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Acute and chronic laryngitis: treatment
Last reviewed: 23.04.2024
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[Indications for hospitalization
Treatment of acute catarrhal laryngitis is carried out on an outpatient basis. All patients with edematous laryngitis, epiglottitis and epiglottis abscesses, complicated forms of the disease (infiltrative and abscessing) are at hospitalization in a hospital with a threat of development of stenosis of the larynx as well as injuries. Hospitalization is also indicated when surgical treatment is necessary.
Non-pharmacological treatment of acute and chronic laryngitis
Of great importance is the restriction of the voice load, while the whispering speech is prohibited. High local efficacy was demonstrated by the local anti-inflammatory, especially inhalation therapy. For this purpose, antibacterial, mucolytic, hormonal medicinal herbs and herbal preparations with anti-inflammatory and antiseptic effect, as well as mineral water are used. A good effect is provided by the use of physiotherapy methods: 1% potassium iodide, hyaluronidase or calcium chloride electrophoresis on the larynx, therapeutic laser, microwaves, phonophoresis, including endolaryngeal, etc. With complicated abscessed and phlegmonous laryngitis, chondroperichondritis, hyperbaric oxygenation is possible. In the stage of reconvalescence and in those cases when intense phonation is one of the etiopathogenetic factors in the development of hypotonic disorders of the vocal function in the outcome of inflammation, phonopedia and stimulating therapy are indicated.
Drug treatment of acute and chronic laryngitis
Of great importance is therapy of concomitant pathology of the upper and lower respiratory tract, immune status, gastroesophageal reflux.
Antibacterial therapy for acute laryngitis and exacerbation of chronic inflammatory phenomena with the addition of purulent exudation is prescribed empirically, with the use of wide-spectrum drugs (amoxicillin + clavulanic acid, fluoroquinolones). Perioperative antibiotic therapy is prescribed in the case of surgical intervention with direct microlaringoscopy, implantation correction methods, and a large amount of intervention. With fungal laryngitis, antimycotic drugs are prescribed. Perform anti-edema and desensitizing therapy, in the presence of viscous sputum or dryness of the mucosa appoint mucolytics and secretions, enzyme preparations, stimulating and resorptive therapy, drugs that improve microcirculation and neuromuscular transmission, as well as increasing the tone of the mouse. The use of specific therapy for specific laryngitis does not exclude the use of local and general anti-inflammatory therapy. Great attention should be paid to the treatment of patients with infiltrative and abscessed laryngitis. He showed massive detoxification therapy, parenteral nutrition correction of water-salt metabolism, intravenous antibacterial therapy.
Surgical treatment of acute and chronic laryngitis
With abscessed laryngitis, abscesses are opened by indirect laryngoscopy with the Tobolt knife. With complications in the form of phlegmon neck or mediastinitis, combined surgical treatment with external and endolaryngeal access is performed.
In the case of chronic hyperplastic laryngitis, the decortication of the vocal cords and the targeted biopsy are performed with direct and indirect laryngoscopy.
In edematous polyposis laryngitis, two surgical interventions are possible: decortication of the vocal folds according to Kleinsaster and the Hirano technique. When decorticating vocal folds, it is necessary to preserve the epithelium in the field of commissure on both sides in order to avoid their subsequent adhesion and formation of a scar membrane or adhesion. The essence of the Hirano method is: a cut along the lateral edge of the vocal folds, aspirate the gelatinous mass, excision of the excess epithelial tissue with scissors, and the rest is placed on the vocal fold. Laser techniques are also used.
Further management
Patients of the voice professions after the acute laryngitis transferred showed observation of the phoniatric until the voice is fully restored. For patients who endured laryngeal interventions, they are observed until the larynx clinically-functional state is fully restored on the average 3 months with the frequency of examinations once a week in the first month and every 2 weeks starting from the second month. Patients with chronic hyperplastic laryngitis should be placed on dispensary records with examinations every 3 months, with a favorable course - every six months.
The period of incapacity for work depends on the patient's profession: the streets of the voice professions they extend until the voice function is restored. Uncomplicated acute laryngitis is allowed within 7-14 days; infiltrative forms - about 14 days. When surgical treatment of chronic forms of laryngitis, the period of incapacity for work is from 7 days to 1 month in persons with voice professions with full decortication of the vocal folds.
Information for Patient
With the development of acute laryngitis, it is necessary to limit the voice load. Prohibited the reception of hot, cold and spicy food, alcoholic beverages, smoking, steam inhalation. Permanent moistening of air in the room is shown with the help of special humidifiers.