Acute and chronic laryngitis: diagnosis

When collecting anamnesis, attention is drawn to the presence of etiopathogenetic factors of the disease development, the frequency of relapses.

[1], [2], [3], [4], [5]

Indications for consultation of other specialists

To clarify the etiology of the inflammatory process in the larynx, consultation of a gastroenterologist, pulmonologist, allergist, immunologist, endocrinologist, mycologist, therapist, gastroenterologist, rheumatologist and phthisiatrist is shown. Patients with severe phlegmonous laryngitis if a suspected development of phlegmon of the neck or mediastinitis shows consultation of the surgeon; patients with chronic hyperplastic laryngitis - an oncologist.

Laboratory diagnosis of laryngitis

Patients with a catarrhal form of acute or chronic laryngitis do not need a special examination. Ballroom with acute abscessing, infiltrative and chronic laryngitis is performed by a comprehensive clinical examination. In addition, microbiological, mycological, histological studies are necessary; in a number of cases, diagnostics using PCR is used to identify the etiological factors of the disease.

Instrumental diagnosis of laryngitis

The main method of diagnosing laryngitis is laryngoscopy. For a picture of acute laryngitis is characterized by hyperemia, edema of the mucous membrane of the larynx, increased vascular pattern. Vocal folds, as a rule, pink or bright red, thickened, a slit with a background oval or linear, spleen accumulates in the nodular zone.

Sublining laryngitis is a roll-like thickening of the mucous membrane of the podgolosal larynx. If it is not associated with intubation trauma, its detection in adults requires differential diagnosis with systemic diseases and tuberculosis. With infiltrative laryngitis, significant infiltration, hyperemia, an increase in volume and impaired mobility of the affected larynx are determined. Fibrinous raids are often seen, purulent contents appear in the place of formation of the abscess. With severe form of laryngitis and chondroperichondritis of the larynx, tenderness in palpation, impaired mobility of the cartilage of the larynx, infiltration and hyperemia of the skin in the projection of the larynx are possible. The abscess of the epiglottis looks like a globular formation on its lingual surface with sifting purulent contents.

The laryngoscopic picture of chronic laryngitis is diverse. In the vast majority of cases, pathology is bilateral. Chronic catarrhal thlingitis is characterized by increased vascular pattern of vocal folds, their hyperemia, dryness of the mucous membrane. In chronic edematous polypous laryngitis, the appearance of polypoid mucosal degeneration can vary from a light spindle-vitreous tumor (like the "abdomen") to a heavy flotating polypoid-translucent gray or gray-pink jelly thickening stenosing the laryngeal lumen.

Candida laryngitis is characterized by hyperemia and edema of the mucosa, the presence of white fibrinous plaques. There are tumoral, catarrhal-membranous and atrophic forms. In chronic hyperplastic laryngitis, the presence of infiltration of vocal folds, foci of keratosis, hyperemia and pachydermia (hyperplasia of the mucous membrane in the inter-percutaneous region) is noted. Keratosis is a common name for dermatoses characterized by thickening of the oral layer of the epidermis. In the case of hyperplastic laryngitis - a pathological keratinization of the epithelium of the mucous membrane of the larynx in the form of pachydermia, leukoplakia and hyperkeratosis. With atrophic laryngitis, the mucous membrane of the vocal folds looks dull, it is possible that there is viscous sputum, hypotension of the vocal folds, and nonclosure in phonation.

To clarify the severity of the inflammatory process and differential diagnosis, X-ray or computed tomography of the larynx and trachea, endofibrolarine and tracheoscopy, the function of external respiration to assess the degree of respiratory failure with laryngitis, accompanied by stenosis airway. In patients with phlegmonous and abscessed laryngitis, radiographs of lungs, X-ray tomography of the mediastinum are performed. To exclude the pathology of the esophagus, especially in patients with purulent processes in the larynx, esophagoscopy is indicated. The use of micro-laryngoscopy and micro-laryngostroscopy allows to carry out differential diagnostics with cancer, papillomatosis and tuberculosis of the larynx. Mikrolaringostroboscopic study in keratosis allows to identify the areas of keratosis, which is conjugated with the underlying layers of the mucous membrane, the most suspicious in terms of malignancy.

Differential diagnosis of acute and chronic laryngitis

Differential diagnosis is carried out primarily with cancer and tuberculosis of the larynx. In all cases of podgolosovogo laryngitis, arthritis perstnecherpalovodnogo joint should be excluded systemic disease. Involvement in the pathological process of the larynx with Wegener's granulomatosis occurs in about 24% of cases in the form of sublingual laryngitis, accompanied by stenosis of the podogolosovogo department. Isolated lesion of the larynx in sclera is observed in 4.5% of cases, the bowl, nasopharynx and larynx are involved in the process. At the same time, pale pink, tuberous infiltrates are formed in the podgolospace. The process can spread to the trachea or cranial direction to other parts of the larynx. There is a primary amyloidosis of the larynx (nodal or diffusively infiltrative forms) and secondary, developing against a background of chronic inflammatory systemic diseases (Crohn's disease, rheumatoid arthritis, tuberculosis, etc.). More often, the lesion is diffuse in an intact mucosa, sometimes with a spread to the tracheobronchial tree. Amyloid depositions are localized mainly in the nadgolovnomu department of the larynx, sometimes in the form of sublingual laryngitis. Sarcoidosis occurs in the larynx in 6% of cases in the form of epiglottitis and granulomatosis. Vocal folds are rarely affected. In rheumatoid arthritis, the pathology of the larynx is diagnosed in 25-30% of patients. Clinically, the disease manifests itself in the form of arthritis perstnecherpalovidnogo joint. Differential diagnosis is based on general clinical, serological studies and biopsy. Tuberculosis of the larynx is characterized by polymorphism of changes. They note the formation of miliary nodules, infiltrates, which undergo disintegration with the formation of granulations, ulcers and scars. Often formed tuberculomas and chondroperichondritis. Syphilis of the larynx manifests itself in the form of erythema, papules and condylomas. Often ulcers are formed, covered with a greyish-white coating.

Differential diagnosis of abscessed and phlegmonous laryngitis is carried out with a congenital polycystone of the tongue root, suppurating laryngocel, laryngeal cancer or entry into the esophagus. Abscess of the epiglottis must be differentiated with the ectopic thyroid gland.

Differential diagnosis of chronic hyperplastic laryngitis and laryngeal cancer often presents great difficulties. With indirect microlaringoscopy, attention is drawn to the nature of the vascular pattern. For cancer of the larynx pathognomonic atypia of capillaries - an increase in their number, a convoluted shape (in the form of a corkscrew), uneven vasodilation, and pinpoint hemorrhages. The vascular pattern as a whole is chaotic. Violation of the mobility of the voice fold, the one-sided nature of the process may be indicative of the malignancy of chronic laryngitis. Attention is drawn to other changes in the vocal fold - pronounced dysplasia, infiltration of the mucous membrane, the formation of foci of dense keratosis, soldered with the underlying tissues, etc.

The final diagnosis with laryngitis is established by the results of histological examination.

[6], [7], [8], [9]