Chronic atrophic laryngitis

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Chronic atrophic laryngitis

Clinical picture

    • Dryness in the throat
    • Hoarseness
    • Rapid fatigue of the voice. Laryngoscopy. The mucous membrane of the larynx is thinned, smooth, shiny, sometimes covered with viscous mucus and crusts. The vocal folds are sluggish, thin, and incompletely close during phonation, leaving an oval-shaped gap. The lumen of the larynx can be narrowed due to the accumulation of crusts with the likely development of laryngeal stenosis II-II1 degrees.

Treatment

    • Eliminate the cause of the disease
    • Avoiding smoking and eating irritating foods
    • Gentle voice mode
    • Irrigation of the pharynx and inhalation of a mixture consisting of 200 ml of 0.9% NaCl solution and 5 drops of 10% tincture of iodine, 2-3 r / day (40-60 ml per procedure) for 5-6 weeks or more
    • Alkaline-oil inhalations for 5 days – in the presence of viscous mucus and crusts in the larynx
    • Intralaryngeal infusions of 1-2% oil solution of menthol every day

within 10 days

CHRONIC HYPERPLASTIC LARYNGITIS (diffuse form)

Clinical picture

    • Persistent hoarseness and fatigue of the voice, sometimes aphonia
    • Cough with mucus. Laryngoscopy
    • The mucous membrane is edematous, hyperemic, which leads to a narrowing of the lumen of the larynx, its surface is uneven, which is clearly visible when examining the free edges of the vocal folds. They are spindle-shaped thickened, which prevents the complete closure of the glottis during phonation.

CHRONIC HYPERPLASTIC LARYNGITIS (limited forms) is characterized by the locality of the process and the presence of thick mucus both in the interarytenoid space, and on the entire mucous membrane and in the lumen of the larynx. Nodules of the vocal folds (nodules of singers, nodules of screamers). They occur when the vocal apparatus is overloaded and more often in people with vocal professions (singers, announcers, guides, etc.) and in babies who cry or scream a lot.

Laryngoscopy

    • The mucous membrane is pink, on the border between the anterior and middle thirds of the vocal folds there are symmetrical formations in the form of nodules on a wide base up to 1 mm in diameter (connective tissue outgrowths resembling corns)
    • Vocal fold nodules appear approximately equally often in patients with weakness (atony) of the vocal folds and with their excessive tension.
    • Nodules located symmetrically along the edges of the vocal folds prevent complete closure of the glottis, as a result, the voice becomes hoarse. Features of various clinical forms
    • Pachydermia of the larynx
    • Laryngoscopy. Pachydermia is a limited outgrowth of the mucous membrane of the larynx, outwardly resembling tubercles, granulations, localized in the posterior third of the vocal folds and interarytenoid space (posterior commissure). Their surface is often smooth, but may be rough; viscous discharge in the lumen of the larynx
    • Differential Diagnosis
    • Fibroma of the larynx on a wide base of light gray color
    • Papilloma of the larynx (has a papillary structure and a gray color)
    • Granulation in tuberculosis (history of tuberculosis, the presence of infiltrates with an ulcerated surface).
    • Chronic subglottic laryngitis
    • Laryngoscopy. In the subglottic space – hypertrophy of the mucous membrane, resembling a picture of a false croup
    • Differential diagnosis – subglottic laryngitis (stenosis of the larynx of varying degrees, paroxysmal course, mainly children are ill).
    • Morgagian ventricular prolapse
    • A chronic inflammatory process of the mucous membrane of the Morganian (laryngeal) ventricle can lead to its hypertrophy. This is facilitated by trauma and irritation of the ventricular mucosa.
    • Laryngoscopy. With forced exhalation, phonation, coughing, the hypertrophied mucous membrane protrudes from the ventricle of the larynx and partially covers the vocal folds. Edema formations, protruding beyond the edge of the vocal fold, prevent the complete closure of the glottis, causing a hoarse voice.
    • contact ulcer
    • Elongated vocal processes of the arytenoid cartilages during phonation injure the mucous membrane of the opposite vocal fold
    • Laryngoscopy. On the border between

a defect (saucier) is formed along the middle and posterior thirds of the vocal folds on one side, and a pistil is formed on the other, which prevents the complete closure of the glottis and is expressed in the loss of sonority of the voice

    • Differential Diagnosis
    • Neoplasm of the larynx (biopsy followed by histological examination)
    • Granulomas in chronic specific infections (tuberculosis, syphilis, scleroma). Treatment
    • Elimination of the etiological factor.
    • Emollient and anti-inflammatory drugs, for example, daily infusions into the larynx of 1.5-2 ml of 1% oil solution of menthol, sea buckthorn oil, daily inhalations of chlorobutanol for 10 days.
    • Astringents and cauterizers: infusions into the larynx 1.5-2 ml 1-3% solution of collargol, 2% solution of protargol, 0.5% solution of resorcinol every day for 10 days, 0.5 ml 0 25% silver nitrate solution every other day (with hypersecretion), 1 ml 1% halocorbin solution for 10 days.
    • Lubrication of the mucous membrane of the larynx with 1-2% silver nitrate solution after 1-2 days, Lugol’s solution.
    • To thin viscous mucus – infusion into the larynx of 1.5-2 ml of solution of chymotrypsin or trypsin (0.5-1: 1000) and after 3-5 minutes of vaseline oil every day for 10 days.
    • In case of insufficiency of the function of the neuromuscular apparatus of the larynx – electrophoresis with 5% solution of calcium chloride on the collar zone (12-15 procedures for 15-20 minutes).

Medical examination. The diffuse form of chronic hypertrophic laryngitis and dyskeratosis of the mucous membrane of the larynx are classified as precancerous conditions. Patients should be examined 2 r / year using modern diagnostic methods. Forecast. With systematic and adequate treatment of chronic laryngitis, the outcome is favorable. See also Laryngitis, Acute laryngitis, Acute phlegmonous laryngitis