Laryngotracheitis is a combined infectious and inflammatory disease that affects both the trachea (tracheitis) and larynx (laryngitis). Due to the imperfection of the immune system, laryngotracheitis is more common in children under the age of 6 years, but laryngotracheitis often occurs in adult patients. This disease is dangerous because at the very beginning of the disease it can be mistaken for a common acute respiratory viral infection. Untimely diagnosis and self-treatment can have the most severe consequences, especially in young patients.
The content of the article:
Classification of laryngotracheitis
Morphological signs of various forms of laryngotracheitis
Causes of laryngotracheitis
Symptoms of laryngotracheitis
Diagnosis of laryngotracheitis
Complications of laryngotracheitis
Treatment of laryngotracheitis
Laryngotracheitis
Classification of laryngotracheitis
Depending on what caused the disease, laryngotracheitis is usually classified into infectious, bacterial and mixed.
According to the nature of the course of the disease, acute and chronic forms of pathology are distinguished. In turn, acute forms can have a primary and recurrent character, as well as a continuous or undulating course. Laryngotracheitis develops laryngeal stenosis, that is, its pathological narrowing. This condition is dangerous because the air does not enter the respiratory tract well and oxygen deficiency may develop. This condition is a threat to all human organs and systems and is fraught with serious consequences. Stenosis is possible to compensate for breathing .:
Compensated;
Incomplete compensation;
Decompensated;
Terminal (asphyxia or suffocation).
According to the morphology of laryngotracheitis, it is customary to divide into catarrhal, hypertrophic and atrophic.
This classification makes it possible to carry out differential diagnostics and provide timely medical care to the patient. It is necessary to start treatment as soon as possible if the patient is suspected of laryngotracheitis, the symptoms of the disease are quite characteristic and have a decisive diagnostic value.
Morphological signs of various forms of laryngotracheitis
The most common form of the disease is acute laryngotracheitis. During the initial visual examination, it can be seen that the patient’s larynx is highly hyperemic, has a bright red hue, and a purulent plaque (exudate) is visible in large quantities in the lumen of the larynx. The mucous membrane is swollen and thickened. By the consistency of the exudate, it is possible to determine how long ago the inflammatory process began in the patient. If at an early stage of the disease the exudate has a liquid consistency, then when the disease progresses, it becomes thicker, and fibrous films are formed. By the color of the plaque itself on the mucous membrane of the larynx, even the etiology of the disease can be determined. So, with staphylococcal and streptococcal infections, the larynx is covered with very characteristic yellow-green crusts.
The catarrhal form of laryngotracheitis is characterized by characteristic changes in the mucous membrane. The mucosa is hyperemic and has a bluish color, thickened and has small small-point hemorrhages in the submucosal layer.
In chronic hypertrophic laryngotracheitis, the patient has an overgrowth of the structural elements of the mucous membrane (hyperplasia), as well as hyperplasia of the submucosal layer and infiltration (impregnation) with exudate of the fibers of the muscles of the larynx and trachea, including the vocal cords. Thickening of the vocal cords can be either diffuse or localized in the form of nodules. Such changes in the structures of the vocal cords are characteristic of people with an increased load on the speech apparatus (singers, teachers, commanders, actors, lecturers and speakers). Hypertrophic laryngotracheitis can be complicated by the formation of cysts or characteristic laryngeal ulcers.
The atrophic form of pathology is characterized by various degenerative processes. The vocal cords of the patient are very thinned, the mucous membranes are dry, with a visual examination, characteristic dry crusts can be found on the mucosa. There is atrophy of the muscles and glands inside the larynx and the nature of the epithelial tissue changes.
Causes of laryngotracheitis
There are many causes of laryngotracheitis, but it is very important to understand that the main cause is immunodeficiency of various etiologies. A weakened organism is very susceptible to various viruses and bacteria and is an excellent habitat for bacterial microflora. Even those microorganisms that are considered conditionally pathogenic (those with which a person gets along well) in conditions of weakened immunity actively multiply and often lead to the development of quite severe pathologies. Also predisposing factors can be considered:
alcohol abuse, especially of low quality;
tobacco smoking;
environmental factor;
the presence of severe chronic diseases in the patient;
constant hypothermia;
stagnant processes in the lungs of various etiologies (chronic bronchitis, bronchial asthma, COPD, etc.);
various diseases of the nasopharynx that make it difficult to breathe through the nose or make it impossible at all (choan atresia, sinusitis, sinusitis, allergic rhinitis, etc.).
In most cases, laryngotracheitis is a complication of a particular viral infection:
adenovirus;
ARVI;
influenza virus;
parainfluenza;
rubella;
cory;
mumps;
chickenpox;
scarlet fever, etc.
Less often laryngotracheitis may have a bacterial etiology and be a consequence of infection:
staphylococcus;
streptococcus;
tuberculosis;
pneumococcus;
pale treponema;
mycoplasma;
chlamydia, etc.
Infection occurs by airborne droplets, especially with intense sneezing or coughing of a sick person in a confined space. That is why, more than others, laryngotracheitis affects children who spend a lot of time in a peer group, where any infection spreads very quickly.
Symptoms of laryngotracheitis
Symptoms of acute laryngotracheitis
The first symptoms of the disease occur, in most cases, against the background of progressive upper respiratory tract infection of various etiologies. The main symptoms of an infectious disease (hyperthermic syndrome, fever, rhinitis, etc.) are joined by a dry “barking cough”, sore throat, difficulty or painful swallowing. In some cases, the disease occurs when the main symptoms of the viral disease have already passed.
Cough and its nature is an important diagnostic sign. Dry and barking cough with laryngotracheitis has some features. First of all, such a cough is characterized by pain behind the sternum, both during and after the cough. Cough occurs in the patient more often at night or immediately after waking up. The rest of the time, anything can provoke a coughing attack: deep breathing, inhaling dust or too cold air, laughing, crying, etc. In acute laryngotracheitis, sputum is released when coughing, but there is not much of it and it has a viscous consistency.
As the disease progresses, sputum becomes more abundant and liquid and has a mucopurulent character. The patient experiences severe discomfort in the larynx: a feeling of the presence of a foreign body, difficulty swallowing, sore throat, dryness, burning, etc. The patient’s voice changes its timbre and becomes hoarse, hoarse.
The lymph nodes of the patient’s cervical group are enlarged during palpation, while listening — the patient’s breathing is noisy, sometimes dry wheezing is heard.
Symptoms of chronic laryngotracheitis
Particular attention should be paid to cough. If in the acute form of laryngotracheitis it is episodic and paroxysmal, then in the chronic form of this pathology the cough is permanent. Moreover, the patient constantly experiences a feeling of discomfort in the pharynx and trachea, as well as frequent painful sensations behind the sternum. A constant persistent feeling that the throat is scratched, dry mouth, painful swallowing — this is an incomplete list of manifestations of chronic laryngotracheitis.
The most characteristic diagnostic sign is dysphonia or disorders of the patient’s vocal function. Dysphonia can be of varying intensity from mild “hoarseness” to complete inability to talk. Attempts to make sounds cause discomfort to the patient. Some climatic factors or various hormonal changes can aggravate this condition. Especially severe forms of dysphonia occur in women in menopause, during pregnancy or during menstruation. This condition can be both periodic and permanent. Constant dysphonia indicates various morphological changes in the structures of the vocal cords. If the patient’s professional activity is associated with the need to constantly communicate and be in public, the most insignificant changes in the timbre of the voice can become a traumatic factor for them. As a result, the psychosomatic state of the patient is disturbed: sleep dysfunction, constant nervous tension, depression or neurasthenia.
Diagnosis of laryngotracheitis
The result of treatment depends on the correct and timely diagnosis. Therefore, when you notice the first signs of the disease, you should immediately consult a doctor. Particular attention should be paid to laryngotracheitis in children, as the disease progresses rapidly and takes threatening forms. Often parents underestimate the seriousness of the situation, and therefore children get to pediatricians already in a deplorable state.
