Chronic laryngitis: symptoms and treatment, causes of the disease. Chronic laryngitis. Clinical recommendations Exacerbation of chronic laryngitis symptoms

Catad_tema Diseases of ENT organs - articles

ICD 10: J37.0, J37.1

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

ID: KR321

Professional associations:

National Medical Association of Otorhinolaryngologists

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-polypous laryngitis

List of abbreviations

GERD is gastroesophageal reflux disease.

CHL - chronic hyperplastic laryngitis

CL - chronic laryngitis

COPD - chronic edematous-polypous laryngitis

Terms and Definitions

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

Chronic edematous-polypous laryngitis (COPL) - Reinke-Gayek's disease (Reinkae edema)- chronic laryngitis, characterized by a polypoid proliferation of the mucous membrane of the vocal folds.

Gastroesophageal reflux disease (GERD) - morphological changes and a 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 mucous membrane of the larynx 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 mucous membrane of the larynx. The pathogenesis of the disease is not fully known. The pathogenesis of chronic edematous polypous laryngitis (COPL) is better known. The course of the disease is associated with the anatomical features of the Reinke's space. Immunohistochemical examination and electron microscopy of remote areas of the mucous membrane of the vocal folds in patients with Reinecke's disease reveal increased subepithelial vascularization with a large number of dilated vessels. The walls of the vessels are thinned, fragility of capillaries is noted. Fragility and change in the vascular pattern in the Reinecke's space is the cause of edema in this area, contributes 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, the violation of lymphatic drainage is of great importance.

1.3. Epidemiology

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

1.4. ICD-10 coding

J37.0- Chronic laryngitis;

J37.1- Chronic laryngotracheitis.

1.5. Classification

Chronic laryngitis is divided into catarrhal, hyperplastic, atrophic and edematous-polyposis (Reinke-Gayek disease). Separately, specific laryngitis is isolated and, by some authors, pachydermia of the larynx is separately determined. Allocate a limited and diffuse form 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 an independent one. Also, chronic laryngitis is divided into specific and nonspecific.

2. Diagnostics

2.1. Complaints and anamnesis

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

When collecting anamnesis, attention is paid to the screening of etiopathogenetic factors in the development of the disease, the frequency of relapses. The anamnesis of the voice disorder is important (the nature of the violation of the voice function, its duration, the patient's need for voice loads), as this allows not only to carry out the 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 skeleton of the larynx by palpation and during swallowing, and the participation of the neck muscles in phonation. With tense phonation, the tension of the external muscles of the neck is clearly visible. Regional lymph nodes are evaluated, their increase may indicate the degeneration of the precancerous process. Determine the size of the thyroid gland, 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 CL 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 determine the etiological factors in the development of the inflammatory process and concomitant pathology.

Comments: Cultures should preferably be taken from the laryngopharyngeal mucosa 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., Actinomycesdiphteriae, Mycoplasma pneumonia, Chlamiophila pneumonia. Chronic hyperplastic laryngitis is characterized by associations of microorganisms, among which the most common are Staphylococcus aureus, 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 with fibrolaryngoscopy, with indirect microlaryngoscopy, with direct microlaryngoscopy by an otorhinolaryngologist or endoscopist or oncologist who has the necessary surgical skills.

The microscopic picture in CHL is a combination of reactive changes in the surface epithelium and inflammatory, reparative, and sclerotic changes in the lamina propria. The inflammatory infiltrate is characterized by the predominance of mononuclear elements and plasma cells over segmented leukocytes. The predominance of cells of 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 its hyperplasia, acanthosis and impaired keratinization, dysplasia of the respiratory type epithelium - in the form of basal cell hyperplasia, an increase in the number of goblet cells and squamous metaplasia. Pronounced acanthosis of the stratified squamous epithelium is the underlying pachydermia. In COPD, it is not the signs of inflammatory infiltration that come to the fore, but a pronounced interstitial edema, often with stromal myxomatosis, a violation of the vascular wall, and a 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, data from other examination methods, is 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 there is no opportunity to conduct microlaryngoscopy, the patient should be sent for a consultation to those institutions where this method of diagnosis exists. Microlaryngoscopy picture of CL varied. 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-polypous 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 stenosing the lumen of the larynx. With atrophic laryngitis, the mucous membrane of the vocal folds looks dull, there may be viscous sputum, hypotonia of the vocal folds and non-closure during phonation.

