory. For COPD, two surgical techniques are mainly used: vocal fold decortication according to Kleinsasser and the Hirano technique. When decorticating the vocal folds, they try to preserve the epithelium in the commissure area on both sides, in order to avoid subsequent fusion and the formation of a scar membrane or adhesions. The essence of M. Hirano's technique is that an incision is made along the lateral edge of the vocal folds, the gelatinous mass is aspirated, excess epithelial tissue is excised with scissors, and the remaining is placed on the vocal fold. Laser techniques are also used. In the initial stages of the disease, a small area of ​​the changed mucous membrane can be removed. A complication of surgical intervention may be severe scarring of the vocal folds and the formation of a scar membrane.

3.3 Other treatment

Chronic laryngitis is an inflammatory process of the laryngeal mucosa that lasts more than three weeks. This disease is sometimes called an occupational disease of people who, due to their profession, have to talk a lot and often, raise their voice; these include teachers, tour guides and a number of other specialties. However, in fact, this disease can occur in anyone; it is worth knowing about the symptoms and treatment of chronic laryngitis in adults.

It is imperative to treat the chronic form of laryngitis, since some types of the disease without therapy can lead to serious consequences. Mucosal tissue cells may even degenerate into a malignant tumor, which is extremely dangerous to health.

Forms of chronic laryngitis

There are several forms of this disease, which differ slightly in symptoms and course. All of them are quite dangerous, some can change from one form to another.

1. Chronic catarrhal laryngitis. In this case of the disease, thickening of the mucous membrane of the throat occurs, the vocal cords begin to close incompletely, as a result of which the voice begins to quickly get tired, and it sounds very hoarse and muffled to the ear.
2. Chronic atrophic laryngitis. With this form of the disease, there is a pronounced feeling of dryness in the throat, there is a non-productive cough, sometimes wet with extremely difficult sputum production. In this case, upon examination, blood crusts can be detected on the mucous membrane, which can come off when coughing.
3. Chronic hypertrophic laryngitis. This form of the disease is characterized by the occurrence of severe swelling, which can spread to the tissues of the entire larynx. In this case, nodules form on the tissues, the occurrence of which can lead to complete loss of voice.

The latter form is also sometimes called chronic hyperplastic laryngitis. Regardless of the type of disease, treatment must be started as quickly as possible, otherwise it can lead to various complications.

Important! Only an otolaryngologist can accurately determine the form of laryngitis after a full examination.

The ICD-10 code for different types of this disease begins with the number J37. In the registry, the inflammatory process in the throat is called chronic laryngitis and tracheitis. Typically, this information is required exclusively by doctors.

During an exacerbation of laryngitis, the symptoms of any form of the disease will intensify. An exacerbation can last up to two weeks, it all depends on the treatment and external factors influencing the course of the disease.

Causes

The acute form of this inflammatory process usually occurs against the background of colds, however, the causes of chronic laryngitis are often different. In general, the following factors are identified that lead to its occurrence:

• Frequent acute laryngitis. This also includes other infectious inflammatory diseases that occur in the nasopharynx, these include rhinitis, tonsillitis, sinusitis and other pathologies.
• GERD, a disease in which the acidic contents of the stomach back up into the esophagus, creating a slight burn of the mucous membrane that allows harmful organisms to multiply. Also, a high probability of developing chronic laryngitis is present with unhealthy oral microflora, which can arise due to diseases of the teeth and gums.
• Constant tension of the vocal cords and larynx, excessive stress on the vocal apparatus. Therefore, this disease is often called an occupational disease of teachers, tour guides and other similar professions.
• Constant contact with irritants and allergens. The development of the chronic form is promoted by too dry air and constant exposure to dusty, polluted rooms. This also includes constant temperature changes in the place of residence or work.
• Smoking, alcohol abuse. These factors also influence the occurrence of laryngitis. They can worsen the course of the acute form and lead it to a chronic course.

It is also worth noting that the likelihood of transition from an acute to a chronic form increases with reduced immunity, low immune resistance, and the presence of bad habits.

Symptoms

The main symptom of this inflammatory process in the throat is severe pain and soreness. In this case, changes usually occur in the voice, it becomes more muffled, hoarse, and it becomes extremely difficult to speak for a long period of time. With chronic edematous polyposis laryngitis, the voice may disappear almost completely.

With this disease, a cough may be present, at first it is dry, with a sensation of a foreign body. It can become wet, and the sputum is usually difficult to cough up. Depending on the form of laryngitis, blood clots may be present, which occur when crusts break away from the mucous membrane during coughing.

During an exacerbation of the disease, elevated temperature and severe general weakness may occur. It is worth noting that to be diagnosed as chronic, symptoms must persist for three weeks or longer.

Important! It is impossible to make a correct diagnosis based only on external symptoms; an examination by an otolaryngologist and some tests are needed.

Prevention

Prevention of laryngitis is the timely and correct treatment of colds and inflammatory processes in the oral cavity and nasopharynx. In addition, when working in professions that require constant speech, you need to be able to give the ligaments and larynx rest.

You should also avoid dust and constant exposure to too dry a room. For colds and sore throat, you need to avoid foods that irritate the mucous membranes and avoid dehydration.

How to cure chronic laryngitis forever

Treatment of this disease requires an integrated approach; you should prepare for the fact that it may take a long time, and laryngitis may recur. In some cases, you have to change your lifestyle a little and give up bad habits.

It is almost impossible to completely get rid of the chronic form of laryngitis, but it is possible to achieve remission and reduce its manifestations to a minimum. It is worth noting that with a particularly pronounced inflammatory process and the development of complications, hospital treatment may be required.

Treatment at home

First of all, you need to give rest to your speech apparatus; during periods of exacerbation, you need to avoid speaking and drink enough fluids. If the inflammatory process is accompanied by fever, it is better to go to bed rest. The following groups of drugs can be used in treatment:

1. Painkillers and anti-inflammatory drugs for the throat. They can be produced in various forms, usually using tablets or lozenges for resorption, these include Ingalipt, Grandaxin and their analogues.
2. Expectorants. Typically, syrups based on natural ingredients are used: Althea syrup, Herbion and their analogues.
3. Antibiotics or antiviral drugs. They can only be prescribed by the attending physician; they are required if the inflammatory process was caused by a specific pathogen.

Depending on the characteristics of the course of the disease, other drugs, local antibacterial drugs, and vitamin complexes may be prescribed. The main thing is to undergo treatment under the supervision of a doctor.

Treatment with folk remedies

Among traditional medicines there are several that help mitigate the course of the disease. First of all, these are inhalations based on essential oils; it is recommended to choose mint, eucalyptus, and cedar oils. Place a couple of drops of oil in a cup of hot water and breathe over the steam. You can also use special aroma lamps.

To relieve a sore throat and improve coughing, honey is recommended. It can be eaten plain, diluted in water or milk. If the sore throat is extremely severe, it is recommended to dilute one spoon in warmed milk and add a little butter to the drink.

Any chronic disease causes a lot of trouble: you have to constantly remember the danger of relapse, limit yourself in some way, and follow doctors’ recommendations. Laryngitis is no exception to this rule: those suffering from the disease are forced to refuse spicy pizza at friendly parties, dress warmly, and swim in the sea only when the water temperature is at least 22 °C. All these are conditions that reduce the likelihood of recurrence of acute attacks. Patients who do not want to “keep themselves within limits” all their lives are interested in: is it possible to treat chronic laryngitis so that it “goes away” forever? Let's try to answer this question.

Causes of the disease

Chronic laryngitis appears in the presence of the following factors:

• incompletely treated acute laryngitis;
• the presence in the body of a concomitant chronic source of infection (caries, gingivitis, periodontitis, pharyngitis, tonsillitis);
• active smoking;
• constant tension of the vocal cords (work as a teacher, actor, presenter);
• occupational hazard (working with allergens);
• hypothyroidism;
• acid reflux (reflux of stomach contents into the esophagus during chronic gastritis).

At an appointment with an Otolaryngologist, the patient is surprised: “Where do I get chronic laryngitis? It’s never been spicy!” It turns out that the fact is that it developed under the influence of a constant attack of pathogenic microorganisms, for example, due to advanced caries.

Inflammation of the upper respiratory tract, if not given proper attention, can eventually lead to chronic laryngitis. In this case, the disease occurs unnoticed, without an acute form.

Differences between chronic and acute forms

• slight cough;
• sore throat;
• temporary hoarseness.

Therefore, treatment of chronic laryngitis often begins when changes in the mucous membrane have already reached a stage at which complete tissue restoration is impossible. The inflammatory process is sluggish, and sometimes neither the patient nor the doctor pays attention to it.

