Chronic laryngitis is an inflammation of the mucous membrane of the larynx lasting more than 3 weeks. Timely diagnosis and adequate treatment of this pathology is extremely important, since it is a social problem that leads to the disability of persons of vocal and speech professions – vocalists, actors, teachers, tour guides. Malignation of the inflamed laryngeal cells may occur, i.e., their degeneration into a cancerous tumor.
Causes of Chronic Laryngitis
The role in the development of chronic inflammation in the larynx is played by:
- frequent acute laryngitis;
- chronic foci of infection of a different location (sinusitis, pharyngitis, tonsillitis, otitis, caries);
- conditionally pathogenic microflora of the oral cavity;
- concomitant somatic pathology, in particular GERD (with this disease, the acidic contents of the patient’s stomach are thrown into the esophagus, burning the mucous membrane, which creates favorable conditions for reproduction in this area of microorganisms);
- metabolic diseases (in particular, diabetes);
- dust, food, chemical allergens;
- regular excessive loads on the vocal apparatus;
- working or living in conditions of severe air pollution with dust or chemicals;
- sudden changes in temperature;
- smoking and drinking;
- reduced overall body resistance.
Chronic laryngitis: symptoms and diagnosis
The leading symptom of chronic inflammation of the larynx is a change in the tone of voice, its hoarseness. The disease can manifest itself as a constant feeling of dryness, tickling, discomfort in the throat, a sense of the presence of a foreign body or coma in it. Patients are worried about a cough of varying intensity – from constant coughing to paroxysmal coughing. During remission, the above symptoms are mild, and when exacerbated, their intensity increases, body temperature rises to subfebrile numbers, and complaints of weakness, fatigue, and headache may appear.
The diagnosis of acute laryngitis is made on the basis of the patient’s complaints, taking into account the medical history of the disease and life, confirmed during a laryngo or video endoscopy – a simple examination of the laryngeal area or its examination with a video endoscope device. In some cases, for the purpose of accurate diagnosis, microlaryngoscopy is used (examination of the laryngeal mucosa under a microscope). If a malignancy is suspected during a laryngoscopic examination, a puncture biopsy is performed – a special needle is taken from the affected needle for subsequent histological examination.
Depending on the morphological changes of the laryngeal mucosa and the prevailing symptoms of the disease, acute laryngitis can be divided into 3 forms: catarrhal, hypertrophic and atrophic.
In case of catarrhal form of chronic laryngitis, the mucous membrane of the larynx is diffusely thickened, moderately hyperemic, and blood vessels are visualized on the edematous vocal folds. During phonation, the glottis is not fully closed. This form of the disease is manifested by constant hoarseness, tingling sensation in the throat, and rapid voice fatigue. In addition, patients from time to time worried about a moderate-intensity cough with a transparent or whitish sputum.
Chronic hypertrophic laryngitis may be diffuse or limited. With a diffuse form, the mucous membrane of the larynx is evenly swollen, with a limited in the area of the vocal folds, symmetrically located connective tissue tubercles are visualized (the nodules of the singers are in adults, the knots of screamers are in children). A characteristic clinical sign of hypertrophic laryngitis is pronounced hoarseness of the voice, up to its complete absence – aphonia.
In the atrophic form of chronic inflammation of the larynx, its mucous membrane is dry, thinned, covered with thick mucus and crusts. Clinically, the disease manifests itself with a constant sensation of tickling and dry throat, a hacking dry cough, in which crusts with blood streaks go away. During the day, hoarseness of voice is expressed differently: in the morning it is stronger, after coughing it decreases.
Chronic laryngitis: treatment
Unfortunately, it is impossible to completely get rid of this disease, so the treatment of chronic laryngitis in adults should be aimed at reducing its manifestations and improving the quality of life of the patient.
Of great importance in the treatment of chronic inflammation of the larynx are non-pharmacological methods:
- to give up smoking;
- voice rest;
- sparing food (warm, soft, neutral in taste food, with the exception of spicy, hot and cold dishes, carbonated drinks);
- plentiful drink (alkaline mineral waters (“Naftusya”, Borjomi), warm milk with honey);
- preventing hypothermia;
- airing the room in which the patient lives, for 10 minutes every hour;
- adequate microclimate (temperature and humidity) in the room.
An important component of the treatment of chronic laryngitis is the timely treatment of its attendant pathology (rehabilitation of chronic foci of infection, correction of blood glucose levels, treatment of GERD).
Further aspects of therapy are different for different forms of the disease, so we will consider each of them separately.
Treatment of chronic catarrhal laryngitis
This form of the disease is very well treatable. In addition to the above non-drug measures, drug therapy is also used:
- antiviral drugs (interferon inducers, Groprinosin);
- if necessary, systemic antibiotics (Amoxiclav, Moexipril);
- oil and alkaline inhalations;
- antitussives (Codeine);
- expectorants (preparations of Althea, Ivy, Plantain) and mucolytic (Acetyl-, Carbocysteine, Ambroxol, Bromhexin) agents;
- local anti-inflammatory and analgesic drugs (Isla pastilles, Neo-Angin, Dekatilen, Angilex sprays, Thera-flu, Ingalipt);
- local antibacterial drugs (Bioparox);
- multivitamin preparations (Duovit, Multitabs);
- immunomodulators (Resibron, Ribomunil);
- preparations containing bacterial lysates (IRS-19).
In a hospital setting, medicines are also administered in the larynx with a special laryngeal syringe – the so-called instillations.
When the symptoms of exacerbation regress, the use of physiotherapy treatments is recommended:
Treatment of chronic atrophic laryngitis
In the presence of appropriate symptoms, the same remedies are used that are recommended for the treatment of the catarrhal form of the disease. A feature of the therapy of atrophic laryngitis are inhalations of proteolytic enzymes (Chymotrypsin, Trypsin) in the form of aerosols.
Treatment of chronic hypertrophic laryngitis
Depending on the condition of the patient, treatment may be conservative (include all or some of the drugs from the above groups) or surgical. The essence of the latter lies in the fact that under local anesthesia, under the control of a microscope, the ENT surgeon removes the hyperplastic tissues. Not less popular method of surgical intervention is the removal of growths from the vocal folds using a beam of cold plasma – coblation.
After the operation, the patient should observe the following recommendations:
- do not eat for 2 hours after leaving the operating room;
- do not cough (to avoid mechanical injury of a postoperative wound);
- complete voice rest during the next 5–7 days;
- a sharp limitation of physical activity in the next 7–8 days.
- sparing diet;
- avoid contact with tobacco smoke, stop smoking.
Prevention of chronic laryngitis
The main preventive measures are:
- timely and adequate treatment of acute and chronic infectious diseases and somatic pathology;
- the observance of an adequate voice mode (avoidance of voice apparatus overloads);
- regular monitoring of persons with vocal and speech professions at the phoniatrist;
- rejection of active and passive smoking, alcohol intake;
- strengthening the general protective forces of the body (walking in fresh air, measured physical activity, wiping with cold water, foot baths and other activities).
About the treatment of laryngitis and how to distinguish it from similar diseases in the program “School of Doctor Komarovsky”: