Acute and chronic laryngitis - Diagnosis

When collecting anamnesis, attention is paid to the presence of etiopathogenetic factors in the development of the disease and the frequency of relapses.

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Indications for consultation with other specialists

To clarify the etiology of the development of the inflammatory process in the larynx, a consultation with a gastroenterologist, pulmonologist, allergist, immunologist, endocrinologist, mycologist, therapist, gastroenterologist, rheumatologist and phthisiatrician is indicated. Patients with severe phlegmonous laryngitis with suspected development of phlegmon of the neck or mediastinitis are indicated to consult a surgeon; patients with chronic hyperplastic laryngitis - an oncologist.

Laboratory diagnostics of laryngitis

Patients with catarrhal form of acute or chronic laryngitis do not require special examination. Patients with acute abscessing, infiltrative and chronic laryngitis undergo a comprehensive general clinical examination. In addition, microbiological, mycological, histological studies are necessary; in some cases, PCR diagnostics are used to identify the etiological factors of the disease.

Instrumental diagnostics of laryngitis

The main method of diagnosing laryngitis is laryngoscopy. The picture of acute laryngitis is characterized by hyperemia, edema of the mucous membrane of the larynx, and increased vascular pattern. The vocal folds are usually pink or bright red, thickened, the slit during phonation is oval or linear, and sputum accumulates in the nodular zone.

Subglottic laryngitis is a ridge-like thickening of the mucous membrane of the subglottic part of the larynx. If it is not associated with intubation trauma, its detection in adults requires differential diagnosis with systemic diseases and tuberculosis. Infiltrative laryngitis is characterized by significant infiltration, hyperemia, an increase in volume and impaired mobility of the affected part of the larynx. Fibrinous deposits are often visible, and purulent contents are visible at the site of abscess formation. Severe laryngitis and chondroperichondritis of the larynx are characterized by pain upon palpation, impaired mobility of the laryngeal cartilages, and possible infiltration and hyperemia of the skin in the projection of the larynx. An abscess of the epiglottis looks like a spherical formation on its lingual surface with oozing purulent contents.

The laryngoscopic picture of chronic laryngitis is varied. In the absolute majority of cases, the pathology is bilateral. Chronic catarrhal laryngitis is characterized by increased vascular pattern of the vocal folds, their hyperemia, dryness of the mucous membrane. In chronic edematous-polypous laryngitis, the appearance of polypoid degeneration of the mucous membrane can vary from a light spindle-shaped glassy tumor (like a "belly") to a heavy floating polypoid translucent gray or gray-pink gelatinous thickening that stenoses the lumen of the larynx.

Candidal laryngitis is characterized by hyperemia and edema of the mucous membrane, the presence of white fibrinous deposits. There are tumor-like, catarrhal-membranous and atrophic forms. In chronic hyperplastic laryngitis, there is infiltration of the vocal folds, foci of keratosis, hyperemia and pachydermia (hyperplasia of the mucous membrane in the interarytenoid region). Keratosis is a general name for dermatoses characterized by thickening of the oral layer of the epidermis. In the case of hyperplastic laryngitis, this is pathological keratinization of the epithelium of the mucous membrane of the larynx in the form of pachydermia, leukoplakia and hyperkeratosis. In atrophic laryngitis, the mucous membrane of the vocal folds looks dull, there may be viscous sputum, hypotension of the vocal folds and their failure to close during phonation.

To clarify the severity of the inflammatory process and differential diagnosis, X-ray or computed tomography of the larynx and trachea, endofibrolaryngotracheoscopy, and a study of the function of external respiration to assess the degree of respiratory failure in laryngitis accompanied by stenosis of the airways are used. In patients with phlegmonous and abscessing laryngitis, X-ray of the lungs and X-ray tomography of the mediastinum are performed. Esophagoscopy is indicated to exclude esophageal pathology, especially in patients with purulent processes in the larynx. The use of microlaryngoscopy and microlaryngostroboscopy allows for differential diagnosis with cancer, papillomatosis, and tuberculosis of the larynx. Microlaryngostroboscopic examination of keratosis allows for the detection of areas of keratosis fused with underlying layers of the mucous membrane, which is most suspicious in terms of malignancy.

Differential diagnosis of acute and chronic laryngitis

Differential diagnostics are carried out primarily with cancer and tuberculosis of the larynx. In all cases of subglottic laryngitis, arthritis of the cricoarytenoid joint, a systemic disease should be excluded. Involvement of the larynx in the pathological process in Wegener's granulomatosis is also found in 24% of cases in the form of subglottic laryngitis, accompanied by stenosis of the subglottic section. Isolated lesion of the larynx in scleroma is observed in 4.5% of cases, most often the nose, nasopharynx and larynx are involved in the process. In this case, pale pink tuberous infiltrates are formed in the subglottic space. The process can spread to the trachea or in the cranial direction to other parts of the larynx. There are primary amyloidosis of the larynx (nodular or diffusely infiltrative forms) and secondary, developing 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 mucous membrane, sometimes spreading to the tracheobronchial tree. Amyloid deposits are localized mainly in the supraglottic part of the larynx, sometimes in the form of subglottic laryngitis. Sarcoidosis occurs in the larynx in 6% of cases in the form of epiglottitis and granulomatosis. The vocal folds are rarely affected. In rheumatoid arthritis, laryngeal pathology is diagnosed in 25-30% of patients. Clinically, the disease manifests itself as arthritis of the cricoarytenoid joint. Differential diagnosis is based on general clinical, serological studies and biopsy. Tuberculosis of the larynx is characterized by polymorphism of changes. Formation of miliary nodules, infiltrates, which undergo disintegration with the formation of granulations, ulcers and scars are noted. Tuberculomas and chondroperichondritis are often formed. Syphilis of the larynx manifests itself as erythema, papules and condylomas. Ulcers covered with a grayish-white coating are often formed.

Differential diagnostics of abscessing and phlegmonous laryngitis is carried out with congenital polycystic cyst of the tongue root, suppurating laryngocele, cancer of the larynx or entrance to the esophagus. Abscess of the epiglottis must be differentiated from ectopic thyroid gland.

Differential diagnostics of chronic hyperplastic laryngitis and laryngeal cancer often presents great difficulties. Indirect microlaryngoscopy pays attention to the nature of the vascular pattern. Atypia of capillaries is pathognomonic for laryngeal cancer - an increase in their number, a tortuous shape (like a corkscrew), uneven expansion of vessels, and pinpoint hemorrhages. The vascular pattern is generally chaotic. Impaired mobility of the vocal fold, the one-sided nature of the process may indicate malignancy of chronic laryngitis. Other changes in the vocal fold also attract attention - pronounced dysplasia, infiltration of the mucous membrane, the formation of foci of dense keratosis fused with the underlying tissues, etc.

The final diagnosis of laryngitis is established based on the results of histological examination.

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