1. Acute and chronic diseases of larynx - PowerPoint Presentation

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1.Acute and chronic diseases of larynx

Department of Ear, Nose and Throat

Diseases

Sechenov

University

Moscow, Russia

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Department of Ear, Nose and Throat Diseases

Sechenov

UniversityMoscow, Russia

Lecturer Eremeeva Ksenia Vladimirovna, PhD, Associate Professor

1.1.

Part 1 Acute and chronic diseases of larynx

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Disease of larynx can be both an particular disease and a symptom of the pathology of other organs and body systems

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Inflammatory diseases of the larynxAcute laryngitis (catarrhal, submucous or edematous-catarrhal, phlegmonous)

Chronic laryngitis (catarrhal, atrophic, hyperplastic)

Specific laryngitis (tuberculosis, syphilitic, chlamydia)Secondary laryngitis (reflux-laryngitis, laryngeal amyloidosis, laryngitis with lymphoproliferative diseases)

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Acute catarrhal laryngitis

Predisposing factors

:

general and local hypothermia

excessive voice loads

viral infections

contact with irritants

respiratory tract infection

prolonged mouth breathing

Archive of the Department of Diseases of the Ear, Throat, and Nose of

Sechenovsky

University

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Clinical picture

voice change - hoarseness (dysphonia), up to the complete disappearance of the voice (aphonia);

sensation of burning, scratching, foreign body in the throat;

Hacking non-productive cough

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Laryngoscopic picture:

hyperemia and edema of the mucous membrane of all floors of the larynx, incomplete closure of the vocal folds

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Treatment of acute catarrhal laryngitis

Voice mode (silent)

Diet: elimination of spicy, sour, salty and hot foods,Elimination of bad habits: alcohol, smokingAntiviral treatmentInhalation (alkaline)

Antihistamines, with an allergic historyAerosol forms of antiseptics and antibiotics

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Acute subglottic laryngitis (false croup) The main cause of the disease is acute respiratory viral infections, parainfluenza, a combination of various respiratory viruses.

                

  Predisposing factors:Abnormalities of the constitutionHypertrophy and chronic inflammation of the elements of the lymphadenoid pharyngeal ringBurdened allergic history

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Clinical picture

Acute onset, in the form of a breathless attack, mostly at night, usually in a supine position

Inspiratory dyspnea, stridor breathing, restless behaviorBarking cough, sometimes interrupted by laryngospasmAcrocyanosis, participation in the act of breathing auxiliary musclesEndolaryngal picture: red rollers protruding under the vocal foldsRelapse of seizures may occur

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Diphtheria of larynx

Differential diagnostics of subglottic laryngitis

Subglottic laryngitis

Study guides of Department of Ear, Throat and Nose Diseases,

Sechenov

University, 1977

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Признак

False croup

Diphtheric

croup

Acute,

ni

Acute, night time

Gradual deterioration of breathing

Voice

clear

Hoarseness to

aphony

Cough

Barking cough

Loud, then soundless

Lymphadenitis

no

cervical

Fibrinous pellicle

no

Tonsills

, larynx

Intoxication

Expressed due to common cold

Poor, grown on

Study guides of Department of Ear, Throat and Nose Diseases,

Sechenov

University, 1977

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Pre-doctor care:

take the baby in your arms and calm

put the baby in a room with warm, humid airgive a spoonful of warm water or milkhot foot bathsantihistamines

inhalation of hormones through a compression nebulizer

Medical assistance:

intravenous administration of corticosteroids (prednisone at the rate of 1-2 mg per kg of body weight of the child)

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Hospital treatment:

humidified oxygen

antihistaminessedativescorticosteroidsinhalation therapyat accession of a secondary infection - antibioticswith treatment failure - prolonged intubation up to 5 days; with inefficiency - tracheotomy

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Acute stenosing laryngotracheitis Infectious-allergic inflammation of the mucous membrane and muscles of the larynx, combined with inflammation of the mucous membrane of the trachea

Usually increases in winter

Most often occurs at the age from 6 months to 4 yearsMore common in boysCaused by influenza viruses, parainfluenza, adenovirus and RS - virus

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Acute stenosing laryngotracheitis

The clinical picture is a sudden onset of the disease, symptoms of intoxication, "barking" cough, accompanied by stenosis of the larynx, until asphyxia.

