Acute laryngitis refers to acute diffuse catarrhal inflammation of the laryngeal mucosa, mainly in the vocal fold, also known as acute catarrhal laryngitis, and is one of the common acute infectious diseases of the adult respiratory tract. It has a higher incidence in males and occurs mostly in winter and spring.
Etiology
1, infection: the main cause, mostly after the cold and flu, on the basis of viral infection secondary to bacterial infection. Commonly infected bacteria include Staphylococcus aureus, Streptococcus hemolyticus, S. pneumoniae, Cattamora, Bacillus influenzae, etc.
2, harmful gases: inhalation of harmful gases (such as chlorine, ammonia, sulfuric acid, nitric acid, sulfur dioxide, nitric oxide, etc.) and excessive productive dust can cause acute inflammation of the mucous membrane of the larynx.
3, occupational factors: such as teachers, actors, salesmen who use their voices more, the incidence is often higher when vocalization is improper or excessive use of voice.
4.Laryngeal trauma: such as foreign body or instrument damage to the mucous membrane of the larynx.
5, too much alcohol and tobacco, cold, fatigue to reduce the body’s resistance to induce acute laryngitis. Sudden changes in air humidity and indoor dry heat are also triggers.
Pathology
Initially, the laryngeal mucosa is acutely diffuse congestion with polymorphonuclear leukocytes and lymphocytes infiltration, and edema is formed by the accumulation of exudate in the tissue. As inflammation continues to progress, the exudate may become purulent secretions or become pseudomembranous. If the epithelium is damaged and detached, ulcers may also form. If the inflammation is not controlled in time, there is round cell infiltration, gradually forming fibrous degeneration. Sometimes the lesion is deep and can even reach the intramyocardial layer of the larynx and can also spread to the trachea.
Clinical manifestations
1. Hoarseness
The main symptom of acute laryngitis is sudden onset. In mild cases, the voice loses its roundness and clarity, and the pitch becomes lower and coarser. In severe cases, the voice is hoarse, or even only whispering or completely lost voice.
2.Laryngeal pain
The patient has a slight pain in the larynx and the front of the trachea, and the laryngeal pain is aggravated when vocalizing, and the patient feels discomfort, dryness and foreign body sensation in the larynx.
3.Increased laryngeal secretion
There is often a cough, initially dry without sputum, spasmodic, with laryngeal pain when coughing, often intensified at night. Later in the evening, there is mucopurulent secretion, which is thicker, often not easy to cough up, and adheres to the surface of the vocal cords and aggravates hoarseness.
4. Systemic symptoms
Generally, the systemic symptoms are lighter in adults and heavier in children. In severe cases, there may be symptoms such as chills, fever, fatigue and loss of appetite.
5. Inflammatory symptoms of the nose and pharynx
Because acute laryngitis is mostly a downstream infection of acute rhinitis or acute pharyngitis, there are often corresponding symptoms in the nose and pharynx.
Laryngoscopy reveals that the laryngeal mucosa varies with the development of inflammation at different times and is characterized by bilateral symmetry and diffuse nature. Mucosal erythema often first appears in the epiglottis and vocal folds, gradually progressing to the ventricular folds and subglottic cavity, but the vocal folds and aryepiglottic folds are prominent. In the early stage, the surface of the vocal folds is light red with blood-filled capillaries, gradually becoming dark red with rounded edges in the shape of a pike, and when the subglottic mucosa is obviously red and swollen, it is set off under the vocal folds and can be double vocal fold-like. Occasionally, small superficial ulcers and submucosal petechiae are seen in the laryngeal mucosa. The laryngeal mucosa is dry in the early stage, and hoarseness is heavier when mucus or mucopurulent secretions adhere to the surface of the vocal folds later, and is reduced after the secretions are coughed up. The nose and pharynx also often have the corresponding manifestations of acute inflammation.
Diagnosis and differential diagnosis
Based on the symptoms and examination, a preliminary diagnosis can be made, but it should be differentiated from the following diseases.
1, laryngeal nodules
Mostly secondary to more severe active tuberculosis of the lungs or other organs. The lesions mostly occur in the laryngeal mucosa covered with compound squamous epithelium, such as the posterior part of the larynx (interarytenoid region, arytenoid cartilage), as well as the vocal cords, ventricular cords and epiglottis. In the early stage of laryngeal tuberculosis, there is irritation, burning and dryness in the larynx. Hoarseness is its main symptom, which is light at first, gradually worsens, and in the late stage, complete loss of voice can occur. There is often laryngeal pain, which is aggravated when swallowing, and is especially severe when the laryngeal cartilage is involved.
2. Measles laryngitis
Caused by the measles virus, its development is consistent with the course of measles. At the peak of the rash is accompanied by obvious hoarseness, cough or barking cough, which rapidly improves as the rash subsides, and laryngeal obstruction rarely occurs. Laryngitis caused by secondary bacterial infection is often more severe and may lead to laryngeal obstruction. Most of the more severe cases of measles in young children have mild laryngitis, which is almost always a symptom of measles.
Treatment
1, early use of a sufficient amount of broad-spectrum antibiotics, congestion and swelling of significant additional glucocorticoids.
2.Oxygen administration, antispasmodic, sputum, keep the respiratory tract unobstructed: can be given by ultrasonic nebulized inhalation with water oxygen or via nasal oxygen (see section 1 for local treatment). In the early stage of mucosal dryness, add peppermint, compound benzoin tincture, etc. 0.04% Diquantinium chloride (trade name has Daphne Lalu) aerosol spray.
3.Vocal fold rest: no or less articulation.
4.Care and systemic support therapy: adjust room temperature and humidity at any time, keep indoor air circulation, drink more hot water, pay attention to smooth stool, prohibit smoking and alcohol, etc.
Prognosis
The prognosis of acute simple laryngitis is generally good and rarely causes laryngeal chondromyelitis, cartilage necrosis and laryngeal abscess. In acute laryngeal obstruction degree II, close observation of breathing and preparation for tracheotomy should be carried out, and tracheotomy can be considered in degree III. Active treatment of acute laryngitis is the key to prevent its transformation into chronic.