Chronic hyper plastic laryngitis is one of forms of an inflammation of a throat which is followed by a thickening of a mucous membrane and lasts over three weeks. Clinical symptoms: hoarseness, increased fatigue and change of a timbre of a voice, feeling of dryness, irritation or existence of a foreign matter, moderate morbidity in a throat, damp cough. At diagnostics data of the anamnesis, the complaint of the patient, results of fizikalny survey, a laringoskopiya, laboratory researches and KT are used. Treatment includes surgical removal of the struck fabrics, pharmacotherapy and physiotherapy.
Chronic hyper plastic laryngitis
Chronic hyper plastic laryngitis makes 6-8% of all otolaryngologic pathologies. Over 50% of total number of cases develop against the background of sharp process. About 90% of the patients suffering from this form of an inflammation of a throat have a long standing of tobacco smoking. The disease is widespread among persons aged from 35 up to 60 years. According to statistical data, men are ill a little more often than women. Geographical features of distribution are not observed. Restoration terms after surgical treatment average from 1 to 2 months. Serious complications meet rather seldom – in 5-8% of cases.
Reasons of chronic hyper plastic laryngitis
Chronic inflammation of internal covers of a throat – a polietiologichesky state. As a cause of illness the sharp inflammatory processes provoked by a bacterial, viral, fungal, mikoplazmenny or chlamydial infection in most cases act. Synchronization of the secondary specific laryngitis developing against the background of syphilis, tuberculosis, diphtheria, rheumatoid arthritis, an amiloidoz, hard currency and other autoimmune defeats is less often observed. In addition allocate the factors promoting development of pathology. Treat them:
- Traumatic damages. Here the stupid and getting neck wounds, hit enter a cavity of a throat of a foreign matter, a long intubation, statement of a tracheostoma, the postponed surgeries in this anatomic area.
- The accompanying inflammatory pathologies. Endocrine violations (diabetes, a hypothyroidism), chronic bronchitis, pneumonia, pharyngitises, rhinitises and sinusitis, a chronic renal failure, a gastroezofagealny reflux disease and other pathologies of a GIT can promote development of laryngitis.
- Addictions. At most of patients development of inflammatory changes is connected with long smoking, abuse of alcoholic beverages, narcotic substances.
- Professional harm. Include constant exhalation of dust, production evaporations, too dry or hot air. Also developing of laryngitis is connected with constants or excessive voice loadings.
- Immunodeficiency. Development of pathology can be caused long kortikosteroidny, beam or chemotherapy, continuous overcooling, cancer damages of marrow, existence of AIDS or congenital immunological violations.
Pathogenetic mechanisms are finally not studied. The disease is followed by a giperplaziya of all spheres of a mucous membrane of various degree of expressiveness. At the same time sites of a metaplaziya which is shown by replacement of a normal cylindrical vibrating epithelium by orogovevayushchy flat are formed. Often lymphatic cracks increase, also the adventition of regional arterial vessels hypertrophies endoteliya. There is a squeezing of channels of mucous glands the expanded fabrics. In mezhcherpalovidny space the warty thickening of an epithelium as a bokaloobrazny ledge – a pakhidermiya can be formed. When involving in pathological process of vocal chords their expressed infiltration with deformation of free edge in the form of a paunch is observed. Also on them peaked growths of connecting fabric – hyper plastic or "singing" small knots meet. In certain cases there is a prolapse or loss of a morganiyev of a ventricle.
Symptoms of chronic hyper plastic laryngitis
Primary sign of a hyper plastic form of a chronic inflammation of a throat – hoarseness of a voice which initially appears at the end of the day or after loading. Over time it gains constant character and is supplemented with bystry fatigue of a voice at a conversation. At many patients the timbre changes – it becomes lower, rough. There is irritation, tickling, paresteziya, including feeling of a foreign subject in a throat. Moderate morbidity, constant cough with unsuccessful attempts "to clear the throat" joins the listed symptoms. The allocation of a small amount of a viscous mucopurulent phlegm amplifying in the mornings is often observed. At some patients short wind of the mixed character is noted.
