Catad_tema Diseases of the ENT organs - articles

ICD 10: J37.0, J37.1

Year of approval (revision frequency): 2016 (reviewed every 3 years)

ID: KR321

Professional associations:

• National Medical Association of Otolaryngologists

Approved

Chief freelance specialist otorhinolaryngologist of the Ministry of Health of Russia Doctor of Medical Sciences, Professor N.A. DaikhesPresident of the National Medical Association of Otorhinolaryngologists Honored Doctor of Russia, Corresponding Member of the Russian Academy of Sciences Professor Yu.K. Yanov

Agreed

Scientific Council of the Ministry of Health of the Russian Federation__ __________201_

chronic hyperplastic laryngitis

chronic edematous polyposis laryngitis

List of abbreviations

GERD – gastroesophageal reflux disease.

CHL – chronic hyperplastic laryngitis

CL – chronic laryngitis

COPL – chronic edematous polyposis laryngitis

Terms and definitions

Chronic hyperplastic laryngitis (CHL) (l. chronica hyperplastica) - a type of chronic laryngitis characterized by diffuse hyperplasia of the laryngeal mucosa or limited hyperplasia in the form of nodules, mushroom-shaped elevations, folds or ridges.

Chronic edematous polyposis laryngitis (COPL) - Reinke-Hajek disease (Reinkae edema)- chronic laryngitis, characterized by polypoid growth of the mucous membrane of the vocal folds.

Gastroesophageal reflux disease (GERD) - morphological changes and symptom complex that develop as a result of the reflux of the contents of the stomach and duodenum into the esophagus.

1. Brief information

1.1. Definition

Chronic laryngitis (CL) is a chronic inflammatory disease of the laryngeal mucosa lasting more than 3 weeks.

1.2. Etiology and pathogenesis

Almost all chronic laryngitis are precancerous diseases. Chronic hyperplastic laryngitis (CHL) is characterized by hyperplasia of the epithelium of the laryngeal mucosa. The pathogenesis of the disease is not fully known. The pathogenesis of chronic edematous polyposis laryngitis (COPL) is better known. The course of the disease is associated with the anatomical features of Reinke's space. Immunohistochemical examination and electron microscopy of remote sections of the vocal fold mucosa in patients with Reinecke's disease reveal increased subepithelial vascularization with a large number of dilated vessels. The walls of the blood vessels are thinned, and capillaries are fragile. Fragility and changes in the vascular pattern in Reinecke's space are the cause of edema in this area and contribute to the progression of the disease. This can also explain the occurrence of hemorrhages in the vocal folds in the initial stage of the disease with a sharp increase in vocal loads. In addition, disruption of lymphatic drainage is of great importance.

1.3. Epidemiology

Chronic laryngitis accounts for 8.4% - 10% of all pathologies of the ENT organs. Reinke-Hajek COPL accounts for 5.5 - 7.7% of all diseases of the larynx leading to voice impairment. CGL is more common in men aged 40-60 years, and Reinke-Hajek COPL is more common in women.

1.4. Coding according to ICD-10

J37.0- Chronic laryngitis;

J37.1- Chronic laryngotracheitis.

1.5. Classification

Chronic laryngitis is divided into catarrhal, hyperplastic, atrophic and edematous-polyposis (Reinke-Hajek disease). Specific laryngitis is distinguished separately and, by some authors, pachyderma of the larynx is separately defined. There are limited and diffuse forms of hyperplastic laryngitis. Vocal fold nodules, according to some authors, are a form of hyperplastic laryngitis, but most authors tend to define this pathology as independent. Chronic laryngitis is also divided into specific and nonspecific.

2. Diagnostics

2.1. Complaints and anamnesis

In HL, the leading complaint is persistent impairment of vocal function, sometimes cough, sore throat with vocal stress, paresthesia in the projection of the larynx, and sometimes shortness of breath. Changes in vocal function are different in different forms of laryngitis. Chronic hyperplastic laryngitis is characterized by constant hoarseness with a deepening of the voice and the presence of many overtones. In chronic edematous polyposis laryngitis, the leading symptom is persistent hoarseness, which is characterized by a gradual shift in voice timbre to the low frequencies of a male timbre. Atrophic laryngitis is more characterized by decreased tolerance to vocal stress, the appearance of cough and pain when trying to improve voice volume, and hoarseness. In patients with catarrhal laryngitis, complaints of various paresthesias in the projection of the larynx and hoarseness, which increases during vocal stress, and decreased vocal endurance come to the fore. With edematous polyposis laryngitis, respiratory failure may develop to grade 3 laryngeal stenosis. The appearance of patients suffering from Reinecke's edema is characteristic: symptoms of hirsutism in women, a tendency to facial swelling. With long-term laryngitis, in some cases, hypertrophy of the vestibular part of the larynx develops due to the formation of vestibular-fold phonation. Cough is not a constant symptom of laryngitis. If the patient complains of cough, further examination is necessary to determine the cause of the cough.

When collecting anamnesis, attention is paid to screening for etiopathogenetic factors in the development of the disease and the frequency of relapses. An anamnesis of voice disorder is important (the nature of the voice dysfunction, its duration, the patient’s need for vocal stress), as this allows not only to carry out an initial differential diagnosis of the disease and determine its duration, but also to build the correct system of staged voice restoration treatment.

2.2. Physical examination

During a physical examination of a patient with chronic laryngitis, attention should be paid to the external contours of the neck and larynx, the mobility of the laryngeal skeleton by palpation and during swallowing, and the participation of the neck muscles in phonation. With intense phonation, the tension in the external muscles of the neck is clearly visible. Regional lymph nodes are assessed; their enlargement may indicate the degeneration of a precancerous process. The size of the thyroid gland is determined, which is especially important for patients with COPD. At the same time, a subjective assessment of voice quality, articulation and individual speech characteristics is carried out.

2.3. Laboratory diagnostics

A comprehensive general clinical examination of a patient with HL is recommended with the involvement of doctors of other specialties (gastroenterologist, endocrinologist, pulmonologist, neurologist, rheumatologist, infectious disease specialist, dermatologist, etc.).

Comments: is carried out to clarify the etiological factors in the development of the inflammatory process and concomitant pathology.

Comments: It is preferable to take cultures from the mucous membrane of the hypopharynx without anesthesia or from the vocal folds under local anesthesia. The most common causative agents of laryngitis are: Streptococcus pneumonia, Haemophilus influenza, S. aureus, Mycoplasma spp., Actinomyces diphteriae, Mycoplasma pneumonia, Chlamiophila pneumonia. Chronic hyperplastic laryngitis is characterized by associations of microorganisms, among which the most common are Staphylococcus aureus and epidermidis. It has been established that the causative agents of laryngomycosis in 97% of cases are yeast-like fungi of the genus Candida, most often Candida albicans and Candida spp., other species are less common - C.tropicalis, C.krusei, C.pseudotropicalis, C.glabrata.

Comments: Taking a biopsy in the larynx can be carried out during fibrolaryngoscopy, during indirect microlaryngoscopy, during direct microlaryngoscopy by an otolaryngologist or an endoscopist or an oncologist with the necessary surgical skills.

The microscopic picture of CGL is a combination of reactive changes in the surface epithelium and inflammatory, reparative and sclerotic changes in the lamina propria of the mucous membrane. The inflammatory infiltrate is characterized by a predominance of mononuclear elements and plasma cells over segmented leukocytes. The predominance of cells from the productive phase of inflammation is the main distinguishing feature of chronic inflammation. The second morphological component is reactive changes in the integumentary and glandular epithelium in the form of hyperplasia, acanthosis and keratinization disorders, dysplasia of the respiratory epithelium - in the form of basal cell hyperplasia, an increase in the number of goblet cells and squamous metaplasia. Severe acanthosis of the stratified squamous epithelium is the main pachyderma. With COPD, it is not the signs of inflammatory infiltration that come to the fore, but pronounced interstitial edema, often with stromal myxomatosis, disruption of the vascular wall, and thickening of the basement membrane of the integumentary epithelium. Morphological examination for specific laryngitis and laryngomycosis, although it has its own characteristics, is only part of the diagnosis; the entire clinical picture of the disease and data from other examination methods are of great importance. Histological examination in these cases is not always informative.

2.4. Instrumental diagnostics

Comments: It is optimal if the examination is recorded on video, as this will make it possible to fully monitor the patient with a precancerous process. If it is not possible to perform microlaryngoscopy, the patient should be sent for consultation to those institutions where this diagnostic method exists. Microlaryngoscopy picture of CL diverse. In the vast majority of cases, the pathology is bilateral. Chronic catarrhal laryngitis is characterized by an increase in the vascular pattern of the vocal folds, their hyperemia, and dryness of the mucous membrane. In chronic edematous-polyposis laryngitis, polypoid degeneration of the mucous membrane can be different: from a mild fusiform-vitreous tumor that looks like an “abdomen” to a severe floating, polypoid, translucent or gray, gray-pink gelatinous thickening that stenoses the lumen of the larynx. With atrophic laryngitis, the mucous membrane of the vocal folds looks dull, there may be viscous sputum, there is hypotonia of the vocal folds and non-closure during phonation.

In the diffuse form of CGL, infiltration of the vocal folds is observed, foci of keratosis are visible, hyperemia of the laryngeal mucosa, the presence of fibrinous deposits, and accumulation of viscous or purulent sputum are possible. Keratosis is a pathological keratinization of the epithelium of the laryngeal mucosa, which can manifest itself in the form of pachyderma (thickening of the mucous membrane in the interarytenoid region), leukoplakia (white smoky formation), hyperkeratosis (lumpy formation) located on the vocal folds.

In all forms of laryngomycosis, a common microlaryngoscopic sign was noted - the presence in all patients of whitish deposits or accumulation of thick sputum in various parts of the larynx. The diagnosis of laryngomycosis can be made only after verification of the pathogen.

The endovideolaryngostroboscopic picture in the catarrhal form of laryngitis shows minor changes in the vibrator cycle; there is a decrease in the amplitude of vibration of the vocal folds and mucous waves. The subatrophic form of chronic laryngitis is characterized by a symmetrical decrease in the amplitude of vibrations of the vocal folds, a decrease in the mucous wave and the absence of the closure phase. With edematous-polyposis laryngitis, the closure phase is complete, the vibrations of the vocal folds are asymmetrical and irregular, the amplitude of vibrations of the vocal folds is reduced, and the mucous wave, on the contrary, is sharply increased. In the hyperplastic form of laryngitis, pronounced disturbances in the vibrator cycle are determined. They are determined by a decrease in the amplitude of vibrations of the vocal folds (along the entire length or in a separate area), the mucous wave is reduced or absent, non-vibrating areas of the mucous membrane are determined, an asymmetrical and uneven change in the amplitude of vibrations and the mucous wave is noted. Video laryngoscopy is indicated for patients with limited keratosis. There are superficially located keratosis and fused with the underlying layers. Adhesive keratoses are particularly suspicious for cancer and are an absolute indication for surgical treatment.

