Laryngeal sore throat

One of the most common diseases of the nasopharynx is laryngeal angina. This disease has been known to many of us since childhood. The cause of this condition is streptococcal infection. The greatest danger of angina is its complications. Even if the disease is not very difficult, bed rest is required. This is due to the fact that angina can give serious complications to the kidneys (in the form of pyelonephritis) and the heart (in the form of myocarditis, pericarditis).

Laryngeal angina refers to an acute inflammation of the lymphadenoid tissue of the larynx (in the area of the scooped-supraglottic folds, the intercranial space, in the morganic ventricles, in the piriform sinuses and individual follicles). And can occur in both acute and chronic form. 

Acute laryngeal angina is often a mild and self-limiting condition that usually lasts 3 to 7 days. If this condition lasts more than 3 weeks, it is called chronic laryngeal angina. [1]

Epidemiology

Laryngeal angina can affect patients of any age, although it is more common in adults, usually affecting people between the ages of 18 and 40, although it can occur in children as young as three years of age. Isolated voice symptoms in children younger than three years of age require more careful examination to identify additional pathologies, including vocal cord paralysis, GERD, and neurodevelopmental disorders. [2] Accurate measurements of the incidence of laryngeal angina are still difficult to explain as the condition remains underestimated and many patients do not seek medical attention for this often self-limiting condition.

Causes of the laryngeal sore throat

The etiology of laryngeal sore throat can be infectious or non-infectious. The infectious form is more common and usually occurs after an upper respiratory tract infection.

Viral agents such as rhinovirus, parainfluenza virus, respiratory syncytial virus, coronavirus, adenovirus and influenza are potential etiological agents (listed in decreasing order of frequency). With viral laryngeal sore throat, bacterial superinfection is possible, usually about seven days after the onset of symptoms.

The most common bacterial organisms are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, in that order. Exanthematous febrile diseases such as measles, chickenpox and whooping cough are also associated with symptoms of acute laryngitis, so it is advisable to obtain an accurate vaccination history. Laryngeal angina caused by a fungal infection is very rare in immunocompetent people and is more likely to manifest as chronic laryngitis in immunocompromised people or in patients taking inhaled steroid drugs. 

At first glance, it may seem that there are many reasons for the development of laryngeal sore throat. In one case, the disease was preceded by contact with a sick sore throat, in another case, hypothermia or overwork of the body was the cause. But in fact, these are all just predisposing factors, trigger mechanisms that triggered the development of diseases in millet. There is only one reason for the development of sore throat - streptococcal infection. [3]

The disease develops if the level of streptococcus in the body exceeds the permissible norm. So, normally streptococcus lives in the human body, and its indicators should not exceed 10 ³  CFU / ml. If the level of streptococcal infection exceeds these values, an infectious and inflammatory process develops in the form of laryngeal sore throat. Streptococcus belongs to the representatives of conditionally pathogenic microflora, that is, it is a normal inhabitant of the human body, and causes an infectious process only if there is a violation of the normal microbiocenosis. This means a violation of the normal qualitative and quantitative states of the mucous membranes, in which there are fewer representatives of the normal microflora, and their place is taken by a pathogenic strain. Or there is a rapid growth of the microorganism that is stronger than the rest. This can be facilitated by a violation of local and general immunity, hypothermia, malnutrition, stress, GERD  [4] and many other factors related to risk factors.

Risk factors

There are quite a few risk factors that predispose to the development of laryngeal sore throat. For example, vitamin deficiency, or bacterial or fungal infection of the body can contribute to the development of laryngeal sore throat. Angina is often observed in somatically weakened patients who have reduced immunity, disturbed hormonal levels or a biochemical cycle. At the same time, patients who have a history of a recent viral, fungal, and less often bacterial infection are often sick. This is due to the fact that the body's defense mechanisms against the background of the transferred infection are sharply reduced. Angina develops when a person's compensatory and adaptive mechanisms are disturbed, dysbiosis, mucous membranes develops.

