Stenosis of the larynx is a significant reduction or complete closure of its lumen. There are acute and chronic stenoses of the larynx.
Acute stenosis of the larynx develops over a short time, a life-threatening condition begins.
Chronic stenosis of the larynx is characterized by slow development.
The reasons
Acute stenoses can occur suddenly, at lightning speed, or develop gradually over several hours. Observed with true and false croup, acute laryngotracheobronchitis in children, laryngeal edema, phlegmonous laryngitis, chondroperichondritis, foreign body, trauma (mechanical, thermal, chemical), bilateral paralysis of the posterior cricoarytenoid muscle.
Chronic stenoses are characterized by the slow development of narrowing of the lumen of the larynx and its persistence. However, during the period of chronic narrowing of the larynx under adverse conditions (inflammation, trauma, hemorrhage, etc.), acute stenosis of the larynx can quickly develop. Chronic stenoses appear on the basis of cicatricial changes in the larynx as a result of trauma, chondroperichondritis, scleroma, diphtheria, syphilis, tumors.
Symptoms
Symptoms, course depend on the stage of stenosis.
Stage 1 – compensation – is accompanied by a pause between inhalation and exhalation, lengthening of inhalation, a reflex decrease in the number of breaths and a normal ratio of the number of respiratory movements and pulse. The voice becomes hoarse (with the exception of stenosis due to paralysis of the lower laryngeal nerves), a stenotic noise appears on inspiration, which is heard at a considerable distance.
Stage II – decompensation: all signs of oxygen starvation are clearly visible, shortness of breath increases, the skin and mucous membranes take on a bluish hue, when inhaling, there is a sharp retraction of the intercostal spaces, supraclavicular and subclavian fossae, jugular fossa. The patient becomes restless, rushes about, covered with a cold sweat, breathing quickens, respiratory noise increases.
Stage III – asphyxia (suffocation) – is characterized by a drop in cardiac activity, breathing is not frequent and shallow, the pallor of the skin increases, patients become lethargic, indifferent to the environment, the pupils are dilated, persistent respiratory arrest occurs, loss of consciousness, involuntary discharge of feces and urine. To assess the degree of stenosis, the size of the lumen of the glottis is most significant. However, with a slow increase in stenosis, the patient sometimes satisfactorily copes with breathing with a narrow lumen of the larynx.
Diagnostics
When establishing a diagnosis, it is necessary to exclude tracheal stenosis, respiratory distress due to diseases of the lungs and heart.
Treatment
If there is a violation of breathing (it becomes difficult to breathe), it is essential to call the ambulance brigade.
Mode of high humidity in the bathroom, drinking plenty of water, rubbing hands and feet, holding the child in his arms and trying to calm him down can improve the condition. You need to get together and help your child, a loved one.
Hospitalization is required. In a hospital, stenosis of the larynx is treated with anti-edematous, anti-inflammatory, antibacterial, anti-allergic treatment. In the first days, with stenosis of the larynx, treatment is carried out in the intensive care unit.
In the case of a severe manifestation of stenosis of the larynx, when suffocation begins, an emergency operation is necessary – a tracheotomy. At the same time, an incision is made between the tracheal rings in the neck area on its anterior plane.
In chronic stenosis of the larynx, surgical treatment (removal of papillomas, placement of expanding tubes, etc.).