Comments: at hastily used and other , based on the analysis of the vascular pattern of the affected areas of the mucous membrane, it is also possible to use contact endoscopy, which is an intravital morphological study of the mucous membrane.

Comments: the study helps in later stages of therapy to determine the quality and nature of phonation for each individual patient in order to build the correct system of voice restoration treatment.

Computed tomography of the neck organs is recommended if differential diagnosis is necessary, and pulmonary function testing is indicated for patients with COPD to verify symptoms of latent respiratory failure in laryngeal stenosis.

Comments: consultation is indicated to identify etiopathogenetic factors in the development of the inflammatory process in the larynx.

2.5. Differential diagnosis

Comments: The differential diagnosis of CGL and laryngeal cancer is often very difficult. With indirect microlaryngoscopy, attention is paid to the nature of the vascular pattern. Laryngeal cancer is characterized by atypia of capillaries: an increase in their number, their convoluted shape in the form of a corkscrew and uneven dilation of blood vessels, pinpoint hemorrhages. In general, the vascular pattern of the vocal fold is chaotic. Impaired mobility of the vocal fold, the unilateral nature of the process is alarming in terms of malignancy of chronic laryngitis. Other changes in the vocal fold are also noteworthy: severe dysplasia, infiltration of the mucosa, foci of dense keratosis adherent to the underlying tissues, and others. The final differential diagnosis for HL is made as a result of histological examination.

Comments: Involvement of the larynx in the pathological process with Wegener's granulomatosis occurs in 6-25% of cases in the form of subglottic laryngitis, accompanied by subglottic stenosis. Isolated damage to the larynx with scleroma is observed in 4.5% of cases, more often the nose, nasopharynx and larynx are involved in the process. Pale pink lumpy infiltrates form in the subglottic space. The process can spread into the trachea or upward to other parts of the larynx. There is primary amyloidosis of the larynx, nodular or diffuse-infiltrative forms, and secondary - against the background of chronic inflammatory systemic diseases (Crohn's disease, rheumatoid arthritis, tuberculosis, etc.). Most often, the damage is diffuse in nature with intact mucosa, sometimes spreading to the tracheobronchial tree. Amyloid deposits are localized mainly in the supraglottic part of the larynx, sometimes in the form of subglottic laryngitis. Sarcoidosis occurs in the larynx in 6% of cases in the form of epiglotitis and granulomas. The vocal folds are rarely affected. With rheumatoid arthritis, laryngeal pathology is diagnosed in 25-30% of patients. Clinically, the disease manifests itself as arthritis of the cricoarytenoid joint. Differential diagnosis is carried out on the basis of general clinical, serological examination and biopsy. Laryngeal tuberculosis is characterized by polymorphism of changes. The formation of miliary nodules and infiltrates is noted, which undergo disintegration with the formation of granulations, ulcers and scarring. Tuberculomas and chondroperichondritis often form. Syphilis of the larynx manifests itself in the form of erythema, papules and condylomas. Ulcers often form, covered with a grayish-white coating.

3. Treatment

The purpose of treatment is to eliminate the inflammatory process in the larynx, restore a sonorous voice, and prevent the degeneration of the inflammatory process into a malignant formation.

Indications for hospitalization. Patients who are scheduled for surgical treatment are hospitalized.

3.1. Conservative treatment

Antibacterial therapy is recommended for exacerbation of HL, and it is prescribed empirically using broad-spectrum drugs (amoxicillin + clavulanic acid, respiratory fluoroquinolones, macrolides).

Comments: in case of severe inflammatory phenomena with the addition of purulent exudation. Perioperative antibiotic therapy is prescribed for surgical intervention with direct microlaryngoscopy, implantation methods of surgical correction, and a large volume of surgical intervention. When diagnosing a fungal infection, antimycotic drugs are prescribed. The use of specific therapy in the diagnosis of specific laryngitis does not exclude the use of local and general anti-inflammatory therapy.

Comments: indicated for exacerbation of hyperplastic and edematous-polypous laryngitis, when indicating a history of allergies and in some cases of laryngomycosis. The use of antihistamines should be avoided for catarrhal and subatrophic forms of laryngitis, as these drugs cause dryness of the laryngeal mucosa.

Decongestant therapy with systemic corticosteroids is recommended, which is indicated for patients after surgical interventions, if decortication of the vocal folds has not been performed, as well as for stenosis of the upper respiratory tract caused by exacerbation of a chronic inflammatory process, and cannot be used as monotherapy.

Comments: locally – in the form of inhalations. Local and systemic mucolytics can be prescribed simultaneously. The indication for the use of mucolytics is the visualization of sputum and crusts in various parts of the larynx. It is possible to use long courses (up to 14 days) of preparations of plant origin or containing essential oils in the presence of dry crusts, including in patients with laryngomycosis. When choosing a mucolytic, it should be remembered that one of the etiological factors of HL is the pathology of the gastrointestinal tract, and therefore preference should be given to drugs that do not have side effects that affect gastric function.

A good clinical effect in patients with hyperplastic and edematous-polyposis laryngitis is achieved by using complex enzyme preparations for at least 14 days. These drugs are able to reduce inflammatory infiltration, local swelling, and affect cellular and humoral immunity.

Comments: For inhalation, antibacterial drugs, mucolytic, hormonal agents, herbal preparations with anti-inflammatory and antiseptic effects, as well as mineral water are used. The choice of drug for inhalation depends on the form of inflammation: if edema predominates, inhalation with corticosteroids; in case of severe inflammation - inhalation with antiseptics and antimycotic drugs. Inhalation of antibiotics is not currently carried out. Exceptions are the drug Thiamphenicol glycinate acetylcysteinate, which contains an antibiotic and mucolytic and an antimicrobial drug hydroxymethylquinoxaline dioxide. It is better to start the inhalation procedure with inhalation of mucolytic drugs and only after that, after 20 minutes, prescribe aerosols of other drugs. After inhalation of a corticosteroid and/or antiseptic, 20 minutes later you can inhale mineral water to moisturize the mucous membrane. Such inhalation procedures are carried out 1-2 times a day. The course of treatment is no more than 10 days.

Comments: in order to create conditions for physiological phonation and moisturizing the mucous membrane, inhalations with mineral water can be prescribed for long periods, for example, 1 month.

It is recommended to use physiotherapeutic methods of treatment: electrophoresis of 1% potassium iodide, hyaluronidase or calcium chloride on the larynx, therapeutic laser, microwaves; phonophoresis, including endolaryngeal.

Comments: For the treatment of patients with chronic edematous polyposis laryngitis, especially in the initial stages of the disease, injections of corticosteroid drugs into the vocal folds are also used. This procedure is performed with indirect, less often with direct microlaryngoscopy.

3.2 Surgical treatment

Comments: When performing a biopsy, it is necessary to take a sufficient amount of material for examination. The main errors in diagnosing laryngeal cancer are associated with an incorrectly selected area for biopsy and insufficient material for research. Despite the fact that the main purpose of surgical intervention is to verify the diagnosis and remove areas of hyperplastic mucous membrane, you should be gentle with the mucous membrane of the vocal folds, avoiding, if possible, additional deterioration of vocal function. It is better to plan surgical intervention after anti-inflammatory therapy, so that the location for the biopsy can be more accurately determined. The purpose of surgical intervention for COPD is to improve voice function and prevent complications - laryngeal stenosis. Histological examination of the removed mucous membrane is mandatory. For COPD, two surgical techniques are mainly used: vocal fold decortication according to Kleinsasser and the Hirano technique. When decorticating the vocal folds, they try to preserve the epithelium in the commissure area on both sides, in order to avoid subsequent fusion and the formation of a scar membrane or adhesions. The essence of M. Hirano's technique is that an incision is made along the lateral edge of the vocal folds, the gelatinous mass is aspirated, excess epithelial tissue is excised with scissors, and the remaining is placed on the vocal fold. Laser techniques are also used. In the initial stages of the disease, a small area of ​​the changed mucous membrane can be removed. A complication of surgical intervention may be severe scarring of the vocal folds and the formation of a scar membrane.

3.3 Other treatment

Laryngitis is a clinical syndrome of damage to the larynx, caused by inflammatory changes in the mucous membrane due to the development of an infection of viral or bacterial etiology or other causes, manifesting itself in an acute or chronic form. Development is promoted by hypothermia, breathing through the mouth, dusty air, overstrain of the larynx, smoking and drinking alcohol.

The course of the disease depends on a number of conditions (age, body resistance, adequacy of therapy, etc.). How to treat laryngitis, what are the symptoms and first signs in adults, as well as the main methods of prevention - we will talk in more detail in this article.

What is laryngitis?

Laryngitis is a disease of the respiratory system that affects the mucous membrane of the larynx. In adults, the disease is accompanied by a change in voice, up to its complete loss, coughing, and breathing problems. It can occur independently or be a continuation of inflammation of the mucous membranes of the pharynx, nasopharynx or nasal cavity in cases of acute respiratory diseases.

The fact is that when we talk, our vocal cords begin to vibrate, which is why sound appears. But with this disease, the vocal cords swell and completely lose this unique property. At the same time, the airways also narrow, it becomes a little difficult to breathe; another characteristic of the disease may be the so-called barking cough.

It is important to realize in time that silence is golden in the literal sense of the word. It’s better to talk in a whisper for a few days than to suffer for many weeks later.

Types of disease

There are two forms of laryngitis: acute, which lasts only a few days, and chronic, which lasts for weeks or months.

Acute laryngitis

Acute laryngitis relatively rarely develops as an independent disease. Usually it is a symptom of ARVI (influenza, adenoviral infection, parainfluenza), in which the mucous membrane of the nose and pharynx, and sometimes the lower respiratory tract (bronchi, lungs) is also involved in the inflammatory process. Acute laryngitis can result from excessive strain on the vocal cords, such as shouting, greeting, singing, or giving speeches.

Chronic laryngitis in adults

The chronic form follows from an acute manifestation in the absence of treatment or becomes the result of infection from chronic sources of the pathogen (inflammatory diseases in the nasopharynx). It is often diagnosed in smokers, since tobacco smoke negatively affects the condition of the epithelial layer and leads to its depletion, as a result of which the mucous membrane becomes susceptible to the effects of negative factors.

The outcome of chronic laryngitis in adults depends on its form. With hypertrophic and atrophic chronic laryngitis, complete recovery does not occur. Prevention is aimed at eliminating causative factors.