A person should be alerted to constant voice problems that arise with any hypothermia and excitement. This is a reason for examination.

Symptoms

If laryngitis in the acute stage clearly declares itself, then in the chronic form it behaves like a secret ill-wisher.

Characteristic symptoms of chronic laryngitis include:

• cough;
• sore, sore throat;
• frequent desire to cough without visible signs of inflammation;
• voice change;
• feeling of tension when trying to speak.

The influence of factors that weaken the body - from insufficient intake of vitamins as a result of a strict diet to exposure to cold rain and being in wet clothes - can provoke an acute attack “in all its glory”:

• temperature 37–37.5 °C;
• lack of voice;
• cough with phlegm;
• sore throat when swallowing.

Chronic laryngitis in children is sometimes detected during examination. The child constantly coughs and complains that something is itchy or bothersome in the throat. The task of parents is to immediately begin the fight against the disease, since in its acute form it is dangerous for the baby’s life, and in its chronic form it weakens the child’s body.

Kinds

Before starting treatment for chronic laryngitis, an ENT specialist or pediatrician, in the case of a child with a disease, determines its type.

Of all the types of laryngitis found in adults, the catarrhal form is most typical for children.

Is it possible to cure laryngitis forever?

To be honest, for adults such an outcome is unlikely: the tissues have already undergone changes that prevent healing. A source of chronic infection is very difficult to eliminate: microorganisms have become so adapted to drugs that some of them survive under any conditions. The body is weakened.

For children, the likelihood of saying goodbye to laryngitis forever is more likely. A cure is possible, since in childhood the immune system is not yet fully functional, but as you grow older it can become stronger and cope with the infection so that no traces remain of it.

Adults can also avoid exacerbations. To do this, they must direct all their efforts to strengthening the body's immune forces. As long as the immune system is strong, laryngitis will not remind you of itself.

What can you do at home?

First of all, achieve relief from all symptoms of exacerbation. For this:

• for dry cough: Sinekod, Pulmicort, Libexin;
• for wet cough: ACC, Mucaltin, Ambroxol, Ambrobene;
• gargling: Rotocan, Chlorophyllipt, Furacilin;
• resorption of tablets: Faringosept, Strepsils, Doctor Mom;
• provide voice rest;
• avoid drafts.

After the end of the acute period, we continue to do inhalations with Saline and herbs once a day for up to 3 weeks or up to a month.

We involve physiotherapy:

• electrophoresis;
• laser;
• exposure to UV rays;
• exposure to magnetic fields on the diseased area.

If we are talking about a child, we conduct courses of physiotherapy and vitamin therapy two or three times a year, even in the absence of exacerbations. We try to gradually harden the child so that his immune forces “learn” to independently repel viral attacks. We complete all scheduled vaccinations on time.

Treatment with folk remedies

Herbs and foods such as honey and lemon can play a significant role in reducing the number of attacks and making them easier.

Pros and cons of traditional medicine

Treatment with folk remedies can be carried out during an exacerbation, in addition to a course of medication, and during remission.

This is inhalation with:

• chamomile;
• sage;
• calendula.

In addition, this is the consumption of drinks containing vitamins and microelements necessary for the body:

• cranberry and carrot juices;
• rosehip drink;
• natural compotes;
• water with lemon.

Honey in any form – both liquid and crystallized – perfectly strengthens the body’s immune forces. It is useful to eat a teaspoon of honey in the morning on an empty stomach, washing it down with warm water.

In order to always have a remedy on hand that increases the strength of the body’s protective cells, prepare in a small jar a mixture of:

• dried apricots;
• lemon;
• raisins

We put it in the refrigerator for a day and take a teaspoon every day.

At the beginning of the cold season, you can help yourself and your child protect themselves from the disease by putting 2 drops of menthol or sea buckthorn oil into the nose.

Possible complications

Adults are at risk of chronic laryngitis:

• formation of fibroids, polyps of the mucous membrane;
• transfer of infection downwards - to the trachea, bronchi;
• complete loss of voice.

All these complications, fortunately, are quite rare, but let's not leave the disease any chance: let's not limit ourselves to relieving the symptoms of acute inflammation, but patiently treat the disease to the end, as far as possible.

Chronic laryngitis, which turns into acute, is dangerous for babies: they may develop laryngeal stenosis and asphyxia. In addition, the chronic course of the disease leads to the fact that the child “catch” other ailments, begins to lag behind his peers, and suffers from ARVI and influenza more often and more severely.

Conclusion

Be sure to strengthen your immune system as soon as the disease subsides. A person whose immune forces are active, other things being equal, is much less likely to experience laryngitis than one whose body is weakened.

Engage in strengthening your health - and you will forget for a long time (and maybe forever) what chronic laryngitis is!

The persistence of the inflammatory process in the laryngeal mucosa for more than 20 days leads to chronicity of the disease. This is facilitated by late detection of laryngitis and its improper treatment. Early diagnosis of the disease is especially important for people with voice-speech professions (teacher, actor or vocalist). Treatment of chronic laryngitis should be carried out taking into account the form of the disease, concomitant diseases and the presence of allergic reactions in the patient. Note that chronic inflammation can lead to malignant tissue degeneration and the development of cancer.

Causes

The transition from an acute form of the disease to a chronic form may be due to the following factors:

• frequent colds due to weakened immunity;
• the presence of long-term foci of infection in the oral cavity (caries, gingivitis) or oropharynx (tonsillitis);
• gastrointestinal diseases, one of the symptoms of which is heartburn. It appears due to the entry of stomach contents into the esophagus and damage to the mucous membrane by hydrochloric acid. Such diseases include gastroesophageal reflux disease and hernias;
• air pollution with dust particles or chemicals that, when inhaled, irritate the mucous membrane of the throat;
• tendency to allergies, frequent contact with allergens;
• heavy loads on the voice-forming apparatus;
• occupational hazards (work in the mining, paint and varnish, flour-grinding industries). This group of reasons also includes professions associated with constant tension on the vocal cords (vocalists, speakers);
• smoking;
• low level of immune defense due to severe somatic pathology (diabetes, tuberculosis, HIV).

Symptoms and diagnostic methods

Chronic laryngitis can be suspected based on:

• hoarseness;
• changes in voice timbre;
• dryness, soreness, and the sensation of a foreign lump in the oropharynx;
• cough. It can be an infrequent cough or in the form of an attack.

During the period of remission, the listed clinical symptoms are much less pronounced compared to exacerbation. As symptoms increase, low-grade fever, weakness, and decreased appetite may appear.

To cure chronic inflammation of the larynx, you need to see a doctor for diagnosis. It includes:

• analysis of anamnestic data and complaints;
• physical examination (palpation of regional lymph nodes, auscultation of the lungs);
• laryngoscopy or videolaryngoscopy;
• examination of the laryngeal mucosa under a microscope (microlaryngoscopy);
• biopsy of a “suspicious” area of ​​the laryngeal mucosa (material is collected during a laryngoscopic examination).

Chronic inflammation can occur in several forms:

• catarrhal It is characterized by swelling of the vocal folds, hyperemia and slight thickening of the mucosa. During phonation, the gap is not able to close completely;
• hypertrophic. This form can occur in a limited or diffuse form. The mucous membrane is swollen, and “singer’s nodules” may be observed on the vocal folds. Clinically, the form manifests itself as aphonia;
• atrophic. It is characterized by severe dryness, thinning of the mucous membrane, the surface of which is covered with viscous mucus and dry crusts. The patient is bothered by a strong cough, which may cough up crusts with blood streaks. The appearance of blood indicates damage to the blood vessels by the atrophic process.

Treatment tactics

How to treat chronic laryngitis? We emphasize that it will not be possible to completely get rid of the pathology, but it is quite possible to slow down its progression. To reduce the severity of clinical signs and improve the quality of life, it is recommended to follow the following rules:

• quitting smoking, strict control over the amount of alcohol consumed and the frequency of its intake;
• voice rest;
• gentle nutrition (meals should be at a comfortable temperature, not irritate the mucous membrane of the oropharynx and be beneficial; therefore, spices, pickles, and carbonated drinks are prohibited);
• plenty of warm drinks (milk with soda added, still mineral water, tea with honey);
• prevention of hypothermia and contact with drafts;
• regular ventilation of the room and wet cleaning;
• use of protective equipment in hazardous work or change of place of work.

An integral part of therapy is the treatment of somatic pathology, as well as the rehabilitation of bacterial foci. Depending on the inflammatory form, treatment tactics may have a number of differences.

