Acute catarrhal laryngitis

Acute catarrhal laryngitis is characterized by acute inflammation of the mucous membrane of the larynx, caused by infection with common microbiota.

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Cause and pathogenesis of acute catarrhal laryngitis

Usually acute catarrhal laryngitis is a consequence of a systemic disease defined as ARI, the onset of which is acute nasopharyngitis, the development of which is descending inflammation of the mucous membrane of the larynx and trachea. In the process of ARI development, the larynx in some cases remains intact, in others - it is in it that the main phenomena of acute inflammation develop (individual predisposition). The disease is more common in men exposed to harmful household habits (smoking, alcohol consumption) or professional atmospheric hazards. An important role in provoking acute catarrhal laryngitis and activation of opportunistic microbiota, vegetating as saprophytic, is played by climatic seasonal conditions (cold, high humidity), most actively manifested in spring and autumn. Inhaled cold air causes adverse local vascular reactions in the form of spasm or dilation of the laryngeal vessels, impaired microcirculation, decreased local immunity and, as a result, activation of the microbiota. These phenomena are also promoted by hot dry air and various occupational hazards in the form of vapors of various substances or fine dust particles. Endogenous risk factors include general weakening of the body due to diseases of internal organs (liver, kidneys, endocrine system), negatively affecting metabolic processes, alimentary and vitamin deficiencies.

An important role in the development of acute catarrhal laryngitis is played by chronic banal rhinitis and rhinosinusitis, hypertrophic and polypous rhinitis, curvature of the nasal septum, which impairs nasal breathing, as well as adenoiditis, chronic tonsillitis and other chronic diseases of the nasopharynx and pharynx. Functional overstrain of the vocal function can be of significant importance, especially in conditions of unfavorable climatic factors.

The etiological factors are microorganisms such as hemolytic and viridans streptococcus, staphylococcus, pneumococcus, catarrhal micrococcus. Most often, acute catarrhal laryngitis is caused by a polymicrobial association, which can be activated by influenza infection, and then acute catarrhal laryngitis acts as microepidemic outbreaks, most often in children's groups.

Acute catarrhal and deeper inflammatory reactions of the larynx can occur as a result of exposure to various traumatic factors (foreign bodies, chemical burns, damage to the larynx during intubation or trachea and gastric probing).

Pathological anatomy

In the initial stage of acute catarrhal laryngitis, hyperemia of the mucous membrane is observed as a result of paresis (dilation) of the vessels, followed by submucous effusion of transudate and infiltration of the mucous membrane with leukocytes and, in particularly acute cases, erythrocytes with microhemorrhages. Hemorrhagic forms of acute catarrhal laryngitis are observed in viral etiology of the disease. Following the transudate, there is an inflammatory exudate, initially mucous, then purulent in nature, containing a large number of leukocytes and desquamated epithelial cells of the mucous membrane. In some cases, the toxic effect of the inflammatory process causes the spread of edema into the subglottic space, which is especially common in young children due to the presence of loose connective tissue in this area. In this case, they speak of false croup.

Acute catarrhal laryngitis may be accompanied by secondary myositis of the internal muscles of the larynx with predominant damage to the vocal muscles; less frequently, arthritis of the cricoarytenoid joints occurs, which, as a rule, is manifested by hoarseness of the voice, up to complete aphonia. Cough and vocal strain in acute catarrhal laryngitis often lead to erosions of the mucous membrane in the area of the free edge of the vocal folds, which causes pain during phonation and coughing.

Symptoms of acute catarrhal laryngitis

At the onset of the disease, there is a feeling of dryness, irritation and burning in the larynx, pain during phonation; then hoarseness or aphonia (with paresis of the vocal folds), a barking cough causing painful tearing pains appear. After a day or two, sputum appears, while the intensity of the pain syndrome and hyperesthesia decrease sharply. The general condition in typical uncomplicated forms suffers little. Sometimes, especially if acute catarrhal laryngitis occurs against the background of generalized ARI, the body temperature, accompanied by chills, can rise to 38 ° C. In these cases, the inflammatory process, as a rule, spreads to the trachea and, in severe forms, to the bronchi and lung tissue (bronchopneumonia). Usually, such development of ARI is characteristic of an unfavorable epidemic situation.

During the culmination of the disease, the endoscopic picture of the larynx is characterized by hyperemia of the entire mucous membrane, especially pronounced in the area of the vocal folds and pyriform sinuses, often spreading to the upper parts of the trachea, as well as edema, the presence of mucopurulent exudate, and failure of the vocal folds to close.

Myositis of the internal muscles of the larynx manifests itself as paresis of the thyrocricoid muscles, which may continue for some time after the elimination of local inflammatory phenomena, especially if the voice regime is not observed at the height of the disease. In plethoric (full-blooded) individuals or those suffering from chronic upper respiratory tract infections, the disease may become protracted and develop into a chronic form of laryngeal inflammation.

After 5-6 days, the severity of dysphonia gradually decreases, and signs of catarrhal inflammation completely disappear by the 12th-15th day from the onset of the disease.

In some cases, localized acute catarrhal laryngitis is observed. Sometimes, severe hyperemia and infiltration of the mucous membrane involve only the epiglottis, with complaints of pain when swallowing predominating, since during this act the epiglottis descends and covers the entrance to the larynx. In other cases, the inflammatory process is expressed mainly in the mucous membrane of the vestibule folds or only the vocal folds, with phonation disorder (hoarseness or aphonia) predominating. Often, severe hyperemia of the mucous membrane is observed only within the arytenoid cartilages and interarytenoid space (laryngitis acuta posterior), which is accompanied by a strong cough, since this area contains very sensitive "cough" receptors of the superior laryngeal nerve. The most severe form of isolated laryngitis is subglottic laryngitis, which is characterized by inflammation and swelling of the lower surface of the vocal folds and the subglottic space, the walls of which contain loose submucous connective tissue. This disease occurs mainly in children with exudative or lymphatic diathesis. The form of subglottic laryngitis, in which spasms of the larynx occur periodically, is called false croup.

