Laryngotracheitis

The reasons

Development mechanism

Classification

Manifestations of acute laryngotracheitis

Symptoms of the chronic process

Diagnostics

Treatment of laryngotracheitis

Laryngotracheitis is an infectious-inflammatory lesion of the larynx and trachea, accompanied by signs of acute respiratory infection.

In adults, laryngotracheitis is manifested by impaired breathing and an agonizing cough, and in children it can manifest signs of a severe complication — a false croup.

The reasons

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Usually laryngotracheitis develops in children, although adults may also be ill. Often laryngotracheitis is a complication of acute respiratory infection, or occurs when the immune defense decreases, either in the respiratory system or in the whole organism. Diseases can occur each separately – laryngitis or tracheitis, but usually due to the structural features of the organs flow together and give similar clinical manifestations.   

The main causes of laryngotracheitis are:

  • respiratory viral lesions (especially dangerous are influenza virus , parainfluenza and adenovirus ),    
  • bacterial lesions (streptococcal or staphylococcal, tuberculosis),
  • mycoplasma lesions 
  • herpes lesions,
  • allergic causes
  • chemical agents.

The provoking factors for the development of laryngotracheitis are:

  • inhalation of dusty and polluted air.
  • scream,
  • loud singing
  • smoking, alcohol,
  • symptoms of general hypothermia or freezing of the legs.

Development mechanism

The trachea performs the function of an air- conductive tube and, during inflammation, edema may occur in the region of its mucosa. This leads to the formation of difficult to separate content, irritating the receptors and disrupting the conduct of air masses.

The larynx, in addition to the air- conducting function, also plays the role of the voice-forming element. Due to the vocal cords. Flows of air and vibrations of the ligaments create a certain sound heard by the ear.

With inflammation, the vocal cords are damaged and swell, and the region of the periosteous fiber begins to accumulate fluid, and squeeze the laryngeal area.

There may be a complication – false croup (swelling with compression of the respiratory tract and suffocation).

Classification

There are acute and chronic laryngotracheitis. Acute laryngotracheitis is divided into

  • primary, which is detected for the first time,
  • recurrent, recurring, with the occurrence of colds or the action of adverse factors.

Primary acute laryngotracheitis can have three variants of the course:

  • sudden laryngotracheitis without signs of acute respiratory infections,
  • acutely occurring against the background of the existing ARD, 
  • gradually emerging as a complication of colds.

Downstream acute laryngotracheitis may be continuous or wavy.

Chronic laryngotracheitis occurs with the wrong treatment of acute or in the absence of its treatment. Often occurs with professional ligament overvoltage.

There are three forms of the disease:

  • catarral, in which there is redness and some swelling in the vocal cords and trachea
  • atrophic, there is a gradual atrophy in the area of ​​the mucous membrane, because of which it loses its protective properties and becomes inflamed. Often happens to smokers and workers of coal mines, people working in dusty rooms
  • hyperplastic, growth of areas or the entire mucous area in the trachea and larynx is manifested, breathing and voice suffers as a result

Manifestations of acute laryngotracheitis

Acute laryngotracheitis manifests itself against ARVI , starting acutely or gradually. There are: 

  • sharp rise in temperature
  • sore throat,
  • sternity behind the sternum
  • rough, dry cough with soreness,
  • a cough has the character of a croak or bark due to a sharp swelling and spasm of the vocal cords,
  • when coughing, pain in the chest increases;
  • coughing episodes occur when laughing, breathing deeply, breathing in dusty or cold air,
  • a small amount of thick and viscous sputum is released,
  • hoarseness or hoarseness in the voice
  • discomfort in the larynx with dryness, burning .

As the process develops, the cough becomes wet, less painful, with a lot of mucus mucous- phlegm.

Cervical lymph nodes can react – they become painful and enlarged. When listening to the lungs, hard breathing and dry rales in the projection of the trachea are noted.