The most important diagnostic treatment is the initial interview of the patient and the collection of anamnesis. If you have suffered from acute respiratory viral infections, have recently had the flu or other diseases of the upper respiratory tract — do not forget to inform your doctor about this. After the survey is conducted, the doctor conducts a visual examination. For this purpose, microlaryngoscopy is performed (a diagnostic procedure that allows you to determine the condition of the ligamentous apparatus and the larynx of the patient). If the doctor sees such a need, a surface biopsy can be performed during microlaryngoscopy (scraping of tissue samples for their subsequent examination).
In order for the treatment of the disease to be as effective as possible, it is necessary to identify the infectious pathogen. To do this, smears from the patient’s throat and nose are sent to the clinical diagnostic laboratory, as well as sputum for bacteriological seeding. As additional research methods, sputum analysis for oxygen resistant bacteria and its microscopy are used. Laboratory research methods such as enzyme immunoassay (ELISA), polymerase chain reaction (PCR) and immunofluorescence reaction (RIF) are also used. These advanced technologies make it possible to identify almost all pathogens of infectious diseases known to medicine.
It is also necessary to conduct radiography and computed tomography for the purpose of differential diagnosis of diphtheria, malignant and benign neoplasms of the larynx, pneumonia, bronchial asthma and pharyngeal abscess.
Complications of laryngotracheitis
The main complications of laryngotracheitis concern the bronchopulmonary system. Infection of the upper respiratory tract tends to descend into the bronchi and lungs, which causes the addition of tracheobronchitis, obstructive bronchitis or pneumonia. Inflammatory processes in the bronchi and lungs are accompanied by changes in the somatic state of the patient: general weakness and intoxication of the body, dizziness, an increase in body temperature (subfebrile temperature or hyperthermic syndrome), pain and discomfort in the throat, etc.
The most threatening conditions occur in the youngest patients. Due to the peculiarities of the anatomical structure of the larynx, complications in children can be very serious. Anatomically, the already narrow lumen of the larynx in a child with laryngotracheitis is filled with accumulated sputum and spasm of the laryngeal muscles often occurs. This condition can cause the baby to have an attack of false croup — an acute inflammatory process of the larynx. False croup is classified as a life-threatening condition of the patient. If medical care is not provided, various respiratory disorders are possible, up to hypoxia and asphyxia. Cases of fatal outcome have been recorded in pediatric practice.
In chronic laryngotracheitis, in the absence of adequate therapy, there is constant irritation of the laryngeal mucosa. Such “injuries” do not pass without a trace. Against the background of chronic laryngotracheitis (especially with hypertrophic form), various neoplasms often occur. Initially, they are benign in nature, but they tend to degenerate over time into a malignant tumor (laryngeal cancer).
Treatment of laryngotracheitis
It is impossible to give an unambiguous answer to the question of how to treat laryngotrocheitis. Treatment depends on the form of the disease, the prevalence of the pathological process, the etiology of the disease and the clinical course. If a patient is diagnosed with laryngotracheitis, treatment should be started immediately to avoid complications.
In most cases, treatment is carried out in an outpatient clinic and only children with suspected false croup are hospitalized.
Treatment has several directions: antibiotic therapy with broad-spectrum drugs, the use of antiviral drugs, symptomatic therapy (expectorants, antiallergic agents and antipyretics). Physiotherapy procedures such as UHF, inhalation, massage, electrophoresis, etc. are quite effective.
Treatment of the chronic form of the disease has some differences. It is customary to attach more importance to physiotherapy. In addition to the above measures, the patient is shown general strengthening and immunostimulating therapy (vitamins, mineral complexes, immunosuppressants, etc.).
In complicated cases of chronic hypertrophic laryngotracheitis, surgical intervention is possible. Such an intervention allows excision of neoplasms and excess laryngeal tissue, as well as to eliminate ventricular prolapse.
It is worth noting that the treatment regimen is selected by the doctor in each clinical case individually. It is categorically not recommended to self-medicate, since the consequences of such “treatment” can be the most unpredictable.
