acute laryngitis
Introduction
Introduction to acute laryngitis Acute laryngitis (acutelaryngitis) is an acute catarrhal inflammation of the laryngeal mucosa, often secondary to acute rhinitis, sinusitis, acute pharyngitis, which is part of the entire upper respiratory tract infection and can occur separately. Sometimes shouting loudly, excessive use of sputum, severe cough, can also cause acute laryngitis, if it occurs in children, the condition is more serious. Indirect laryngoscopy revealed diffuse congestion of the mucous membrane of the larynx, swelling, vocal cords were reddish or bright red, sometimes visible submucosal hemorrhage or viscous secretions, vocal cord swelling, free margins became pure, vocal cords on both sides when vocalization Can't close. Indirect laryngoscopy, fiber laryngoscopy or electronic laryngoscopy showed acute congestion and swelling of the laryngeal mucosa, characterized by bilateral symmetry, diffuse, normal vocal cord movement, closed gap. Mucosal congestion and swelling, usually first appeared in the vocal cords, gradually developed to lead to mucosal congestion and swelling under the ventricular zone and glottis, with vocal cords and sputum most obvious. The surface of the early vocal cord mucosa was reddish, and the blood-filled vascular pattern gradually became dark red, and the vocal cord edge was round and blunt into a fusiform shape. The early secretion of the mucous membrane of the larynx is less, and then the mucus secretion adheres to the surface of the vocal cords. The hoarseness is aggravated due to the incomplete closure of the vocal cords. After the secretion is coughed out, the hoarseness can be alleviated. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: blocked throat
Cause
Cause of acute laryngitis
Systemic factors (30%):
When the tobacco and alcohol stimulate, cool, and fatigue, the body's resistance is reduced, it is easy to induce the disease. The disease is mostly related to colds, usually with viral invasion and secondary bacterial infection. Common pathogenic viruses include: influenza virus, parainfluenza virus, rhinovirus, adenovirus; common pathogenic bacteria include hemolytic streptococcus, Streptococcus pneumoniae, Haemophilus influenzae, and catarrhalis.
Occupational factors (30%):
Inhalation of excessive production dust, harmful gases (such as chlorine, ammonia, sulfuric acid, nitric acid, etc.) can cause acute inflammation of the laryngeal mucosa. Improper vocalization or excessive use of sputum can also cause acute laryngitis, especially in occupations such as teachers, actors, and sales clerk.
Trauma (20%):
Laryngeal foreign body, neck and throat trauma and examination of instrument damage to the laryngeal mucosa can also cause laryngeal mucosal edema or submucosal hematoma secondary to acute laryngitis.
Allergies (10%):
Specific foods, gases or drugs can cause edema of the larynx mucosa in patients with specific constitution, resulting in acute laryngitis.
Prevention
Acute laryngitis prevention
1. Conduct appropriate physical exercise, maintain a healthy routine, ensure adequate sleep and rest, adjust your physical condition and good mentality to improve your overall immunity and avoid colds.
2. Avoid excessive use and abuse of voices.
3. Light diet, avoid alcohol and tobacco stimulation, avoid dry mouth, drink plenty of water, light diet, often eat vegetables and fruits, avoid spicy and stimulating diet, such as excessive consumption of pepper, strong tea, espresso, carbonated drinks, Fried foods, puffed foods and dried fruit foods, such as sweet and salty foods such as chocolate and candy.
4. Keep indoor air circulation and moisture, avoid cold and high heat temperature stimulation; avoid contact with dust, irritating gases and harmful gases, poor air quality and other factors that are unfavorable to the throat mucosa.
5. Try to avoid exposure to allergens that cause chronic allergic pharyngitis. Avoid allergic foods.
6. Active treatment of upper respiratory tract infections and adjacent lesions such as rhinosinusitis, pharyngitis, bronchitis, etc.
Complication
Acute laryngitis complications Complications
The systemic symptoms are heavy, the complications are many, and acute laryngeal obstruction is prone to occur after the onset.
Symptom
Acute laryngitis symptoms Common symptoms Fever, difficulty breathing, cold, chills, chills, sore throat, throat congestion
symptom
1. Acoustic hoarseness and hoarseness are the main symptoms of acute laryngitis, mainly due to edema and congestion of vocal cord mucosa. When the light is vocal, the sound quality is less rounded and clear, the pitch is lower and thicker than before; the heavy voice is hoarse and vocal, and even more can only be whispered or completely lost.
2. Patients with sore throat feel discomfort, dryness, burning sensation, foreign body sensation, slight pain in the throat and trachea, and increased sore throat during vocalization. Usually the pain caused by acute laryngitis does not affect swallowing.
3. Cough due to increased inflammation of the laryngeal mucosa, often cough, dry cough without sputum, to the late throat there are sticky purulent secretions, because thicker, often difficult to cough up. If the secretion adheres to the surface of the vocal cords, it can aggravate the hoarseness.
4. Difficulty in breathing a small number of severe adult acute laryngitis due to laryngeal mucosal edema can cause inspiratory dyspnea, this condition is common in subglottic acute laryngitis, due to the narrow space under the glottic region, if the mucosal height edema is bound to cause The airway is blocked.
5. Systemic symptoms Adults generally have less symptoms of systemic poisoning. Heavier bacterial infections can be associated with systemic symptoms such as fever, chills, burnout, and loss of appetite.
6. Infection of adjacent organs Because the respiratory mucosa continues each other, acute laryngitis may be a descending infection of acute rhinitis or acute pharyngitis, so it is often accompanied by inflammatory symptoms of the nose and throat. Acute laryngitis can also be associated with symptoms of lower respiratory tract infections such as the trachea, bronchi, and lungs.
Sign
Indirect laryngoscopy, fiber laryngoscopy or electronic laryngoscopy showed acute congestion and swelling of the laryngeal mucosa, characterized by bilateral symmetry, diffuse, normal vocal cord movement, closed gap. Mucosal congestion and swelling, usually first appeared in the vocal cords, gradually developed to lead to mucosal congestion and swelling under the ventricular zone and glottis, with vocal cords and sputum most obvious. The surface of the early vocal cord mucosa was reddish, and the blood-filled vascular pattern gradually became dark red, and the vocal cord edge was round and blunt into a fusiform shape. The early secretion of the mucous membrane of the larynx is less, and then the mucus secretion adheres to the surface of the vocal cords. The hoarseness is aggravated due to the incomplete closure of the vocal cords. After the secretion is coughed out, the hoarseness can be alleviated.
Examine
Acute laryngitis examination
Indirect laryngoscopy revealed diffuse congestion of the mucous membrane of the larynx, swelling, vocal cords were reddish or bright red, sometimes visible submucosal hemorrhage or viscous secretions, vocal cord swelling, free margins became pure, vocal cords on both sides when vocalization Can't close.
Diagnosis
Diagnosis and differentiation of acute laryngitis
diagnosis
Careful medical history, patients usually hoarse after a cold, fatigue or resistance, or after the above incentives, or / and throat swelling, cough, increased throat secretion, or with systemic symptoms, indirect laryngoscope , fiber laryngoscope or electronic laryngoscopy can be seen vocal cord congestion, edema, laryngeal mucosa is also congested and swollen, vocal cord movement is good, closed gap, the diagnosis of acute laryngitis is basically established.
Differential diagnosis
Vocal cord benign lesion
Benign vocal cord lesions such as vocal cord nodules, vocal cord polyps, papilloma, vocal cord submucosal cysts, submucosal hematoma, contact ulcers and granuloma, Ren Ke's layer edema, hemangioma, neurofibroma, laryngeal amyloidosis, etc. . The above lesions can also be expressed as hoarseness, accompanied by aggravation of hoarseness, laryngeal discomfort and sore throat. However, the above-mentioned vocal cord benign lesions have a long history of hoarseness, and the course of the disease is usually more than 3 months. The corresponding vocal cord lesions can be seen by indirect laryngoscopy, fiberoptic laryngoscopy or electronic laryngoscopy. Combined with pathological examination, the diagnosis can be confirmed.
Laryngeal precancerous lesion
Laryngeal precancerous lesions are a group of diseases that are more prone to cancer (but not necessarily) than normal laryngeal mucosa, including laryngeal leukoplakia, laryngeal thick skin disease, adult laryngeal papilloma, chronic laryngitis with atypical hyperplasia of mucosal epithelial cells, Laryngeal keratosis and the like. Laryngeal precancerous lesions usually have a longer course of disease, and the symptoms can be gradually aggravated. Indirect laryngoscopy, direct laryngoscopy or fiber laryngoscopy can be used to detect the corresponding laryngeal lesions. Combined with pathological examination, the diagnosis can be confirmed, but the initial stage of the disease needs to be differentiated from acute laryngitis. .
Laryngeal leukoplakia refers to flaky keratinizing lesions on the laryngeal mucosa, which are more common in vocal cords. May be associated with smoking, improper use, chronic inflammatory irritation or vitamin deficiency. The main pathological changes were laryngeal mucosal epithelial hyperplasia with incomplete keratinization, and submucosal tissue with mild hyperplasia. The main symptom is hoarseness. Under the laryngoscope, there are white patchy ridges with smooth surface on the front and middle third of the vocal cord surface or front edge. The range is limited, it is difficult to remove, and the vocal cords move well.
Laryngeal thick skin disease is a kind of hypertrophic laryngitis. The main pathological changes are mucosal epithelial hyperplasia in the posterior larynx, the number of cell layers is increased, and the surface cells are keratinized. The connective tissue under the epidermis of the mucosa thickens to form a papillary process that extends into the epidermis. The epidermis layer has a clear boundary with the connective tissue under it, and there is no cell infiltration. The main clinical manifestations are hoarseness and dry throat.