In the diffuse form of CHL, infiltration of the vocal folds is noted, foci of keratosis are visible, hyperemia of the mucous membrane of the larynx, there may be fibrinous deposits, accumulation of viscous or purulent sputum. Keratosis is a pathological keratinization of the epithelium of the mucous membrane of the larynx, which can manifest itself in the form of pachydermia (thickening of the mucous membrane in the interarytenoid region), leukoplakia (white smoky formation), hyperkeratosis (hilly formation) located on the vocal folds.

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

The endovideolaringostroboscopic picture in the catarrhal form of laryngitis shows minor changes in the vibratory cycle, there is a decrease in the amplitude of the oscillation of the vocal folds and mucous waves. The subatrophic form of chronic laryngitis is characterized by a symmetrical decrease in the amplitude of the vocal folds, a decrease in the mucous wave and the absence of a closing phase. With edematous-polypous laryngitis, the closing phase is complete, the vocal folds fluctuations are asymmetric and irregular, the amplitude of the vocal folds fluctuations is reduced, and the mucous wave, on the contrary, is sharply increased. In the hyperplastic form of laryngitis, pronounced violations of the vibratory cycle are determined. They are determined by a decrease in the amplitude of oscillations of the vocal folds (along the entire length or in a separate area), the mucous wave is reduced or absent, non-vibrating sections of the mucous membrane are determined, an asymmetric and uneven change in the amplitude of oscillations and the mucous wave is noted. Video laryngoscopy is indicated for patients with limited keratosis. There are superficially located keratosis and soldered to the underlying layers. Adhesive keratosis is especially suspicious for cancer and is 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 at later stages of therapy to determine the quality and nature of the phonation of 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 a study of the function of external respiration is indicated for patients with COPD to verify the symptoms of latent respiratory failure with 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 CHL and laryngeal cancer is often 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 expansion of blood vessels, petechial hemorrhages. In general, the vascular pattern of the vocal fold is chaotic. Violation of the 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, mucosal infiltration, foci of dense keratosis, soldered to the underlying tissues, and others. The final differential diagnosis in CL is based on histological examination.

Comments: involvement in the pathological process of the larynx 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 bumpy infiltrates form in the subglottic space. The process can spread into the trachea or up to other parts of the larynx. Primary amylodiosis of the larynx occurs, 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 lesion is diffuse in nature with an intact mucosa, sometimes with spread to the tracheobronchial tree. Amyloid deposits are localized mainly in the supraglottic region 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 in the form of arthritis of the cricoarytenoid joint. Differential diagnosis is carried out on the basis of general clinical, serological examination and biopsy. Tuberculosis of the larynx is characterized by polymorphism of changes. The formation of miliary nodules, infiltrates, which undergo decay with the formation of granulations, ulcers and scarring, is noted. Tuberculomas and chondroperichondritis are often formed. Syphilis of the larynx manifests itself in the form of erythema, papules and warts. Ulcers are often formed, covered with a grayish-white coating.

3. Treatment

The goal of treatment is the elimination of the inflammatory process in the larynx, the restoration of a sonorous voice, the prevention of 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 CL, while it is prescribed empirically with the use of broad-spectrum drugs (amoxicillin + clavulanic acid, respiratory fluoroquinolones, macrolides).

Comments: with severe inflammatory phenomena with the addition of purulent exudation. Perioperative antibiotic therapy is prescribed during surgical intervention with direct microlaryngoscopy, with implant methods of surgical correction, and a large amount 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, with a history of allergies and, in some cases, laryngomycosis. The use of antihistamines should be avoided in catarrhal and subatrophic forms of laryngitis, as these drugs cause dryness of the mucous membrane of the larynx.

Anti-edematous 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 an exacerbation of a chronic inflammatory process, and cannot be monotherapy.

Comments: locally - in the form of inhalations. You can prescribe local and systemic mucolytics at the same time. An 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-term courses (up to 14 days) of herbal preparations or containing essential oils in the presence of dry crusts, including patients with laryngomycosis. When choosing a mucolytic, it should be remembered that one of the etiological factors of CL is the pathology of the gastrointestinal tract, and therefore preference should be given to drugs that do not have side effects that affect the function of the stomach.