In diffuse acute laryngitis, the mucous membrane is sharply hyperemic, the edema is most pronounced in the area of the vestibular and aryepiglottic folds. The sharp edge of the vocal folds thickens and takes the form of rounded ridges. Stroboscopic examination reveals limited mobility and asynchrony of oscillations of the vocal folds. The epithelium peels off in places, causing ulcers to form in places. Blood sometimes leaks from dilated vessels, forming purple-red dots and stripes on the surface of the mucous membrane of the vocal folds (acute hemorrhagic laryngitis), which occurs more often with viral influenza. With this form of acute laryngitis, the amount of exudate increases, but due to the high protein content, it quickly dries into crusts covering a significant part of the inner surface (laryngitis acuta sicca).

Complications of acute catarrhal laryngitis

Complications of acute catarrhal laryngitis are rare and are observed in individuals weakened by previous infectious diseases or concomitant viral infections. These complications are manifested mainly by the spread of the inflammatory process to the submucosal layers, which is manifested by severe edema, up to obstructive laryngitis with impaired respiratory function of the larynx, especially common in children in the form of false croup (subglottic laryngitis). Complications such as laryngeal abscess, perichondritis and chondritis are rare, but their occurrence should always be foreseen in the treatment tactics and at the slightest suspicion of their possibility, the most effective treatment methods should be taken.

The diagnosis is established on the basis of anamnesis data (presence of a cold factor, etc.), acute onset, symptoms of the disease and laryngeal endoscopy data. Differential diagnostics are carried out with influenza and measles laryngitis, laryngeal diphtheria and other infectious diseases characterized by laryngeal lesions). In particular, laryngeal diphtheria cannot be rejected even in cases where it occurs atypically, without the formation of diphtheria films (true croup). In doubtful cases, it is necessary to conduct a bacteriological study of mucopurulent discharge obtained from the surface of the mucous membrane of the larynx and preventive treatment with antidiphtheria serum.

Syphilitic laryngitis, which affects the larynx in the secondary stage of this disease, is also difficult to differentiate from banal acute catarrhal laryngitis; general good condition, the absence of pronounced signs of pain syndrome, the presence of rashes on the skin and mucous membrane of the oral cavity should alert one to the possibility of a syphilitic disease of the larynx.

Miliary tuberculosis of the larynx in the initial stage may manifest itself with signs of acute banal laryngitis. In these cases, the general condition of the patient and the data of the pulmonary examination, along with specific serological reactions, are taken into account. Laryngitis of allergic genesis differs from acute catarrhal laryngitis by the presence of predominantly gelatinous edema of the mucous membrane, rather than inflammatory manifestations.

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Treatment of acute catarrhal laryngitis

The main treatment for patients with acute catarrhal laryngitis is a strict voice regimen with the exclusion of sonorous phonation. Whispered speech is allowed in necessary cases. The patient should be in a warm room with high humidity in a state of relative rest for 5-7 days. Spicy, salty, hot food, smoking, and alcohol consumption are excluded. In mild cases, voice rest, a gentle diet (not spicy food), warm drinks, and antitussives and expectorants for coughs are sufficient. This is often enough for the patient to recover spontaneously. In moderate cases, manifested by a strong cough, an increase in body temperature to 37.5 ° C, general weakness, and pain syndrome, complex treatment is prescribed, including physiotherapy, symptomatic medication, decongestants, and antibacterial agents, mainly of local action. In case of abundant viscous sputum, inhalations of proteolytic enzymes are prescribed.

Of the physiotherapeutic means, semi-alcoholic warming compresses on the front surface of the neck are indicated, in some cases, if there is a suspicion of aggravation of the inflammatory process - UHF on the larynx in combination with antihistamines and local antibiotics (bioparox). V. T. Palchun et al. (2000) recommend an effective mixture for infusion into the larynx, consisting of 1% menthol oil, hydrocortisone emulsion with the addition of a few drops of 0.1% adrenaline hydrochloride solution. The means of choice are the metered aerosol preparations cameton and camphomen, the combined local drug laripront, which includes lysozyme and dequalinium chloride, which has antimicrobial and antiviral properties. In case of abundant and viscous sputum with the formation of crusts in the larynx, mucolytic drugs are prescribed, in particular, mistabron for inhalation in a diluted form, etc., as well as thermopsis preparations, ammonia-anise drops, bromhexine, terpin hydrate, ambroxol, etc. At the same time, vitamins (C, pentavit), calcium gluconate, antihistamines (diazolin, diphenhydramine) are prescribed.

In severe acute catarrhal laryngitis with a protracted course and a tendency for the process to generalize towards the lower respiratory tract, the treatment is the same + broad-spectrum antibiotics at the beginning of treatment, and then in accordance with the antibiogram.

The prognosis is generally favorable, however, in the presence of concomitant diseases of the upper respiratory tract, and possible household and professional hazards, acute catarrhal laryngitis may develop into other forms of nonspecific laryngitis and into a chronic stage. The prognosis for complicated forms such as perichondritis, laryngeal abscess, etc. is determined by the severity of a specific complication and its consequences (deforming cicatricial stenosis of the larynx, respiratory function deficiency, persistent paresis of the internal muscles of the larynx, ankylosis of its cartilages).

Prevention of acute catarrhal laryngitis

Prevention of acute catarrhal laryngitis consists of timely treatment of infection foci in the upper respiratory tract, adherence to an anti-cold regimen, elimination of household and professional hazards, and reasonable hardening of the body.