I. Overview of chronic laryngitis
Chronic non-specific inflammation of the larynx is a common disease of the larynx, including chronic laryngitis, laryngeal polyps, vocal cord nodules and laryngeal arthropathy. Chronic laryngitis is also divided into chronic simple, chronic atrophic and chronic hypertrophic laryngitis. Chronic simple laryngitis is a chronic nonspecific inflammatory lesion that occurs mainly in the laryngeal mucosa and can involve submucosal tissues. Atrophic laryngitis, also known as dry laryngitis or odorous laryngeal disease, is caused by atrophy of the laryngeal mucosa and mucus glands and reduced secretion. It is common in middle-aged and elderly women, and is more likely to be aggravated in those who are often exposed to dusty air.
The cause of chronic laryngitis
1, the causes of chronic simple laryngitis
(1) rhinitis, sinusitis, chronic tonsillitis, chronic pharyngitis and other adjacent parts of the inflammation spread directly to the larynx or the stimulation of purulent secretions.
(2) Nasal obstruction, breathing through the mouth, so that the pharyngeal mucosa vasodilatation, laryngeal muscle tension fatigue produced inflammation.
(3) Harmful gases (such as chlorine, ammonia, sulfuric acid, nitric acid, sulfur dioxide, nitric oxide, etc.) and long-term stimulation by tobacco, alcohol, dust, etc.
(4) Gastroesophageal reflux and Helicobacter pylori infection.
(5) Excessive use of voice or improper pronunciation.
(6) Systemic diseases such as diabetes, liver cirrhosis, heart disease, nephritis, rheumatism, endocrine disorders, etc. make the systemic resistance decline and affect the larynx.
2, the etiology of chronic atrophic laryngitis
There are two types of laryngitis: primary and secondary. The primary cause is still not very clear, most scholars believe that it is a local manifestation of systemic disease, which may be related to endocrine disorders, autonomic dysfunction, vitamin and trace element deficiency or imbalance; or due to various reasons resulting in mucosal and submucosal tissue nutritional disorders and reduced secretion. Secondary to atrophic rhinitis, atrophic pharyngitis, radiotherapy to the pharynx and long-term laryngeal inflammation are most often induced. It can also be part of Sjogren’s syndrome.
3. Etiology of chronic proliferative laryngitis
Chronic hyperplastic laryngitis is also known as chronic hypertrophic laryngitis. The etiology is the same as that of chronic simple laryngitis, which mostly develops from the condition of chronic simple laryngitis. In recent years, it has been suggested that hypertrophic laryngitis may be associated with infection with EBV, herpes simplex virus (HSV), and Mycoplasma pneumoniae. Hypertrophic changes can be diffuse or restrictive.
Third, the clinical manifestations of chronic laryngitis
The main symptom of chronic simple laryngitis is hoarseness of different degrees; the larynx is slightly painful and tight, foreign body sensation, etc. The degree of laryngeal lesions varies according to the severity and duration of the disease. On examination, the laryngeal mucosa is diffusely congested and symmetrical on both sides. The vocal folds are light red or dark red. Thick mucus is seen on the mucosal surface, often forming mucus filaments between the vocal cords. Fiberoptic laryngoscopy with fine fiber optics and good directionality is suitable for peering into the deep concave stenosis of microscopic lesions and allows simultaneous biopsy. Electroacoustic hilarography can maintain the basic waveform when the vocal fold lesions are mild. Dynamic laryngoscopy in vocal fold edema amplitude, mucosal wave, vibration off phase can be enhanced with variable symmetry and periodicity.
Paroxysmal cough is the main symptom of chronic atrophic laryngitis, often coughing up scabs or thick sputum to stop coughing, and coughing often increases laryngeal pain; there is dryness and discomfort in the larynx, foreign body sensation, swelling and pain; hoarseness, which is worse in the morning. On examination, the laryngeal mucosa is congested and dry, the laryngeal cavity is widened, and yellow-green pus crusts often cover the posterior end of the vocal cords, the interarytenoid region and the ventricular zone of the larynx. If the laryngeal muscles are atrophied, the vocal cords become thin, flaccid and weak, and the sides are not fully closed when pronouncing, so the voice leaks, the voice is hoarse and it is hard to speak. Secondary to atrophic rhinitis and pharyngitis, the nasal and pharyngeal cavities are widened and the mucosa is dry. The electroacoustic hilar map mostly shows a shortened closed phase or no closed phase, and the wave crest becomes lower.
The symptoms of chronic proliferative laryngitis are the same as those of chronic simple laryngitis, but hoarseness is heavier and cough is lighter, and laryngeal pain is evident during acute or subacute attacks. Examination: In addition to the manifestations of chronic simple laryngitis, the laryngeal mucosa is extensively thickened. The vocal cords are congested, with rounded and thick edges, rough and uneven surfaces, and may be nodular or polyp-like. The ventricular zone is also often hypertrophic and obscures the vocal cords. The electroacoustic hilar view mostly shows a prolonged closed phase and a shortened open phase. The laryngeal dynamic microscopy shows poor symmetry and periodicity, and in severe cases the amplitude and mucosal waves disappear and the vocal fold closes poorly.
The diagnosis and differential diagnosis of chronic laryngitis can be made based on the symptoms and signs, but the nasal, pharyngeal, pulmonary and systemic conditions should be considered to find out the cause. For those who have hoarseness for a long time, it should be differentiated from laryngeal nodules and early laryngeal cancer. Chronic proliferative laryngitis should be differentiated from laryngeal cancer, syphilis, tuberculosis, etc.
The treatment of chronic laryngitis
1. Treatment of chronic simple laryngitis
(1) Etiological treatment Actively treat rhinitis, sinusitis, pharyngitis, pulmonary and systemic diseases, and perform articulation training for inappropriate pronunciation.
(2) Local use of anti-inflammatory drugs.
(3) Change the bad habits and remove the stimulating factors, including quitting smoking, alcohol and voice rest.
(4) Oxygen or ultrasonic nebulizer inhalation, with antibiotics and dexamethasone nebulization if necessary.
(5) Physiotherapy DC drug ion (iodine ion) introduction or audio electrotherapy, ultrashort wave, direct current or specific electromagnetic wave treatment.
(6) Vocal correction including vocal exercises and vocal exercises, etc. Many countries have professional speech therapists and speech pathologists.
(7) Anti-reflux treatment For those with gastroesophageal reflux, adults are given: (1) cimetidine, 0.8g daily, intravenously; (2) omeprazole, 20mg, at bedtime; (3) cisapride, 5-10mg each time, 3 times daily. The dose can be increased or decreased as appropriate.
2.Treatment of chronic atrophic laryngitis
The cause of the disease should be actively searched for and treated for. Potassium iodide, 30mg each time, 3 times a day can be given to stimulate laryngeal mucus secretion and reduce the dryness of the larynx. Steam nebulization or medication containing aromatic oil, oral administration of vitamins A, E and B2, etc. When there are scabs attached, they can be removed under laryngoscope.
3. Treatment of chronic proliferative laryngitis
The treatment principle is the same as chronic simple laryngitis. In the early stage of hyperplasia of the vocal cords, direct current drug ion (iodine ion) introduction or audio electrotherapy can be added. Local physical therapy can help improve blood circulation, reduce inflammation and soften and dissipate the hyperplastic tissue. In severe cases, mucosal tissues of the hypertrophic part can be removed by surgery under a surgical microscope or by laser cautery or cryotherapy, but care should be taken not to damage the vocal cord muscle. The hypertrophic tissue in the arytenoid space can be coated with an etching agent (silver nitrate, silver protein, etc.).
Six, the prevention of chronic laryngitis
(1) Exercise, enhance physical fitness, and improve the ability to adapt to the external climate.
(2) Active treatment of systemic diseases.
(3) pay attention to rest, when the mucous membrane inflammatory reaction, should be strictly abstain from sound, to avoid the evolution of chronic.