Laryngotracheitis — an inflammatory disease with the combined damage of a throat and trachea which emergence is caused by a viral or bacterial infection. The clinical picture of laryngotracheitis is characterized by violation of voice function, cough with a mucopurulent phlegm, discomfort and pains in a throat and behind a breast, regionarny lymphadenitis. At diagnosis of laryngotracheitis percussion and an auskultation of lungs, a mikrolaringoskopiya, KT of a throat and a trachea, a X-ray analysis of lungs, a bacteriological and microscopic research of a phlegm, IFA, RIF and PTsR identification of the activator is carried out survey of the patient. Medical actions at laryngotracheitis come down to performing antiviral or antibacterial therapy, use of protivokashlevy, mukolitichesky, antihistaminic, febrifugal medicines, physiotherapeutic procedures.
Laryngotracheitis represents the infectious and inflammatory process extending to a throat (laryngitis) and a trachea (tracheitis). Laryngotracheitis can arise as a complication of pharyngitis, laryngitis, tonsillitis, adenoides, rhinitis, sinusitis. In too time it can be complicated by distribution of inflammatory process to the lower airways with development of bronchitis, a bronkhiolit or pneumonia. Due to the age features of a structure of a throat at children 6 years against the background of laryngotracheitis quite often are younger the narrowing of a gleam of a throat leading to respiratory violations — a false croup is observed.
Causes of laryngotracheitis
Laryngotracheitis has the infectious nature. Most often there is viral laryngotracheitis. They are observed at an adenoviral infection, a SARS, paraflu, flu, a rubella, measles, chicken pox, scarlet fever. Bacterial laryngotracheitis can be caused by a beta and hemolytic streptococcus, staphylococcus, a pneumococcus, in rare instances tuberculosis mikobakteriya (throat tuberculosis), pale treponemy (at tertiary syphilis), a mikoplazmenny or chlamydial infection. Infection occurs in the airborne way from the sick person, especially if he coughs or sneezes. However at good shape of immune system and small virulence of the infectious agent development of laryngotracheitis after infection can not happen.
The factors favoring to developing of laryngotracheitis and promoting its transition to a chronic form are: the weakened condition of an organism of the patient owing to overcooling or chronic diseases (chronic gastritis, hepatitis, cirrhosis, glomerulonefrit, pyelonephritis, rheumatism, diabetes, IBS, tuberculosis), stagnant processes of airways at bronchial asthma, a bronkhoektatichesky disease, emphysema of lungs, a pneumosclerosis; continuous breath through a mouth owing to violation of nasal breath at chronic allergic rhinitis, a curvature of a nasal partition, atresia Joán, antritis and other sinusitis; adverse parameters of the inhaled air (too hot or cold, excessively dry or damp); professional harm (dust content of air or existence in it of the irritating substances; the strengthened respiratory or voice loading), smoking.
Classification of laryngotracheitis
On the cause distinguish the viral, bacterial and mixed (virus and bacterial) laryngotracheitis. Depending on the happening morphological changes in otolaryngology chronic laryngotracheitis is classified on catarrhal, hypertrophic and atrophic.
On the course of inflammatory process allocate sharp and chronic laryngotracheitis. Sharp laryngotracheitis lasts several weeks and comes to an end with an absolute recovery. At adverse contributing factors it can accept a long current and pass into chronic laryngotracheitis which is characterized by a long current with the periods of remission and aggravations more often arising during the autumn and winter period.
Morphological characteristic of various forms of laryngotracheitis
At sharp laryngotracheitis the expressed hyperaemia mucous a bright red shade, a congestion in a gleam of a throat and trachea of a large amount of putreform exudate, a thickening is noted by ekssudativny liquid, mucous at the expense of its treatment. In an initial stage of laryngotracheitis exudate has a liquid consistence, in process of development of a disease it is condensed, on mucous fibrinozny films appear. In a case strepto-or a staphylococcal etiology of laryngotracheitis formation of the flavovirent crusts filling a gleam of airways is observed.
