Chronic catarrhal laryngitis – an inflammation of a mucous membrane of a throat which remains more than 3 weeks is followed by puffiness of fabrics and hyper secretion of mucous glands. It is shown by an osiplost and change of a timbre of a voice, his excessive fatigue, paresteziya, feeling of a foreign matter in a throat, unproductive or dry cough. Diagnostics is based on anamnestichesky data, results of external survey, an indirect laringoskopiya, laboratory techniques, if necessary – a computer tomography. Treatment includes antibiotics, inhalation therapy, symptomatic and pathogenetic medicines.
Chronic catarrhal laryngitis
Chronic catarrhal laryngitis – a widespread otolaryngologic disease. According to statistical data, this pathology makes up to 35% of all inflammatory defeats of area of a throat. More often males suffer, the ratio of sick men and women makes about 1,5-2:1. Experts note that in recent years the tendency to reduction of this coefficient is traced. Most likely, it is connected with increase in number of the smoking women. Pathology is more often diagnosed for persons 60 years are more senior. Increase in quantity of exacerbations of a disease is characteristic of the autumn and winter period.
Reasons of chronic catarrhal laryngitis
The catarrhal form of an inflammation of mucous membranes of a throat is connected with the activation which is available opportunistic and penetration of pathogenic microflora, most often – stafilokokk and streptococci. It occurs against the background of influence of various exogenous and endogenous promoting factors lowering local and general protective forces of an organism. Treat them:
- Considerable voice loadings. Are one of the leading reasons of chronic laryngitis. Persons whose professional activity is connected with long or excessive use of a voice enter into risk group: teachers, dispatchers, singers, workers of noisy productions, builders.
- Addictions. The inflammation of a mucous membrane of a throat can be provoked by abuse of alcoholic beverages, narcotic substances and tobacco products.
- Irritation of a mucous throat. The irritation of mucous can be caused by contact with household and production chemicals, constant inhalation of smoke, dusty, excessive cold or hot air. In this group also refer radiation therapy of area of a neck.
- Pathologies of the top airways. Microbic contamination of tissues of throat is promoted by the available centers of a chronic infection: tonsillitis, sinusitis, rhinitises, pharyngitises, carious teeth. Besides, include violation of nasal breath at a curvature of a nasal partition, growth of adenoidny vegetations in group and so forth.
- Laringofaringealny reflux. Both the physiological reflux, and the accompanying GERB acts as a provocative factor. The throwing of sour gastric contents in airways is followed by irritation and inflammatory reactions of mucous membranes.
- Traumatic damages. Laryngitis is caused by the closed and open injuries of a neck, penetration of foreign matters into a throat gleam, the postponed surgeries in this area, frequent bronkhoskopiya and long intubations of a trachea.
- Medicines. Some medicines are capable to injure mucous or to provoke its dryness that promotes development of inflammatory changes. Diuretic, antigipertenzivny and antipsychotic means, H1-gistaminoblokatory, inhalation glucocorticosteroids concern to those.
Characteristic pathogenetic feature of a catarrhal form of chronic laryngitis is violation of local blood circulation in combination with a metaplaziya and classical inflammatory changes of an integumentary epithelium. The cylindrical epithelium, typical for this anatomic area, is replaced with a version flat, then loosened and gradually torn away. In parallel in podepitelialny fabrics there is a kruglokletochny infiltration. The combination of hypostasis and cellular proliferation leads to violation of mobility of eyelashes of an epithelium of a back wall of a throat. As a result one of the main functions of body – a drainage of slime of a bronchial tree because of what there is its congestion on voice folds suffers. It can be followed by a laryngospasm, defeat of an epitelialny cover as a giperkeratoz, a diskeratoz, an akantoz, an atipiya of cages.
Symptoms of chronic catarrhal laryngitis
The clinical picture is characterized by a long current with regular aggravations and remissions. Increased fatigue of a voice and minor change of a timbre becomes the first symptom often. Then there are complaints to an osiplost of different degree of expressiveness, "coarsening" of a voice, a paresteziya which remain for all day. The periodic tussiculation or dry joins them, is more rare – unproductive cough, feeling of dryness and existence of a foreign subject in a throat. The laryngospasm episodes which are followed by severe inspiratory short wind develop rather seldom. Painful and intoksikatsionny syndromes are poorly expressed or are absent. At contact with cold air and other irritants clinical displays of a disease sharply amplify.