Sometimes, due to the similarity of the clinical picture, this pathology is confused with, however, how to treat laryngitis in an adult and what to do with pharyngitis are very different. Therefore, you should not take any medications until your doctor makes an accurate diagnosis.

Also distinguished:

• Catarrhal laryngitis– the patient has a sore throat, hoarseness, a feeling of rawness in the throat, an intermittent cough, dry and poorly expressed. The course is favorable and easy. Characteristic symptoms of laryngitis in adults: most often patients complain of dysphonia, hoarseness, soreness, rawness and dryness in the throat at normal or subfebrile temperature. Sometimes a dry cough occurs, which is subsequently accompanied by expectoration of sputum.
• Atrophic type of laryngitis characterized by a decrease in the thickness of the mucous membrane. Given this feature, coughs often include discharge with traces of blood. Characteristic sign- the formation of yellow-green or dirty brown crusts on the mucous membrane is a distinctive feature.
• Allergic laryngitis occurs in a patient with an allergic reaction (allergic rhinitis, pharyngitis and others).
• Hypertrophic laryngitis, unlike atrophic laryngitis, is characterized by thickening of the laryngeal mucosa. Excessively thickened areas of the larynx, in the form of whitish or transparent elevations, can become so large that they interfere with the closure of the vocal cords.
• In case of diphtheria form the development of the disease occurs due to the spread of infection into the larynx from the tonsils. The mucous membrane becomes covered with a white membrane, which can detach and cause blockage of the airways at the level of the vocal cords. A similar membrane can also form during streptococcal infection.

Causes of occurrence in adults

The causative agents of laryngitis are divided into two groups:

• viruses (influenza virus, parainfluenza, and others);
• bacteria (the causative agent of scarlet fever, diphtheria, whooping cough, streptococci, staphylococci, mycobacteria, treponema and others).

The main causes of laryngitis:

• General and local hypothermia, eating irritating food (usually very cold), cold drinking, mouth breathing, excessive vocal stress (long, loud conversation, singing, screaming) - all this leads to disruption of local defense systems, damage to the cellular structures of the mucous membrane and the development of inflammatory process. In the future, infection may occur.
• Contacts with patients with whooping cough, influenza or other acute respiratory viral infections. The incubation period for laryngitis of infectious origin can range from several hours to several days, depending on the pathogen.
• Spread of infections from the paranasal sinuses, oral cavity and other nearby areas.
• Inhalation of various irritants - air contaminated with dust, soot, chemicals.
• Constant or one-time strong tension of the vocal cords - prolonged loud conversation, as well as screaming, especially in the case of unfavorable conditions indicated in the previous paragraph.
• Damage to the surface of the mucous membrane of the larynx - surgical intervention, mechanical (fish bone, attempt to swallow poorly chewed food, crackers).
• Alcohol abuse, smoking.
• Laryngitis can develop if gastric contents enter the larynx (). This condition can develop in case of weakness of the esophageal sphincters, which normally prevent gastric contents from entering the esophagus, pharynx, and larynx.

Symptoms of laryngitis

Signs of inflammation of the larynx in adults can be suspected independently. The following symptoms may indicate the development of laryngitis:

• The appearance of a dry cough;
• Hoarseness of voice;
• Sore and sore throat;
• Severe pain when swallowing;
• General malaise;
• Increase in body temperature;
• Increased amount in the blood.

Laryngitis in adults usually lasts from several days to 2 weeks. Usually, after 2-3 days, body temperature normalizes and overall health improves. Then the voice is restored and gradually the dry cough turns into a wet one and stops.

Throat in the photo with laryngitis

In the first seven to ten days, the disease has an acute course. If the inflammatory process lasts longer, then doctors diagnose chronic laryngitis.

	Symptoms and signs in adults
Acute laryngitis	First, a person’s general health deteriorates, headache and weakness appear. Performance drops sharply, constant drowsiness occurs. At the same time, the temperature may rise, but this does not always happen, and the thermometer rarely rises above subfebrile levels. Typically, the temperature during laryngitis ranges from 37.0° to 37.5°. there is a sore throat that gets worse when swallowing, coughing and trying to talk; dry cough in the form of attacks with scanty sputum; runny nose and nasal congestion.
Chronic laryngitis	Characteristic, frequently recurring symptoms of the chronic form: hoarse voice; severe sore throat; cough; swelling and hyperemia of the mucous membrane.

Complications

The most common complication of laryngitis is tonsillitis. Often in the acute phase there is a danger of developing laryngeal edema and the occurrence of false croup. In this condition, the person begins to choke, the skin turns pale, and the nasolabial triangle appears blue. If a person in this condition is not given immediate assistance, he may die.

Chronic laryngitis can also lead to complications such as:

• benign tumor formation in the larynx;
• proliferation of polyps, formation of cysts or granulomas;
• development of laryngeal cancer;
• laryngeal stenosis;
• impaired mobility of the larynx.

Diagnostics

Determination of symptoms and treatment of laryngitis in adults should be under the supervision of a physician.

During the diagnostic process, the doctor initially examines the medical history, conducts a physical examination and interviews the patient about the nature of the onset and development of the disease. A thorough examination of the sound of the voice, as well as the vocal cords, helps to select the right approach to treating the disease.

In addition to a general medical examination, the doctor may also use additional research methods, especially in case of chronic laryngitis or protracted acute laryngitis:

• laryngoscopy;
• blood test;
• fluorography of a difficult cell;
• bacteriological examination of swabs, smears from the larynx, etc.

A person who does not have a medical education can diagnose laryngitis on his own, but the likelihood of an error is very high. Although the pathology has characteristic symptoms, in some cases it can take a “blurred” course. Some signs may be completely absent.

You should contact an otolaryngologist if:

• Your symptoms do not improve within 2 weeks;
• You have sudden severe pain (especially radiating to the ear), difficulty swallowing, or coughing up blood;
• Suspect another disease;
• There is a suspicion that laryngitis may become chronic.

Treatment of laryngitis in adults

How to quickly cure laryngitis in adults at home? Treatment of laryngitis involves following a gentle regimen (the patient requires rest) and eliminating factors that can increase inflammation (quitting smoking, spicy, cold and hot foods).

General treatment plan:

• elimination of possible causes - reducing stress on the larynx and vocal cords (silence);
• exclusion of foods that irritate the mucous membrane - carbonated drinks, salty, spicy foods;
• complete cessation of smoking, drinking alcoholic beverages, including beer and alcoholic cocktails;
• plenty of warm drinks - teas, infusions, decoctions, milk, jelly, juices.

If laryngitis has developed, treatment in adults can be carried out by prescribing the following drugs for local and systemic therapy:

• external medications for basic treatment: aerosols - Camphomen, Ingalipt, Tera-Flu; lozenges and absorbable tablets - Isla, Strepsils, Neo-Angin;
• providing expectoration: Mucaltin, Prospan, Gedelix, Eucabal, Gerbion;
• medications that can alleviate cough: Cofex, Sinekod;
• antiallergic drugs (antihistamines): Zodak, Suprastin;
• antibacterial antibiotic: Bioparox spray;
• targeted antibiotics: Ampicillin, Amoxicillin, Oxacillin and cephalosporins;
• antiviral drugs: Fusafungin, Fenspiride;
• improving immune defense and strengthening the body - compositions based on radiola, aralia, pantocrine, eleutherococcus.

Antibacterial drugs (antibiotics) are prescribed for laryngitis only if the bacterial nature of the pathology is confirmed. To do this, bacterial culture is performed and the causative agent of the infection is identified. If this is not done, treatment may be ineffective due to the lack of sensitivity of some strains of bacteria to certain types of antibiotics.

The use of physiotherapeutic methods of treatment gives good results. The following procedures may be prescribed to adult patients:

• electrophoresis with novocaine;
• microwave therapy;

How to treat acute laryngitis?

In adults, treatment of acute laryngitis should primarily be aimed at eliminating the problem that provoked the disease.

• Local antibacterial drugs are used in the form of lozenges, aerosols, sprays, such as Strepsils, Hexoral, Tantum Verde, etc.
• For severe sore throat, NSAIDs are prescribed - non-steroidal anti-inflammatory drugs: Nimesil, Nise, Nurofen. They effectively eliminate all symptoms associated with inflammation - pain, voice disturbance, etc.
• To stimulate the activity of metabolic processes and increase the activity of the immune system, adaptogens are prescribed (tinctures of Eleutherococcus, pantocrine, ginseng, rosea radiola).
• An excellent remedy for laryngitis is lubricating the throat with Lugol's solution. This remedy helps protect the mucous membrane of the larynx from the effects of pathogenic flora. On the 3-4th day of illness, you can replace the lubrication with Lugol's solution with sea buckthorn oil. This substance promotes rapid restoration of the mucous membrane.

To ensure complete rest of the larynx, a person It is not recommended to talk for about a week. If this is not possible, you need to speak as quietly and softly as possible.

Until the mucous membrane of the larynx is restored, the doctor must prescribe a strict diet, during which only gentle food should be consumed. However, it should not be too cold or hot.

An exact list of medications and recommendations for their use, as well as the advisability of inhalations, is given to the patient by the attending physician. Subject to compliance with the prescribed therapy, the patient returns to a normal state within 10 days.

How to treat chronic laryngitis in adults?

It is almost impossible to completely get rid of the chronic form of laryngitis, but it is possible to achieve remission and reduce its manifestations to a minimum. It is worth noting that with a particularly pronounced inflammatory process and the development of complications, hospital treatment may be required. When treating exacerbations of chronic laryngitis, special attention should be paid to the treatment of chronic infections that contribute to this exacerbation.

Its course for too long can disrupt vocal function and completely change the patient’s voice. And people suffering from chronic laryngitis are at risk for laryngeal cancer. Therefore, this disease must be treated comprehensively and until complete recovery.

For adults, laryngitis therapy will consist of the following procedures:

• Taking medications and vitamins;
• Alkaline and antibiotic inhalations;
• Physiotherapy;
• Traditional medicine methods.

Non-drug methods are of great importance in the treatment of chronic inflammation of the larynx:

• quitting smoking;
• voice rest;
• gentle nutrition (warm, soft, neutral-tasting food, exclusion of spicy, hot and cold foods, carbonated drinks);
• drink plenty of fluids (alkaline mineral waters (Naftusya, Borjomi), warm milk with honey);
• prevention of hypothermia;
• ventilate the room in which the patient lives for 10 minutes every hour;
• adequate microclimate (temperature and humidity) in the room.

Inhalations

Inhalation is effective for laryngitis. It is better if it is an ultrasonic inhaler, and the patient will breathe with an infusion of medicinal herbs, such as chamomile.

Inhalation therapy can be using steam inhalations with herbs (chamomile, oregano, sage and others), potato steam, alkaline inhalations. This can be inhalation using a nebulizer (with mineral water or medications prescribed by a doctor). Inhalations are carried out from 3 to 7 times a day.

But know that steam inhalations cannot be carried out in the following cases:

• at elevated temperatures,
• with purulent processes in the nasopharynx,
• intolerance to drugs used for inhalation,
• adults with exacerbation of bronchial asthma and other breathing disorders,
• tendency to nosebleeds,

Nutrition

Proper therapy means an integrated approach to treating the disease; drug treatment cannot be used exclusively. It is important to follow a certain diet. For laryngitis, adults are strictly prohibited from consuming:

• all alcoholic drinks;
• sparkling water;
• seeds, nuts;
• garlic, pepper, mustard, onion, horseradish;
• seasonings, spices, herbs.

Food should be liquid or pureed, not too hot and not cold. It is advisable to exclude fried and fatty foods, and steam meat and fish.

Vegetable oils, which can be dropped a few drops into the nose or lubricated with them in the throat, will help in the fight against inflammation and irritation of the larynx. Fresh fruits, vegetables, and juices will be of great benefit in the treatment of laryngitis, but they should be eaten in pureed form.

Drinking for laryngitis should be warm (not hot) and quite plentiful. All products should be taken in small sips. Borjomi, milk and sage will help cope with the disease.

Folk remedies

Before using folk remedies for laryngitis, it is recommended to consult with your doctor.

1. At the first manifestations of laryngitis, it is advisable to drink more warm drinks. Tea should be decaffeinated, as caffeine has a dehydrating effect.
2. Two teaspoons calamus pour a glass of boiling water, leave for 5 hours, use for gargling. 3 teaspoons of chopped onion peels are poured into 0.5 liters of water, let boil and leave for 4 hours, filter and use for gargling.
3. Ideal for treating laryngitis at home gargling with blueberry decoctions, beet juice and homemade apple cider vinegar solution. In case of false croup, the child is recommended to take hot foot baths (the duration of the procedure is 3-5 minutes).
4. Gogol-mogol. To prepare, beat two yolks with a tablespoon of sugar, then add a tablespoon of melted butter and mix thoroughly. It is believed that using this remedy for 4-5 days twice a day helps restore your voice.
5. For laryngitis, adults are recommended to use the following recipe: boil 3 finely chopped carrots in 1 liter of milk until tender; the broth can be rinsed and taken orally.
6. Add egg white to 100 ml of vegetable oil and mix thoroughly. Drink in small sips throughout the day.
7. Vitamin teas from linden, rowan, black elderberry which you can drink twice a day. Frozen viburnum is irreplaceable, which is also added to tea or eaten in its pure form.
8. Another good folk remedy - tea with ginger and honey- the root is grated on a fine grater and added to tea, about 2 teaspoons of freshly grated ginger per 200 ml of boiling water, we eat honey, but only as a taste, do not add it to boiling water.

During treatment, and especially at home, It's important to listen to your body! If you feel significant discomfort and worsening laryngitis symptoms, it is better not to tempt fate and change the treatment method to a more proven one.

Prevention of laryngitis

Prevention of laryngitis in adults involves preventing factors leading to the development of the disease.

• Remember that even some drugs can cause drying of the mucous membrane, so read the instructions before drinking.
• Timely treatment of colds and chronic bacterial outbreaks.
• If an acute respiratory infection or acute respiratory viral infection occurs, adherence to the regime (home regimen, warm plenty of fluids, sparing your voice - speak quietly or whisper, do not be nervous, do not walk, avoid physical activity).
• Fighting bad habits (smoking, alcohol).
• You should also not forget about simple things, such as wet cleaning of premises: dust is the primary thing that can irritate absolutely any mucous membrane.
• Sports activities.

Laryngitis is not a serious disease, but advanced cases sometimes require surgical intervention. To prevent this, it must be treated promptly and completely. To do this, we recommend that you contact an otolaryngologist at the first sign.

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Banal chronic laryngitis is a superficial diffuse nonspecific inflammation of the mucous membrane of the larynx with a long course and periodic exacerbations in the form of catarrhal inflammation. In most cases, banal chronic laryngitis is combined with chronic inflammatory processes in the upper respiratory tract, covering both the nasopharyngeal spaces, the trachea and the bronchi.

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ICD-10 code

J37.0 Chronic laryngitis

Causes of chronic laryngitis

The causes and pathogenesis of banal chronic laryngitis are based on three factors:

1. individual predisposition to chronic inflammatory diseases of the upper respiratory tract, including individual anatomical features of the structure of the larynx;
2. risk factors (professional, household - smoking, alcoholism);
3. activation of opportunistic (vulgar) microbiota.

Banal chronic laryngitis is more common in adult men, who are more often exposed to occupational and household hazards. In childhood, banal chronic laryngitis occurs mainly after 4 years, especially with frequently recurring adenoamygdalitis.

Banal polymorphic microbiota indicates nonspecific inflammation in banal chronic laryngitis. Childhood infections (measles, whooping cough, diphtheria, as well as repeated sore throats and influenza infections) cause damage to the epithelium and lymphoid tissue of the larynx, which helps to reduce local immunity and activate the saprophytic microbiota and increase the pathogenic influence of exogenous risk factors. An important role in the pathogenesis of banal chronic laryngitis is played by descending infection in chronic rhinosinusitis, adenoiditis, tonsillitis, periodontitis, dental caries, which are foci of pathogenic microbiota, often causing chronic inflammatory processes in the larynx. The same role can be played by ascending infection in chronic tracheobronchitis, pulmonary tuberculosis, purulent diseases of the bronchopulmonary system (bronchiectasis), asthma, which, along with infection of the larynx with sputum and pus, cause irritation of its mucous membrane with prolonged bouts of coughing.

An important role in the occurrence of banal chronic laryngitis is played by impaired nasal breathing (rhinitis, polyps, deviated nasal septum), in which the patient is forced to constantly breathe through the mouth, which adversely affects the condition of the mucous membrane of the larynx (there is no hydration, warming or disinfection of the air). Particularly harmful effects on the condition of the larynx are impaired nasal breathing, unfavorable external climatic conditions (cold, heat, dryness, humidity, dust) and microclimatic conditions of human habitation and work.

The load on the larynx in people whose profession is related to vocal function or work in noisy production is often the main risk factor for the development of banal chronic laryngitis.

Endogenous factors play an important role in the occurrence of banal chronic laryngitis, causing a decrease in local immunity and trophism of the larynx, which, along with the own pathogenetic effect of these factors on the larynx, potentiates the harmful influence of external risk factors, transforming them into active causes of banal chronic laryngitis. Such endogenous factors may include chronic diseases of the digestive system, liver, cardiovascular and excretory systems, allergies, which often lead to circulatory, and therefore immune and trophic disorders of the mucous membrane of the upper respiratory tract. An important role in the occurrence of banal chronic laryngitis is played by endocrine disorders, in particular dysfunction of the thyroid and insular apparatus of the pancreas. Similar influences can be played by ischemic conditions due to various reasons, vitamin deficiency, a number of common chronic infections (syphilis) and some specific diseases of the upper respiratory tract (ozena, scleroma, lupus, etc.).

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Chronic catarrhal laryngitis

In chronic catarrhal laryngitis, hyperemia of the mucous membrane is noted, which is more stagnant in nature than inflammatory-paretic, characteristic of acute diffuse catarrhal laryngitis. Thickening of the mucous membrane occurs due to round cell infiltration, rather than serous infiltration. The squamous epithelium on the vocal folds is thickened; on the posterior wall of the pharynx, the ciliated epithelium is replaced by stratified squamous epithelium by metaplasia; The glands of the vestibular folds are enlarged and secrete more secretions. There is especially a lot of sputum in cases of similar damage to the trachea, which often manifests itself as a strong, sometimes convulsive cough, increasing irritation and inflammation of the vocal folds. The blood vessels of the submucosal layer are dilated, their walls are thinned, which is why pinpoint submucosal hemorrhages occur with a strong cough. Around the vessels there are foci of plasmacytic and round cell infiltration.

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Chronic hypertrophic laryngitis

In chronic hypertrophic laryngitis, the epithelium and connective tissue of the submucosal layer hyperplasia; Infiltration of the internal muscles of the larynx also occurs, most often the muscle fibers that form the basis of the true vocal folds; proliferation of cells of the mucous glands and follicles of the ventricles of the larynx occurs.

Hyperplasia is understood as an excessive increase in the number of structural elements of tissues through their excessive new formation. Hyperplasia, which underlies hypertrophy, manifests itself in cell proliferation and the formation of new tissue structures. With rapidly occurring hyperplastic processes, a decrease in the volume of the multiplying cellular elements themselves is often observed. As noted by A. Strukov (1958), hyperplastic processes in the narrow sense are understood only as those associated with hypertrophy of tissues or organs, when it comes to the functional identity of newly formed and previous (“uterine”) tissues. However, in pathology, any proliferation of cells is often referred to as “hyperplasia.” The term proliferation is also used for cell reproduction in a broad sense. As a universal morphogenetic process, hyperplasia underlies all processes of pathological tissue formation (chronic inflammation, regeneration, tumors, etc.). In structurally complex organs, such as the larynx, the hyperplastic process can affect not only any one homogeneous tissue, but also all other tissue elements that form the morphological basis of the organ as a whole. Strictly speaking, this is the case with chronic hyperplastic laryngitis, when not only the epithelial cells of the ciliated epithelium, but also flat multilayered epithelium, cellular elements of the mucous glands, connective tissue, etc., undergo proliferation. Hence such a variety of forms of chronic hypertrophic laryngitis - from “singing nodules » to prolapse of the mucous membrane of the ventricles of the larynx and retention cysts.

The thickening of the vocal folds in chronic hypertrophic laryngitis is continuous, uniform along the entire length, then they acquire a fusiform shape with a rounded free edge, or limited, in the form of individual nodules, tubercles or slightly larger dense whitish formations (laryngitis chronica nodosa). Thus, more massive thickenings, formed by proliferation of squamous epithelium, sometimes form in the area of ​​the vocal fold at the vocal process of the arytenoid cartilage, where they have the appearance of a mushroom-shaped elevation on one side with a “kissing” depression on the opposite vocal fold or symmetrically located contact ulcers. Much more often, pachydermia occurs on the posterior wall of the larynx and in the interarytenoid space, where they acquire a lumpy grayish surface - pachydermia diffusa. In the same place, hyperplasia of the mucous membrane in the form of a pillow with a smooth red surface (laryngitis chronica posterior hyperplastica) can be observed. A hyperplastic process can develop in the ventricles of the larynx and lead to the formation of folds or ridges of the mucous membrane that extend beyond the ventricles and cover the vocal folds. Hyperplasia can also develop in the subglottic space, forming ridges parallel to the vocal folds (laryngitis chronica subglotica hyperplastica). In people whose professions involve vocal strain (singers, teachers, actors), often symmetrically located cone-shaped nodules appear on the vocal folds, approximately in the middle, the basis of which is thickened epithelium and elastic tissue - the so-called singing nodules.

