Acute catarrhal laryngitis

Acute catarrhal laryngitis is characterized by acute inflammation of the mucous membrane of the larynx, caused by infection with its banal microbiota.

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The cause and pathogenesis of acute catarrhal laryngitis

Usually acute catarrhal laryngitis is a consequence of a systemic disease, defined as acute respiratory disease, which is initiated by acute rhinopharyngitis, the development of which is the descending inflammation of the mucous membrane of the larynx and trachea. In the process of developing ARI, the larynx remains intact in some cases, in others it is in it that the main phenomena of acute inflammation develop (individual predisposition). The disease is more common in men who are prone to harmful household habits (smoking, drinking alcohol) or occupational atmospheric hazards. An important role in provoking acute catarrhal laryngitis and activating a conditionally pathogenic microbiota that grows as a saprophyte is played by climatic seasonal conditions (cold, high humidity), most actively manifested in spring and autumn. Inhaled cold air causes adverse local vascular reactions in the form of spasm or dilatation of the vessels of the larynx, disturbance of microcirculation, reduction of local immunity and, as a consequence, activation of the microbiota. These phenomena are also promoted by hot dry air and various occupational hazards in the form of vapors of various substances or fine dust particles. Endogenous risk factors include general weakening of the body with diseases of internal organs (liver, kidneys, endocrine system), negatively affecting the metabolic processes, alimentary and vitamin deficiency.

An important role in the emergence of acute catarrhal laryngitis is played by chronic banal rhinitis and rhinosinusitis, hypertrophic and polyposic rhinitis, curvature of the septum of the nose, disturbing nasal breathing, as well as adenoiditis, chronic tonsillitis and other chronic diseases of the nasopharynx and pharynx. The functional overstrain of the voice function can be of great importance, especially in the face of unfavorable climatic factors.

As the etiological factors are such microorganisms as hemolytic and green streptococcus, staphylococcus, pneumococcus, catarrhal micrococcus. Most often acute catarrhal laryngitis is caused by polymicrobial association, which can be activated by influenza infection, and then acute catarrhal laryngitis acts as micro epidemic outbreaks, most often in children's groups.

Acute catarrhal and deeper inflammatory reactions of the larynx can occur due to the influence of various traumatic factors (foreign bodies, chemical burns, laryngeal damage during intubation or trachea and gastric probing).

Pathological anatomy

In the initial stage of acute catarrhal laryngitis, hyperemia of the mucous membrane is observed as a result of vascular paresis (expansion), followed by the submucous effusion of the transudate and infiltration of the mucous membrane by leukocytes and in especially acute cases - red blood cells with microcirculation. Hemorrhagic forms of acute catarrhal laryngitis are observed in the viral etiology of the disease. Following the transudate follows inflammatory exudate, at the beginning of mucous, then purulent, containing a large number of leukocytes and desquamated cells of the epithelium of the mucous membrane. In some cases, the toxic effect of the inflammatory process causes the spread of edema in the underlayment space, which is especially common in young children, due to the presence of loose connective tissue in this area. In this case, speak of a false rump.

Acute catarrhal laryngitis may be accompanied by a secondary myositis of the internal muscles of the larynx with a predominant lesion of the vocal muscles; Less common are arthritis of the pustnestherpalovidnyh joints, which, as a rule, is manifested hoarseness of the voice, up to complete aphonia. Cough and vocal load in acute catarrhal laryngitis often lead to erosion of the mucous membrane in the region of the free edge of the vocal folds, which causes soreness in phonation and coughing.

Symptoms of acute catarrhal laryngitis

At the beginning of the disease there is a feeling of dryness, perspiration and burning in the larynx, pain during phonation; then appear hoarseness of voice or aphonia (with a paresis of vocal cords), barking cough, causing painful tearing pains. After a day or two, sputum appears, while the intensity of pain and hyperesthesia is sharply reduced. The general condition of typical uncomplicated forms suffers little. Sometimes, especially if acute catarrhal laryngitis occurs against the background of generalized acute respiratory disease, the body temperature, accompanied by chills, may rise to 38 ° C. In these cases, the inflammatory process, as a rule, extends to the trachea and in severe forms - bronchi and lung tissue (bronchopneumonia). Usually such development of ARI is typical for an unfavorable epidemic situation.

During the culmination of the disease, the endoscopic picture of the larynx is characterized by hyperemia of the entire mucosa, especially pronounced in the region of vocal folds and pear-shaped sinuses, often extending to the upper trachea, as well as by edema, the presence of mucopurulent exudate, and the lack of vocal folds.

Myositis of the internal muscles of the larynx is manifested by the paresis of the thyroid-plexus muscles, which can continue and after some time after the elimination of local inflammatory phenomena, especially if at the height of the disease the voice mode is not observed. In individuals with plethoric (full-blooded) or chronic upper respiratory tract infections, the disease can take on a protracted character and transform into a chronic form of inflammation of the larynx.

After 5-6 days, the severity of dysphonia gradually decreases, and signs of catarrhal inflammation completely pass to the 12-15th day from the onset of the disease.

In some cases, localized acute catarrhal laryngitis is observed. Sometimes sharp hyperemia and infiltration of the mucosa cover only the epiglottis, with the prevalence of complaints and pain when swallowing, since in this act the epiglottis drops and covers the entrance to the larynx. In other cases, the inflammatory process is expressed predominantly in the mucosa of the folds of the vestibule or only the vocal folds, with a predominance of phonation disorder (hoarseness or aphonia). Often a sharp hyperaemia of the mucous membrane is observed only within the arytenoid cartilage and the intergrowth space (laryngitis acuta posterior), which is accompanied by a strong cough, since in this area very sensitive "cough" receptors of the upper laryngeal nerve are laid. The most severe form of isolated laryngitis is lumbar laparitis, which causes inflammation and edema of the lower surface of vocal folds and lining space, the walls of which contain loose submucosal connective tissue. This disease occurs mainly in children with exudative or lymphatic diathesis. That form of lumbar lining under which spasms of the larynx periodically occur is called a false croup.

