Chronic atrophic laryngitis is the form of a nonspecific inflammation of a throat which is followed by thinning of a mucous membrane, a sclerosis of regionarny capillaries, intra guttural muscles and glands. The main symptoms – an osiplost or hoarseness of a voice, dryness, burning in a throat, feeling of a foreign matter, dry cough. Characteristic – an aggravation of manifestations at inhalation of dry air. At diagnostics data of the anamnesis, the complaint of the patient, results of an indirect laringoskopiya, laboratory tests, a computer and magnetic and resonant tomography are used. Treatment is conservative, includes elimination of etiologichesky factors, pharmacotherapy and physiotherapy.
Chronic atrophic laryngitis
Chronic atrophic laryngitis is the most rare option of an inflammation of a throat – to 10% of total number of cases. Inflammatory defeats of this body win first place in structure of violations of the voice device at adult population. Chronic laryngitis makes 31-47% of all diseases of a throat and 2-7% of all diseases of ENT organs. The highest incidence is observed at persons of efficient age – from 21 to 45 years. Pathology occurs at men by 1,2-1,5 times more often than at women. At the same time female representatives are more inclined to a dysphonia – the expressed violations of a voice come to light more than at 90% of patients.
Reasons of chronic atrophic laryngitis
As a rule, pathology develops against the background of earlier postponed infectious and inflammatory damages of a nasopharynx or is combined with them. The isolated form meets extremely seldom. Taking into account the reasons of formation and the promoting factors allocate the following options of a disease:
- Trofonevrotichesky. There are against the background of frequent SARS, tendencies to an allergy, a large number of the postponed sharp laryngitis, specific infectious diseases (diphtheria, scarlet fever, tuberculosis, syphilis), pathology of the nervous and vascular structures innervating and krovosnabzhayushchy throat tissues.
- Functional. It is caused by natural aging of fabrics and age decrease in regenerator opportunities, and also deterioration in nasal breath because of defects of a nasal partition, growths of adenoidny vegetations, polyps and malformations of a nasopharynx.
- Hormonal. The atrophy of a mucous membrane of a throat is promoted by hormonal dysfunction thyroid and a pancreas, in particular – diabetes. Similar impact is exerted by use of inhalation glucocorticosteroids at treatment of bronchial asthma.
- Food. Kakheksiya of various etiology, avitaminosis, the use of a large number of hard alcoholic beverages can provoke emergence of this option of laryngitis. Separately allocate a long-term experience of smoking as one of the most significant reasons of an atrophy of mucous.
- Professional. Excessive dryness, too high temperature, dust content of the inhaled air or content of vapors of chemicals in it exert direct negative impact on mucous membranes of airways and cause their atrophy. The constant tension of a voice characteristic of the singers and people working in the conditions of constant strong noise also belongs to professional risk factors.
The atrophy is a pathological process which is followed by reduction of volume and loss of function of fabrics, their fibrous replacement. At development of an atrophic form of chronic laryngitis there is a metaplaziya of a normal cylindrical vibrating epithelium in flat orogovevayushchiya. The hypotrophy and fibrosis of vessels of the microcirculator course, the muscular device and mucous glands is observed. As a result the secret quickly dries and is transformed to the dry crusts covering atrophied voice folds.
The age atrophy – result of normal processes of aging at which ability of fabrics to restoration decreases raises sensitivity to influence of other pathogenic factors. The Trofonevrotichesky option is shown by damage of regionarny arteries (most often – atherosclerotic) and/or the nervous terminations that reduces reparative and functionality of a throat. Insufficiency of nutrients, vitamins and endocrine pathologies lead to decrease in local immunity and the general protective forces of an organism that increases probability of development of inflammatory changes. Professional and tobacco smoke exert harm direct cytotoxic impact on epitelialny cages, causing their atrophy.
Symptoms of chronic atrophic laryngitis
Change of a voice – a dysphonia becomes the first symptom of a disease. Patients complain of an osiplost or a hoarseness which are initially observed only after awakening and at the end of the working day. Over time these symptoms become constants, their expressiveness amplifies at voice loading, adverse weather conditions and during periods. Then dryness, irritation, burning, feeling of the accumulated slime or a foreign matter in a throat is shown. The patient unsuccessfully tries to clear the throat that provokes an aggravation of other symptoms of pathology. At the smokers and persons working at harmful productions developing of dry hoarse cough is noted in the mornings. Characteristic of a disease – a sharp aggravation of all available symptoms during stay in rooms with dry air and their reduction in the conditions of the increased humidity.