A good clinical effect in patients with hyperplastic and edematous-polypous laryngitis is achieved with the use of complex enzyme preparations for a period of at least 14 days. These drugs are able to reduce inflammatory infiltration, local edema, affect cellular and humoral immunity.

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

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

The use of physiotherapeutic methods of treatment is recommended: 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-polypous laryngitis, especially in the initial stages of the disease, injections of corticosteroid preparations 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 the diagnosis of laryngeal cancer are associated with an incorrectly chosen site for biopsy and insufficient material for research. Despite the fact that the main goal of surgical intervention is to verify the diagnosis and remove areas of hyperplastic mucous membrane, the mucous membrane of the vocal folds should be treated sparingly, avoiding, if possible, additional deterioration of the voice function. It is better to plan a surgical intervention after anti-inflammatory therapy, so that you can more accurately determine the place for a biopsy. The goal of surgery for COPD is to improve voice function and prevent complications - laryngeal stenosis. Histological examination of the removed mucous membrane is mandatory. Two surgical techniques are mainly used in COPD: the Kleinsasser vocal cord decortication 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 adhesion. The essence of the M. Hirano technique is that an incision is made along the lateral edge of the vocal folds, the gelatinous mass is aspirated, the excess epithelial tissue is excised with scissors, and the rest is placed on the vocal fold. Laser techniques are also used. In the initial stages of the disease, a small area of the altered mucosa can be removed. A complication of surgical intervention may be gross scarring of the vocal folds, the formation of a scar membrane.

3.3 Other treatment

Preservation of the inflammatory process in the mucous membrane of the larynx for more than 20 days leads to chronic disease. This is facilitated by the late detection of laryngitis and its improper treatment. Early diagnosis of the disease is especially important for people with voice-speech professions (teacher, actor or vocalist). Treatment of chronic laryngitis should be carried out taking into account the form of the disease, concomitant diseases and the presence of allergic reactions in the patient. Note that chronic inflammation can lead to malignant degeneration of tissues and the development of cancer.

The reasons

The transition from an acute form of the disease to a chronic one can be due to the following factors:

frequent colds against the background of weakened immunity;
the presence of long-term foci of infection in the oral cavity (caries, gingivitis) or oropharynx (tonsillitis);
diseases of the gastrointestinal tract, one of the symptoms of which is heartburn. It appears due to the ingestion of the contents of the stomach into the esophagus and damage to the mucosal hydrochloric acid. These diseases include gastroesophageal reflux disease and hernias;
air pollution with dust particles or chemicals that, when inhaled, irritate the throat mucosa;
prone to allergies, frequent contact with allergens;
heavy loads on the voice-forming apparatus;
occupational hazards (work in the mining, paint and varnish, flour-grinding industries). This group of reasons also includes professions associated with constant tension of the vocal cords (vocalists, speakers);
smoking;
low level of immune protection due to severe somatic pathology (diabetes, tuberculosis, HIV).

Symptoms and diagnostic methods

Chronic laryngitis can be suspected based on:

hoarseness;
changes in the timbre of the voice;
dryness, perspiration, as well as a sensation of a foreign lump in the oropharynx;
cough. It can be a rare cough or in the form of an attack.

During the period of remission, the listed clinical symptoms are much less pronounced than during the exacerbation. With an increase in symptoms, subfebrile condition, weakness and decreased appetite may appear.

To cure chronic inflammation of the larynx, you need to see a doctor for a diagnosis. It includes:

Chronic inflammation can take several forms:

catarrhal. It is characterized by swelling of the vocal folds, hyperemia and a slight thickening of the mucosa. During phonation, the gap is not able to close completely;
hypertrophic. This form can occur in a limited or diffuse form. Mucous edematous, "nodules of singers" on the vocal folds can be observed. Clinically, the form is manifested by aphonia;
atrophic. It is characterized by severe dryness, thinning of the mucous membrane, the surface of which is covered with viscous mucus and dry crusts. The patient is disturbed by a strong cough, in which crusts with blood streaks can be coughed up. The appearance of blood indicates damage to the blood vessels by the atrophic process.