The situation is aggravated by the fact that often dysbiosis is accompanied by a general metabolic disorder, the predominance of dissimilation over assimilation. This negatively affects the state of the body as a whole, the state of immunity. The danger of sore throat is that there is an accumulation of waste metabolites, toxins in the blood. Accordingly, angina is accompanied by intoxication of the body.

Some pharmaceuticals and medicines, for example, antibiotics, antimycotics, antineoplastic agents, and anti-tuberculosis drugs, also act as risk factors. They can weaken the body, cause intoxication, decreased immunity, hormonal imbalance. Sometimes the development of toxic substances, harmful factors of production contributes to the development of angina (in fact, in this case we are talking about laryngeal sore throat, as an occupational disease).

Among the risk factors are endogenous (internal) causes, and exogenous (external) causes. Endogenous causes include an improper lifestyle, malnutrition, an unbalanced diet, and a lack of vitamins. Exogenous factors include the state of the body: dysbiosis, impaired immunity, hormonal imbalance.

Frequent laryngeal sore throats develop against the background of anti-tuberculosis therapy, in patients who receive radiation therapy, or chemotherapy due to severe cancer. Laryngeal angina can develop against the background of acute or chronic intoxication of the body. In some cases, the development of laryngeal sore throat can be promoted by stress, neuropsychic overstrain, physical overwork, lack of sleep, since all this leads to a decrease in the body's defense mechanisms.

Diagnostics of the laryngeal sore throat

When the first signs of laryngeal sore throat appear, you need to see a doctor as soon as possible. First of all, they turn to the local therapist (family doctor), after which he determines the course of further diagnostics and further treatment. If necessary, analyzes, additional consultations of specialists can be prescribed. [5]

As a rule, the diagnosis is based on the usual examination of the patient, taking anamnesis, examination. According to the external signs that are characteristic of angina, one can assume the primary diagnosis. But it must be confirmed in the course of laboratory and other studies. If there is no time to wait for the test results (and this happens in most cases, since angina is rapidly progressing), standard treatment is prescribed according to the protocol. It usually includes antibiotic therapy, anti-inflammatories, topical agents. For more information, the doctor can prescribe laboratory tests, instrumental diagnostic methods. Differential diagnosis may be required. Most often, laryngeal angina is differentiated from diseases such as infectious mononucleosis, severe forms of pharyngitis, laryngitis (similar symptoms are noted). [6]

Analyzes

With laryngeal angina, he prescribes a standard set of tests: a clinical analysis of blood and urine, a feces analysis. These tests provide important information about the patient's condition, indicate the severity of the disease, and may indicate the development of an inflammatory or infectious process. According to these analyzes, it is possible to track the state in dynamics, in particular, the body's response to the prescribed therapy.

Bacteriological inoculation is also required from the analyzes. For this, a smear is taken from the throat and nose, then further inoculation of biological material is done in the laboratory. Sowing is done under sterile conditions. The crops are incubated under optimal conditions (in a thermostat). Then a pure culture is isolated, it is identified (species and generic affiliation are determined). An additional antibiotic susceptibility test is often performed. For this, an antibiotic is selected for each of the isolated microorganisms. Its optimal dosage and mechanism of action are determined. This allows the most accurate and effective selection of treatment suitable for each individual. [7]

Virological, immunological, serological research methods can also be used additionally. If necessary, a detailed immunogram is performed, phagocytic activity is determined. This makes it possible to judge the state of immunity, if necessary, to carry out immunocorrection in a timely manner.

Instrumental diagnostics

Instrumental diagnostics is rarely used. Sometimes pharyngoscopy (an additional examination of the posterior wall of the larynx using auxiliary mirrors) may be required. However, this method is often unnecessary as a simple visual inspection is sufficient. But instrumental diagnostic methods are often used if there is a risk of complications, for example, pyelonephritis, myocardial diseases. In this case, appropriate methods are applied.

To diagnose kidney diseases, in particular, pyelonephritis, an ultrasound of the kidneys, CT, MRI, and other imaging methods may be required. If myocarditis, pericarditis is suspected, ECG, EchoCG, ultrasound of the heart are used.

Differential diagnosis

Differential diagnosis is based on the need to differentiate one disease from another. So, most often you have to differentiate angina from infectious mononucleosis. This is quite simple to do. With laryngeal sore throat, bacteriological culture shows a sharp increase in bacterial microflora with a predominance of streptococcus. Whereas with infectious mononucleosis, a viral infection is diagnosed, and the microbiocenosis of the mucous membranes is predominantly in a normal state. The cause of the development of mononucleosis is a viral infection, in particular, EBV infection, cytomegalovirus. Accordingly, different treatments are prescribed. [8]

It is also often necessary to differentiate various forms of pharyngitis, laryngitis, tracheitis from laryngeal sore throat. The differentiated diagnosis is also based on various laboratory tests, in particular, biochemical and clinical blood tests, less often urine tests. According to the analyzes, one can judge the nature of the inflammatory and infectious process.

If the cause of the development of laryngeal sore throat is a bacterial or fungal infection, bacteriological inoculation is carried out, which makes it possible to differentiate the pathogen, up to determining its species and genus. Fungal and bacterial infections require different treatment approaches. You can also determine the quantitative indicators of pathogenic microflora, and its individual sensitivity in relation to a particular antibiotic.

Treatment of the laryngeal sore throat

Treatment is often supportive and depends on the severity of the laryngeal sore throat.

• Voice Rest: This is the most important factor. The use of the voice for laryngeal sore throat leads to incomplete or delayed recovery. Complete rest of the voice is recommended, although this is almost impossible to achieve. If the patient needs to speak, he should be instructed to use a “confidential voice”; that is, a normal vocal voice at low volume without whispering or projection.
• Inhalation of vapor: Inhalation of humidified air increases the moisture in the upper respiratory tract and helps in the removal of secretions and exudates.
• Avoiding irritants: Smoking and alcohol should be avoided. Smoking delays the rapid resolution of the painful process.
• Diet modification: dietary restriction is recommended for patients with gastroesophageal reflux disease. This includes avoiding caffeinated drinks, spicy foods, fatty foods, chocolate, and peppermint. Another important lifestyle change is avoiding late meals. The patient should eat at least 3 hours before bedtime. The patient should drink plenty of water. These dietary measures have been shown to be effective in classic GERD, although their effectiveness in LPR has been disputed, they are still used. [9]
• Medication: Prescribing antibiotics to a healthy patient with laryngeal angina is not currently supported; however, antibiotics can be given to high-risk patients and patients with severe symptoms. Some authors recommend narrow-spectrum antibiotics only in the presence of identifiable Gram stain and culture. The basis of the treatment of laryngeal sore throat of bacterial origin is antibiotic therapy. Various antibiotics are prescribed, affecting mainly streptococcal infection, or other coccal forms of microorganisms. Additionally, anti-inflammatory drugs are prescribed. If necessary, symptomatic therapy is prescribed, in particular, antipyretic drugs, pain relievers. Bed rest must be observed. This will avoid complications such as pyelonephritis, myocarditis.

Fungal laryngeal sore throat can be treated with oral antifungal agents such as fluconazole. Treatment is usually required within three weeks and can be repeated if necessary. This should be done in patients with confirmed fungal infection by examination of the larynx and / or culture.

Mucolytics such as guaifenesin can be used to clear secretions.

In addition to lifestyle and dietary changes, LPR-associated laryngitis is treated with antireflux medications. Medicines that suppress acid production, such as H2 receptor and proton pump blockers, are effective against gastroesophageal reflux, although proton pump inhibitors are most effective in LPR. This may require higher doses or a twice daily dosing regimen. [10]

Available data do not support the use of antihistamines or oral corticosteroids for the treatment of laryngeal sore throat.

Medicines

Consider the main drugs that are used in the treatment of laryngeal sore throat.

• Suprastin. (Antihistamine, anti-inflammatory agent)

Dosage: take 1 tablet 1-2 times a day for a course of 7 days.

Precautions: not recommended during pregnancy, lactation. It should not be taken by people whose activities require increased concentration of attention.

Side effects: drowsiness, lethargy.

• Ciprofloxacin (antibacterial, anti-inflammatory effect).

Dosage: one tablet (500 mg) once a day. The course of treatment is no more than 5 days.

Precautions: not to be taken by pregnant women, lactating women, children under 6 years of age.

Side effects: nausea, vomiting, diarrhea, headache, dysbiosis, lack of appetite, liver pain.

• Sumamed (antibiotic)

Dosage: in the form of a suspension, take a tablespoon, dissolving in a glass of water, drink three times a day. In the form of tablets - 1 tablet 3-4 times a day.

Precautions: not recommended for pregnancy, dysbiosis, liver and gastrointestinal tract pathologies, bleeding tendency.

Side effects: headache, nausea, vomiting, dystonic disorders, diarrhea, flatulence.

• Anaferon (immunostimulating, antiviral, anti-inflammatory agent).

Dosage: one tablet 2-3 times a day. The course of treatment is 7-14 days.

Precautions: not for children under 6 years of age, pregnant women.

Side effects: nausea, vomiting, intoxication, fever.

Physiotherapy treatment

Sometimes for the treatment of laryngeal sore throat, various methods of physiotherapeutic treatment are prescribed, in particular, KUF (directed exposure to the larynx, pharynx, nasopharynx of ultraviolet light). Apply light procedures, electrical procedures. If there is no temperature, thermal procedures are indicated, as well as inhalation. For the rest, it is recommended to stay in bed. Physiotherapy is usually prescribed for severe forms of the disease, with a long course. In other cases, it is advisable to dispense with medication.

Herbal treatment

With laryngeal sore throat, herbal treatment is often used. But it must be borne in mind that this is an auxiliary method of treatment. It is resorted to after prior consultation with a doctor, since even the most harmless herb can have numerous side effects. For angina, herbs are most often used in the form of decoctions for gargling. Gargle with a warm broth. Cooking the broth is quite simple: 1-2 tablespoons of plant materials are poured with a glass of boiling water, after which they are allowed to brew for about 30-40 minutes. You need to insist the product under a tightly closed lid. Gargling is recommended 5-6 times a day. Below is a description of the herbs that are most effective for angina.

Grass cuff. It has anti-inflammatory, antibacterial effects. Contains many vitamins and minerals: vitamins of groups A, B, E, C. The herb has a rejuvenating, immunostimulating, hemostatic, wound healing effect, lowers body temperature. Eliminates allergic, autoimmune reactions, normalizes digestion, relieves swelling. Can be used not only for rinsing, but also taken orally (no more than a glass per day).

Stevia herb. Stevia is a perennial herb whose action is aimed at normalizing metabolic processes in the body. It has an immunomodulatory effect: it normalizes the state of the immune system, increases the body's endurance, resistance to infectious disease. Stevia has an antiviral effect. Effectively eliminates autoimmune aggression and allergy symptoms. In fact, we can say that stevia has a complex effect on the body. An irreplaceable remedy for laryngeal sore throat. It can be taken both internally and for gargling, rinsing the nose.

The goat's rue herb is a perennial medicinal plant. It normalizes metabolic processes, lowers blood sugar levels, and also improves appetite, increases immunity, activates the body's adaptive potential, and increases resistance to infectious diseases. The herb has a diuretic, choleretic effect, is a source of vitamin C. This vitamin accelerates recovery, is indispensable for infectious and inflammatory processes.

Amaranth herb in its properties is as close as possible to a rose or rosehip. Contains a large amount of essential oils, flavonoids, resins. Quickly relieves inflammation, sore throat, eliminates cough, nasal congestion. Improves digestion, metabolic processes, has a choleretic and diuretic effect, lowers blood sugar. There are practically no contraindications, It is used in the form of decoctions, infusions, leaves and petals are added to tea.

Forecast

In general, with properly selected treatment and timely diagnosis, laryngeal angina ends favorably with complete recovery.