What Is Chronic Laryngitis?

Chronic laryngitis refers to chronic non-specific inflammation of the laryngeal mucosa. The disease lasts more than 3 months and can affect the submucosa and the internal laryngeal muscles. Chronic laryngitis is a common cause of hoarseness. According to the patient's hoarseness, increased laryngeal secretions, and throat discomfort for more than 3 months, combined with indirect laryngoscope, direct laryngoscope, fiber laryngoscope or electronic laryngoscope, chronic congestion and swelling of the vocal cords, thickening of the mucosa, or Mucosal atrophy is accompanied by palate skin, which can be initially diagnosed as chronic laryngitis.

Basic Information

English name: chronic laryngitis
Visiting department: ENT
Common locations: Laryngeal mucosa

Common causes: Acute laryngitis persists; excessive and improper vocalization; infection of adjacent organs
Common symptoms: Hoarseness, increased throat secretions, and throat discomfort

Causes of chronic laryngitis

1. Acute laryngitis occurs repeatedly or without adequate vocal cord rest, the condition does not heal and gradually evolves into chronic laryngitis.

2. Excessive use of voice, improper vocalization, chronic cough, chronic fatigue of internal muscles, rupture of collagen fiber fibers of acoustic ligaments, submucosal vascular congestion, bleeding, increased fluid leakage, and chronic inflammation of the throat, common in teachers, actors, and singers Home and strong noise environment workers. Talking loudly for a long time, singing too high or too long can cause this disease.

3. Infection of adjacent organs, which stimulates the formation of chronic laryngitis in the laryngeal mucosa. Infections of the nose, sinuses, pharynx, trachea, bronchus, lungs and other organs are one of the important reasons for chronic laryngitis. The mechanism is: due to the continuity of the respiratory mucosa, the inflammation in the above areas spreads directly to the throat; Nasal congestion: often breathe through the mouth, causing the laryngeal mucosa to become excessively dry; inflammatory secretions enter the throat, directly irritating the laryngeal mucosa and cause chronic inflammation; the lesions in the above areas often make the resonance of vocalization obstacles, easy to cause Improper vocalization and increased fatigue in the laryngeal muscles.

4. Caused by exogenous irritating factors, the environment with too high ambient temperature, dust in the air, harmful gases in the environment, and excessive alcohol and tobacco cause chronic laryngitis.

5. As a sensitive organ, the larynx is extremely sensitive to changes in the body's environment. Changes in sex hormone levels, hypothyroidism, and certain systemic diseases (such as heart, kidney disease, diabetes, rheumatism, etc.) cause vasomotor contractions and disorders, chronic congestion in the throat, and secondary chronic laryngitis.

6. Gastroesophageal reflux or laryngo-pharyngeal reflux (see laryngo-pharyngeal reflux): Gastric juice directly damages the laryngeal mucosa due to gastroesophageal reflux or causes chronic inflammation of the laryngeal mucosa and submucosa through nerve reflex.

7. Allergies: Certain foods, gases or drugs can cause chronic mucosal edema in the laryngeal cavity of patients with specific constitutions, resulting in chronic laryngitis.

Clinical manifestations of chronic laryngitis

Hoarse

Hoarseness is the main symptom. The beginning is intermittent. If the sacroiliac joints are involved, the hoarseness becomes more prominent in the morning or after the vocal cords have been resting for a long time, but it is generally believed that the more hoarse the hoarseness becomes, the more the hoarse gradually becomes continuous. Completely silent people are rare.

2. Increased throat secretions

Often feel sputum adhesion, whenever you speak, clear your throat or cough to clear the thick sputum.

3. There is often discomfort in the throat

Such as tingling, burning, foreign body, dryness and so on. Patients use cough to temporarily reduce the feeling of throat discomfort. This cough is often a dry cough without secretions, which is a unique symptom of chronic laryngitis.

4. Atrophic laryngitis

There may be spasmodic cough, crusting is the cause of spasmodic cough, so lumps or sticky secretions are often discharged with the cough, sometimes with a small amount of blood in it.

Chronic laryngitis examination

Laryngoscopy: Generalized chronic laryngitis. Through laryngoscopy, the following 5 types can be divided according to the degree of the lesion:

Chronic simple laryngitis

Diffuse congestion and edema of the laryngeal mucosa. The vocal cords lost their original pearly white, pinkish color, and their edges became dull. Mucus adheres to the mucosal surface, often forming mucofilaments between glottis.

2. Chronic hypertrophic laryngitis

The major histological changes of chronic hypertrophic laryngitis are hyperplasia and degeneration of the epithelium, and there is often extensive infiltration of chronic inflammatory cells in the subepithelial layer. The laryngeal mucosa is extensively hypertrophic, chronically congested, and generally symmetrical, with the intermucosal area being more pronounced. 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.

