What Is Acute Laryngitis?

Acute laryngitis refers to acute non-specific inflammation of the laryngeal mucosa and vocal cords. The course of disease is usually within one month. It is one of the common acute infectious diseases of the respiratory tract, accounting for 1% to 2% of ENT diseases. Acute laryngitis generally refers to acute laryngitis that occurs in adults. Often secondary to acute rhinitis and acute pharyngitis. The incidence is higher in men than in women. Occurs frequently in winter and spring. Acute laryngitis in children has its particularity, which seriously affects breathing, is more severe and changes rapidly.

Basic Information

English name: Acute laryngitis
Visiting department: ENT
Multiple groups: male

Common causes: Tobacco and alcohol irritation, cold, inhalation of harmful gases, trauma, allergies, etc.
Common symptoms: Hoarseness, sore throat, cough, dyspnea, infection of nearby organs

Causes of acute laryngitis

Systemic factors

Tobacco and alcohol irritation, cold, and fatigue can reduce the body's resistance, which can easily induce the disease. The disease is mostly associated with a cold, usually preceded by a virus invasion followed by a bacterial infection. Common pathogenic viruses include: influenza virus, parainfluenza virus, rhinovirus, and adenovirus; common pathogenic bacteria include hemolytic streptococcus, streptococcus pneumoniae, haemophilus influenzae, and catarrhalis.

2. Occupational factors

Excessive production of dust and harmful gases (such as chlorine, ammonia, sulfuric acid, nitric acid, etc.) can cause acute inflammation of the laryngeal mucosa. Improper vocalization or excessive voice can also cause acute laryngitis, especially in occupations that use more voices such as teachers, actors, and salespeople.

3. Trauma

Throat foreign body, trauma to the neck and throat, and examination equipment damage to the laryngeal mucosa, can also cause larynx mucosal edema or submucosal hematoma and secondary acute laryngitis.

4. Allergies

Specific foods, gases, or drugs can cause edema of the laryngeal mucosa in patients with specific constitutions, causing acute laryngitis.

Clinical manifestations of acute laryngitis

Hoarse

Hoarseness is the main symptom of acute laryngitis, mainly due to congestion and edema of the vocal cord mucosa. The lighter sounds are less rounded and clearer, and the tones become lower and thicker than before. The heavy sounds are hoarse and laborious, and they can only whisper or lose their voice completely.

2. Sore throat

The patient feels throat discomfort, dryness, burning sensation, foreign body sensation, slight pain in the throat and front of the trachea, sore throat when speaking, and the pain caused by acute laryngitis does not affect swallowing.

3. cough

Due to increased secretion of laryngeal mucosa, cough is often present, and dry cough without sputum at first, but mucopurulent secretion in late throat, which is thicker and often difficult to cough. If the secretion sticks to the surface of the vocal cords, it can make the voice hoarse.

4. difficulty breathing

A few severe adult acute laryngitis can cause inspiratory dyspnea due to laryngeal mucosal edema. This condition is common in subglottic acute laryngitis. Due to the narrow space in the subglottic region, if the mucosa is highly edema, the airway will be obstructed.

5. Systemic symptoms

Adults generally have mild symptoms of systemic poisoning. Heavier bacterial infections may be accompanied by systemic symptoms such as fever, chills, burnout, and loss of appetite.

6. Infections in nearby organs

Due to the continuation of the respiratory mucosa, acute laryngitis can be a descending infection of acute rhinitis or acute pharyngitis, so it is often accompanied by inflammatory symptoms of the nose and pharynx. Acute laryngitis may also be accompanied by symptoms of lower respiratory tract infections such as trachea, bronchus, and lungs.

Acute laryngitis examination

Indirect laryngoscope, fiber laryngoscope, or electronic laryngoscope examination showed acute congestion and swelling of the laryngeal mucosa, which was characterized by bilateral symmetry, diffuse, normal vocal cord movement, and closed gaps. Mucosal congestion and swelling usually occurs first in the vocal cords. Gradual development leads to congestive and swollen mucosa in the ventricles and subglottis. Vocal cords and epiglottis are most prominent. The surface of the vocal cord mucosa in the early period was reddish, and the blood vessel veins congested could be seen, which gradually turned into dark red, and the edges of the vocal cords were round and blunt. Laryngeal mucosa is secreted early, and mucus secretions adhere to the vocal fold surface, causing hoarseness and exacerbation due to aggravated insufficiency of vocal cord closure; hoarseness can be reduced after secretion.

Diagnosis of acute laryngitis

Careful inquiry about the medical history, patients generally have hoarseness after a cold, fatigue or decreased resistance, or during the above-mentioned causes, and / or sore throat, cough, increased laryngeal secretions, or accompanied by systemic symptoms, indirect laryngoscope 5, fiber laryngoscope or electronic laryngoscope examination showed vocal cord congestion and edema, laryngeal mucosa was also congested and swollen, vocal cord movement was good, closed gap, diagnosis of acute laryngitis was basically established.

Differential diagnosis of acute laryngitis

Benign vocal cord lesions

Various benign lesions of the vocal cords such as vocal nodules, vocal cord polyps, papilloma, vocal cord submucosal cysts, submucosal hematomas, contact ulcers and granulomas, Renker's edema, hemangiomas, neurofibromas, and laryngeal amyloidosis. The above-mentioned lesions can also be expressed as hoarseness, with hoarseness worsening with vocalization, throat discomfort and sore throat. However, the history of hoarseness of benign vocal cord lesions is relatively long, and the course usually exceeds 3 months. Corresponding vocal cord lesions can be seen by indirect laryngoscope, fiber laryngoscope or electronic laryngoscope. Combined with pathological examination, a clear diagnosis can be made.

2. Laryngeal precancerous lesions

Laryngeal precancerous lesions are a group of diseases that are more likely to become cancerous (but not necessarily) than normal laryngeal mucosa, including leukoplakia, laryngeal thick skin disease, laryngeal papilloma in adults, chronic laryngitis with atypical hyperplasia of mucosal epithelial cells, Laryngeal keratosis and so on. Laryngeal precancerous lesions usually have a longer course, and symptoms can gradually increase. Indirect laryngoscopy, direct laryngoscopy, or fiber laryngoscopy can show corresponding laryngeal lesions. Combined with pathological examination, a clear diagnosis can be made, but it must be distinguished from acute laryngitis at the beginning of the onset. .

3. White spot of throat

It refers to the flaky keratoproliferative lesions on the laryngeal mucosa, which are more common in the vocal cords. May be associated with smoking, inappropriate voice use, chronic inflammatory irritation, or vitamin deficiency. The main pathological changes were hyperplasia of the laryngeal mucosa with incomplete keratosis, and mild hyperplasia of the submucosal tissue. The main symptom is hoarseness. Under the laryngoscope, there are flat white patches on the front or middle third of the vocal cord surface or the front edge. The range is limited, it is not easy to remove, and the vocal cord movement is good.

4. Larynx pachyderma

It is a type of hypertrophic laryngitis. The main pathological change is hyperplasia of the mucosa in the posterior larynx, the number of cell layers increases, and the surface cells are keratinized. The connective tissue beneath the epidermis of the mucous membrane thickens, forming papillary protrusions, which extend into the epidermal layer. The boundary between the epidermal layer and the connective tissue beneath it is clear, and there is no cell infiltration infiltration. The main clinical manifestations are hoarseness and dry throat.

5. Laryngeal papilloma in adults

It is a tumor from the laryngeal epithelial tissue. It grows from the multilayer squamous epithelium and the underlying connective tissue to the surface as a papillary protrusion. It is more malignant and manifests as hoarseness. In the later stage, breathing difficulties can also appear. The creature has a rough appearance and is pale red.