Medical tactics

How to treat chronic laryngitis? We emphasize that it will not be possible to completely get rid of the pathology, but it is quite possible to slow down its progression. To reduce the severity of clinical signs and improve the quality of life, it is recommended to follow the following rules:

smoking cessation, strict control over the amount of alcohol consumed and the frequency of its intake;
voice rest;
sparing nutrition (dishes should be at a comfortable temperature, not irritate the oropharyngeal mucosa and be beneficial, in this regard, spices, pickles, carbonated drinks are prohibited);
plentiful warm drink (milk with the addition of soda, non-carbonated mineral water, tea with honey);
prevention of hypothermia and contact with drafts;
regular airing of the room and wet cleaning;
the use of protective equipment in hazardous production or a change of job.

An integral part of therapy is the treatment of somatic pathology, as well as the rehabilitation of bacterial foci. Depending on the inflammatory form, treatment tactics may have a number of differences.

Treatment of laryngitis of various forms

A good therapeutic effect is observed in the catarrhal form. Of the medications can be prescribed:

Irrigation of the mucous membrane of the larynx with drugs is carried out in a medical institution. Additionally, physiotherapeutic procedures are prescribed, for example, electrophoresis, UHF, and also DDT.

When atrophic processes predominate, the treatment of chronic laryngitis consists in the use of drugs prescribed for the catarrhal form. The only feature is inhalations with proteolytic enzymes, for example, Trypsin.

As for the hypertrophic form, treatment tactics are determined on the basis of diagnostic results and clinical symptoms. In addition to conservative tactics, the doctor may recommend surgery. The operation is performed under local anesthesia using special instruments and a microscope. This makes it possible to remove hypertrophied areas of the mucosa.

Removal of singing nodules from the surface of the vocal folds can be carried out by the coblation method, which implies the impact of a cold plasma beam on nodular formations.

An important role in the treatment is played by compliance with the rules of rehabilitation in the postoperative period. The patient must strictly follow the medical recommendations:

it is forbidden to eat for the first time 3 hours after the operation;
you can not cough, so as not to increase the postoperative wound;
physical activity should be limited during the week;
a sparing diet and voice rest are needed in the first week after surgery;
smoking is prohibited.

You can fight chronic inflammation of the larynx using folk methods, however, not forgetting about drug therapy. Thanks to the healing properties of herbs, a mild anti-inflammatory effect is provided. and antimicrobial action, regenerative processes are stimulated, and healing is accelerated.

For gargling, you can use infusions and decoctions of chamomile, sage, oak bark or calendula. Here are some recipes that can be used for chronic laryngitis:

10 g of chamomile, cinquefoil and calendula should be poured with 470 ml of boiling water and left to infuse for 10 minutes. As soon as the temperature of the steam drops, you can start inhalation or gargle;
soda-salt solution for rinsing the oropharynx. To prepare it, it is necessary to dissolve 5 g of the ingredients in warm water with a volume of 240 ml, add 2 drops of iodine;
honey can be simply absorbed or taken in combination with lemon juice;
5 garlic cloves should be crushed, pour 230 ml of milk, boil for several minutes and filter. Take 15 ml three times a day;
for inhalation, you can use essential oils (fir, chamomile, eucalyptus). It is enough to add 5 drops of oil to hot water with a volume of 460 ml.

It is not worth relying solely on the help of folk remedies, because chronic inflammation is quite difficult to cure.

The wrong treatment approach can lead to complete loss of voice, paresis of the ligaments, as well as the formation of a fibroma, cyst or contact ulcer.

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 this should be done on time with the help of a specialist. Running forms can eventually lead to disability of persons whose profession is associated with the vocal 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, trachea. It is much more difficult to treat this form than an acute process.

True 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 the contents of the stomach are thrown back into the esophagus, burning the mucous membrane;
diabetes;
allergy;
excessive stress on the vocal folds;
sudden changes in temperature;
contaminated air;
weakened immunity;
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;
curvature of the nasal septum;
prolonged 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

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

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 tickling in the throat, and their voice in the late afternoon or after a long conversation becomes low and rough.

