Chronic laryngeal stenosis
Chronic stenosis of the larynx is a partial or complete narrowing of the lumen of the larynx, which develops gradually over a long time, as a result, it leads to oxygen starvation of the body, and sometimes even to asphyxia. The larynx is part of the respiratory system of the human body, namely the respiratory tube (upper part) and the vocal cords.
Causes of chronic stenosis of the larynx
The main causes of chronic stenosis of the larynx are: chondroperichondritis (inflammation of the cartilage and perichondrium) and its complications, surgical scars, malignant tumors, benign neoplasms, various burns of the larynx, dysfunction of the lower laryngeal nerves, specific inflammatory diseases.
Sometimes chronic stenosis is the result of an unsuccessful or improperly performed tracheotomy, an improperly fitted tube, or prolonged wearing. It can develop sharply into acute stenosis when certain provoking conditions occur, for example, hemorrhage, inflammation, etc.
Symptoms of chronic laryngeal stenosis
The symptoms of chronic laryngeal stenosis depend on the stage of the disease. There are three stages:
Stage I (stage of compensation) - characterized by deeper and less frequent breathing, loss or decrease in pauses between inhalation and exhalation, a decrease in the number of breaths, a violation of the normal ratio between the pulse and respiratory movements;
Stage II (stage of decompensation) - signs of asphyxia and hypoxia are clearly manifested. There is cyanosis of the mucous membranes, whites of the eyes, skin (around the mouth, under the eyes), a sharp retraction of the intercostal spaces, jugular and subclavian fossae when inhaling, breathing becomes more frequent and accompanied by noise when inhaling, the patient has perspiration;
Stage III (asphyxia or dyspnea) - cardiac activity significantly worsens, breathing becomes superficial and rare, pupils dilate, the patient turns blue, becomes indifferent to everything, lethargic. Uncontrolled discharge of urine and feces, loss of consciousness, and respiratory arrest may occur.
The stage of stenosis depends on the degree of narrowing of the glottis. Often, with a slow course of the disease, the patient's body gradually adapts itself to breathe through the narrow lumen of the larynx. With physical exertion, breathing becomes even more difficult and normalizes at rest. In addition, the voice function is impaired, hoarseness of the voice appears, sometimes a person can only whisper (complete clogging of the larynx).
Consequences of chronic laryngeal stenosis
With chronic stenosis of the larynx, adaptive functions are actively activated in the body, aimed at providing the body with the necessary amount of oxygen. In this case, you can observe the following changes:
- increased tension of the vascular walls, increased heart rate, hypotension, accelerated blood flow;
- shortness of breath, providing an increase in lung ventilation;
- more frequent breathing involving abnormal muscles (back, neck, shoulders);
- the number of red blood cells in the blood and vascular permeability increase;
- anaerobic processes start in cells;
- hypertrophy of the heart muscle develops.
Due to the need to wear a tracheotomy tube (cannula) in chronic stenosis, such functions as humidification, warming of the upper airway, biological and mechanical air purification are temporarily disabled. This, in turn, leads to secondary changes in the trachea, tracheitis, bronchitis, and can even cause the development of bronchopneumonia or pulmonary emphysema.
Diagnostics of the chronic stenosis of the larynx
Diagnosis of the disease is based on the patient's complaints, symptoms, history and the results of the following studies (at the discretion of the doctor):
- direct or indirect laryngoscopy, sometimes with biopsy;
- X-ray examination (tomographic, contrast, direct);
- endoscopic examination (the level and extent of the lesion is revealed).
When determining the diagnosis, it is important to exclude the presence of tracheal stenosis and diseases of the heart and lungs, which could cause respiratory distress.
Treatment of chronic laryngeal stenosis
When the first symptoms of suffocation appear, you should immediately call an ambulance. Before the ambulance arrives, first aid should be given to the patient - to calm him down, rub the patient's hands and feet, humidify the air in the room where the person is staying, or place him in the bathroom by typing hot water in the bathroom. The patient is subject to compulsory hospitalization.
The choice of the method of treatment depends on the primary disease that provoked the chronic stenosis of the larynx and on the stage of the stenosis. Treatment can be conservative (stages I, II) and surgical. If the cause is an infectious disease, antibiotic therapy is used. Antihistamines can help relieve allergic swelling. The cause may be a foreign object (more often in children), but it is almost impossible to remove it independently at home.
Often, when treating chronic stenosis, there is a need for surgical treatment: tracheotomy (insertion of a tube that prevents narrowing of the larynx), laryngotomy (dissection of the anterior wall of the larynx), dilation with T-tubes, bougie (stretching) of the larynx with dilators and bougie. These are complex and often multi-stage operations with good results.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".