6. Chronic laryngitis with atypical hyperplasia of the mucosa

The main histological change is epithelial hyperplasia and degeneration, which is basically the same as laryngeal dermatosis, but only to a certain extent. The clinical symptoms are mainly hoarseness and larynx discomfort. Examination shows that the laryngeal mucosa is extensively hypertrophic, chronically congested, and generally symmetrical, with the intersacral mucosa being more obvious. The vocal cords are obviously thick, and there are gaps when they are closer to the center line, which is incomplete. The ventricular zone is often affected by hypertrophy and covers part of the vocal cords. The epiglottis can also be thicker than normal.

7. Laryngeal Malignancy

Laryngeal malignant tumors include laryngeal squamous cell carcinoma, adenocarcinoma, basal cell carcinoma, poorly differentiated cancer, and lymphoma. Among them, laryngeal squamous cell carcinoma (laryngeal carcinoma) is the most common, accounting for about 90%. Laryngeal malignant tumors also present with hoarseness and discomfort in the throat at the beginning of the onset. New laryngeal organisms can be seen on examination, and pathological examination should be performed to further confirm the diagnosis.

Laryngeal cancer can be divided into supraglottic, subglottic, and subglottic according to the site of occurrence. According to morphological observation, laryngeal cancer can be divided into ulcer infiltrating, cauliflower, nodular, and mixed. The main early symptoms of laryngeal cancer are hoarseness. With the development of the disease, a foreign body sensation in the throat, cough, difficulty swallowing, and lymph node metastasis in the neck may occur. On examination, new organisms in the larynx can be seen, the surface is not smooth, and the vocal cord movement can be affected as the disease progresses. Through laryngeal CT and nuclear magnetic resonance examination, the invasion and metastasis of laryngeal cancer to surrounding tissues and organs were determined. Ultrasound can observe the lymph node metastasis and its relationship with surrounding tissues. Ultimately, the diagnosis needs to be confirmed by pathological examination.

8. Vocal cord dyskinesia

Under normal conditions, the larynx muscle movement causes the vocal cords to move and close. This complex and coordinated movement is dominated by the recurrent laryngeal nerve. The vocal cords can be in different positions according to different laryngeal physiological needs. When paralysis of the nerves that dominate vocal cord movement occurs, laryngomuscular pathology, sacral arthritis, or dislocation of the sacral joint, the vocal cord movement ability will be limited to varying degrees, and the vocal cords will be dislocated and vocal cord paralysis simultaneously, manifested as hoarseness. Indirect laryngoscope, fiber laryngoscope, or electronic laryngoscope examination showed pathological dysfunction of the vocal cords. The vocal cords cannot be abducted during inhalation, while the healthy vocal cords are abducted normally, and the glottis can still be closed during vocalization. With limited lateral vocal cord movement, the patient will immediately experience severe breathing difficulties. A clear diagnosis can be made based on the patient's medical history, signs, and laryngeal examination.

9. Special inflammation of the larynx

Laryngeal diphtheria is an acute respiratory tract B-type infectious disease, which is mainly transmitted through respiratory droplets or contact with infected patients. The pathogenic bacteria are Corynebacterium diphtheria. Laryngeal diphtheria can also show symptoms such as hoarseness, sore throat, and cough. Examination of the throat can show the formation of thick gray and white false membranes. The false membranes of the throat may be atypical in the early stages of the disease, but the development of the diphtheria and diphtheria is 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 "bull neck". Laryngeal diphtheria is more common in children and rarely occurs in adults. It is possible to further diagnose the suspicious throat smear and bacteria culture in suspicious cases.

10. Laryngeal tuberculosis

The pathogenic bacterium 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, which gradually worsens, often accompanied by sore throat, and worsens when swallowing. Indirect laryngoscopy, fiber laryngoscopy, or electronic laryngoscopy can show pale larynx mucosa, local congestion in the intercondylar area or one side of the vocal cords, which may appear. The worm-like ulcers have irregular edges and granuloma at the bottom. Epiglottic and epiphyseal epiphyseal swelling and thickening. If the lesions involve the zygomatic joints, the vocal cords can be fixed. Diagnosis can be confirmed by sputum examination for acid-fast bacilli, chest X-ray film, tuberculin test, and biopsy.

Acute laryngitis treatment

Vocal cord rest

The most important treatment for acute laryngitis is vocal cord rest, no vocalization or minimization of vocal frequency and vocal intensity, and reduction of vocal edema caused by bilateral vocal cord movement and friction caused by pronunciation. Whispering should be prevented from replacing the usual vocalization. The vocal vocalization can increase the subglottic pressure and cannot achieve the purpose of vocal cord rest.

2. General treatment

Keep indoor air flowing and moist to avoid cold and high heat temperature stimulation; ensure adequate sleep and rest, adjust physical condition and strengthen resistance; avoid dry mouth, drink plenty of water, eat lightly, eat vegetables and fruits regularly, avoid Spicy and irritating diet, no smoking, no alcohol, etc. Avoid allergic foods and irritating gases. Actively treat upper respiratory infections and adjacent lesions such as sinusitis, pharyngitis, and bronchitis.

3. Antiviral and antibiotic treatment

Acute laryngitis caused by viral infection can be treated with antiviral drugs on the basis of general treatment, and acute laryngitis secondary to bacterial infection should be treated with antibiotics orally or by injection to control inflammation in time.

4. Glucocorticoid Treatment

Those with obvious hyperemia and swelling of the vocal cords can take glucocorticoids orally or intravenously to quickly eliminate edema of the laryngeal mucosa and reduce the degree of hoarseness. For subglottic laryngitis, inhale oxygen and observe the breathing closely, and apply glucocorticoids intravenously in time to prevent the worsening of breathing difficulties.

5. Ultrasonic Nebulization Inhalation Treatment

An oral inhalation treatment with an antibiotic solution containing a steroid hormone can be used to make the aerosol directly act on the throat, which is conducive to anti-inflammatory and swelling, thinning throat secretions, and reducing throat pain.

6. Symptomatic treatment

For severe cough, the vocal cord vibration caused by cough should be controlled, and cough medicine should be applied. Those with more sputum should use mucus excretion enhancers. Sore throat can be appropriately treated with throat tablets and local spray. Cooperate with Chinese medicine and traditional Chinese medicine treatment, etc. ^[1] .

Prognosis of acute laryngitis

Acute laryngitis is usually cured after controlling the various pathogenic factors. If the patient does not receive adequate vocal cord rest or is not treated promptly, acute laryngitis may be delayed into chronic laryngitis.

Acute laryngitis prevention

1. Perform proper physical exercise, maintain a healthy and regular schedule, 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 voice.

3. Light diet, avoid tobacco and alcohol stimulation, avoid dry mouth, drink plenty of water, light diet, often eat vegetables and fruits, avoid spicy and irritating diet, such as excessive consumption of pepper, strong tea, strong coffee, carbonated drinks, Fried food, puffed food and dried fruit food, too sweet and salty foods such as chocolate, candy, etc.

4. Keep indoor air flowing and moist, avoid cold and high heat temperature stimulation; avoid contact with dust, irritating gas and harmful gas, poor air quality environment and all other irritating factors to the laryngeal mucosa.

5. Try to avoid contact with allergens that cause chronic allergic laryngitis. Avoid allergic foods.

6. Actively treat upper respiratory infections and adjacent lesions such as sinusitis, pharyngitis, and bronchitis.

references:

1. CummingsCW, FredericksonJM, HarkerLA.Otolaryngology-HeadAndNeckSurgery [M] .3rdedition.USA: Mosby-YearBook, 1999.