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

Chronic atrophic laryngitis

With this form, atrophic changes are observed on the part of 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 broken;
nerve sensitivity worsens;
the functioning of the circulatory and lymphatic systems is disrupted.

Treatment includes gentle voice mode

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 also covered with crusts and mucous secretions. Clinically, this manifests itself in the form of constant perspiration and a feeling of dryness in the throat, as well as a hacking dry cough with streaks of blood. A viscous secret is secreted from the pharynx, which, as a result of solidification, forms crusts. Expectoration of mucus is almost impossible. Usually hoarseness occurs in the morning, and after coughing it decreases.

With regards to 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 drugs that have an expectorant property and thin the sputum. For this purpose, you can use an isotonic solution, to which a few drops of iodine are added. The tool is used as an irrigation of the pharynx and inhalation. In order to accelerate the recovery of atrophied tissues, proteolytic enzymes are prescribed in the form of inhalations.

Typically, patients experience a decrease in performance, they feel constant weakness and become inattentive.

Chronic hypertrophic laryngitis

The hypertrophic form is characterized by an increase in the size of the mucous membrane of the larynx. There is also a thickening of the vocal folds. On the surface of the larynx, nodes, tubercles and various kinds of dense formations are found. When in contact with each other, these formations 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 a 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, there is weakness, headache, loss of strength.

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

consume warm food and water. Refusal of carbonated drinks, as well as spicy and pickled;
sparing mode of the vocal folds. Even a whisper strains the ligaments, so it's best to talk as little as possible;
fluid intake in sufficient quantity. It can be teas, herbal decoctions, milk with honey. The liquid dilutes sputum, contributing to its better discharge, and removes toxic substances from the body faster;
giving up bad habits: smoking and drinking;
in the cold season, dress according to the weather and try not to contact the sick;
regularly ventilate the room and carry out wet cleaning;
keep track of humidity and temperature.

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

In the initial stages, the disease is amenable to conservative treatment. Antibiotics, antiseptic sprays, non-steroidal anti-inflammatory drugs are prescribed. The atrophic and hypertrophic form of laryngitis is treated surgically, and this is subject to the ineffectiveness of conservative methods of treatment. 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 vocal apparatus undergoes. Let's highlight the main signs of the disease:

sore throat;
periodic cough;
hoarseness;
dryness in the throat;
expectoration;
rapid fatigue of the voice.

Usually, smokers and workers in hazardous industries have a coughing fit after waking up. Loss of voice can be aggravated in the following cases:

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

The clinical picture of chronic laryngitis in children proceeds with some peculiarities. In general, most often the disease occurs in children after four years. Unlike adults, a chronic process in children rarely occurs as an independent disease. 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;
asthma attack due to a decrease in the lumen of the larynx;
cysts, polyps, fibromas, angiomas in the larynx;
contact ulcer;
prolapse of the larynx;
the formation of precancerous tumors;
throat carcinoma.

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

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

Can the disease be prevented?

Let's talk about the main preventive measures:

timely and adequate therapy of infectious and somatic diseases;
refusal of active and passive smoking;
adequate voice mode;
walks in the open air;
moderate physical activity;
rubbing with cold water and foot baths.

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

inhalation procedures based on mineral water;
irrigation of the throat with sea water;
visiting sea resorts;
the use of special humidifiers;
minimize exposure to heat;
the use of means to protect the oropharynx;
reduction of contact with dust and harmful substances at work.

Purchase a room humidifier. Dry air adversely affects the condition of the mucous membrane of the respiratory tract, making it vulnerable

How to treat inflammation at home

Consider the main therapeutic measures for chronic laryngitis:

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

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

take in equal proportions sage, chamomile, nettle, calamus. Pour two tablespoons of herbal collection with half a liter of boiling water. Let the product brew, then heat it again until steam is formed. 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 the juice of beets and potatoes. Use the remedy 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. With atrophic laryngitis, honey is combined with aloe juice to speed up regeneration.

Treatment of children is carried out according to a similar scheme, but taking into account the adjustment of dosages based on age indicators.

Features of the treatment of children

An exacerbation of a chronic process in children occurs more often and hypothermia or SARS can provoke a relapse. 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 such drugs: mucolytics, antihistamines, immunostimulants. Herbal collections.
If the exacerbation is accompanied by stenosis of the larynx, it is urgent to call an ambulance and give the child an antihistamine and antispasmodic.

