Chronic laryngitis: symptoms, causes, treatment
The content of the article:
- The causes of chronic laryngitis
- Chronic laryngitis symptoms
- Diagnostics
- How to treat laryngitis
- Prevention
- Video
Chronic laryngitis accounts for 10% of the entire pathology of ENT organs and is a disease characterized by chronic inflammation of the laryngeal mucosa lasting more than three weeks. At the same time, there is a decrease in the patient's quality of life, therefore, timely treatment of acute inflammatory pathologies of the upper and lower respiratory tract is very important.
The most common symptoms of the disease are pain in the head during voice load and voice changes.
Chronic laryngitis code according to ICD-10 (International Classification of Diseases 10 revision): J37.0 / 37.1.
Forms of pathology:
- catarrhal;
- hyperplastic or hypertrophic;
- atrophic;
- edematous polyposis.
Chronic hyperplastic laryngitis can be limited and diffuse. The following types of hyperplasia of the laryngeal mucosa are distinguished:
- fibrous nodules of the vocal folds or singing nodules;
- pachyderma of the larynx;
- chronic lining laryngitis;
- prolapse (prolapse) of the blinking ventricle.
Also, the disease can be specific and non-specific.
The causes of chronic laryngitis
The etiological factors of chronic inflammation of the mucous tissues of the larynx are:
- frequent relapses of acute laryngitis;
- various infections: bacterial, viral, chlamydial, mycoplasma, fungal;
- parasites;
- external and internal trauma to the neck and larynx (foreign body damage, inhalation lesions);
- increased voice load;
- allergy;
- gastroesophageal reflux disease;
- smoking;
- alcohol abuse;
- occupational hazards: work in a dusty, gas-polluted room or at elevated temperatures;
- chronic diseases of the nose and paranasal sinuses;
- pathology of the bronchopulmonary system;
- diseases of the gastrointestinal tract, liver;
- metabolic disorders (diabetes mellitus, hypothyroidism, etc.);
- transferred radiation therapy;
- history of topical corticosteroid therapy;
- violation of the interferon and immune system.
A specific lesion of the larynx can be observed with diseases such as:
- tuberculosis;
- syphilis;
- systemic diseases: rheumatoid arthritis, Wegener's disease, polychondritis, sarcoidosis, amyloidosis, systemic lupus erythematosus, etc.;
- diphtheria and other infectious diseases;
- diseases of the blood and skin (pemphigus).
The pathogenesis of chronic inflammation of the larynx is based on impaired blood circulation in its mucous membrane. There are marked manifestations of venous stasis. Small-cell tissue infiltration occurs, the cylindrical epithelium of the vocal folds is replaced by a multilayer flat epithelium.
Chronic laryngitis symptoms
The main complaints that patients present with chronic inflammatory lesions of the larynx:
- violation and change of voice;
- sore throat with voice stress;
- cough;
- paresthesia in the larynx;
- dyspnea.
Voice impairment associated with inflammation of the larynx and vocal cords
Symptoms are more pronounced in the morning and late afternoon.
The most common chronic catarrhal laryngitis. Depending on the severity of the pathological process, the patient is worried about a feeling of perspiration, dryness, a feeling of a foreign body in the larynx, cough.
For chronic hyperplastic laryngitis, constant hoarseness is characteristic, the voice becomes rough with many overtones.
In the chronic edematous-polypous form of the disease, hoarseness is characterized by a gradual shift in the timbre of the voice to low male frequencies. This form of the disease is dangerous because respiratory failure can develop up to laryngeal stenosis of the III degree.
Atrophic laryngitis is also characterized by hoarseness, coughing, and pain when trying to improve the volume of the voice. Due to the violation of the integrity of the epithelium of the mucous membrane of the larynx, streaks of blood can be released during coughing.
Diagnostics
To establish a diagnosis, the doctor finds out the patient's complaints, carefully collects data from the medical history, conducts an examination, which includes laryngoscopy, and also prescribes additional laboratory and instrumental research methods.
The disease is most often caused by viruses and bacteria, in particular pneumococcus, which is usually detected during bacteriological examination
Bacteriological and mycological research is being carried out. In this case, a specialist takes a culture from the mucous membrane of the larynx or from the vocal folds under local anesthesia. The most common causative agents of laryngitis are:
- Pneumococcus;
- haemophilus influenzae;
- Staphylococcus aureus;
- mycoplasma;
- chlamydia;
- diphtheria bacillus;
- yeast-like fungi of the genus Candida.
The main method of differential diagnosis of chronic hyperplastic, specific and edematous-polyposis laryngitis is histological examination. Taking a biopsy in the larynx is carried out by indirect microlaryngoscopy. What it is?
To clarify the diagnosis, fibrolaryngoscopes are used, allowing, if necessary, to take a photo
Indirect microlaryngoscopy is an endoscopic method of visual diagnosis of pathology of the larynx and vocal cords. Modern fibrolaryngoscopes make it possible to take a photo or shoot a video during the study and thus record and save the identified case of pathology.
In chronic catarrhal laryngitis during laryngoscopy, there is moderate hyperemia, edema of the laryngeal mucosa, mainly in the area of the vocal folds, pronounced vascular pattern.
In the hypertrophic form, indirect laryngoscopy can detect thickening, pastiness and hyperemia of the mucous membrane, thick mucus in different parts of the larynx. The limited form of hypertrophic laryngitis is characterized by the presence of nodules on the vocal folds. In a diffuse form, the vocal folds are thickened and deformed.
In chronic atrophic laryngitis, thinning of the mucous membrane is determined during diagnosis. It is smooth, shiny, covered with viscous mucus and crusts in places. The vocal folds are also thinned. During phonation, they do not close completely, leaving an oval-shaped gap.
How to treat laryngitis
It is very important to take seriously the treatment of chronic laryngitis in adults and children, since all forms of the disease are precancerous.
Therapy requires an integrated approach with the involvement of doctors of other specialties: gastroenterologist, pulmonologist, infectious disease specialist, rheumatologist, endocrinologist, dermatologist, etc.
Treatment goals:
- elimination of the inflammatory process in the larynx;
- restoration of a sonorous voice;
- prevention of the transformation of chronic inflammation into malignant formation.
First of all, it is necessary to eliminate harmful exogenous factors that irritate the mucous membrane of the larynx, a gentle voice mode. It is recommended to stop smoking, exclude occupational hazards, humidify the air in the room.
It is necessary to monitor the humidity in the room, for which special humidifiers can be used
Conservative treatment involves the selection and appointment of antibiotic therapy for exacerbation of a chronic process. The drugs of choice are broad-spectrum antibiotics: protected penicillins (Amoxicillin Clavulanate), respiratory fluoroquinolones (Levofloxacin), macrolides (Azithromycin).
With exacerbation of hyperplastic and edematous-polypous laryngitis, second-generation antihistamines are used (Claritin, Loratadin). In the catarrhal and atrophic form of the disease, antihistamines are usually not prescribed due to the fact that they can aggravate the dryness of the laryngeal mucosa.
Systemic corticosteroids are indicated to relieve edema of the mucous tissues of the larynx with stenosis of the upper respiratory tract against the background of exacerbation of chronic inflammation.
If sputum or crusts are detected during laryngoscopy in different parts of the larynx, local and systemic mucolytics are prescribed: preparations of herbal origin or containing essential oils. Patients with hyperplastic or edematous-polypous laryngitis are shown complex enzymatic preparations for a period of at least 14 days.
Inhalation is an important part of comprehensive treatment
Inhalation therapy plays an important role. Inhalations are prescribed in courses of up to 10 days, for this they apply:
- antibacterial agents (Tiamphenicol, Dioxidin);
- mucolytics;
- corticosteroids;
- herbal preparations with anti-inflammatory and antiseptic effect;
- mineral water.
Inhalation with mineral water lasting 10 minutes can be carried out 4 times a day for a long time, for example, within one month.
To increase local immunity, the immunostimulating agent IRS 19 is used.
Physiotherapy treatments are also recommended:
- electrophoresis of 1% potassium iodide, lidase or calcium chloride;
- therapeutic laser, microwaves;
- ultraphonophoresis (endolaryngeal).
At the initial stages of edematous-polypoid laryngitis with indirect microlaryngoscopy, injections of corticosteroid drugs are carried out into the vocal cords.
According to indications, surgical intervention is possible to prevent stenosis of the larynx and improve vocal function.
In some cases, phonopedic treatment is prescribed
If necessary, patients undergo phonopedic treatment.
During the restoration of the voice at home, you can rinse and inhale with folk remedies, having previously agreed with your doctor. The most effective are infusions of chamomile, oak bark, St. John's wort.
Prevention
Prevention includes:
- timely diagnosis and therapy of acute laryngitis;
- treatment of pathology of the upper and lower respiratory tract, gastroesophageal reflux disease, gastritis, chronic foci of infection in the body;
- to give up smoking;
- voice mode control;
- compliance with labor protection conditions;
- frequent ventilation and humidification of air in the room (use of special purifiers and humidifiers).
It is important to remember that before starting self-treatment, you must consult a doctor, undergo an examination and receive clinical recommendations.
Video
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Alina Ervasova Obstetrician-gynecologist, consultant About the author
Education: First Moscow State Medical University. THEM. Sechenov.
Work experience: 4 years of work in private practice.
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