Scleroma of the larynx: causes, symptoms, diagnosis, treatment

Scleroma of the larynx is a chronic specific inflammatory process in the mucosa of the airways with predominant localization in the nasal and laryngeal cavities (according to international statistics, 60% in the nasal cavity and 39% in the larynx). Often there is a simultaneous lesion of the nose and larynx. In most cases, the infection will make its debut in the nasal cavity (rhinoskleroma), but cases of primary laryngeal lesions are also often that are clinically significantly more significant, since the emerging sclerotic infiltrates invariably end with stenosis of the larynx of various degrees, up to asphyxia.

Scleroma is widespread all over the world, but there are regions where the incidence of scleroma is endemic (Belarus, Ukraine, Poland, Czechoslovakia, certain regions of Serbia, Montenegro, Romania, Switzerland, Indonesia, Central American countries.Some endemic centers are in Austria, Spain, Asia, Africa).

[1], [2], [3], [4], [5], [6]

The cause of scleroma of the larynx

A pathogenic agent is an encapsulated bacterium similar to a Friedlander rod or isolated Abel-Levenberg in patients with an osteoporosis microorganism. This bacterium was isolated in 1882 by V.Frisch (V.Frisch) from sclerous infiltrates, from which it can be cultivated. Less often Frish's wand is found in the secretions of the mucosa. Scleroma - the disease is almost not contagious, and the microorganism becomes pathogenic only under certain conditions. It is believed that the wet climate, swampy and wooded terrain, absence of insolation, conditions of rural life contribute to infection. Most often they are sick with female faces. Approximately 5% of scleroma cases occur in children under 15 years of age.

Pathological anatomy. The scleroma of the larynx begins with the formation of dense infiltrates in the submucosal layer, consisting of small rounded cells and plasmocytes, as well as a large number of spindle-shaped cells and fibroblasts that complete the formation of the scleral focus, turning it into a close tumor. The cylindrical epithelium located above the infiltrate is transformed into a multilayer flat keratinizing epithelium. The difference between scleroma and other specific diseases of the upper respiratory tract lies in the fact that the changes in the mucous membrane that arise with it do not ulcerate. As for the scleral infiltrate, it contains typical for scleroma vacuolated cells of foamy species, described by Mikulic. These cells contain small hyaline inclusions (Russelean bodies) and clusters of sclerotic bacteria, which are often found between the cells of Mikulich. Scleral foci evolve over a number of years, then undergo cicatrization (without decay), which leads to the formation of stenosing throat scars, respiratory disturbances and voice formation.

Symptoms of larynx scleroma

The disease begins gradually, manifested in the debut signs of banal catarrhal laryngitis, which then goes to the "dry phase". Simultaneously, similar phenomena are observed in the nasal cavity. A feature of scleral foci is their occurrence in the narrow areas of the upper respiratory tract. Since scleral infiltrates are located mainly in the backbone space, the most pronounced and early sign of the scleroma of the larynx is a violation of breathing, and then, as the foci of inflammation spread to the voice apparatus, dysphonia is added, progressing to complete aphonia.

Laryngoscopy reveals pale pink infiltrates; places where the process of scarring begins, infiltrates acquire a whitish shade and become dense to the touch. Infiltrates are usually located symmetrically under the vocal folds, spreading over time to the entire circumference of the larynx. Scleral infiltrates possess the property of creeping spreading both upward, into the region of vocal folds, and down, covering the trachea, and sometimes the main bronchi. Significantly less often the process begins in the above-deposited space: infiltrates are formed on the laryngeal surface of the epiglottis, on the vestibular and cherpalodnagortan folds. Sclerosis of infiltrates leads to deformation of the anatomical formations on which they originated. So, the epiglottis decreases, shrinks and mixes in the direction of traction of scar tissue - latsralno or in the lumen of the anterior larynx. Usually, in the vestibular part of the larynx, in addition to typical dense infiltrates, granulomatous tissue appears, reminiscent of the appearance of the papilloma of the larynx.

The laryngeal lumen is considerably narrowed by annular stenosis, breathing becomes noisy, hissing, and with shortness of breath, dyspnea occurs. The epithelium covering the infiltrates is not ulcerated (an important differential diagnostic feature), it is covered with a tightly adhering whitish-muddy secret, which produces a sweetish-sugary smell (not fetid, as in the lake, but rather unpleasant).

Diagnosis of larynx scleroma

Diagnosis with advanced forms of scleroma of the larynx does not cause difficulties, especially when similar lesions are detected at the same time in the nasal cavity and pharynx. Gives scleroma and the above characteristic sweetish-sugary smell, sensed at a distance. If scleral lesions affect only the larynx, then they should be differentiated from other specific diseases of the larynx and tumors. Along with various methods of complex examination of the patient (lung radiography, serological tests, bacteriological research), a biopsy is mandatory in the formulation of the final diagnosis. The material should be taken with direct laryngoscopy or even in some cases with dissection of the thyroid cartilage, from the depth of the infiltrate, because because of its density with indirect laryngoscopy, the instrument usually slides over the surface of the mucosa and does not penetrate into the interior of the object.

[7], [8], [9], [10], [11]

Treatment of larynx scleroma

Treatment with non-operative methods with sclerosis of the larynx practically does not differ from that in the rhinosclerome. The peculiarity of treatment in sclerosis of the larynx is its focus on the elimination of stenosis of the larynx and the provision of natural functions of the larynx. To do this, apply methods of endolaryngeal surgery, galvanocautery, diathermocoagulation, dilatation methods of the narrowed parts of the larynx. However, the effectiveness of these methods is not high enough due to relentless relapses. With severe stenosis, tracheostomy is applied, after which the scar tissue is removed either by endolaryngeal access, or by access via laryngophyssure followed by plasty with local mucosal flaps according to BSKrylov (1963).

Prognosis for sclerosis of the larynx

The prognosis for sclerosis of the larynx for life is favorable, but with respect to the functions of the larynx depends on the degree of severity of the process. Often, such patients need multiple plastic surgeries and even become lifelong cannulae.