With diffuse acute laryngitis, the mucous membrane is sharply hyperemic, the edema is most pronounced in the region of the vestibular and cherpalodnagortan folds. The sharp edge of the vocal folds thickens and takes the form of rounded ridges. Stroboscopic examination reveals the limitation of mobility and asynchrony of vocal folds. The epithelium is slipped in places, because of which ulcers form in places. From the dilated blood vessels, sometimes blood seeps, forming on the surface of the mucous membrane of the vocal folds crimson-red dots and striae (acute hemorrhagic laryngitis), which happens more often with viral influenza. With this form of acute laryngitis, the amount of exudate increases, but because of the large amount of protein it quickly dries into the crusts covering a significant part of the inner surface (laryngitis acuta sicca).

Complications of acute catarrhal laryngitis

Complications with acute catarrhal laryngitis occur infrequently and are observed in persons weakened by any previous infectious diseases or concomitant viral infection. These complications are manifested mainly by the spread of the inflammatory process in the submucosa, which is manifested by pronounced edema, up to obstructive laryngitis with impaired respiratory function of the larynx, which especially often occurs in children in the form of false croup (lumbar lining). Such complications as laryngeal abscess, perichondritis and chondritis occur rarely, but their occurrence should always be provided in the treatment tactic and at the slightest suspicion of their possibility, the most effective methods of treatment should be taken.

The diagnosis is made on the basis of the history (the presence of a cold factor, etc.), acute onset, symptoms of the disease and endoscopy data of the larynx. Differential diagnosis is carried out with influenza and measles laryngitis, laryngeal diphtheria and other infectious diseases characterized by laryngeal involvement). In particular, laryngeal diphtheria can not be rejected even in cases when it occurs atypically, without the formation of diphtheria films (true croup). In doubtful cases it is necessary to carry out a bacteriological study of mucopurulent discharges obtained from the surface of the mucous membrane of the larynx and preventive treatment with antidiphtheria serum.

It is also difficult to differentiate from syphilitic laryngitis from commonplace catarrhal laryngitis, which affects the larynx in the secondary stage of the disease; general good condition, absence of severe signs of pain syndrome, presence of rashes on the skin and mucous membrane of the oral cavity should be alerted to the possibility of syphilitic laryngeal disease.

Milliard tuberculosis of the larynx in the initial stage may manifest as signs of acute banal laryngitis. In these cases, the general condition of the patient and the pulmonological examination data are taken into account, along with specific serological responses. Laryngitis of allergic origin differs from acute catarrhal laryngitis by the presence of predominantly gelatinous edema of the mucous membrane, rather than inflammatory manifestations.

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Treatment of acute catarrhal laryngitis

The main in the treatment of patients with acute catarrhal laryngitis is a strict voice mode with the exception of voiced phonation. Allowed in the necessary cases, whisper speech. The patient should stay in a warm room with a high humidity for 5-7 days in a state of relative rest. Excludes acute, salty, hot food, smoking, drinking alcohol. In mild cases, voice calm, sparing diet (not spicy food), warm drink, coughing - antitussives and expectorants. This is enough for spontaneous recovery of the patient. In cases of moderate severity, manifested by severe cough, an increase in body temperature to 37.5 ° C, general weakness, pain syndrome, a complex treatment is prescribed, including physiotherapeutic, medicinal symptomatic, decongestant and antibacterial agents, mainly local action. With abundant viscous sputum, inhalation of proteolytic enzymes is prescribed.

From the physiotherapeutic tools, semi-alcohol warming compresses are shown on the front surface of the neck, in some cases with the suspicion of aggravation of the inflammatory process - UHF in the larynx region in combination with antihistamines and local antibiotics (bioparox). VT Palchun et al. (2000) recommend an effective mixture for infusion into the larynx consisting of 1% menthol oil, an emulsion of hydrocortisone with the addition of a few drops of 0.1% solution of epinephrine hydrochloride. Means of choice are metered-dose aerosol formulations, kamethon and camphor, a combination of local action larypront, which includes lysozyme and dequalinium chloride, which has antimicrobial and antiviral properties. With abundant and viscous sputum, the formation of crusts in the larynx is prescribed by mucolytic drugs, in particular, the mistabrone for inhalations in a diluted form, etc., as well as preparations of thermopsis, ammonia-anise drops, bromhexine, terpinhydrate, ambroxol, etc. At the same time, vitamins (C , pentavit), calcium gluconate, antihistamines (diazolin, dimedrol).

In severe acute catarrhal laryngitis with prolonged course and tendency of generalization of the process towards the lower respiratory tract, treatment of the same + broad-spectrum antibiotics at the beginning of treatment, and then in accordance with the antibioticogram.

The prognosis is generally favorable, however, in the presence of concomitant diseases of the upper respiratory tract, not excluded household and occupational hazards, acute catarrhal laryngitis can pass into other forms of nonspecific laryngitis and into the chronic stage. The prognosis for complicated forms in the form of perichondritis, larynx abscess, etc. Is determined by the degree of severity of the specific complication and its consequences (deforming cicatricial stenosis of the larynx, deficit of respiratory function, persistent paresis of the internal muscles of the larynx, ankylosis of its cartilages).

Prevention of acute catarrhal laryngitis

Prevention of acute catarrhal laryngitis is the timely sanation of foci of infection in the upper respiratory tract, compliance with the anti-cold regime, the exclusion of domestic and occupational hazards, reasonable tempering of the body.