The catarrhal form of chronic laryngotracheitis is characterized by hyperaemia mucous with a stagnant tsianotichny shade, a thickening mucous due to its infiltration, expansion of submucous vessels and existence in a submucous layer of the melkotochechny (petekhialny) hemorrhages caused by the increased permeability of vessels.
At chronic hypertrophic laryngotracheitis the giperplaziya of an epithelium mucous, soyedinitelnotkanny elements of a submucous layer and mucous glands, infiltration of fibers of internal muscles of a throat and trachea including muscles of vocal chords takes place. The thickening of vocal chords at hypertrophic laryngotracheitis can have diffusion character or have limited localization in the form of small knots. The last received the name of "singing small knots" as they are most often observed at persons whose work is connected with the raised voice loading (singers, lecturers, teachers, actors). At hypertrophic laryngotracheitis emergence of a prolapse of a ventricle of a throat or a contact ulcer of a throat, formation of cysts is possible.
The atrophic form of chronic laryngotracheitis is followed by replacement of a cylindrical resnitchaty epithelium mucous flat orogovevayushchy, a sklerozirovaniye of soyedinitelnotkanny elements of a submucous layer, an atrophy of intra guttural muscles and mucous glands. Thinning of vocal chords, drying of a secret of mucous glands in the form of covering wall of a throat and a trachea of crusts is observed.
Symptoms of sharp laryngotracheitis
As a rule, symptoms of sharp laryngotracheitis appear against the background of already available displays of an upper respiratory tract infection: the increased body temperature, cold, a congestion of a nose, irritation or a sore throat, discomfortable feelings when swallowing. Clinical symptoms of viral laryngotracheitis can arise after decrease in body temperature to subfebrilny figures.
Sharp laryngotracheitis is characterized by dry cough which because of narrowing of a throat in the field of vocal chords can have the "barking" character. During cough and some period after it is noted pain, typical for tracheitis, behind a breast. Cough is noted more often in the morning and at night, can be shown in the form of an attack. The fit of coughing provokes inhalation of cold or dusty air, laughter, crying, sometimes just deep breath. Cough is followed by allocation of a small amount of a viscous mucous phlegm. In process of development of laryngotracheitis a phlegm to become more liquid and plentiful, gains mucopurulent character. Along with cough hoarseness or an osiplost of a voice, discomfort in a throat (tickling, burning, dryness, feeling of a foreign matter) is noted.
At patients with sharp laryngotracheitis increase and morbidity of cervical group of lymph nodes quite often comes to light (lymphadenitis). At percussion of change of a perkutorny sound it is not observed. Auskultativno is listened noisy breath, sometimes the dry or medium-caliber damp rattles which are localized mainly in the field of bifurcation of a trachea.
Symptoms of chronic laryngotracheitis
At chronic laryngotracheitis patients complain of violation of a voice, cough and unpleasant feelings in a throat and behind a breast. Violation of a voice (dysphonia) can vary from the insignificant osiplost which is appearing generally in the morning and in the evening and not shown during the day to constant hoarseness. At some patients having chronic laryngotracheitis fatigue after voice loading is noted. Aggravation of a dysphonia at adverse climatic conditions is possible, in the period of an exacerbation of chronic laryngotracheitis, at women — at hormonal reorganization (pregnancy, a climax, the beginning of periods). The constant dysphonia demonstrates morphological changes of vocal chords, generally hypertrophic or keratozny character. For persons of certain professions even little change of a voice as a result of the chronic course of laryngotracheitis can become the psychoinjuring factor leading to a sleep disorder, a depression, a neurasthenia.
Cough at chronic laryngotracheitis has constants character. The phlegm separates in a small amount. In the period of an exacerbation of laryngotracheitis against the background of constant cough kashlevy attacks are observed, increase in quantity of a phlegm is noted. Constant cough at patients is often caused by the unpleasant feelings provoking it in a throat: irritation, dryness, tickling and so forth.