In the absence of timely full treatment catarrhal chronic laryngitis passes into an atrophic or hyper plastic form. It leads to progressing of the available clinical symptoms, permanent loss of voice functions or a stenosis of a throat with respiratory insufficiency. There is an abstsedirovaniye and formation of an abscess less often. Existence of the center of a chronic inflammation and violation of drainage function promote development of defeats of the below-located departments of a trakheobronkhialny tree and lungs – tracheitises, bronchitis, pneumonia. Metaplaziya of an epitelialny cover, in particular – at transformation in a hyper plastic form is a precancer state which becomes the reason of formation of malignant tumors.
Diagnosis is made on the basis of the complex analysis of complaints of the patient, results of fizikalny and laboratory tests. When collecting the anamnesis the otolaryngologist finds out potential etiologichesky factors, including working conditions and the patient's profession, associated diseases, earlier undergone operations and injuries, the use of alcoholic drinks, smoking. The further diagnostic program includes:
- Fizikalny survey of area of a neck. At a palpation moderately increased lobbies and back cervical groups of lymph nodes come to light. During the conversation and at cough the raised load of muscles of a lobby and the side surface of a neck is defined.
- Indirect laringoskopiya. At survey of a cavity of a throat the general thickening and a zakruglennost of free edge of voice folds, the expressed hyperaemia and expansion of vessels on their surface and on a back wall of a throat is visualized. The mucous membrane of the last can be dryish or excessively damp, on some sites the slime congestion is defined.
- General laboratory tests. At clinical blood test there are nonspecific inflammatory changes: , shift of a leykotsitarny formula towards stab and young neytrofilny leukocytes, increase in SOE.
- Microbiological research. It is appointed for identification of pathogenic microflora with further definition of its sensitivity to the main groups of antibacterial medicines. As material for a research the phlegm, otkharkivayemy at cough, or dab taken from a mucous throat is used.
- Computer tomography. KT of a neck is shown at impossibility to fully differentiate laryngitis with suppurated to a laringotsela, malignant new growths of regionarny anatomical structures. At a chronic inflammation of a throat on the tomogram the diffusion thickening of soft fabrics is displayed, at other pathologies process often has unilateral, limited character.
Treatment of chronic catarrhal laryngitis
The integrated therapeutic approach including local and system pharmacological means, physiotherapeutic procedures is used. Treatment begins with elimination of an etiologichesky factor, purpose of voice rest and a diet from unirritating products. Further depending on a clinical situation are applied:
- System therapy. The leading role is played by antibacterial medicines of a broad spectrum of activity. Groups of the choice – penicillin and macroleads. In the subsequent correction of antibiotic treatment according to results of a microbiological research is carried out. If necessary mukolitichesky means, antatsida and/or inhibitors of a protonew pomp, NPVS enveloping medicines are appointed.
- Local treatment. Consists in use of compression inhalers from simpatomimetika, topichesky glucocorticoids. It allows to stop cough, local puffiness of mucous. The oil solutions which also have the enveloping effect, local antiseptics and antibiotics are in addition applied.
- Physical therapy. It is shown only during remission. In out-patient conditions the phonoelectrophoresis according to Kryukov-Podmazov with augumentiny and Prednisolonum is carried out. Sanatorium treatment in the conditions of arid coastal climate is considered effective.
Forecast and prevention
The forecast for health and life at correctly picked up full treatment favorable. Adequate therapy allows to reach a condition of full clinical remission. Complications meet very seldom. Specific prevention concerning this disease it is not developed. Nonspecific preventive actions include avoiding of excessive voice loadings and a travmatization of a throat, refusal of smoking, alcohol intake and drugs, use of individual protection equipment during the work on harmful productions, rational application of medicines, timely treatment of associated diseases.