Diagnosis of acute laryngitis

Diagnosis of acute laryngitis is based on clinical data, and in the case of stenosing laryngitis - on data from direct laryngoscopy.

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Laboratory diagnostics of acute laryngitis

In case of acute simple laryngitis, there is no need for laboratory testing.

In case of stenosing laryngitis, the acid-base balance of the blood is determined and a peripheral blood analysis is performed.

• The acid-base balance of the blood in stage I is without significant changes.
• In stage II, the partial pressure of oxygen in the blood is moderately reduced, the partial pressure of carbon dioxide is unchanged.
• In stage III, the partial pressure of oxygen is reduced, the pressure of carbon dioxide is increased, respiratory or mixed acidosis is noted. Oxygen saturation decreases.
• In stage IV, the terminal stage, pronounced acidosis is observed. Oxygen saturation is sharply reduced.

In the analysis of peripheral blood in stages I-II with viral etiology of stenosing laryngitis, normal or slightly reduced leukocytosis and lymphocytosis are noted. In stage III of stenosing laryngitis, a tendency to leukocytosis, neutrophilia and a shift in the formula to the left appears.

To decipher the etiology, serological diagnostic methods are used to determine specific antibodies (IgG and IgM) to various viruses and bacteria, and the PCR method, provided that material is taken early from the oropharynx in the acute period of the disease to identify a wide range of respiratory viruses.

In cases of prolonged course, with the ineffectiveness of conventional therapy methods, it may be necessary to identify mycoplasma, chlamydial or other infections. For this purpose, PCR diagnostics of pharyngeal and/or nasal smears and sowing of discharge from the pharynx and nose on conventional nutrient media and Sabouraud's medium (to identify mycoses) are performed.

Instrumental diagnostics of acute laryngitis

In simple acute laryngitis, there is no need for instrumental examination. In stenosing laryngitis, the main examination is direct laryngoscopy.

• Stage I laryngeal stenosis - hyperemia and slight swelling of the mucous membrane of the larynx.
• Stage II - edema and infiltrative changes in the mucous membrane of the larynx. narrowing of the diameter of the lumen of the larynx to 50% of the norm.
• Stage III - infiltrative and fibrinous-purulent changes in the mucous membrane of the larynx. Areas of hemorrhage are detected on the mucous membrane of the larynx. Purulent crusts, viscous mucus, and mucopurulent strands are possible in the lumen of the larynx. Narrowing of the lumen of the larynx by 2/3 of the norm.
• Stage IV - terminal - narrowing of the lumen of the larynx by more than 2/3 of the norm.

X-ray of the chest, paranasal sinuses, and neck organs plays an auxiliary role in differential diagnosis or suspected development of complications (pneumonia).

Differential diagnosis of acute laryngitis

Differential diagnostics are carried out primarily between viral or opportunistic bacterial genesis of acute stenosing laryngitis with laryngeal diphtheria, which is characterized by a slow gradual increase in the clinical picture of obstruction, dysphonia, the transition of the process to nearby tissues, and an increase in cervical lymph nodes. Bacteriological examination is of decisive importance.

Allergic laryngeal edema, which develops in response to exposure to various allergens - inhalation, food and others - is characterized by the absence of signs of acute respiratory infections, the absence of fever and intoxication. The anamnesis may indicate allergic manifestations.

A foreign body in the larynx and trachea is the most common cause of asphyxia in young children. It is typical that the signs of suffocation and coughing occur suddenly, during the day, while the child is eating or playing. The child is frightened and restless. A foreign body is detected during direct laryngoscopy.

A neglected retropharyngeal abscess also sometimes has to be differentiated from acute stenosing laryngitis. Unlike the latter, it is characterized by the gradual onset of difficulty breathing against the background of severe intoxication and often severe fever. Characteristic features include a nasal voice, a forced posture with the head thrown back, and when examining the pharynx, a bulging of the back wall of the pharynx is noted.

And finally, differential diagnostics must be carried out with acute epiglottitis - inflammation of the epiglottis and surrounding tissues of the larynx and pharynx. Epiglottitis is characterized by rapidly increasing symptoms of difficulty breathing due to swelling of the epiglottis and aryepiglottic folds. Intolerable pain in the throat, a feeling of suffocation, a muffled voice and high body temperature are typical. Drooling, dysphagia, inspiratory dyspnea, noisy breathing are observed. When examining the pharynx, swelling and hyperemia of the epiglottis are visible. The tongue is displaced forward, swollen, swelling of the pharyngeal tissues is pronounced.

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