The main complication of chronic atrophic laryngitis – a throat stenosis which has several mechanisms of development. It can be direct result of an atrophy of voice folds or a spastic contracture of the voice muscles caused by continuous attempts of the patient to clear the throat. Formation of a stenosis – the reason of permanent change of a voice or its full loss, emergence of the expressed short wind, feelings of shortage of air. Metaplaziya of epitelialny covers arising at this form of damage of a throat is a prerequisite for development of tumors. Cancer processes, including sarcoma meet as good-quality new growths (polyps, papillomas, angiofibroma), and.
Diagnostics is based on comparison of anamnestichesky data and data of fizikalny survey, laboratory and tool methods of a research. At the patient's poll the otolaryngologist focuses attention to the sequences of emergence of symptoms, earlier postponed diseases of the top airways, existence of other contributing factors. Further for the purpose of comprehensive inspection of the patient are carried out:
- Indirect laringoskopiya. At objective survey of a throat its moderate expansion, dryness, thinning and pathological gloss of mucous membranes is defined. Mucous often become dim red, through them blood vessels are visualized. At a surface of hyperemic and atrophied voice folds there are dry crusts of yellowish or brown color at which rejection there are sites of hemorrhages.
- Laboratory tests. In the general blood test slight increase of level of leukocytes decides on shift of a leykotsitarny formula to the left, increase in SOE. Against the background of allergic pathologies there is an eozinofiliya. For reliable verification of a form of laryngitis the patomorfologichesky research of samples of a mucous throat can be carried out.
- Hardware methods of diagnostics. At impossibility to carry out full differential diagnostics neck KT with contrast strengthening which allows to visualize defeat of regionarny vessels is used, to exclude existence of tumoral educations, foreign matters. For detailed studying of all regionarny structures carrying out MRT of soft tissues of neck is shown.
Differential diagnostics is performed with new growths, foreign matters, primary ozeny throat. In favor of a benign or malignant tumor expressiveness of symptoms on the one hand, existence of dense education by results of a palpation of a neck, a X-ray analysis, MPT and KT testifies. At hit of a foreign matter symptoms appear suddenly, are supplemented with feeling of insufficiency of air or a stridor. On the roentgenogram in such cases the subject located on voice folds is found. At the ozena of a throat in breath of the patient the specific fetid smell is defined, and expressiveness of subjective symptoms depends on environment conditions a little.
Treatment of chronic atrophic laryngitis
Main treatment conservative. Its purpose – knocking over of symptoms of a disease, restoration of normal voice function and prevention of possible complications. It is reached by fluidifying of slime, moistening of mucous membranes and stimulation of processes of proliferation. The therapeutic program includes:
- Drug treatment. Means application of mucolytics and sekretolitik, local use of iodglycerin, solutions of Lugol, iodide of potassium, menthol, aloe extract. Biostimulators, inhalations of mix of physiological solution and tincture of iodine, alkaline and oil means are shown. For the purpose of prevention of bacterial complications antibiotics of a tsefalosporinovy row are appointed.
- Pathogenetic treatment. Assumes an exception of potential mechanisms of formation of a disease. Depending on an etiology full treatment of atherosclerosis, pathologies of a thyroid gland, diabetes is carried out, vitamin complexes, folic acid are appointed. Physiotherapeutic procedures – UVCh, a diathermy, radiation by a lamp of Sollyuks and others are used. If necessary therapeutic actions for restoration of nasal breath are carried out.
Forecast and prevention
The forecast at chronic atrophic laryngitis favorable. At early diagnostics and high-quality treatment it is possible to stop the majority of symptoms of a disease, to prevent development of complications. Specific prevention does not exist. Observance of the adequate voice mode, full treatment of inflammatory pathologies of a nasopharynx and sharp forms of laryngitis, cardiovascular and endocrine diseases, elimination of professional factors, refusal of addictions, early correction of violations of nasal breath belongs to nonspecific preventive measures.