Distribution of infectious process of a trachea to underlying departments of respiratory system leads to emergence of a trakheobronkhit and pneumonia. At chronic laryngotracheitis there can be long pneumonia. At children emergence of a bronkhiolit is possible. Development against the background of laryngotracheitis of bronchopulmonary complications is characterized by rise in body temperature and strengthening of symptoms of intoxication. Cough gains constant character. In lungs diffusion dry and focal damp rattles are auskultativno listened. Perhaps local obtusion of a perkutorny sound.
The phlegms arising at a sharp lagingotrakheit a congestion in a gleam of a throat and a reflex spasm of guttural muscles at small children can lead to emergence of an attack of false croup. The expressed obstruction accompanying a croup can cause the asphyxia constituting danger of death to the patient.
The constant irritation of a mucous throat and trachea at cough and as a result of a chronic inflammation at chronic laryngotracheitis can provoke emergence of a benign tumor of a throat or trachea. Besides, chronic laryngotracheitis, especially its hypertrophic form, belongs to precancer states as can lead to malignant transformation of cages mucous with development of throat cancer.
Diagnosis of laryngotracheitis
Laryngotracheitis is diagnosed on the basis of complaints of the patient and data of his anamnesis; results of survey, percussion and auskultation of lungs; results of a laringotrakheoskopiya, bacteriological researches, X-ray and KT of diagnostics.
Helps to diagnose laryngotracheitis and to define its form the mikrolaringoskopiya allowing to carry out if necessary an intake of biopsiyny material. Identification of the causative agent of laryngotracheitis is carried out by bacteriological crops of a phlegm and dabs from a pharynx and a nose, microscopy of a phlegm and the analysis of a phlegm on the CUBE (kislorodoustoychivy bacteria), IFA, RIF and PTsR-researches. At detection of a tubercular etiology of laryngotracheitis consultation of the phthisiatrician is necessary. In cases when laryngotracheitis is display of syphilis, the patient is examined the otolaryngologist together with the venereologist.
To patients with it is long the current chronic laryngotracheitis, especially at identification during a laringotrakheoskopiya of hypertrophic changes, consultation of the oncologist, carrying out frontal KT of a throat and an endoscopic biopsy is necessary. For diagnostics of bronchopulmonary complications of laryngotracheitis the X-ray analysis of lungs is shown.
Laryngotracheitis needs to be differentiated from diphtheria, a foreign matter of a throat and a trachea, pneumonia, a papillomatoz of a throat and malignant tumors, bronchial asthma, zaglotochny abscess.
Treatment of laryngotracheitis
In most cases therapy of laryngotracheitis is performed in out-patient conditions. Cases of a false croup can demand hospitalization in a hospital. Reception of a large amount of warm liquid (tea, compote, kissel) is recommended to the patient with sharp laryngotracheitis or an exacerbation of chronic laryngotracheitis. Indoors, where there is a patient there has to be rather moistened warm air.
Etiotropny therapy of viral laryngotracheitis consists in purpose of antiviral medicines (interferon, remantadin, , ). At the bacterial and mixed laryngotracheitis system antibiotic treatment is shown by medicines of a broad spectrum of activity (tsefuroksy, , amoxicillin, ). Symptomatic therapy of laryngotracheitis consists in use of protivokashlevy, antihistaminic, mukolitichesky and febrifugal medicines. The good effect at patients with laryngotracheitis is rendered by oil and alkaline inhalations, an electrophoresis on area of a throat and trachea.
Treatment of chronic laryngotracheitis is supplemented with immunomodulatory therapy (bronkho-munat, , immunat), purpose of vitamin C, polyvitaminic complexes, a karbotsesteina. At chronic laryngotracheitis physiotherapeutic methods are widely applied: UVCh, medicinal electrophoresis, induktotermiya, inhalation therapy, massage.
Surgical treatment is shown in some cases chronic hypertrophic laryngotracheitis when medicamentous therapy does not give desirable effect and there is a threat of emergence of a malignant new growth. Surgery can consist cysts, elimination of a prolapse of a ventricle, excision of excess tissue of throat and vocal chords at a distance. Operations are made by an endoscopic method with use of the microsurgical equipment.