3. Laryngeal dermatosis

This disease is associated with throat reflux. The posterior structure of the laryngeal cavity is widely thickened symmetrically, and the anterior joint thickened tissue is white or off-white, with a hard texture and protruding into the laryngeal cavity. Laryngeal dermatosis mostly appears on the basis of chronic hypertrophic laryngitis. It is a precancerous lesion with a tendency to malignant changes.

4. Atrophic laryngitis

Mostly secondary to atrophic rhinitis and atrophic pharyngitis. The laryngeal mucosa is atrophic, manifested by dry, thin, and shiny laryngeal mucosa. There is often white, yellow-green, or dark brown dryness in the intercondylar area and under the glottis. If the dryness is coughed, a small amount of bleeding on the mucosal surface can be seen, the vocal cords become thinner, and their tension weakens.

5. Renk edema

In recent years, some scholars have classified it as a separate disease from the classification of chronic laryngitis because of some unique manifestations of the disease. Renke's edema is mainly located in the Renke layer, which is the superficial layer of the vocal folds. The bilateral vocal folds are symmetrical and diffuse edema, and the bilateral vocal folds are shaped like fish belly or long vesicles. The disease is closely related to smoking, more common in smokers over 40 years of age, and more common in women.

Diagnosis of chronic laryngitis

According to the patient's hoarseness, increased laryngeal secretions, and throat discomfort for more than 3 months, combined with indirect laryngoscope, direct laryngoscope, fiber laryngoscope or electronic laryngoscope, chronic congestion and swelling of the vocal cords, thickening of the mucosa, or Mucosal atrophy is accompanied by palate skin, which can be initially diagnosed as chronic laryngitis.

Differential diagnosis of chronic laryngitis

Benign vocal cord lesions

Various vocal cord benign lesions such as vocal nodules, vocal cord polyps, vocal cord submucosal cysts, submucosal hematomas, contact ulcers and granulomas, hemangiomas, neurofibromas, amyloidosis, lipomas, chondroma, etc. The above benign vocal cord lesions can also be clinically expressed as hoarseness, accompanied by aggravation of hoarseness, throat discomfort, and sore throat after the use of voices. The history of hoarseness is long, usually more than 3 months, and indirect laryngoscope, fiber laryngoscope or Electronic laryngoscopy can show corresponding vocal cord lesions, combined with pathological examination, can confirm the diagnosis.

2. Laryngeal precancerous lesions

Laryngeal precancerous disease refers to a group of diseases that are more likely to become cancerous (but not necessarily) than normal laryngeal mucosa, including white laryngeal disease, laryngeal papilloma in adults, laryngokeratosis, laryngeal dermatosis, and some chronic laryngitis with epithelial insufficiency Typical hyperplasia, etc. Laryngeal precancerous lesions usually have a longer course, and symptoms can gradually worsen. Indirect laryngoscopy, direct laryngoscopy, or fiber laryngoscopy can show corresponding laryngeal lesions. Combined with pathological examination, a clear diagnosis can be made.

Laryngeal leukoplakia refers to lamellar keratoproliferative lesions on the larynx 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 patch-like bulges at the front and middle thirds of the vocal cord surface or anterior edge. The range is limited, it is not easy to remove, and the vocal cord movement is good.

The cause of laryngeal papilloma in adults is unclear and may be related to human papilloma virus infection. Laryngeal papilloma is a tumor from the laryngeal epithelial tissue. It grows from the multilayer squamous epithelium and the connective tissue beneath it to the surface in a papillary manner. Adults are susceptible to solitary rims or vocal cords on one side, which is more malignant. The clinical manifestations are hoarseness, and dyspnea may also occur in the later stage. On examination, new creatures in the throat are found, and their appearance is rough and pale red.

3. 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. Laryngeal malignant tumors also show hoarseness and throat discomfort in the early stage of onset. New laryngeal organisms can be seen on examination, and pathological examination should be performed to further confirm the diagnosis.

The main early symptoms of glottic laryngeal cancer are hoarseness. As the disease progresses, there may be a feeling of foreign body in the throat, cough, difficulty swallowing, and cervical lymph node metastasis. 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. By CT and magnetic resonance examination, it is possible to determine the invasion and metastasis of laryngeal cancer to surrounding tissue organs. Through ultrasound and imaging examination, metastatic lymph nodes and the relationship with surrounding tissues can be observed. The diagnosis can be confirmed by pathological examination.