Treatment of laryngitis of various forms

A good therapeutic effect is observed with catarrhal form. Medications that may be prescribed include:

• antiviral drugs, for example, Ingavirin, Amiksin, Groprinosin, Remantadine or Tsitovir;
• antibacterial agents (if the cause of the disease is the proliferation of bacterial pathogens) - Amoxicillin, Klacid or Cefix;
• antitussives, such as Codeine, Tusuprex or Libexin;
• expectorant and mucolytic medications (for thick, difficult to separate sputum) - Acetylcysteine, Lazolvan, Ascoril, Brombexin and licorice root;
• local anti-inflammatory, antiseptic and analgesic drugs (Miramistin solution, Chlorhexilin, Furacilin, Stopangin aerosol, Bioparox, Strepsils Plus, Decatylene lozenges, Faringosept, Strepsils or Septefril);
• multivitamin complexes (Multitabs, Supradin, Duovit);
• inhalations (Interferon, still mineral water, saline solution, Tussamag, Ambrobene).

Irrigation of the laryngeal mucosa with drugs is carried out in a medical institution. Additionally, physiotherapeutic procedures are prescribed, for example, electrophoresis, UHF, and DDT.

When atrophic processes predominate, treatment of chronic laryngitis involves the use of medications prescribed for catarrhal form. The only feature is inhalation with proteolytic enzymes, for example Trypsin.

As for the hypertrophic form, treatment tactics are determined based on diagnostic results and clinical symptoms. In addition to conservative tactics, the doctor may recommend surgical intervention. The operation is performed under local anesthesia using special instruments and a microscope. This makes it possible to remove hypertrophied areas of the mucosa.

Removal of singing nodules from the surface of the vocal folds can be carried out using the coblation method, which involves the impact of a beam of cold plasma on the nodular formations.

Compliance with the rules of rehabilitation in the postoperative period plays an important role in treatment. The patient must strictly follow medical recommendations:

• It is forbidden to eat for the first 3 hours after surgery;
• you should not cough so as not to enlarge the postoperative wound;
• physical activity should be limited for a week;
• a gentle diet and vocal rest are required in the first week after surgery;
• Smoking is prohibited.

You can fight chronic inflammation of the larynx using traditional methods, however, without forgetting about drug therapy. Thanks to the healing properties of herbs, a mild anti-inflammatory and antimicrobial effect is provided, regenerative processes are stimulated, and healing is accelerated.

To gargle, you can use infusions and decoctions of chamomile, sage, oak bark or calendula. Here are a few recipes that can be used for chronic laryngitis:

• 10 g of chamomile, cinquefoil and calendula should be poured with 470 ml of boiling water and left to infuse for 10 minutes. As soon as the temperature of the steam drops, you can begin inhalation or gargling;
• Soda-saline solution for rinsing the oropharynx. To prepare it, you need to dissolve 5 g of ingredients in 240 ml of warm water, add 2 drops of iodine;
• honey can be simply sucked or taken in combination with lemon juice;
• 5 garlic cloves should be chopped, pour 230 ml of milk, boil for several minutes and filter. Take 15 ml three times a day;
• For inhalation, you can use essential oils (fir, chamomile, eucalyptus). It is enough to add 5 drops of oil to 460 ml of hot water.

You should not rely solely on the help of folk remedies, because chronic inflammation is quite difficult to cure.

An incorrect treatment approach can lead to complete loss of voice, paresis of ligaments, as well as the formation of fibroids, cysts or contact ulcers.

Most of those who are susceptible to colds prefer to be treated at home. This also applies to the inflammatory process of the larynx - laryngitis. The lack of timely adequate therapy can lead to the development of severe complications, especially from the child’s body. How to treat laryngitis at home effectively and quickly? Let's look further.

Is it possible to cure laryngitis quickly and is it worth rushing?

Cure from laryngitis within a few days is not one of the mythical stories about this disease. Quick identification of the etiological factor will speed up the recovery time by almost half. In most cases, inflammation of the larynx is of viral origin. Antiviral medications should be started immediately after symptoms appear.

Allergic nature of laryngitis requires elimination of the factor that caused the pathological reaction of the body. Dust, citrus fruits, pollen, pet hair - all this can aggravate the development of allergic laryngitis if the destructive effect is not stopped in time.