With chronic laryngitis, it is forbidden to drink alcohol

What mistakes should not be made

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

instead of traditional treatment, choose folk methods;
skip physical therapy sessions;
put mustard plasters;
with a tendency to stenosis, take expectorant drugs;
spray alcohol-based products down the throat;
scream or whisper. By the way, when whispering, the folds tighten no less;
hot inhalations during the acute phase;
eat onions and garlic;
ignore medical advice and self-medicate.

How to restore 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. Breathe in and out for three minutes. You can also take a deep breath through your nose, then slowly exhale through your mouth;
drinking raw eggs helps restore the voice. Eggs must be fresh and domestic;
coniferous garlic inhalations are another way to restore the 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 remedy.

So, chronic laryngitis is treatable, but it is important to adhere to the doctor's prescriptions. An effective fight against the disease is the elimination of provoking causes. In order to completely get rid of the disease, you should give up bad habits, follow the right diet and conduct adequate drug therapy. The disease can lead to serious complications, including cancer of the larynx, so do not let the problem take its course, consult a doctor and start treatment after making an accurate diagnosis.

The inflammatory process that occurs on the mucous membrane of the larynx, in medical practice, is called - laryngitis. This disease can occur in both acute and chronic forms with frequent relapses. Constant bouts of coughing are debilitating, disrupt sleep, and worsen the quality of life. But first of all, chronic laryngitis is dangerous for its complications. What is this sore and how to choose the right treatment? This is what we will talk about today.

Causes of chronic laryngitis

The chronicity of the inflammatory process in the larynx is said to last for more than three weeks. What can provoke such a serious mucosal damage? Consider the main reasons:

Acute form of laryngitis. The lack of full-fledged treatment for acute laryngitis and non-compliance with the recommendations of the attending physician is the first step towards the development of a chronic disease.
Excessive stress on the vocal cords. The greatest risk group is made up of people whose work is directly related to prolonged tension of the vocal cords, including opera performers, pop singers, actors, teachers and announcers.
Smoking. Tobacco smoke irritates the mucous membrane, causing it to dry out and deprive it of its protective properties.
Occupational activities involving the inhalation of chemical fumes or polluted air. This may be work in a mine, in production, or simply in a room with a high concentration of dust particles, polluted air.
Allergic reactions of a respiratory nature. Signs of chronic laryngitis of allergic origin are similar to stenosis of the larynx. The main difference is that when the allergen is eliminated, the attack stops, while the stenosing form of the disease requires immediate hospitalization.
Any inflammatory processes of the nasopharynx (chronic runny nose, tonsillitis, pharyngitis, measles and others). With any of these diseases, local immunity weakens, provoking the spread of infection to the lower parts of the oropharynx.

Interestingly, any disease of a chronic nature, whether it is inflammation of the heart muscle, bronchitis or pyelonephritis, can provoke the development of an inflammatory process in the larynx. This is due to a decrease in general immunity and the inability of the body to fully resist infections.

Symptoms of laryngitis depending on the form of the disease

Symptoms of chronic laryngitis in adults are determined by the form of the disease. Common symptoms are a feeling of sore throat, which provokes constant coughing, and a hoarse voice.. All other clinical manifestations will depend on the changes occurring on the mucosa.

catarrhal laryngitis

The main symptom of the catarrhal form of laryngitis is hyperemia of the mucosa, detected by the doctor during an instrumental examination.. With a long course of the inflammatory process, there may be an expansion of blood vessels and, as a result, a slight swelling of the tissues.

Chronic catarrhal laryngitis during periods of remission practically does not manifest itself. Sometimes patients may experience the following symptoms:

episodes of dry unproductive cough;
a feeling of slight discomfort in the throat;
hoarseness of voice after exercise of the vocal cords(shouting, singing).

But periods of exacerbation of laryngitis are characterized by vivid symptoms. The patient begins to complain of severe pain in the throat and frequent bouts of dry cough. At the same time, the timbre of the voice is disturbed, hoarseness appears. In especially difficult cases, a complete loss of voice functions is possible.