Archive of the Department of Diseases of the Ear, Throat, and Nose of

Sechenovsky

University

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Acute stenosing laryngotracheitis

Forms:

Edematous-infiltrativeFibrous purulentHemorrhagicNecrotic

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Pathogenesis

Swelling of the mucous membrane

larynx and tracheaHypersecretion glandsmucous membranelarynx, trachea and bronchi

Muscle spasm of the larynx,

  trachea and bronchi

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Treatment

Etiotropic

      - antiviral      -antibacterialPathogenetic    anti-inflammatory (NSAIDs)     -dehydration     desensitizing     - antitussiveSymptomatic     - antipyretics     - sedatives     - analgesicsWith an increase in laryngeal stenosis - intubationno more than 5 days, with inefficiency - tracheotomy

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Acute epiglottitis

A special form of edema-catarrhal laryngitis with predominant lesion of the epiglottis

Incidence - year-roundOccurs in both children and adults (more often in men)  H. Influenzae is caused - type B - in children, in adults - pneumococcus, GABHS, meningococcus

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Clinical pictureAcute onset

Severe general hyperthermia

Inspiratory dyspnea and stridorSevere sore throatDysphagiaHypersalivationOrtopneaMuffled or muffled voice

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Forms:

Edematous

InfiltrativeAbscessing

Archive of the Department of Diseases of the Ear, Throat, and Nose of

Sechenovsky

University

Archive of the Department of Diseases of the Ear, Throat, and Nose of

Sechenovsky

University

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Acute eppiglottiеis should be differentiated with

:

lingual angina  pharyngeal abscessacute stenosing laryngotracheitis  sublingual laryngitis  foreign body  trauma to the pharynx and larynx  laryngeal edema

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Treatment

Urgent hospitalization

When the infiltrative form - make "notches" of the mucous membrane of the epiglottis in the place of the greatest infiltration.

With abscess form of epiglottitis - opening of an abscess

Antibiotics of choice - “protected”

penicillins

or cephalosporins

Corticosteroids

NSAID

  With decompensated laryngeal stenosis - intubation or tracheotomy

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Department of Ear, Nose and Throat Diseases

Sechenov

UniversityMoscow, Russia

Lecturer Eremeeva Ksenia Vladimirovna, PhD, Associate Professor

1.2.

Part

2

Acute and chronic diseases of larynx

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Allergic swelling of the larynx

develops due to sensibilization of the body to various allergens

begins acutely, sometimes - lightning, on the background of general health, in the absence of catarrhal phenomena, normal body temperaturecomplaints of marked difficulty in breathing, difficulty in swallowing, hypersalivation

Archive of the Department of Diseases of the Ear, Throat, and Nose of

Sechenovsky

University

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Treatment

Allergen elimination  Antihistamine drugs  Corticosteroids  Inhalation with corticosteroids

  In extreme situations - conicotomy

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Monochorditis

Types of monochorditis:Nonspecific: vasomotor, traumaticSpecific: tuberculosis, syphilis or precancerArchive of the Department of Diseases of the Ear, Throat, and Nose of Sechenovsky University

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Definition

Chronic laryngitis - a chronic inflammatory disease of the mucous membrane of the larynx lasting more than 3 weeks

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Forms of chronic laryngitis

Catarrhal

HypertrophicAtrophicEdematous PolyposisReflux LaryngitisFungal laryngitisSpecific

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Etiology of chronic laryngitis

recurrence of acute laryngitis  long voice load  smoking and alcohol abuse  occupational hazards  chronic inflammatory diseases of the broncho-pulmonary system, nose and paranasal sinuses  chronic gastrointestinal diseases, renal failure, hypothyroidism, diabetes mellitus, radiotherapy