4. Vocal cord dyskinesia

Under normal conditions, the larynx muscles, including the vocal cords, are innervated by the larynx nerves, and the vocal cords can be in different positions according to different laryngeal physiological needs. When paralysis of the motor nerves that dominate the vocal cords occurs, laryngeal muscle disease, sacral arthritis, or dislocation of the sacral joints, the vocal cord movement ability will be restricted to varying degrees, and the vocal cords will be dislocated at the same time, manifested as hoarseness. When unilateral vocal cord paralysis occurs, indirect laryngoscopy, fiber laryngoscope, or electronic laryngoscope examination shows pathological dysfunction of the vocal cords. The vocal cords cannot be abducted during inhalation, while the healthy lateral vocal cords are abducted normally, and the glottis can still be closed when vocalizing When bilateral vocal cord paralysis occurs, bilateral vocal cord movement is limited and severe breathing difficulties occur. A preliminary diagnosis can be made based on the patient's medical history and physical examination.

5. Laryngeal tuberculosis

The pathogenic bacteria of laryngeal tuberculosis is tubercle bacillus. Primary laryngeal tuberculosis is rare and mostly spread from 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 shows pale larynx mucosa, localized congestion in the intercondylar area or one side of the vocal cords, which may appear. The worm-like ulcers have irregular edges and granulosa at the bottom. Epiglottic and epiphyseal epiphyseal edema can be edema and thickened. If the lesions involve the zygomatic joints, the vocal cords can be fixed. The diagnosis can be confirmed by sputum examination (look for acid-fast bacilli), chest X-ray radiograph and biopsy.

6. Other

The performance of other diseases in the larynx: for example, in rheumatoid patients, due to autoimmune diseases, the larynx appears as nodules with a bamboo appearance under the mucosa in the middle of the vocal cords; in patients with hypothyroidism, due to vasomotor Disturbance in function, chronic congestion in the throat, and chronic laryngitis can be secondary.

Chronic laryngitis treatment

1. Remove pathogenic factors

Removal is the key to treating chronic laryngitis. Nasal cavity, sinus, oral cavity, and pharyngeal lesions should be actively treated, systemic diseases must be treated; occupational pathogenic factors should be removed, and labor protection should be strengthened; try to avoid contact with allergens that cause chronic allergic pharyngitis; quit bad habits (such as smoke Excessive drinking), develop good health habits; carry out appropriate physical exercise, enhance physical fitness, maintain a healthy and regular schedule, maintain a good mentality to improve their overall immunity.

2. Avoid chronic overuse

Vocal rest is an important treatment. Absolute rest is best. If it is caused by improper vocalization, the correct vocalization method training must be performed after inflammation control.

3. Drug treatment

For patients with atrophic laryngitis, iodine-containing laryngeal tablets and oral vitamins that have a slight stimulation of increased glandular secretion can be applied.

4.Partial lozenges and inhalation

Topical lozenges and aerosolized inhalation can relieve throat discomfort.

5. Voice Therapy

Through systematic and scientific vocal training methods, correct incorrect vocal habits and methods, and reduce friction between bilateral vocal cords during pronunciation to gradually improve or even cure chronic laryngitis.

6. Surgical treatment

For patients with chronic laryngitis with pre-cancerous lesions such as atypical hyperplasia of the mucosa and laryngeal dermatosis, there is a tendency to malignant changes. If the cause of the treatment is not effective, surgery can be considered. For vocal cord edema and hypertrophy, the diseased mucosa can be removed with a cold knife, laser or plasma under the operating microscope or endoscope. The bilateral vocal cord lesions should be resected in stages to prevent laryngeal adhesions. ^[1-2]

Chronic laryngitis prevention

1. Try to avoid repeated episodes of acute laryngitis.

2. Avoid excessive use and improper vocalization.

3. Actively treat infections of nearby organs (nose, sinuses, pharynx, trachea), reduce or even remove irritation of the mucosa of the throat.

4. Reduce gastroesophageal reflux: Avoid eating foods that promote gastric acid secretion, such as chocolate, spicy foods, etc. to reduce larynx reflux to reduce irritation of the laryngeal mucosa; control water intake 3 to 4 hours before bedtime . On the basis of general treatment of chronic laryngitis, gastric acid inhibitors and gastric mucosal protective agents can be used in combination with treatment of gastric diseases.

5. Avoid irritation to the throat due to excessive ambient temperature, dust in the air, harmful gases in the environment, excessive tobacco and alcohol.

6. Actively treat systemic diseases, such as allergic diseases and rheumatoids.

References

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

2. Huang Xuanzhao, Wang Jibao, Kong Weijia. Practical Otolaryngology Head and Neck Surgery. Beijing: People's Medical Publishing House, 2008: 134.