The leading complication of hyper plastic laryngitis – the permanent change or loss of a voice caused by paresis of vocal chords. For representatives of certain professions it becomes the reason of full disability. Existence of the constant center of an infection in a throat promotes frequent inflammatory defeats of the below-located departments of respiratory system – to tracheitises, bronchitis, pneumonia. The available metaplaziya of a mucous membrane is precancer change. Further it is capable to lead to formation of benign and malignant tumors – angiy, fibromas, cystous educations, sarcomas. In rare instances after performing expeditious treatment development of a cicatricial stenosis of a throat is possible.
Diagnosis is carried out on the basis of anamnestichesky data, clinical symptomatology, results of fizikalny survey. At poll the otolaryngologist finds out dynamics of development of all available symptoms, the events, factors or diseases preceding their emergence, the patient's profession. At a conversation the expert focuses attention on sounding of a voice of the patient. Further inspection includes the next researches:
- Fizikalny survey. At objective survey of area of a neck its contours, participation of regional muscles in a fonation are estimated. During the conversation and cough the excessive tension of external muscles is accurately visualized. Palpatorno is defined moderate increase in lobbies and back cervical groups of lymph nodes.
- Indirect or endoscopic laringoskopiya. The Laringoskopichesky picture is characterized by a diffusion or focal, but symmetric thickening and hyperaemia of mucous membranes of structures of a throat. Also the hypertrophy of covers of ventricles and their transition out of limits of vestibular and voice folds is defined. On the last at a pakhidermiya there are roundish symmetric small knots a dimeter of 1-2 mm.
- Laboratory tests. In clinical blood test the nonspecific changes characteristic of any inflammatory process are displayed: increase in level of leukocytes, shift of a leykotsitarny formula towards young neutrophils, increase in SOE. The bacteriological research for the purpose of definition of the activator is in addition conducted.
- Histologic research. Studying of a sample of tissues of throat gives the chance to reveal a combination of jet changes of a blanket of an epithelium, inflammatory, regenerative and fibrous – own plate of a mucous membrane. Infiltrate is mainly presented by mononukleara and plazmotsita. Pakhidermiya is followed by a pronounced akantoz of a multilayered flat epithelium.
- Computer tomography of a neck. KT is appointed at impossibility to carry out full differentiation with tumoral educations. At a chronic inflammation the symmetric thickening of mucous membranes and folds of a throat while at tumors pathological process has unilateral character is noted.
Treatment of chronic hyper plastic laryngitis
Main objective of treatment – knockings over of inflammatory process, restoration of voice function, prevention of cancer regeneration of the struck fabrics. One of important points – minimization of voice loading, including shepotny speech. It allows to create conditions for formation of a natural fonation. The therapeutic program at this pathology can consist from:
- Pharmacotherapy. Antibacterial therapy according to results of an antibiotikochuvstvitelnost is initially appointed. For fight against a giperplaziya of mucous fabrics the tushirovaniye is used by solution of a lyapis. Anti-inflammatory, antihistaminic medicines, vitamin complexes, system mucolytics, enzymes are in addition applied.
- Surgical treatment. At this option of laryngitis the endolaringealny decortication of voice folds and excision of hypertrophied mucous membranes of a throat is carried out. Intervention is carried out under application anesthesia. If necessary "singing small knots" by means of guttural nippers with Kordes's nozzle are removed.
- Physiotherapeutic procedures. An important role is played by inhalations with mucolytics, corticosteroids, antiseptic solutions, mineral waters. The choice of means depends on carrying out time – before surgery in quality of training or after it for improvement of a fonation. Also widely apply an electrophoresis, endolaringealny , laser and microwave therapy.
Forecast and prevention
The forecast at hypertrophic option of chronic laryngitis favorable. On condition of full high-quality treatment it is possible to reach permanent clinical remission. Nevertheless, this pathology belongs to precancer states, there is a risk of a malignization. Early diagnosis and treatment of sharp forms of laryngitis, GERH, pathologies of the top airways belong to preventive actions; prevention of injuries of area of a neck; refusal of addictions; observance of safety regulations on production; correction of immunodeficiency.