Adult laryngeal papilloma is a tumor from the laryngeal epithelial tissue. The multi-squamous squamous epithelium and the connective tissue under it grow to the surface as papillary protrusions. It is more likely to be malignant, showing hoarseness and dyspnea in the late stage. The body is visible as a new creature in the throat, which has a rough appearance and a reddish color.
Chronic laryngitis with mucosal dysplasia, the main histological change is epithelial hyperplasia and degeneration, this hyperplasia and degeneration is basically the same as laryngeal epidermis, only to a certain extent. The main clinical symptoms are hoarseness and throat discomfort. The body's laryngeal mucosa is extensively hypertrophied and chronically congested. It is generally symmetrical, and the mucosa is more obvious in the intercondylar region. The vocal cords are obviously thick and thick, and there is a gap when they are close to the center line, which is closed and incomplete. The chamber belt is often subjected to hypertrophy and covers part of the vocal cords. can also be thicker than normal.
Laryngeal malignancy
Malignant laryngeal tumors include laryngeal squamous cell carcinoma, adenocarcinoma, basal cell carcinoma, poorly differentiated carcinoma, lymphoma, etc. Among them, laryngeal squamous cell carcinoma (laryngeal cancer) is the most common, accounting for about 90%. In the early stage of the disease, laryngeal malignant tumors also show hoarseness and throat discomfort. The new organisms in the throat can be seen in the examination, and pathological examination should be performed to further confirm the diagnosis.
Laryngeal cancer can be divided into supraglottic, glottic and subglottic according to the site of occurrence; according to morphological observation, laryngeal cancer can be divided into ulcer invasive, cauliflower, nodular and mixed. The main early symptoms of laryngeal cancer are mainly hoarseness. As the disease progresses, there may be a foreign body sensation of the throat, cough, difficulty in swallowing, and lymph node metastasis in the neck. Physical examination revealed new neoplasms in the throat, the surface is not smooth, and the vocal cord movement can be affected as the disease progresses. Through throat CT and MRI, the status and metastasis of laryngeal cancer invading surrounding tissues and organs were determined. Ultrasound can be used to observe lymph node metastasis and its relationship to surrounding tissues. The final diagnosis is to be confirmed by pathological examination.
Vocal cord dyskinesia
Under normal conditions, the movement of the larynx muscles causes the vocal cords to move and close. This complex and coordinated movement is dominated by the recurrent laryngeal nerves, and the vocal cords can be in different positions according to different physiological needs of the larynx. When there is neurogenesis paralysis, laryngeal muscle disease, ring ankle arthritis or dislocation of the ankle joint that dominates the vocal cord movement, the vocal cord movement ability will be limited to varying degrees, and the vocal cords will be displaced at the same time and vocal cord paralysis, showing hoarseness. Indirect laryngoscopy, fiberoptic laryngoscopy or electronic laryngoscopy can detect the vocal cord dyskinesia of the lesion. The vocal cords can not be abducted while inhaling, while the healthy side vocal cords are abducted normally. The glottis can still be closed when vocalization; The lateral vocal cord movement is limited and the patient will immediately experience severe breathing difficulties. The diagnosis can be confirmed based on the patient's medical history, physical signs and throat examination.
Special inflammation of the larynx
Throat diphtheria is an acute respiratory tract type B infectious disease, which is mainly transmitted through respiratory droplets or in contact with infected patients. The pathogenic bacteria are Corynebacterium diphtheriae. Throat and diphtheria can also be expressed as hoarseness, sore throat, cough and other symptoms. The formation of gray and thick pseudomembrane can be seen in the throat. The pseudomembrane of the throat in the early stage of the disease can be atypical, but the condition of the throat and diphtheria develops sharply, accompanied by symptoms of systemic poisoning. Such as fever, fatigue, nausea and vomiting, headache and so on. Severe cases of neck swelling due to cervical lymphadenitis such as "cattle neck". Throat diphtheria is more common in children, rarely occurs in adults, and it is possible to further confirm the diagnosis of suspected throat smear and bacterial culture.
The pathogenic bacteria of laryngeal tuberculosis is Mycobacterium tuberculosis. Primary laryngeal tuberculosis is rare, and it is mostly spread by open tuberculosis through the lower respiratory tract. The main symptoms are hoarseness, gradual increase, often accompanied by sore throat, aggravation when swallowing, indirect laryngoscopy, fiberoptic laryngoscopy or electronic laryngoscopy revealed pale laryngeal mucosa, intercondylar or lateral vocal cord localized congestion, may appear It is a worm-like ulcer with irregular edges and granulation hyperplasia at the bottom. It is swollen and thickened by epiglottis and phlegm. If the lesion involves the ankle joint, the vocal cords can be fixed. Can be diagnosed by sputum examination, acid-fast bacilli, chest X-ray positive lateral film, tuberculin test and biopsy.
