Acute and chronic stenosis of the larynx and trachea - Symptoms

Regardless of the cause of acute stenosis, the symptoms of laryngeal stenosis are uniform. A sharp negative pressure in the mediastinum during intense inspiration and hypoxia cause a characteristic symptom complex: a change in the breathing rhythm, retraction of the supraclavicular fossae and retraction of the intercostal spaces, a forced position of the patient with the head thrown back, lowering of the larynx during inspiration and rise during expiration. The severity of the clinical manifestations of acute and chronic stenosis depends on the nature of the traumatic impact on the body, the degree of damage to the hollow organs of the neck, the length of the stenosis, the duration of its existence, individual sensitivity (resistance) to hypoxia, and the general condition of the body.

Disruption of laryngeal innervation leads to severe functional disorders; changes in breathing patterns; organ, tissue, and cellular hypoxia. Peripheral nerve damage is more common than central damage and differs from them in clinical manifestations and prognosis.

The main symptom of acute and chronic respiratory failure is dyspnea. Depending on its severity, the following degrees of respiratory failure are distinguished:

• Stage I - shortness of breath occurs during physical exertion:
• Stage II - shortness of breath occurs with little physical exertion (slow walking, washing, dressing);
• Grade III - shortness of breath at rest.

Based on the clinical course and the size of the airway lumen, four stages of laryngeal and tracheal stenosis are distinguished.

• Compensation stage. Characterized by slower and deeper breathing, shorter or missing pauses between inhalation and exhalation, and decreased heart rate. The size of the glottis is 6-8 mm, or the lumen of the trachea is narrowed by 1/3 of the diameter. There is no shortage of breathing at rest, shortness of breath appears when walking.
• Subcompensation stage. Characterized by inspiratory dyspnea with the inclusion of accessory muscles in the act of breathing, retraction of the intercostal spaces, soft tissues of the jugular and supraclavicular fossae, stridor (noisy) breathing at rest, pallor of the skin. Blood pressure remains normal or elevated; the size of the glottis is 4-5 mm, the lumen of the trachea is narrowed by 1/2 of the diameter or more;
• Decompensation stage. Frequent shallow breathing, pronounced apnea, forced sitting position are characteristic. The larynx makes maximum excursions. The face acquires a pale-blue color, increased sweating, acrocyanosis, tachycardia, threadlike pulse, arterial hypotension are noted. The glottis is 2-3 mm, the lumen of the trachea is slit-like.
• Asphyxia. Intermittent or cessation of breathing is typical. The glottis and/or tracheal lumen are 1 mm. Sharp suppression of cardiac activity. The pulse is frequent, threadlike, and often undetectable. The skin is pale gray due to spasm of small arteries. Loss of consciousness, exophthalmos, involuntary urination, defecation, and cardiac arrest are possible. Rapid development of stenosis aggravates the severity of the condition, since compensatory mechanisms in such a situation do not have time to develop.

The nature of organ changes in stenosis of the larynx and trachea depend on the severity and duration of the disease.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ]