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Abscess and phlegmon of the larynx
Last reviewed: 05.07.2025
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[ Causes of Laryngeal Abscess
Laryngeal abscess and phlegmon of the larynx most often occur as a complication of a paratonsillar abscess or abscess of the lingual tonsil, as well as when the larynx is damaged by a foreign body with subsequent infection of the resulting brine. Sometimes these diseases occur as complications of severe pharyngeal laryngitis. Streptococcus, pneumococcus, staphylococcus act as pathogenic microbiota, and in gangrenous forms, this microbiota is associated with anaerobes.
How does phlegmon of the larynx manifest itself?
Symptoms of phlegmon of the larynx are usually the same as those of inflammatory edemas of the larynx, but qualitatively they are much more pronounced, develop lightning fast, especially with gangrenous laryngitis, and after a few hours the resulting inflammatory infiltrate and edema of the larynx can lead to rapid suffocation. The general condition quickly worsens, the body temperature reaches 39-41 ° C with severe chills, indicating the progression of the septic process.
Particularly distressing sensations include unbearable pain in the larynx, radiating to the ear, temporal and occipital regions, as well as coughing, unbearable pain which sometimes brings the patient to pain shock, characterized by disruption of cardiac activity, general vasoconstrictive reaction and hypoxia, clouding of consciousness.
At the onset of the disease, the endoscopic picture is very similar to that of edematous laryngitis; after 1-2 days, with the increase in general phenomena, yellowish infiltrates appear on the mucous membrane of the larynx against the background of pronounced hyperemia of the surrounding mucous membrane. At the same time, edema and infiltration of surrounding tissues increase with the formation of a purulent fistula.
Most often, the abscess develops in the area of the epiglottis pits, the lingual surface of the epiglottis, less often on the aryepiglottic folds in the vestibule of the larynx. At the same time, regional lymph nodes increase significantly, becoming dense, painful and not fused with the surrounding tissues. In particularly large intralaryngeal abscesses and phlegmons, the purulent masses that have broken through can enter the trachea and lower respiratory tract, causing acute purulent inflammation, up to a lung abscess. Untimely treatment can aggravate the purulent-inflammatory process and cause chondroperichondritis, damage to its joints, generalized phlegmon with melting of cartilage and the threat of asphyxia and rapidly approaching death. Other complications of abscess and phlegmon of the larynx also include cervical purulent cellulitis, mediastinitis, and general sepsis.
Diagnosis of phlegmon of the larynx
Phlegmon of the larynx is usually diagnosed without difficulty and is based on the general severe condition, laryngoscopic picture, and pronounced pain syndrome. The most common error in diagnosing phlegmon of the larynx, as well as laryngeal abscess, is mistaking them in the initial phase for vulgar edematous laryngitis.
What do need to examine?
Treatment of laryngeal abscess
Treatment of laryngeal abscess should be early, at the stage of inflammatory edema of the larynx, the evolution of which towards phlegmon is always unpredictable. Massive doses of antibiotics in combination with sulfonamides, anti-edematous and desensitizing therapy, microlaryngosurgical interventions for opening and suction of contents from the formed abscesses are used. In this case, the incisions should be superficial, penetrating only into the cavity, without damaging the perichondrium, since the risk of developing chondroperichondritis is very high. Opening of the laryngeal abscess is performed with the patient lying down with a slightly lowered head end (prevention of pus from flowing into the trachea), simultaneously with opening the cavity of the abscess or phlegmon, pus is sucked out. The cough reflex helps to throw it out.
Laryngeal abscess has a guarded prognosis due to the potential for severe complications.