Treatment of laryngitis at home in adults and children requires quick action, since the progression of the disease can cause the following complications:

• swelling of the larynx, provoking an attack of suffocation (typical of childhood);
• mediastinitis;
• lung abscess;
• phlegmon of the neck;
• sepsis;
• impaired mobility of the larynx;
• development of benign formations against the background of a chronic form.

The course of the disease depends on the form of its development. The following forms of laryngitis are distinguished:

• acute catarrhal;
• acute phlegmonous;
• chronic.

Catarrhal form of laryngitis accompanied by the spread of the inflammatory process to the mucous, submucosal layer and nearby muscles. In the phlegmonous course of the disease, symptoms appear against the background of purulent inflammation up to damage to the cartilage tissue. Chronic laryngitis can be atrophic, hypertrophic, or catarrhal.

The saying “Silence is golden” is very relevant if you want to cure laryngitis as quickly as possible

Acute manifestations of the disease begin with a sudden sore throat, a scratching sensation, and coughing. The cough is unproductive and causes pain in the throat and chest. Sputum production appears later. The discharge does not have pathological inclusions, unless complications of a bacterial nature are added.

The voice becomes hoarse and rough, and may disappear altogether. In some cases, laryngitis causes hyperthermia, headache, and other manifestations of intoxication of the body. Children quite often develop swelling of the larynx - false croup. This condition requires urgent medical intervention, as it provokes the development of asphyxia.

False croup

There are several stages of edema, depending on which the clinical picture develops and drug assistance is selected.

1. Stage of compensated stenosis - the patient is conscious, has calm and even breathing. Coughing attacks and shortness of breath appear in case of emotional overstimulation.
2. Subcompensated stage - the patient is overexcited and pale. The skin of the nasolabial triangle has a blue tint. The state of rest is accompanied by a barking cough, becoming more hoarse and whistling. When talking, you can hear that the voice is hoarse.
3. Decompensated stenosis – the patient is in a lethargic or overexcited state. Severe expiratory shortness of breath (difficulty exhaling). Hypotension and a bluish discoloration of the skin develop.
4. The asphyxia stage is characterized by strong cyanosis, shallow breathing, rapid and weak pulse. The patient may be unconscious.

The development of such edema requires immediate medical attention and hospitalization.

General concepts of therapy

With the development of the inflammatory process, the patient asks the question: “Is it possible to cure laryngitis with improvised means?”

A person suffering from inflammation of the larynx needs a large amount of warm drink, preferably alkaline. Mustard baths for hands and feet are used as a distraction therapy. When the process escalates, you need to remain silent so as not to completely lose your voice. If the disease appears in a small child, you should monitor him so that he cries less.

The room where the patient is located must have optimal temperature and humidity levels. Dry air provokes an increase in symptoms and the spread of swelling. Harmful foods, fried, smoked foods, cold and hot dishes, spices, and marinades are excluded from the diet.

Laryngitis, treatment at home is complex, requires the use of the following groups of medications:

• antiviral (Anaferon, Lavomax, Oscillococcinum);
• antibiotics (Augmentin, Clarithromycin, Flemoxin);
• antitussives (Libexin, Sinekod, Panatus);
• expectorants (Prospan, Gedelix);
• mucolytics (Ambrobene, Bromhexine);
• antihistamines (Tavegil, Loratadine, Zyrtec);
• antipyretics (Paracetamol, Nurofen, Bofen, Nimesil);
• antiseptics for local treatment (Hexoral, Tantum Verde, Bioparox, Chlorophyllipt).

The choice of drugs, dosage and duration of therapy is determined by the treating specialist. Even if the patient has decided to undergo treatment on his own, it is advisable to discuss this issue with the local doctor.

Is it possible to cure laryngitis at home? So, quickly, harmlessly and effectively? It is possible, but only after consulting a doctor. At the same time, do not forget to ask your doctor about the universal remedy for laryngitis - the complex homeopathic preparation GOMEOVOX. Only natural ingredients, no contraindications or side effects, but you will get the desired therapeutic result quite quickly.

Treatment of the disease at home

Inhalation is considered the most common and safe method of treating laryngitis. The procedure softens sore throat, eliminates hoarseness, and helps moisten the cough. Steam inhalations are used only in the absence of hyperthermia. At home, they use propolis, calendula tincture, anise oil, and eucalyptus.

At elevated body temperatures, inhalations can only be carried out with a nebulizer - a special device that converts a liquid drug into an aerosol without using heating of the active substance. To carry out such inhalations, saline solution, alkaline mineral waters of Essentuki, Narzan, as well as antitussive or expectorant drugs in diluted form are used.

Drink plenty of fluids

For laryngitis, it is recommended to drink up to 2.5 liters of warm liquid per day. This can be alkaline water, compotes, fruit drinks, rosehip decoctions, lungworts. You can use warm milk (not hot!) with the addition of honey and butter.

Among people whose professions involve public speaking or singing, recipes for medicinal drinking mixtures are widely used to quickly restore the functioning of the vocal cords. Here is one of them: Crush a few figs, pour a glass of milk and heat well (but not to a boil). Take warm.

Gargling

A similar treatment procedure is carried out every 3.5-4 hours. Only regularity helps to quickly relieve inflammation. The following combinations of drugs are used:

• St. John's wort, calendula and chamomile flowers in equal parts (decoction);
• elderberry, coltsfoot leaves, golden mustache - a teaspoon of each in 250 ml of water;
• apple cider vinegar with honey (3:2), diluted in a liter of water;
• 3-4 drops of iodine, a teaspoon of sea salt, 0.5 tsp. soda per liter of water.

For rinsing at home, use raw vegetable juice, sea buckthorn oil, marshmallow, and strong tea.

Compresses

Warming compresses are used only at normal body temperature. There is an increase in local blood circulation and activation of metabolic processes at the cellular level. At home, medications, oils, vodka, and diluted ethyl alcohol are used.

To prepare a compress, several layers of gauze are folded and moistened with a medicinal agent. Squeeze lightly so that the liquid does not drain, then apply to the chest and throat area, avoiding the projection area of ​​the heart and mammary glands. An oilcloth is placed on top and a warm scarf is wrapped. The procedure takes about 8 hours, controlling the affected area. Compresses using nutria and badger fat to treat laryngitis are left overnight.

Mustard plasters

The application of mustard plasters activates microcirculation, warms the skin, and has an irritating and distracting effect. Use for laryngitis can reduce attacks of dry cough, reduce the sensation of tickling and scratching.

Mustard plasters are applied to the front surface of the neck, and if swelling of the larynx develops, they are applied to the sternum or feet. Contraindications for use are hyperthermia, the presence of rashes or other dermatological problems in the affected area, and children under 3 years of age.

Therapeutic baths

Allowed at normal body temperature. Using this method of therapy, skin heating and inhalation occur simultaneously. For laryngitis, bath water is mixed with sea salt and decoctions of medicinal herbs. Foot baths with the addition of dry mustard, sea salt or soda are also used.

Treatment with folk remedies

How to treat laryngitis at home using folk remedies? There are a large number of proven recipes that reduce inflammation, eliminate hoarseness and normalize the condition of the mucous membrane.

1. Pour ½ cup of anise seeds into 250 ml of water and boil. Strain. Add a quarter cup of honey and 1 tbsp. l. cognac Take 100 ml every half hour.
2. Mix the pulp of a whole lemon with 2 tbsp. l. honey Use the resulting pulp, slowly dissolving.
3. Grind the horseradish and pour in a third cup of boiling water. After 15 minutes, stir in 2 tsp. sugar and drink in small sips throughout the day.
4. At home, mix a glass of raw carrot juice with 3 tbsp. l. honey Take a tablespoon.
5. Bake an apple with honey and eat it slowly while it is hot.
6. Mix Borjomi and milk in equal quantities to make a glass of liquid. Add honey, cognac and butter 1 tsp each. everyone. Drink hot.

Prevention

Laryngitis, the symptoms and treatment at home of which are discussed in the article, requires careful measures to prevent exacerbation. Timely treatment of respiratory diseases, chronic inflammatory processes, and carious teeth helps minimize the risk of developing new pathologies.

Prevention of laryngitis is also aimed at stimulating the immune system, hardening, and giving up bad habits, especially smoking. Visiting the bathhouse and carrying out preventive inhalation measures allows you to clear the respiratory tract of dust, transient microorganisms, and decay products.

You should adhere to the optimal temperature in the room and air humidity level. Also pay attention to personal hygiene measures.

If treatment for laryngitis is started in a timely manner and advice regarding treatment is followed, the disease has a favorable prognosis for recovery.