Chronic laryngitis is divided into chronic pharyngitis and chronic laryngitis, which is a chronic inflammation caused by a general bacterial infection of the laryngeal mucosa. Depending on the degree of lesion, it can be divided into chronic simple laryngitis, hypertrophic laryngitis and atrophic laryngitis.
Etiology
1, the result of recurrent or prolonged acute laryngitis.
2, use of voice
Laryngitis
1, excessive use of voice, improper vocalization, common in teachers, actors singers, women workers in yarn mills, or not necessarily professional vocalists, too strong or too much use of voice, long-term continuous speech, too high, too long singing.
2, inhalation of harmful gases such as industrial gases, smoking, chemical dust can make the vocal cords thicken.
3.Infection of the nose, sinuses and pharynx is also a source of chronic irritation of the larynx.
4, lower respiratory tract infection of purulent secretions and long-term contact with the larynx, but also prone to chronic laryngitis.
Pathological classification
1, chronic simple laryngitis: laryngeal mucosa diffuse congestion, redness and swelling, the vocal cords lose their original pearly white, pink, blunt edges, thick mucus visible on the surface of the mucosa, often between the vocal cords even into mucus filaments.
2, hypertrophic laryngitis: laryngeal mucosa hypertrophy, to the aryepiglottic area is more obvious, the vocal folds are also hypertrophic, can not be closed to the midline and poor closure, the ventricular zone is often hypertrophic and cover part of the vocal folds, the aryepiglottic fold can also be thickened.
3, atrophic laryngitis: laryngeal mucosa dry, thinning and shiny, the interarytenoid area, the vocal folds often have yellow-green or dark brown dry scabs, such as coughing up the scabs, visible mucosal surface with a small amount of oozing blood. Vocal folds become thin. Its tension is weakened.
Classification
(1) Chronic simple laryngitis: the laryngeal mucosa is congested, red and swollen. Microscopically, the mucosa and submucosal tissues are congested and edematous, with some lymphocytic infiltrates and the basement membrane is widened and becomes lax.
Chronic hypertrophic laryngitis: thickening of the laryngeal mucosa, microscopically, thickening of the mucosal epithelium, there may be squamous epithelial hyperplasia and keratinization; submucosal fibrous tissue is obviously hyperplastic, there is a large number of lymphocytes, plasma cell infiltration, and even the formation of lymphoid follicles.
Chronic atrophic laryngitis: the laryngeal mucosa is atrophied and thin, dry and shiny, and the vocal cords are thin and hypotonic. Microscopically, submucosal fibrous tissue proliferation, mucosal atrophy and glandular atrophy, disappearance, and replacement of ciliated columnar epithelium by chemotactic squamous epithelium are seen. Vocal fold nodules are a type of chronic laryngitis, mostly caused by long-term excessive or inappropriate use of the voice. The nodules are mostly located in the center of the vocal fold membrane. At the beginning, the nodules are soft and reddish, with dilated blood vessels and interstitial edema. Subsequently, due to fibrosis and vitreous changes, the epithelial spine layer on the surface thickens and keratinizes, and the nodules become solid and pale.
Chinese medicine classification
A. Lung and kidney yin deficiency type
[Treatment]: Nourishing the lung and kidney, lowering fire and improving pharynx
Radix et Rhizoma Ginseng 15g, Radix Rehmanniae 20g, Radix Macrocephalae 15g, Radix Lily 15g, Radix Rehmanniae 12g, Radix Rehmanniae 15g, Radix Fritillariae 10g, Radix Cicadae 6g, Radix Chebulae 12g, Radix Angelicae 8g, Radix Rehmanniae 12g, Radix Jinyinhua 15g, Radix Asparagus 12g.
B. Phlegm-heat and blood stasis type
[Treatment]: Clearing heat, resolving phlegm, activating blood circulation and resolving blood stasis
Scutellaria baicalensis 12g Chuanbei 10g Sangbai Pi 15g Medlar 12g Tianzhu Huang 10g Zhi Mu 12g Qianlipiao 10g Cicadellia 6g Smallpox Powder 15g Guaogou Ren 20g Floating sea stone 20g Red peony 12g Peach kernel 10g Safflower 8g
Symptoms
(a) Hoarseness is the main symptom, the voice becomes low and rough, the symptoms are heavier in the morning, then gradually improve with increased activity and coughing up laryngeal secretions, and become worse in the next morning, the hoarseness is reduced after abstinence, and the symptoms are aggravated by more speech, intermittent, and evolve into persistent over time.