The main symptom of atrophic laryngitis is a paroxysmal cough, provoked by irritation of the dry mucosa.. On the walls of the larynx, dry crusts and a hard-to-remove plaque of a viscous consistency are formed. An exacerbation of laryngitis is accompanied by sputum discharge along with crusts, which provokes the appearance of small bleeding erosions.

During laryngoscopy, the doctor notes atrophy (thinning) of the mucous membrane, swelling of the vocal cords and an unnatural color of the walls of the larynx - gray-red.

The concept of hypertrophy in medicine means an increase in an organ. In our case chronic hypertrophic laryngitis is an overgrowth of the mucosa and a thickening of the ligamentous apparatus. It is noteworthy that in this form the patient continues to complain of the same symptoms as in catarrhal laryngitis. But during a deep examination, the otolaryngologist discovers dense nodular formations on the walls and ligaments, which are characteristic only of the hyperplastic form.

Patients with hypertrophic laryngitis are at risk of developing cancer. And the process of mucosal growth itself refers to precancerous conditions.

Treatment

Given the severity of the disease, self-medication in this situation is unacceptable. The use of drugs from advertising can cause serious harm to health, worsening the patient's condition. Therefore, chronic laryngitis can be treated at home, but under the strict supervision of a doctor..

Of the drugs can be prescribed:

Antibacterial therapy of laryngitis is carried out using drugs of the penicillin group (preferably combined with clavulanic acid), among them Augmentin or Amoxiclav. In case of intolerance to antibiotics of this group, macrolides (Erythromycin, Sumamed) are prescribed to the patient.
The choice of antitussive drugs depends on the nature of the cough and the presence of sputum. With a dry cough, Stoptussin or another medicine that acts on cough receptors is used. With a wet cough with sputum that is difficult to separate, it is advisable to prescribe mucolytics in the form of tablets, syrups or inhalations.
To eliminate sore throats, antiseptic preparations are used in the form of lozenges or lozenges.

But any drug therapy will be ineffective if the provoking factors that lead to the development of a chronic inflammatory process are not eliminated. Therefore, during treatment and rehabilitation, patients are recommended:

give up cigarettes, since smoking with chronic laryngitis can cause cancer of the larynx;
control the level of stress on the vocal cords;
if it is necessary to work in hazardous working conditions, it is worth using protective equipment (respirators or gauze bandages);
limit the time spent in rooms with dry and hot air, if necessary, use special humidifiers;
follow a diet that excludes the use of spicy, sour or salty foods that irritate the inflamed mucosa.

With the ineffectiveness of the ongoing drug therapy for hypertrophic laryngitis, surgery is indicated. A similar method of surgical treatment is also used in the advanced form of the disease, accompanied by the growth of neoplasms that impede the normal performance of vocal and respiratory functions. The technique of the operation and the volume of surgical intervention is selected on an individual basis.

It is not enough to simply cure chronic laryngitis; in the future, the patient will have to take all measures to prevent the recurrence of the disease. To do this, it is enough to avoid the provoking factors that were mentioned above, consult a doctor in a timely manner at the first signs of the disease (and not only the upper respiratory tract) and, finally, cure the allergy, if any.

Possible risks and complications

Everyone should know about the symptoms and treatment of chronic laryngitis in adults. After all, this is a dangerous disease, which, in the absence of timely qualified assistance, can threaten with serious complications. Among them:

Growth of neoplasms on the mucous membrane of the larynx and vocal cords. Among them are polyps, retention cyst, vocal cord granuloma, fibroma, angioma, cancerous tumor and others. As you can see, the list of complications includes both tumor-like formations and tumors directly, which can be both benign and malignant.
Stenosis of the larynx. This is a pathological process of narrowing the lumen of the larynx, which leads to impaired airway patency. The condition is dangerous for patients of any age category. With complete closure of the lumen, death occurs from suffocation.
Decreased motor activity of the laryngeal muscles. The disease threatens with persistent violations of voice and respiratory function.. The patient has a strong hoarseness of voice and the appearance of shortness of breath even at rest.
Disability in persons whose profession is directly related to the voice function.

Take care of your voice, strengthen your general immunity and treat all infectious diseases in time. This will be enough to prevent the development of a chronic form of laryngitis and prevent the development of sad consequences.