Symptoms of the chronic process

Chronic laryngotracheitis occurs gradually, the main symptoms are:

  • voice disorders, from mild dysphonia and hoarseness, up to a complete lack of voice – aphonia,
  • coughing episodes, provoked by laughter, cold, or deep breathing,
  • soreness in the larynx and behind the sternum,
  • voice fatigue may occur (with prolonged singing or talking).

Exacerbations of chronic laryngotracheitis can occur during hormonal alterations in women, during hypothermia, after stress, after heavy loads on the ligaments – when screaming, singing with anguish.

In chronic laryngotracheitis, cough is usually constant, with a small amount of sputum, and amid aggravations, coughing attacks become more frequent and sputum becomes larger. Against the background of cough, in the area of ​​the trachea and larynx there may be a feeling of itching and dryness.

Diagnostics

The basis of the diagnosis is typical patient complaints – a hoarse voice, a dry cough and chest pain, as well as examination and listening to the lungs and the trachea.

Laboratory studies are conducted:

  • general blood analysis,
  • general urine analysis,
  • bacteriological examination of sputum,
  • if available, serological testing for viruses of respiratory infections.

The diagnosis is supplemented by micro-laryngoscopy and tracheoscopy – examination of the vocal cords and larynx with the help of a special apparatus, if necessary, x-rays and CT scans of the larynx and trachea are prescribed.

In chronic laryngotracheitis, laryngoscopy should be performed with a piece of tissue taken for biopsy to rule out cancer, and when wheezing occurs, an x-ray of the chest with the exception of pneumonia and bronchitis .   

It is important to distinguish laryngotracheitis from the foreign body of the larynx and trachea, from diphtheria and laryngeal papillomatosis , and pharyngeal abscesses.  

Treatment of laryngotracheitis

Laryngotracheitis is treated by general practitioners, general practitioners or otolaryngologists, with an uncomplicated course of treatment is carried out on an outpatient basis, under the supervision of a polyclinic doctor. 

With an acute or acute chronic process, to relieve cough, it is necessary to take a large amount of warm liquids in the form of tea, compotes, and you can brew chamomile, chest preparations. Indoor air requires moisture and coolness.

With a moderate increase in body temperature and satisfactory tolerability, it is not necessary to knock it down, because it helps the body fight viruses, if the temperature is above 38.5 ° C, paracetamol or a combination agent can be taken (for example, tera-flu or coldrex ).

At the beginning of the disease, it is possible to use antiviral drugs (anaferon, ergoferon ) according to the scheme for 5 days. If the increased body temperature persists on the 4th day of the disease, you should start taking antibacterial drugs.

With respiratory infections are used

  • antibiotics penicillin series ( amoxiclav , Augmentin ) 
  • macrolides ( sumamed , klacid ), 
  • in severe cases, cephalosporins may be prescribed (for example, ceftriaxone intramuscularly or intravenously).

To relieve cough with laryngotracheitis it is necessary to carry out inhalation through a nebulizer (this device should be kept at home and used in case of illness in both adults and children). With a mild course you can use saline, moisturizing the mucous membranes of the respiratory tract itself has a positive effect. If this is not enough, you can add mucolytic (for example, a solution for inhalation Lasolvan ).

In the acute period, with marked edema of the respiratory tract (especially in children), the use of the drug Pulmicort is possible . It is a metered-dose suspension for inhalation of 2 ml (1 mg), it should be diluted with saline in a ratio of 1: 1, pour a nebulizer into the container for medicines and carry out inhalation, then rinse the mouth with water and wash. 

Orally, when coughing, mucolytics are used : ACC, ACC- Long , combined means (for example, Codelac-broncho syrup with thyme)

Physiotherapeutic treatment is quite effective: electrophoresis of drugs, exposure to an ultrahigh frequency (UHF) electric field, therapeutic exercise, massage, exposure to low-intensity laser radiation on the throat area. 

The prognosis for laryngotracheitis is favorable, however, for people whose profession is associated with singing or long conversations, laryngotracheitis can disrupt the voice formation and cause prof. unsuitability.

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