In chronic atrophic laryngitis, which occurs less frequently than chronic hypertrophic laryngitis, metaplasia of the columnar ciliated epithelium into keratinizing squamous epithelium is observed; capillaries, mucous glands and intralaryngeal muscles atrophy, and the interstitial connective tissue undergoes sclerosis, due to which the vocal folds become thinner, and the secretion of the mucous glands quickly dries out and covers them with dry crusts.

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Chronic atrophic laryngitis

Chronic atrophic laryngitis is much less common; more often it occurs in the form of a subatrophic process in the mucous membrane of the larynx, combined with systemic subatrophy of the mucous membrane of the upper respiratory tract.

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Causes of chronic atrophic laryngitis

Atrophy is understood as a pathological process characterized by a decrease in volume and size, as well as qualitative changes in cells, tissues and organs expressed to varying degrees, usually occurring during various diseases or as their consequence, differing in this from hypoplasia and hypogenesis (pathological atrophy). In contrast to the latter, a distinction is made between physiological (age-related) atrophy, which is caused by the natural aging of tissues, organs and the body as a whole and their hypofunction. An important role in the occurrence of physiological atrophy is played by the withering of the endocrine system, which is largely reflected in such hormone-dependent organs as the larynx, organs of hearing and vision. Pathological atrophy differs from physiological atrophy both in the reasons for its occurrence and in some qualitative features, for example, faster fading of the specific function of an organ or tissue during pathological atrophy. The basis of any type of atrophy is the predominance of dissimilation processes over assimilation processes. Depending on the reasons causing atrophy, there are:

1. tropho-neurotic atrophy;
2. functional atrophy;
3. hormonal atrophy;
4. nutritional atrophy;
5. professional atrophy resulting from the harmful effects of physical, chemical and mechanical factors.

In otorhinolaryngology, there are quite a lot of examples of the latter (occupational anosmia, hearing loss, atrophic rhinitis, pharyngitis and laryngitis, and many others). To the forms of atrophy listed above should be added atrophy caused by the consequences of acute or chronic infection, both banal and specific. However, this type of atrophy is also accompanied by pathological changes in tissues and organs, characterized by complete destruction or replacement of specific tissues by fibrous tissue. As for chronic atrophic laryngitis specifically, all of the above types of causes can take part in its pathogenesis to one degree or another, causing atrophy not only of the epithelium of the mucous membrane, but also of all its other elements (trophic and sensory nerve endings, blood and lymphatic vessels, connective tissue layer, etc.). On this basis, chronic atrophic laryngitis should be recognized as a systemic disease that requires an analytical approach for its study, as well as for the development of etiotropic and pathogenetic treatment.

Symptoms of atrophic laryngitis

With a pronounced clinical and pathological form, there is significant dryness of the mucous membrane, acquiring a reddish-gray tint, the vocal folds are hyperemic, covered with dry crusts of yellow or greenish-dirty color, tightly fused to the underlying surface. After rejection, minor hemorrhages and damage to the epithelial cover remain in their place. In general, the laryngeal cavity appears expanded, with a thinned mucous membrane, through which small convoluted blood vessels are visible. A similar picture is observed in the mucous membrane of the pharynx. Such patients constantly cough and attempt to remove crusts from the larynx using characteristic vocal sounds; their voice is constantly hoarse and gets tired quickly. In dry rooms these phenomena intensify and, on the contrary, in a humid environment they weaken.

Diagnosis of atrophic laryngitis

The diagnosis is established on the basis of anamnesis (long-term course, the presence of addictions and corresponding occupational hazards, chronic foci of infection in the neighborhood and at a distance, etc.), patient complaints, and a characteristic endoscopic picture. The variety of morphological disorders of just banal chronic inflammatory processes in the larynx, not counting those that occur during infectious and specific diseases, makes the diagnosis of chronic laryngitis a very responsible process, since many of the diseases noted above are regarded as precancerous, the degeneration of which into malignant neoplasms, including even sarcoma are not such a rare phenomenon, which was especially clearly demonstrated by official statistics at the end of the 20th century. When determining the nature of a particular chronic disease of the larynx, it should be borne in mind that almost always chronic hypertrophic laryngitis accompanies one or another malignant process or specific disease of the larynx and often masks the latter until both the first and the second reach their destructive forms. Therefore, in all cases of dysphonia and the presence of “plus tissue,” such a patient should be referred for a consultation to an ENT oncologist, where he will undergo a special examination, including a biopsy.

In doubtful cases, especially with hyperplastic chronic laryngitis, an X-ray examination of the patient is mandatory. Thus, in chronic hypertrophic laryngitis, the use of frontal tomography of the larynx makes it possible to visualize the following changes: 1) thickening of the vocal or vestibular folds; thickening of the ventricular fold; 2) its prolapse, as well as other changes without detecting defects in the internal walls and anatomical formations of the larynx.

An important differential diagnostic feature that testifies to the benign nature of the process is the symmetry of morphological changes in the larynx, while malignant neoplasms are always one-sided. If chronic hypertrophic laryngitis manifests itself as a unilateral “inflammatory process,” then an X-ray examination of the patient and a biopsy of suspicious “plus tissues” are always necessary. They differentiate banal chronic laryngitis from primary infiltrative tuberculosis of the larynx, tertiary syphilis and benign and malignant tumors, scleroma and papillomatosis of the larynx. In children, chronic hypertrophic laryngitis is differentiated from papillomatosis and unidentified foreign tissue of the larynx. Chronic atrophic laryngitis is differentiated from primary ozena of the larynx. Myogenic dysfunctions of the larynx, which often occur with banal chronic laryngitis, should be differentiated from neurogenic paralysis of the internal muscles of the larynx, which are characterized by specific symptoms.

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Symptoms of chronic laryngitis

Complaints of patients with banal chronic laryngitis do not differ in any significant features and depend solely on the pathoanatomical changes that occur, as well as on the degree of vocal load and the professional need for the voice apparatus. Almost all patients complain of hoarseness, rapid fatigue, sore throat, often dryness and constant cough.

The degree of vocal dysfunction can vary from mild hoarseness, which occurs after a night's sleep and during work, little bothering the patient and only reappearing in the evening, to severe constant hoarseness. Permanent dysphonia occurs in cases where banal chronic laryngitis and other chronic diseases of the larynx are accompanied by organic changes in the vocal folds and other anatomical formations, especially with proliferative keratotic processes. Dysphonia can significantly worsen under unfavorable weather conditions, during endocrine changes in women (menopause, menstruation, pregnancy, during exacerbation of the underlying inflammatory process in the larynx).

For professionals, even minor dysphonia is a factor of mental stress, aggravating the phonatory qualities of the voice function, often radically changing their social status and worsening their quality of life.

Disturbances in the sensitivity of the larynx (stingling, itching, burning, sensation of a foreign body or accumulated mucus or, on the contrary, dryness) force the patient to constantly cough, attempt to remove the “interfering” object by closing the vocal folds and vocal effort, lead to further fatigue of the vocal function, and sometimes to spastic contractures of the vocal muscles. Often these sensations contribute to the development of cancerophobia and other psychoneurotic conditions in patients.

Cough is caused by irritation of the tactile receptors of the larynx, and with copious sputum - by chronic inflammation of the mucous membrane of the trachea and bronchi. Cough is more pronounced in the morning, especially in smokers and workers whose professions are associated with hazardous production (foundry workers, chemists, welders, battery workers, etc.).

Of great importance in establishing the form of banal chronic laryngitis is laryngoscopic examination of the larynx, both with indirect and direct laryngoscopy, including microlaryngoscopy, which makes it possible to examine those parts of the larynx that are not visualized when using a conventional directoscope.

In chronic hypertrophic laryngitis, diffuse hyperemia of the mucous membrane is often observed, which is most pronounced in the area of ​​the vocal folds, while the mucous membrane is covered in places with a viscous mucous secretion. In chronic hypertrophic laryngitis, the vocal folds are diffusely thickened, swollen with uneven edges. In the interarytenoid space, papillary proliferation of the mucous membrane or pachydermia is observed, which is clearly visible with mirror laryngoscopy only in the Killian position. This pachydermia prevents the complete closure of the vocal folds, which is why the phonatory function of the larynx suffers: the voice becomes rough, rattling, and quickly gets tired. In some cases, there is also pronounced hyperplasia of the folds of the vestibule, which, with indirect laryngoscopy, cover the vocal folds, inspection of which in this case is possible only with direct laryngoscopy. During phonation, these hypertrophied folds come into contact with each other and, under the influence of exhaled air, give the voice a characteristic, almost pitchless, rough sound, which is sometimes used by pop singers, for example, the great American singer Loone Armstrong. In rare cases, hyperplasia of the mucous membrane occurs in the subglottic space, which takes the form of two elongated and thickened ridges located on both sides of the larynx, as if duplicating the vocal folds located above them and protruding from behind them, narrowing the lumen of the larynx. Exacerbation of the inflammatory process in this area or the occurrence of superinfection can lead to severe swelling of the subglottic space and threatening suffocation.

Two forms of chronic hypertrophic laryngitis deserve special attention - a contact ulcer and prolapse of the laryngeal ventricle (a paired formation located on the lateral wall of the larynx between the vestibule fold and the vocal fold).

Contact ulcer of the larynx

So called by the American authors Ch. Jackson and Lederer, it is nothing more than local symmetrically located pachydermia that forms on the mucous membrane covering the vocal processes of the arytenoid cartilages. Often the rest of the larynx has a normal appearance, although in essence these pachydermas indicate the presence of chronic hypertrophic laryngitis. Contact ulcers owe their origin to excessive vocal efforts in weakened individuals with a poorly developed subepithelial layer (N. Costinescu).

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Prolapse of the ventricle of the larynx

In fact, we are talking about excessive proliferation of the mucous membrane covering one of the ventricles of the larynx, which prolapses into the lumen of the larynx and can partially or completely cover the corresponding vocal fold. This hyperplastic formation is red in color, often has an edematous appearance and can be mistaken for a laryngeal tumor. Often, prolapse of the ventricles of the larynx is combined with a cyst of the ventricular fold, which occurs as a result of proliferation of the epithelium of the mucous gland and blockage of its excretory duct. However, such laryngeal cysts occur rarely; much more often, phoniatrists and general ENT specialists encounter the so-called false cyst of the vocal fold, in which in most cases a defect in the form of a contact ulcer forms symmetrically on the opposite fold. Often, false cysts are visually mistaken for polypous formations of the vocal folds, the distinctive feature of which is a lighter shade, which, in terms of color intensity, occupies an intermediate position between a false cyst and the so-called fusiform edema of the vocal folds. The described space-occupying formations significantly disrupt the function of the vocal folds, preventing their complete closure, which is clearly visualized using the stroboscopy method.

Polypous formations that appear on the vocal folds morphologically belong to the so-called mixed forms, consisting of fibrous and angiomatous tissue. Depending on the relationship between these morphologically different structures, these formations are called fibromas, angiofibromas and angiomas. As noted by D.M. Thomassin (2002), the red or angiomatous type of polyp can be a manifestation of “congenital pathological processes”, and its color depends on the fact that fibrinous exudate envelops the angiomatous elements, giving them a dark red tint.

Mucous retention cysts occur in both adults and children. In appearance, they are “yellowish humps that arise under the mucous membrane and deform the free edge of the vocal fold.” Morphologically, these formations are true cystic cavities located in the stroma of the mucous gland. The cyst develops as a result of blockage of the excretory duct of the gland under the influence of a chronic proliferative inflammatory process. The cavity of the gland is filled with secretion, and its walls undergo proliferation (multiplication of mucous and intercalary cells, thickening and increase in the size of the cyst wall). Unilateral and bilateral cysts, as well as polyps, prevent complete closure of the vocal folds and disrupt the phonatory function of the larynx.

A number of authors attach great importance in the occurrence of the pathological conditions of the vocal folds described above in chronic hypertrophic laryngitis to the so-called Reinke’s space, which forms part of the vocal fold. The bottom of Reinke's space forms a layer of fascia covering the vocal muscle, which thickens towards the free edge of the vocal fold and is woven into the vocal cord, which, in turn, in the caudal direction passes into the elastic cone and cricoid ligament, which provides attachment of the vocal fold to the process of the cricoid cartilage . The ceiling of Reinke's space forms a thin layer of squamous epithelium lying on a strong basement membrane covering the fascia of the vocalis muscle. According to special phoniatric, stroboscopic and model studies, it was found that Reinke's space plays an important role in the subtle modulation of the voice, which is an important acoustic mechanism that enriches the timbre of the singing voice and gives it a unique individuality, therefore one of the principles of modern microsurgery of the larynx is to preserve it in optimal condition structures of the Reinke space during surgical interventions for the pathological conditions of the vocal folds described above. One of the pathological manifestations of chronic hypertrophic laryngitis is swelling of the tissues that make up Reinke's space (Reinke's edema), which occurs in the presence of symptoms of chronic laryngitis and strong vocal tension of the phonatory function of the larynx. Occasionally, cyst-like formations form in Reinke's space, which some authors interpret as retention cysts arising from “lost” mucous glands, others as swelling of this space. The dispute is resolved by histological examination of the removed tissue. Often during prolonged mechanical ventilation, the endotracheal tube is the cause of the so-called endotracheal granuloma.

The variety of morphological changes in chronic hypertrophic laryngitis was mentioned above. Here we note several more forms of this disease, the final differences between which can only be established with microlaryngoscopy and histological examination. One of these forms is the so-called contact granuloma, which occurs, like a contact ulcer, with prolonged traumatic contact of the vocal folds, either of professional origin, or as a complication of a long-term inflammatory process.

Another rare special form of chronic hypertrophic laryngitis is pseudomyxoma of the larynx - a tumor, which may be based on ordinary tissue swelling with its transformation into a substance resembling mucus, but not containing mucin, which is a spindle-shaped infiltrate located on the vocal fold. Sometimes pseudomyxoma is bilateral with a developed network of blood vessels. Single papillomas (a benign tumor from the integumentary epithelium, which has a characteristic appearance of papillary growth protruding above the surface of the surrounding unchanged epithelium - exophytic growth; true papillomas can be difficult to distinguish from papillary growths of inflammatory origin, including productive manifestations of syphilis, gonorrhea, tuberculosis) are not uncommon. hyperkeratosis, occurring exclusively in adult men, having the form of a single outgrowth, a gray or whitish tubercle with a dense consistency. All of the above forms of chronic hypertrophic laryngitis need to be differentiated from laryngeal precancer or laryngeal carcinoma.

Types of chronic laryngitis

Inflammatory phenomena in banal chronic laryngitis are less severe and widespread than in acute catarrhal laryngitis. They develop mainly in the area of ​​the vocal folds and in the interarytenoid space. According to the predominant nature of the inflammatory process, chronic catarrhal laryngitis, chronic hypertrophic laryngitis and chronic atrophic laryngitis are distinguished.

Treatment of chronic laryngitis

Treatment of chronic laryngitis consists primarily of eliminating risk factors that contribute to the occurrence of this disease, which include addictions, occupational hazards, and foci of infection in the upper respiratory tract. The diet that patients must follow is essential (excluding hot and cold drinks, spicy foods, fatty and fried foods). The patient's diet should include fruits, vegetables, and easily digestible foods. In case of dysfunction of the gastrointestinal tract, excretory and endocrine systems, such patients should be referred to appropriate specialists.

Special treatment is divided into non-operative and surgical (microsurgical). Persons suffering from chronic catarrhal laryngitis, chronic atrophic laryngitis and some forms of chronic hypertrophic laryngitis are subject to non-operative treatment; surgical treatment is for chronic hypertrophic laryngitis.

Therapeutic treatment of chronic laryngitis

According to many laryngologists, from the point of view of the use of drugs, chronic catarrhal laryngitis and chronic hypertrophic laryngitis are not much different from each other. At the same time, it is important to emphasize two features of the treatment of these forms of the disease: treatment must be strictly individual, taking into account the patient’s sensitivity to the drugs used and the effect obtained; treatment should not activate proliferative processes, since precancerous conditions may be hidden behind the manifestations of chronic hypertrophic laryngitis. When individually selecting treatment measures (inhalations, installations, aerosol irrigations, etc.), it should be borne in mind that both chronic catarrhal laryngitis and chronic hypertrophic laryngitis have a tendency to exacerbations, in which dryness and the formation of viscous, difficult to separate sputum accumulating on the vocal folds, can be replaced by increased secretion of mucus (intensification of the mucous glands) and exudation (the result of activation of the inflammatory process in the mucous membrane). These changes determine the patient’s treatment tactics and the nature of the prescribed medications (emollients, astringents, cauterizers). During exacerbations, you can use the same remedies as for acute catarrhal laryngitis. The remedies used in the mid-20th century have not lost their healing value. Thus, emollients and anti-inflammatory drugs included a 1% oil solution of menthol, chlorobutanol for inhalation, sea buckthorn oil for infusion into the larynx, etc.

As astringents and slightly cauterizing agents, we used a 1-3% solution of collargol, a 0.5% solution of resorcinol for infusion into the larynx 1-1.5 ml once a day, a 0.25% solution of silver nitrate - infusion of 0.5 ml every other day for hypersecretion; solution of tannin with glycerin, 0.5% solution of zinc sulfate (10 ml) in a mixture of ephedrine hydrochloride (0.2) for infusion into the larynx 1 ml, etc. To liquefy viscous sputum and crusts formed in the larynx, a solution of chymotrypsin or trypsin was used ( 0.05-0.1%) for infusion into the larynx 1.5-2 ml.

For nodular formations, along with other medications (infusion of menthol oil solutions into the larynx, lubrication with a 2% silver nitrate solution), injection of various powdery substances into the larynx was used, for example:

• Rp.: Aluminis 1.0
• Amyli Tritici 10.0 MX pulv. subtil.

• Rp.: Tannini
• Amyli tritici aa 5.0 M. G. pulv. subtil.

For electrophoresis in the larynx area, medications such as 2% calcium chloride solution, 0.25% zinc sulfate solution, 1% potassium iodide solution, lidase 0.1 (64 units) for the procedure for “singing nodules”, etc. were used.

Chronic atrophic laryngitis is usually part of a general systemic degenerative process that has developed in the upper respiratory tract, so isolated treatment of only the larynx without taking into account and treating other ENT organs is ineffective. As for the treatment tactics for chronic atrophic laryngitis and the means used, in a certain sense they are the complete opposite of those methods that are used for chronic catarrhal laryngitis and chronic hypertrophic laryngitis. If in the treatment of the latter astringents, cauterizing agents and agents are used that prevent proliferative (hyperplastic) processes and, as a consequence, hypersecretion and hyperkeratosis, then in the treatment of chronic atrophic laryngitis all measures are aimed at stimulating the natural factors of the “life activity” of the laryngeal mucosa.

Medicines for chronic laryngitis

Medicines used for chronic atrophic laryngitis should help thin the viscous mucus containing high concentrations of mucopolysaccharides (mucin), forming viscous aqueous solutions and drying into dense crusts, facilitate the separation of crusts, moisturize the mucous membrane of the larynx and, if possible, stimulate its proliferation " uterine" cellular elements and the function of the se glands. For this purpose, warm moist inhalations with alkaline mineral waters, as well as inhalations of medicines, are used.

The use of the above remedies, which have been used and are partially used at present, is mainly symptomatic in nature and is aimed at the pathogenesis of the disease in an indirect, not always clearly established way. For example, the use of astringents and cauterizing agents in some forms of chronic hypertrophic laryngitis cannot in any way be called pathogenetic, much less etiotropic, treatment, since these drugs are aimed only at reducing the severity of the symptoms of the disease, but not at the primary mechanisms causing the proliferation of cellular elements of the mucous membrane, goblet cells, connective tissue, etc. In this sense, some methods of treatment for chronic atrophic laryngitis are closer to pathogenetic treatment, since they are to one degree or another aimed at stimulating natural reparative processes by activating stimulating effects aimed at the replication of morphological elements of organs and tissues. Activation of these effects in chronic atrophic laryngitis can only be achieved with complex treatment, when the drugs used have a multidirectional effect, the sum of the effects of which, and often their mutual potentiation, approaches the natural harmony of those physiological processes that are involved in ensuring the trophic and morphological homeostasis of the tissue or organ. The effectiveness of such treatment increases many times if it is possible to establish the cause of atrophy and eliminate it, otherwise a kind of dynamic balance is established between reparative and destructive processes, in which “victory” will always be on the side of the latter.

It cannot be said with certainty that modern therapy for so-called banal chronic diseases of the larynx has achieved significant success; one can only say that this direction in acute laryngitis is one of the most urgent, especially in the context of pressing environmental problems facing humanity, and that this direction is fraught with great potential scientific opportunities. However, today it is possible to offer the practitioner a number of modern methods and drugs that, in combination with traditional remedies, can be used in the treatment of so-called banal chronic laryngitis.