(b) Increased secretions in the larynx, often feeling that there is phlegm adhering to the larynx, and whenever speaking, coughing is required to remove the sticky phlegm.
(3) Dryness of the larynx and soreness of the throat when speaking.
Physical signs
Diagnosis and prevention
Diagnosis
Hoarseness and discomfort in the larynx. The following changes are seen on local examination.
(1) Chronic simple laryngitis may be seen as diffuse congestion of the laryngeal mucosa, loss of normal luster of the vocal folds, light or dark red, or diastolic vascular lines may be seen in its divisions, thickening of the edges of the vocal folds, and secretions often adhering to the laryngeal cavity.
(2) Hypertrophic laryngitis can be seen with dark red laryngeal mucosa, thickened vocal cords, significantly thickened vocal cords or even cover the vocal cords during pronunciation, and secretions can be seen in the laryngeal cavity.
(3) Nodular laryngitis can be seen as a symmetrical nodular protrusion at the junction of the anterior and middle 1/3 of the vocal folds on both sides, with a white color, such as the size of a corn, and a slightly red base, and the two vocal folds cannot close tightly when vocalizing.
Treatment
I. Removal of irritants.
Quit smoking and alcohol. Pay attention to proper rest of vocal cords, reduce vocalization, prohibit loud shouting, and correct the method of pronunciation. Actively treat nasopharyngeal and lower respiratory tract infections to clear the airway and reduce the stimulation of secretions from neighboring organ lesions to the larynx.
Second, apply nebulized inhalation method as appropriate.
Inject penicillin, streptomycin, gentamicin and dexamethasone and other anti-inflammatory and anti-swelling drugs into the nebulizer, and the patient should contain the ejector of the nebulizer, and connect to oxygen or high-pressure air pump to nebulize the medicine. Take deep breaths continuously to make the nebulized medicine inhaled into the throat. 1-2 times per day, 6 times per course. Can be 2-3 courses of treatment.
Third, use Tie Di Wan, Golden Voice Clearing Pill, Huang’s Loud Voice Pill and other Chinese medicines.
Prevention
(a) Treat acute laryngitis in time to prevent it from becoming chronic.
(2) Prevent excessive use of voice. Teachers and literary workers should pay attention to the correct vocal method, especially during cold.
(3) Strengthening labor protection and proper handling of harmful gases and dust in the production process.
Chinese medicine identification
Chronic laryngitis is a kind of diffuse inflammation of the upper respiratory tract. Chinese medicine is called “deficiency fire laryngeal paralysis”.
Chronic pharyngolaryngitis has a long duration, it is advisable to nourish Yin and lower fire, clear the throat to treat the root, detoxify and reduce inflammation, produce fluid and moisten dryness to treat the symptoms, prevention and control, remove the cause of the disease, so that the evil will be cured.
1: 15 grams of Radix Codonopsis Pilosulae, 10 grams each of Poria, Atractylodes Macrocephala, Rhizoma Atractylodis Macrocephala and Pericarpium Chen, 3 grams of roasted licorice.
Dosage: water decoction, 1 dose per day, served twice, 20 days for a course of treatment
2: Prescription Qing Dai, Acorus calamus, Aconite, Safflower, Kombu, Silkworm, Wiryxian, Hosin 10 grams each, vinegar 1000 ml.
Usage: Put the medicine in vinegar and soak for 30 minutes, then decoct for 20 minutes, remove the residue and take the liquid, each drink a little put in the mouth and gargle, 6 times a day.
Efficacy: with 1 – 2 courses of treatment, the efficiency reaches 96.4%.
Daily maintenance
1. Do not use your voice excessively. Excessive use of the voice is the abuse of the voice (use of voice) that exceeds the range of my ability. Each person’s vocal ability has three aspects: pitch (voice frequency range), tone strength (vocal cord tension), and tone time (time to pronounce the voice), beyond which vocal cord lesions will occur.
2, actors should not eat too much before singing, preferably two hours before not eating.
3, bad habits, such as smoking, alcohol, chili pepper hobby and cold drinks after singing, is not good for the larynx organs. Therefore, we should try to change such habits.
4.To change the habit of clearing the throat. Many people may often use this action to cough up the phlegm in their throat or make their voice clearer, but this action makes the vocal cords instantly and severely strained, which can easily cause vocal cord damage.
5, it is best to abstain from sound for more than 1-2 weeks after vocal cord nodule surgery.
6, pay attention to voice rest when you have a cold, especially after a cold with hoarseness, or have been diagnosed with laryngitis.
7, hoarseness often occurs in the case of laryngeal muscle fatigue, laryngeal muscle fatigue is generally more difficult to recover! The professional vocalist should pay attention to the laryngeal muscle to get regular rest in the voice practice.
Four medicinal teas for laryngitis
Laryngitis can be acute or chronic. Acute laryngitis is an acute inflammation of the laryngeal mucosa. The disease starts as a viral infection, and later bacteria invade and cause a secondary bacterial infection. The manifestation is mucosal congestion, submucosal infiltration of polymorphonuclear leukocytes; in severe cases, exudate accumulation to form edema, mucosal surface with mucous-like secretions, and can be knotted into a pseudomembrane. Chronic laryngitis is often the result of untreated acute laryngitis, which is prolonged. It is a chronic non-specific inflammation of the laryngeal mucosa, and is the main cause of hoarseness. The main manifestation is hoarseness and discomfort in the larynx. The following tea recipes are commonly used in the treatment of laryngitis.
Formula 1: Luo Han Guo tea
[Application] Suitable for patients with phlegm fire and sore throat.
[Formula] Luo Han Guo 15 grams, green tea 1 gram.
[Usage] will Luohan fruit chopped, with tea into the same tea cup, brewed into boiling water, cover smothered for 15 minutes, drink as tea. 1 dose daily, can be brewed frequently to drink and serve, for 7-15 days to heal.
[Efficacy] Clearing heat and resolving phlegm, moistening the throat and quenching thirst.
Formula 2: Xia Ku Cao tea
[Application] Suitable for laryngitis patients.
[Recipe] 6 grams of Xia Gu Cao.
[Usage] Put the above medicine into a tea cup, brew into boiling water, cover with a stifling bubble for 15 minutes, drink as tea. 1 dose daily, can be brewed frequently to drink and serve, even drink 7-15 days to cure.
[Efficacy] Dispersing depression and moistening the throat.
Formula 3: peppermint and almond tea
[Application] Suitable for laryngitis patients to drink.
[Formula] 6 grams of peppermint, 9 grams of fried almonds, 6 grams of orris, 6 grams of fat sea.
[Usage] Put the above medicine into a tea cup, brew into boiling water, cover with a stifling bubble for 15 minutes.
Drink as tea. Take 1 dose daily, drink frequently, and heal in 7-15 days.
[Efficacy] Stopping cough and asthma, moistening throat, clearing heat and detoxifying.
Formula 4: Throat tea
[Application] Suitable for patients with laryngitis.
[Formula] Wang Bu Liu Xing 30 grams, dandelion 30 grams.
[Usage] Put the above medicine into a thermos flask with boiling water, steep for 15 minutes, pour into a tea cup and drink it as tea when warm. 1 dose daily, divided into several times to drink, for 7-15 days to heal.
[Efficacy] Clearing heat and detoxifying, activating blood circulation and moistening throat.
With voice health exercise
Section 1 massage both sides of the cheeks: This section focuses on the facial muscles of the two cheeks and the two jaw muscles to massage. Method: Use the palms of both hands on both sides of the cheeks. Show finger (index finger), middle finger, ring finger (ring finger), pinky stick in the cheeks, fingertips towards the two ears, thumb in the jaw angle. Then, the two hands for up and down linear massage 20, and then 20 rotational massage.
Section 2 massage neck: the focus of this section, the neck muscles, mainly on both sides of the neck sternocleidomastoid muscle, chin and tongue muscle massage. Some people before and during singing, this part of the muscle tension, resulting in the phenomenon of the head sticking forward. Method: Place the palm of one hand (left hand. Or right hand) on the front of the neck, thumb and show fingers apart, the hand of the tiger mouth against the throat, thumb pressed one side of the neck muscle, the other four fingers pressed the other side of the neck muscle, fingers gently pinch 20 times, and then a small rotary massage 20 times. Then change hands, according to the former method again.
Section 3 massage of the laryngeal nodes: the focus of this section is to massage the upper side of the laryngeal nodes on the supraglottic nerve area (supraglottic nerve is the nerve that makes the vocal folds move), and the lower side of the laryngeal nodes where the cricothyroid muscle (cricothyroid muscle is the muscle that makes the vocal folds elongate and become tense) Method: use the thumb and index finger of the left hand to do a small rotary massage on both sides of the laryngeal nodes up and down, 20 strokes each time, and then change hands and do 20 strokes again.
Section 4 head shaking exercise: the focus of this section is to make the neck muscles elongation, relieve muscle tension, traction vocal cord movement, cervical joint activities. How to do it: Sit with your body in a seated position, legs apart and hands on your knees. The head is slowly swung to the left first so that the jaw is as close to the left shoulder as possible. Then swing your head slowly to the right so that your jaw is as close to your right shoulder as possible, and swing your head from side to side for a total of 10 times.
Section 5: This section focuses on the movement of the cervical joints and the stretching of the muscles to stretch the laryngeal nerve and improve the excitability of the nerve conduction. How to do it: Lift your head slowly to the back and above, and then slowly to the front and down in a low pressure direction after the neck is straightened. The action must be slow, back and forth for 10 times.
Section 6 massage of the anterior neck depression: this section focuses on the massage of the anterior neck depression. This place is called the sternal concavity, the concavity has the sublingual nerve walking. It is the location of the “tiantu” point of the Ren meridian, which follows the midline of the head and neck and crosses the vocal cord area. Method: Use the right hand to show the finger and the middle finger into a sword finger, fingertip pressure in the anterior neck depression, that is, the upper sternal recess, against the front wall of the trachea, for gentle rotation movement, massage 20 times.
Section 7: Massage the back of the neck: The focus of this section is to massage the hairline at the back of the neck, where the important acupuncture points Mute and Tianzhu are located, both of which are meridian points for the treatment of hoarseness. How to do it: Stretch the palms of both hands towards the back of the neck, put the four fingers together and attach them to the edge of the hairline at the back of the neck. Use the fingers of both hands to massage this area in a rotating motion for 20 times.
Section 8 massage both sides of the nose: both sides of the nose is a sensitive area of the face, where the blood vessels and nerves are very rich, there are several important meridians in this cross or connected, such as the hand Yangming large intestine meridian, foot sun bladder meridian. The Ying Xiang point is in this area. How to do it: Open the palms of both hands straight, fingers up, and place them parallel to the sides of the nose, showing the fingers close to the grooves on both sides of the nose. Then both hands slide at the same time, from the inner canthus of the eye downward massage, to the nostrils on the outside of the Yingxiang point, two show finger tips in the Yingxiang point for a rotary massage, this is a. In this order, massage 10 times.
Section 9 massage of the two hands tiger mouth: the tiger mouth of the hand between the fingers and thumb, for the important points of the human meridian point Hegu point. Belonging to the hand Yangming large intestine meridian, the meridian can reach the throat, nose, and the whole body and a number of meridians connected. Method: Use the left finger and thumb to hold the tiger’s mouth of the right hand and massage 20 times in rotation. Then change hands and massage 20 times with the same method.
Section 10 deep breathing: deep breathing can make the thorax expand, lung expansion, is also one of the basic functions of the practice of gas . Method: standing or sitting position, head vertical, eyes straight ahead, quiet for a moment. Then take a deep breath, try to inhale enough air to fill the lungs, hold your breath for 10 seconds. Then slowly exhale. Exhale and then inhale again, and so on for 10 deep breaths.
Diagnostic tests for chronic laryngitis
Indirect laryngoscopy, according to the degree of lesion, has the following 3 types of changes.
1. Chronic simple laryngitis Diffuse congestion and redness of the laryngeal mucosa, loss of the original pearly white color of the vocal folds, pinkish, and blunted edges. Thick mucus is seen on the surface of the mucosa, often connected to mucus filaments between the vocal folds.
2, hypertrophic laryngitis The laryngeal mucosa is hypertrophic, with the interarytenoid region more obvious. The vocal cords are also hypertrophic and cannot close tightly to the midline and close poorly. The ventricular zone is often hypertrophic and obscures part of the vocal cords. The aryepiglottic folds can also be thickened.
3.Atrophic laryngitis The laryngeal mucosa is dry, thin and shiny. There are often yellow-green or dark brown dry scabs in the interarytenoid region and under the vocal folds. If the scabs are coughed up, a small amount of blood oozing from the mucosal surface can be seen. The vocal folds become thin and their tone is reduced.