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Clinical picture

complaints:

hoarsenessfatigue of voice when talking coughhttps://zdorovjavam.ru/images/kataralniylaringitosobennostitecheniyait_0D5E42D3.jpg

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Laryngoscopic picture and treatment

slight hyperemia and infiltration of the vocal folds, injection of vessels of the mucous membrane

   Treatment:in the period of exacerbation - therapy as in acute laryngitis;during remission - elimination of etiological factors leading to the disease

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Chronic atrophic laryngitis

Laryngoscopic

:dull dry mucosa,

viscous sputum possible

hypotension and disconnection of vocal folds during phonation

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Treatment of chronic atrophic laryngitis

elimination of the cause and treatment of a background disease (diabetes mellitus, chronic renal failure, vasculitis)

stimulating and tonic therapy vitamins (A, B, C) and antioxidantsneuromuscular transmission enhancerssecretory and mucolytics systematically and locallyinhalation with mineral water 2-4 times a day for 5-10 minutes to 1 month indoor air humidificationClinical recommendations of the Ministry of Health of the Russian Federation (2013)

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Chronic hyperplastic laryngitis

Complaints

tickling, foreign body sensation in the throatcoughviscous mucus sputumvoice change(from hoarseness to aphonia, especially in the morning)Archive of the Department of Diseases of the Ear, Throat, and Nose of

Sechenovsky University

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Morphological changes

persistent morphological changes in the tissues of an organ with impaired innervation, blood circulation and secretion;

long persistent flow;background and predisposing disease to malignancy;lack of lasting positive effect on the background of conservative therapy

37

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Singers’ nodes

Connective tissue formations covered with flat keratinizing epithelium

Located on the border of the front and middle third of the vocal foldsPathogenesis:dyskinesia of the folds, so that their mechanical irritation in the place of maximum contact

Infringement of microcirculation with inflammatory reaction

Clinical and morphological types

http://www.manchesterentclinic.co.uk/images/uploaded/vocalcords.jpg

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Pathogenesis factors:

smoking

increased voice loadWhen laryngoscopy:from light spindle-like vitreous edema to severe, accompanying flotation hyperplasia of the mucous, causing asphyxiationswelling of the submucous layer of the vocal fold from the voice process of the scapular-shaped cartilage to the anterior commissure

Chronic edematous

polypous

laryngitis

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During exacerbation:

hyperemia and infiltration

laryngeal mucosa,uneven and vascular-injected vocal folds

  no phase closure during phonation

Laryngoscopic

picture

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1.

Pachydermia

Limited hyperplasia of the laryngeal mucosaLocalization - most often voice and interchordal folds

Clinical and morphological types

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Mucosal lesion - whitish-gray focal keratinization of stratified squamous epithelium

2

. Leukokeratosis of vocal folds

Clinical and morphological types

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3. HyperkeratosisSuperficial keratosis of the left vocal fold

Clinical and morphological types

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Treatment

To give up smoking

Observance of a sparing diet and voice modeTreatment of inflammatory diseases of the nose, paranasal sinuses and nasopharynxInhalations with antiseptic solutions, mucolytics and alkaline mineral waterPhysiotherapy treatment - phonophoresis of 1% potassium iodide, lipid or calcium chloride in the larynx, therapeutic laser, magnetic therapySecret and mucolytic (ambroxol, acetylcysteine, fluimucil) drugs.Surgical treatment - when hyperkeratosis is soldered to the underlying layers and stenotic laryngitis Reinke-Hayek

Clinical recommendations of the Ministry of Health of the Russian Federation (2013)

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Department of Ear, Nose and Throat Diseases

Sechenov

UniversityMoscow, Russia

Lecturer Eremeeva

Ksenia Vladimirovna, PhD, Associate Professor

1.3.

Part

3

Acute and chronic diseases of larynx

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voice change - minor

burning sensation, perspiration, foreign body in the throat and larynx

dry, unproductive paroxysmal cough after eating, especially when lying down

Reflux laryngitis (extra-esophageal manifestation of GERD)

http://www.lorphonplus.ru/articles/img/laringit_9.jpg

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Reflux laryngitis

When laryngoscopy

: hyperemia of the mucosa and proliferation of the mucous of the posterior larynx  accumulation of viscous sputumTreatment by a gastroenterologist

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Fungal laryngitis

Rarely isolated, often combined with fungal pharyngitis

Complaints:

  hoarseness

  burning and itching of the larynx

  paroxysmal cough with sputum with crusts and foul odor

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Fungal laryngitis

When laryngoscopy:

Specific whitish mycotic plaqueTreatment:  exclusion of etiological factors  antifungal drugs topically or systemically

Prevention:

  Rational antibiotic therapy

https://reader001.documents.tips/reader001/slide/20170828/563db999550346aa9a9ee07a/document-40.png

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Laryngomalacia

60-75% cause severe stridor in children

Anatomical and physiological features of the larynx in children:  internal retraction scooped-up the nodular folds and tubular epiglottis,displacement of scarplike cartilages anterior and midline,rear caudal displacement of the epiglottis,shortening scoops  extremely acute angle between the epiglottis and the entrance to the larynxGarashchenko T.I., 2009

50

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Surgical treatment of children with laryngomalacia

Supraglottoplasty

, epiglottopexyIndications:dysphagia,respiratory distress syndromelife-threatening bouts of apnea

Garashchenko T.I., 2009

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Paresis and palsy of larynx

neurogenic

peripheral

central

organic

functional

unilateral

bilateral

Myogenic palsy - limited inflammatory changes in the internal muscles of the larynx

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m.

vocalis

m. interarythenoidea

m.crycoarythenoidea

lat

е

ralisMYOGENIC PARALITIES OF THE LARYNX

m.

vocalis

и

m.crycoarythenoidea

m.

interarythenoidea

lateralis

и

m.

vocalis

http://yandex.ru/clck/jsredir?from=yandex.ru%3Bimages%2Fsearch%3Bimages%3B%3B&text=&etext=1796.i9fH

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Etiology of posttraumatic paralysis of the larynx

surgery on the thyroid gland for cancer or goiter Hashimoto (more than 90%)

surgery on the heart, lung, mediastinum, esophagus, vessels of the neck and cervical spine

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Diagnostics of laryngeal paralysis

Full examination of the head and neck, chest (CT, MRI)

FibrolaryngoscopyVideo stroboscopySpirometry (FER)Assessment of the position of the folds:median,paramedian,Intermediate,lateral

back third of the glottis during phonation

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Clinical picture of bilateral laryngeal paralysis

Inspiratory stridor

The sonorous voice in the middle position of the vocal foldsViolation of the protective function (choking when taking liquid food) with paralysis of the upper and lower laryngeal nerves

Вдох

Выдох

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Clinical picture of unilateral paralysis of the larynx

hoarseness or aphonia depending on the position of the vocal fold

slight difficulty breathing during exercisegagging when taking liquid food

Inhale

Phonation

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Treatment of unilateral paresis of the larynx

reflexology

breathing exercisesanticholinesterase drugs (prozerin, neuromidine)B vitaminssinusoidal modulated currents on the laryngeal area

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Stages of surgical treatment

bilateral paralysis of the larynx

I - tracheostomyII - delayed lateral fixation of the vocal fold with arytenoidotomy, redressing of the cricoid arc and stenting of a T-shaped tube      [Pat. № 2284773 RF]

III - suturing laryngotrachephissis

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Hysterical laryngospasm

shortness of breath short (minutes - hours), or long (weeks - months - years)

more often - in young women with unstable mentality and children of school agethe result of a subconscious attempt to avoid a stressful situation, which is especially evident in adolescence