The tendency of chronic non-atrophic laryngitis to proliferative processes in some cases determines a certain differentiation of methods in the treatment of some of their forms. Thus, during exacerbation of chronic catarrhal laryngitis caused by activation of saprophytic microbiota (acute respiratory infections, adenoviral infection, general and local hypothermia, etc.), the use of the composite drug Strepsils, which has an antiseptic and local anesthetic effect, is indicated. Usually a spray dispenser is used (1 bottle contains 20 ml of solution). When using a spray for treatment of exacerbation of chronic catarrhal laryngitis, when spraying the drug, it is necessary to direct the dose into the laryngopharynx while inhaling, simulating stridor breathing (contraction of the vocal folds). In this case, most of the dose is deposited on the vocal folds and walls of the larynx.

With frequent exacerbations of chronic catarrhal laryngitis, and in some cases of chronic hypertrophic laryngitis, the use of Broncho-Munal (for children Broncho-Munal BP), containing a lyophilized lysate of bacteria that most often causes respiratory tract infections (Str. pneumoniae, Str. Viridans, Str. Pyogenes, Staph. aureus, Moraxella catarrarhalis, Haemophylus influenzae, Kl. The drug has an immunomodulatory effect: stimulates macrophages, increases the number of circulating T-lymphocytes and IgA, IgG and IgM antibodies (including on the mucous membrane of the respiratory tract), stimulates the body’s natural defense mechanisms against infection of the respiratory system, reduces the frequency and severity of respiratory diseases.

The drug of choice may be Bronchalis-Hel, which has anti-inflammatory, antispasmodic, antitussive and expectorant properties. It is indicated not only for chronic catarrhal laryngitis and its exacerbations, but also for obstructive and inflammatory diseases of the upper respiratory tract (smokers' catarrh, chronic bronchitis, bronchial asthma, etc.); It is also effective for exacerbations of the inflammatory nature of chronic hypertrophic laryngitis.

For chronic laryngitis of any of the three forms, accompanying immunodeficiency states of any origin, manifested in the form of chronic, sluggish and recurrent infectious and inflammatory processes not only in the upper respiratory tract, but also in other localizations, Lykopid is indicated - a semi-synthetic glycopeptide, which is the main structural fragment of the cell wall all known bacteria and has a broad immunomodulatory effect.

In case of chronic atrophic laryngitis and their exacerbations, occurring in the form of acute catarrhal laryngitis, accompanied by the release of viscous, quickly drying sputum with the formation of crusts, it is necessary to prescribe secretolytics and stimulants of motor function of the respiratory tract and mucociliary clearance. Among such drugs, Carbocisteine ​​has proven itself well, having mucolytic and expectorant properties due to the activation of sialic transferase, an enzyme of goblet cells of the mucous membrane of the upper respiratory tract and bronchi. Along with restoring the viscosity and elasticity of the mucus secreted by these cells, the drug promotes the regeneration of the mucous membrane and normalizes its structure. During atrophic processes, it increases the replication of goblet cells, and during their excessive proliferation, it regulates their number. The drug also restores the secretion of immunologically active IgA, which provides specific protection (local immunity) of the mucous membrane, improves mucociliary clearance. It is important to note that the maximum concentration of the drug in the blood serum and in the mucous membrane of the respiratory tract is achieved 2 hours after taking it orally and remains for 8 hours, therefore the drug is indicated for immediate use in all diseases of the ENT organs without exception, especially in acute and banal chronic laryngitis, infectious laryngitis and as a prevention of complications in preparation for direct laryngoscopy and bronchoscopy.

Another effective mucoregulating drug is Flunfort (Carbocysteine ​​lysine salt), produced in the form of syrup or granulate for oral use. The drug normalizes the function of the glands of the respiratory tract: restores the physiological state of sialomucins and fucomucins, normalizes the rheological parameters (viscosity and elasticity) of the secretion of goblet cells and mucous gland cells, regardless of their initial pathological state, accelerates the mucociliary transport function of the ciliated epithelium, facilitates the restoration of damaged ciliated epithelium. Indicated for acute and chronic diseases of the respiratory tract and ENT organs, accompanied by impaired secretion (laryngitis, tracheitis, rhinitis, sinusitis, otitis media, bronchitis, bronchiectasis, etc.).

For severe exacerbations of banal chronic laryngitis and their complications of a pyogenic nature, as well as for their prevention, antibiotics from the groups of cephalosporins (Ceftriaxone, Tercef, Cefuroxime, Supero), macrolides (Azithromycin, Sumazid) and fluoroquinolines (Ofloxacin, Toriferide) are used.

In the pathogenesis of chronic atrophic laryngitis, local secondary nutritional deficiency, hypovitaminosis and tissue hypoxia play a significant negative role. To combat these factors that enhance the underlying pathological process, vitamins C, thiamine, riboflavin, folic, para-aminobenzoic, pantothenic acids, vitamins B1, B6, B12 and PP, glucose, ATP, sodium bromide with caffeine are recommended.

Surgical treatment of chronic laryngitis

Surgical treatment for chronic hypertrophic laryngitis is resorted to in cases where the ineffectiveness of non-operative treatment becomes obvious and it is necessary to eliminate any space-occupying formation that is not subject to non-surgical treatment (cyst, papilloma, fibroma, prolapse of the ventricle of the larynx, etc.) that is interfering with the functions of the larynx. The development of endolaryngeal surgery began after the invention of indirect laryngoscopy in 1854 by M. Garcia, and by the end of the 19th century. Many surgical instruments for endosurgical intervention on the larynx were invented, which were adapted specifically for this method of endoscopy. However, an obstacle to the development of laryngeal endosurgery was the inconvenience associated with the flow of blood and mucus into the trachea during attempts at more radical surgical intervention. The use of suction made the surgeon’s task somewhat easier, but not so much that it was possible to operate in a “dry field.” With the invention of tracheal intubation for endotracheal administration of narcotic gases in 1880 by the Scottish physician W. Macewen, the development of endolaryngeal surgery accelerated. In the 20th century In connection with the development of fiber optics, the method of video endoscopy and the improvement of microsurgical instruments, the method of endolaryngeal microsurgery arose and reached perfection. For this purpose, Professor of the University of Marburg Oskar Kleinsasser, in collaboration with the Karl Storz company, developed and put into practice in most countries original models of laryngoscopes and a wide variety of types of surgical instruments, allowing under high magnification using an operating microscope to carry out the finest surgical operations in almost all types of the above. above hyperplastic processes in the larynx.

The author recommends first of all operating with two hands using two instruments. In most cases, forceps are combined with scissors or a coagulator with suction. Tweezers are intended only for fixing the object being removed and in no case for tearing or biting the fabric. “Stipping,” i.e., tearing off a polyp or tearing off Reinke's edema, is a serious surgical mistake, since it can cause injury to the tissue that needs to be preserved, which can subsequently lead to voice impairment and the formation of unwanted scars. Therefore, smooth cutting of the tissue to be removed using sharp scissors or a special scalpel should be a strictly followed rule.

To comply with the gentle principle, which is basic for endolaryngeal microsurgery, especially on the vocal folds, O. Kleinsasser recommends that novice surgeons have a clear understanding of the subtle anatomical structures of the larynx and study in detail the main pathological changes to differentiate them from healthy tissues that need to be preserved. When intervening on the vocal fold, it is necessary to take into account the fact that the squamous epithelium is not fixed to the underlying substrate only above the body of the vocal fold; in the remaining part it is attached above and below to the arcuate lines, dorsally to the vocal process, and ventrally to the anterior commissure. The structure of Reinke space should also be taken into account; Therefore, defects in the epithelium of the vocal fold, formed after the removal of polyps, nodules and varices, should remain as small as possible so that they are quickly covered with a new epithelial cover, and the Reinke's space is closed again. When removing small pathological formations, such as polyps, nodules and small cysts adhering to the epithelium, they should not be grabbed at the very base, but fixed with tweezers at the very edge of the fold of the mucous membrane, pulled to the middle of the glottis and cut off at their very base.

With Reinke's edema, as noted by O. Kleinsasser, suction of mucus, curettage and resection of remnants of the mucous membrane in most cases do not lead to the desired result. The author warns against the often recommended method of “stripping,” in which a strip of epithelium is simply torn from the vocal fold with tweezers. In this pathological condition, the author recommends that you first make an even cut with scissors around the tissue around the strip of epithelium to be removed, and only after this the removed “preparation” with the viscous edematous fluid attached to it can be “pulled off” entirely, without damaging the underlying tissue. The thick secretion remaining on the vocal fold is removed using suction. In case of large Reinke's edema, in order to avoid excessive impairment of vocal function, it is recommended to perform only partial removal of the pathological tissue during the first operation, and then, with an interval of 5-6 weeks, complete surgical treatment with two more similar surgical interventions.

In case of advanced chronic hypertrophic laryngitis with thickening of the vocal folds, it is advisable to excise narrow strips of the most thickened epithelial layer and inflamed submucosal tissue so that in the future it is possible to remodel the shape of the vocal folds due to the remaining epithelial layer.

For juvenile papillomas, it is advisable to use the method of diathermocoagulation with suction of destroyed papillomatous tissue. This method is the fastest, gentlest and almost bloodless, ensuring satisfactory function of the vocal folds. Destruction is carried out by touching the microcoagulator to the most protruding part of the tissue being removed, while the current is set at a low level so that the tissue does not burn during coagulation, but becomes soft (“boiled”) and white and is easily removed without bleeding using suction. This technique does not allow current to be applied to an unacceptable depth and ensures coagulation of only the layer that needs to be removed. Due to the small return of thermal energy, there is no large postoperative edema.

For precancerous tissue changes and small carcinomas, currently, as a rule, an excisional biopsy is performed, and not only small biopsies are taken: the healthy-looking epithelium of the affected part of the vocal fold is cut and this part is separated within the healthy tissue to its very base and removed en masse . Keratoses, as well as preinvasive and microinvasive carcinomas, are usually removed without technical difficulties and without damaging the submucosal structures of the vocal folds. But when determining whether the tumor has penetrated deep into the vocal muscle, it should also be resected within healthy tissue.

As O. Kleinsasser notes, endolaryngeal chordectomy in the clinic he runs is carried out only when only the superficial muscle layer is affected by the tumor. In case of more significant damage to the vocal fold, the author recommends performing the operation from an external approach, which provides a good overview and immediate restoration of the vocal fold and thereby preserves the fullness of the vocal function.

In the last decade, significant advances have been made in laser microsurgery of the larynx (M.S. Pluzhnikov, W. Steiner, J. Werner, etc.) using a carbon dioxide laser (G. Jako).

Chronic laryngitis is an inflammation of the larynx that lasts more than three weeks. The causative agents of the disease are viruses and bacteria. The disease is treatable, but it should be done in a timely manner with the help of a specialist. Advanced forms can ultimately lead to disability for people whose professions involve the voice-speech apparatus: actors, singers, tour guides, etc. Also, inflamed cells of the larynx can become malignant, which leads to the development of laryngeal cancer.

What is chronic laryngitis? Signs of a chronic process usually appear during exacerbations. The disease is characterized by a long and undulating course. Often chronic laryngitis is combined with chronic processes in the nose, paranasal sinuses, bronchi, and trachea. Treating this form is much more difficult than the acute process.

The real reasons

The following factors play an important role in the development of the disease:

• frequent acute laryngitis;
• chronic foci of infection, for example, pharyngitis, tonsillitis, caries, stomatitis;
• GERD is a disease in which stomach contents back up into the esophagus, burning the lining;
• diabetes mellitus;
• allergy;
• excessive stress on the vocal folds;
• sudden changes in temperature;
• polluted air;
• weakened immune system;
• smoking and alcoholism;
• features of the anatomical structure. For example. In children, there is a narrowness of the lumen of the larynx.

Frequent colds and hypothermia can serve as an impetus for the development of a chronic process in the larynx

In children, the disease most often develops under the influence of such factors:

• nasal polyps;
• deviated nasal septum;
• long stay in an unventilated room with low humidity;
• unfavorable living conditions and climate.

Varieties

Experts distinguish three main types of chronic inflammation of the larynx:

• catarrhal;
• atrophic;
• hypertrophic.

Chronic catarrhal laryngitis

Diffuse thickening of the mucous membrane occurs. There is swelling of the vocal folds and hyperemia. Blood vessels are visualized. The glottis does not close completely. Patients complain of constant hoarseness, sore throat and rapid voice fatigue. A wet cough of moderate intensity with white or clear sputum may also be observed.

The catarrhal form does not cause serious changes in the tissues of the larynx. In most cases, mild clinical symptoms are observed. Patients cough, feel a tickling in the throat, and their voice becomes low and rough in the late afternoon or after a long conversation.

Catarrhal laryngitis is treated with immunomodulators and multivitamins. Sometimes intralarynx infusions of drugs using a special syringe are indicated.

Chronic atrophic laryngitis

With this form, atrophic changes are observed in the mucous membrane of the organ. In children, atrophic laryngitis practically does not occur. According to statistics, this form is most often found in smokers, as well as people who work in hazardous industries. The disease causes serious changes in the tissues of the larynx:

• trophism is disrupted;
• nerve sensitivity worsens;
• the functioning of the circulatory and lymphatic systems is disrupted.

Treatment includes gentle voice treatment

In general, this form is quite rare and usually occurs against the background of atrophic rhinopharyngitis. With atrophic laryngitis, the mucous membrane of the organ becomes dry and thinned, and is also covered with crusts and mucous secretion. Clinically, this manifests itself in the form of constant soreness and a feeling of dryness in the throat, as well as an annoying dry cough streaked with blood. A viscous secretion is released from the pharynx, which, as a result of hardening, forms crusts. Coughing up mucus is almost impossible. Hoarseness usually occurs in the morning and decreases after coughing.

As for the treatment of atrophic laryngitis, first of all it should be aimed at eliminating the cause, for example, smokers should give up cigarettes. It is important to avoid eating irritating foods.

Doctors usually prescribe medications that have expectorant properties and thin mucus. For this purpose, you can use an isotonic solution to which a few drops of iodine are added. The product is used as pharyngeal irrigation and inhalation. In order to accelerate the recovery of atrophied tissues, proteolytic enzymes are prescribed in the form of inhalations.

Typically, patients experience decreased performance, feel constant weakness and become inattentive.

Chronic hypertrophic laryngitis

The hypertrophic form is characterized by an increase in the size of the laryngeal mucosa. Thickening of the vocal folds also occurs. Nodules, tubercles and various kinds of dense formations are found on the surface of the larynx. When these formations come into contact with each other, they can contribute to the appearance of erosions and ulcers. Patients are concerned about hoarseness, irritation and sore throat.

Hypertrophic laryngitis is a precancerous form!

The disease can develop independently, but it can also be a complication of the catarrhal or atrophic form. Cough in some cases can be in the form of small coughs, and sometimes it reaches intense hysterical attacks. In such patients, the temperature rises, weakness, headache, and loss of strength occur.

Treatment of hypertrophic laryngitis is a long process that does not always guarantee complete recovery. The most effective ways to get rid of unpleasant symptoms of the disease are surprisingly non-medicinal means:

• consume food and water warm. Refusal from carbonated drinks, as well as spicy and pickled foods;
• gentle treatment of the vocal folds. Even a whisper strains the ligaments, so it’s better to talk as little as possible;
• drinking sufficient fluids. These can be teas, herbal infusions, milk with honey. The liquid dilutes sputum, facilitating its better removal, and quickly removes toxic substances from the body;
• giving up bad habits: smoking and drinking;
• during the cold season, dress according to the weather and try not to contact sick people;
• regularly ventilate the room and carry out wet cleaning;
• Monitor humidity levels and temperature conditions.

Treatment of hypertrophic laryngitis is carried out under the supervision of a doctor

In the initial stages, the disease can be treated conservatively. Antibiotics, antiseptic sprays, and non-steroidal anti-inflammatory drugs are prescribed. Atrophic and hypertrophic forms of laryngitis are treated surgically, and this is subject to the ineffectiveness of conservative treatment methods. Cysts, fibromas, papillomas - all these formations are subject to mandatory excision.

Symptoms and treatment of chronic laryngitis

The symptoms of chronic laryngitis are directly related to the load the voice-speech apparatus undergoes. Let us highlight the main signs of the disease:

• sore throat;
• periodic cough;
• hoarseness;
• dry throat;
• sputum production;
• rapid voice fatigue.

Usually, smokers and workers in hazardous industries have a coughing attack after waking up. Loss of voice may be worsened by the following:

• menopause;
• pregnancy period;
• critical days;
• against the background of atrophic and catarrhal changes in the larynx.

The clinical picture of chronic laryngitis in children has some peculiarities. In general, the disease most often occurs in children after four years of age. Unlike adults, a chronic process in children rarely occurs as an independent illness. In most cases, it is accompanied by other inflammatory processes: adenoiditis, rhinitis, sinusitis, tonsillitis.

Exacerbation of the disease in children is most often accompanied by high fever

What complications may arise?

Chronic laryngitis in adults can lead to the following complications:

• deterioration of motor activity of the larynx;
• aphonia;
• an attack of suffocation due to a decrease in the lumen of the larynx;
• cysts, polyps, fibromas, angiomas in the larynx;
• contact ulcer;
• laryngeal prolapse;
• formation of precancerous tumors;
• laryngeal carcinoma.

Treatment of chronic laryngitis begins with diagnosis, which includes a number of studies:

• collection of anamnestic data;
• examination of the patient;
• laryngoscopy;
• stroboscopy;
• MRI, CT;
• biopsy is indicated for the hypertrophic form.

Is it possible to prevent the disease?

Let's talk about the main preventive measures:

• timely and adequate treatment of infectious and somatic diseases;
• cessation of active and passive smoking;
• adequate voice mode;
• walks in the fresh air;
• moderate physical activity;
• cold water rubdown and foot baths.

Treatment of chronic laryngitis depends on the form of the disease. Still, there are general principles that will help cure the disease:

• inhalation procedures based on mineral water;
• irrigating the throat with sea water;
• visiting sea resorts;
• use of special air humidifiers;
• minimize exposure to heat;
• use of oropharyngeal protection;
• reducing contact with dust and harmful substances at work.

Buy a humidifier for your room. Dry air negatively affects the condition of the mucous membrane of the respiratory tract, making it vulnerable

How to treat inflammation at home

Let's consider the main treatment measures for chronic laryngitis:

• antibiotic therapy in case of exacerbation;
• alkaline inhalation procedures;
• antitussives for dry cough;
• taking expectorants;
• resorption of lozenges with antiseptic effect.

There are many effective non-traditional techniques that help reduce the manifestations of chronic laryngitis:

• take sage, chamomile, nettle, calamus in equal proportions. Pour half a liter of boiling water over two spoons of the herbal mixture. Let the product brew, then heat it again until steam forms. Inhale the vapors for ten minutes;
• combine calamus, cinquefoil, calendula and chamomile. Prepare everything in a similar way;
• gargle with baking soda or sea salt;
• Combine beet and potato juice. Use the product in small sips of one hundred grams three times a day;
• honey. You can use the product either in its pure form or with lemon. For atrophic laryngitis, to speed up regeneration, combine honey with aloe juice.

Treatment of children is carried out according to a similar scheme, but taking into account dosage adjustments based on age indicators

Features of treatment for children

Exacerbation of the chronic process in children occurs more often and a relapse can be triggered by hypothermia or ARVI. At high temperatures, children are prescribed drugs based on paracetamol, as well as non-steroidal anti-inflammatory drugs. In addition, the course of treatment includes the following medications: mucolytics, antihistamines, immunostimulants. Herbal infusions.
If an exacerbation is accompanied by laryngeal stenosis, it is necessary to urgently call an ambulance and give the child an antihistamine and antispasmodic.

In case of chronic laryngitis, it is forbidden to drink alcohol

What mistakes should not be made?

It is better to learn not from your mistakes, but from the mistakes of others. Let's consider common myths in the treatment of chronic laryngitis. So, what not to do:

• instead of traditional treatment, choose traditional methods;
• skip physical therapy sessions;
• install mustard plasters;
• if you are prone to stenosis, take expectorants;
• spray alcohol-based products down the throat;
• shout or speak in a whisper. By the way, when you whisper, the folds become no less tense;
• hot inhalations during the acute phase;
• eat onions and garlic;
• ignore medical recommendations and self-medicate.

How to restore your voice

Laryngitis is a disease in which inflammation affects not only the larynx, but also the vocal folds. Thickening of the ligaments and impaired mobility are the causes of voice changes. The following tips will help you restore your voice:

• UHF and electrophoresis fight inflammation and, as a result, the voice is restored;
• exercises. Take intermittent inhalations and exhalations for three minutes. You can also take a deep breath in through your nose, then exhale slowly through your mouth;
• Drinking raw eggs helps restore your voice. Eggs must be fresh and homemade;
• Garlic-pine inhalations are another way to restore your voice. One hundred grams of pine needles are added to one tablespoon of garlic. You should breathe for ten minutes over the vapors of the product.

So, chronic laryngitis is treatable, but it is important to adhere to the doctor’s prescriptions. Effective fight against the disease is the elimination of the provoking causes. In order to completely get rid of the disease, you should give up bad habits, follow a proper diet and carry out adequate drug therapy. The disease can lead to serious complications, including laryngeal cancer, so do not leave the problem to chance, consult a doctor and begin treatment after making an accurate diagnosis.