Diagnosis The diagnosis is not difficult to make based on the fact that the patient has no systemic symptoms other than hoarseness, the disease is in remission, and the lesions of the vocal folds are often symmetrical on both sides. However, there are many clinical diseases causing hoarseness, which can be differentiated by referring to the differential diagnosis table for hoarseness.
Acute laryngitis
Acute laryngitis is a common acute diffuse inflammation of the laryngeal mucosa in infants and children. It is characterized by rapid onset, fever, hoarseness, barking cough and inspiratory dyspnea. Most of them are secondary bacterial infections on top of viral infections. Since laryngeal obstruction of different degrees often occurs, it is important to be vigilant and actively prevent and treat them.
How to distinguish pediatric acute laryngitis from the flu
Pediatric acute laryngitis occurs in winter, mostly in infants and young children between 6 months and 3 years old with a fat body, this disease is fierce and fast changing, the main danger is to cause laryngeal spasm or laryngeal obstruction in children, serious cases can endanger the lives of children. The larynx is located between the pharynx and the bronchi, and is a necessary route for human breathing. The laryngeal cavity of pediatric trachea is relatively small. Once the mucosa and submucosa tissues become swollen due to inflammation, the vocal folds become narrow or laryngeal spasm occurs, and laryngeal obstruction can occur, causing severe breathing difficulties.
Therefore, if parents find that their child has symptoms such as cough and runny nose and soon a coughing sound like a broken bamboo, they should not think that it is just a cold, but should take the child to the hospital for examination and treatment, otherwise the child may have laryngospasm and laryngeal obstruction in a very short time. With timely detection and treatment, acute laryngitis can usually be effectively controlled within a few hours, and most will improve significantly within 1-2 days.
Differential diagnosis
Many people tend to confuse pharyngitis with laryngitis. Although the onset of pharyngitis and laryngitis are similar in location and symptoms, they can be distinguished if carefully identified.
The pharynx is the pharynx and the larynx is the throat, which are two different parts. The pharynx is divided into three parts: the oropharynx: what we can see when we open our mouth is the soft palate, the uvula, the tongue, and the tonsils on both sides. The cavity between the uvula and the tongue, including the tonsils, is called the oropharynx (its back wall is called the posterior pharyngeal wall); the cavity is called the nasopharynx, which is located from the uvula up to the posterior end of the nasal cavity (we need to use the nasopharyngoscope to see); the tongue root down to the upper edge of the epiglottis (we need to use the indirect laryngoscope to see) is the laryngopharynx; the laryngopharynx is down to the larynx.
The pharynx and larynx are both parts of the upper respiratory tract, and their mucous membranes are continuous with each other, so it is difficult to distinguish clearly whether the disease is in the oropharynx or the laryngopharynx. This is why it is difficult to clearly distinguish between pharyngitis and laryngitis. However, laryngitis and pharyngitis are clearly distinguishable because the larynx functions as a vocal organ, and only when there is a change in the voice does it indicate a disease of the larynx.
Both pharyngitis and laryngitis are pathological changes of the mucous membrane, including congestion, swelling, hypertrophy, and lymphatic follicle growth. Due to the special location of the pharynx, located at the entrance of the upper respiratory and digestive tracts, it is inevitable that it will be violated by bacteria, dust, tobacco, alcohol, foreign bodies, and even nasal and oral diseases.
Pharyngitis is a common disease of the pharynx, which is an inflammation of the pharyngeal mucosa and its lymphatic tissue. Acute pharyngitis is often a part of upper respiratory tract infections, mostly caused by viral infections. Lesions can manifest as acute simple pharyngitis and acute suppurative pharyngitis. Acute pharyngitis recurrent episodes can become chronic, long-term excessive smoking and alcohol or stimulated by harmful gases can also cause chronic pharyngitis. Chronic pharyngitis can be divided into: chronic simple pharyngitis, chronic hypertrophic pharyngitis, chronic atrophic pharyngitis.
Laryngitis is an inflammation of the laryngeal mucosa and submucosal tissues. It is characterized clinically by a severe cough and swelling, warming and pain in the larynx. Depending on the etiology and clinical course, it can be divided into primary and secondary, acute and chronic. Acute catarrhal laryngitis is the most common clinical condition and is often complicated by pharyngitis.