Laryngeal stenosis stages in adults
Laryngeal stenosis is a complete or partial narrowing of the lumen of the larynx, leading to obstructed passage of air during breathing. Acute stenosis can be talked about if it appears in a short time and quickly leads to general hypoxia in the body. Chronic stenosis of the larynx is persistent and is characterized by a slow rate of development of symptoms.
Up to a certain point, the body adapts relatively well to a reduced air intake if the narrowing of the larynx lumen occurs slowly and gradually. With the development of stenosis, a life-threatening condition occurs in a short time, requiring urgent measures to restore impaired breathing. Laryngeal stenosis can also cause burns from chemicals or fire, and foreign body trauma.
Stenosis of the larynx manifests itself depending on many factors: the degree of narrowing of the larynx, the level of activity of the patient, the general condition of the patient, the age of the patient. Newborns who are born prematurely often have breathing problems, and as a result, they have repeated intubations. This, in turn, can contribute to the development of this disease.
The chronic form of stenosis of the larynx can be caused by various diseases: a violation of the innervation of the larynx, a tumor process, cicatricial narrowing, the development of an infectious granuloma. The manifestations of stenosis of the larynx are divided into four stages.
The first stage of laryngeal stenosis in adults
The first stage of the disease is called the compensation stage. It is accompanied by a decrease in the heart rate, a shortening of the pause between inhalation and exhalation, a reflex decrease in the number of respiratory movements and a lengthening of the inhalation. The patient's voice becomes hoarse (with the exception of stenoses resulting from paralysis of the lower laryngeal nerves), a stenonic noise is clearly audible when inhaling. The glottis width is 6-7 mm. Inspiratory dyspnea occurs with walking and exercise.
Second stage of laryngeal stenosis in adults
The second stage of laryngeal stenosis is called the incomplete compensation stage. At this stage, all signs of oxygen starvation are clearly manifested: shortness of breath increases, breathing becomes noisy (it is called stridorous), retraction of the intercostal spaces (above the collarbones and above the sternum) is noted, and difficulty in breathing can be observed.
The patient shows anxiety, rushes about, the skin becomes pale, the body becomes covered with cold sweat. His pulse is fast, tense, and his blood pressure may be high or normal. The glottis is 4-5 mm wide.
The subsequent increase in the signs of stenosis in some cases occurs very quickly. If the ongoing conservative treatment turns out to be ineffective, then doctors may prescribe a surgical intervention already at this stage, the purpose of which will be to restore the patient's airway patency.
Stage 3 laryngeal stenosis in adults
The third stage is the decompensation stage. The patient's condition at this stage is extremely difficult. He quite often takes a forced semi-sitting position with his head slightly thrown back. Breathing becomes even more noisy, while the larynx performs maximum upward movements with exhalation and downward movements with inhalation. The patient's face has a bluish appearance, sometimes redness of the cheeks is possible. In addition, cyanosis of the fingertips, the tip of the nose and lips is noted.
Sweating appears, the pulse becomes thin and frequent, the blood pressure is lowered. The glottis is only 2-3 mm wide.
Stage IV laryngeal stenosis in adults
The fourth stage of laryngeal stenosis is asphyxia (suffocation). This stage is characterized by the appearance of drowsiness, indifference, and severe fatigue. The patient has rapid shallow breathing, sometimes becoming intermittent, the pupils greatly dilate. The skin is gray, pale, the pulse becomes weak. The glottis width does not exceed 1 mm.
Within 1-3 minutes, the patient may experience loss of consciousness, exophthalmos, involuntary discharge of feces and urine, sudden cardiac arrest. The rapid development of stenosis does not allow the development of compensatory mechanisms, i.e. the body does not have time to adapt to this.
Treatment of laryngeal stenosis in adults
To make the correct diagnosis, the patient must be immediately hospitalized. At the stage of compensation, breathing can be restored by therapeutic methods. Mustard plasters are placed on the patient's chest, oxygen is inhaled, appropriate heart drugs are used and morphine is injected. In the last two stages, tracheostomy (special surgery) or intubation (insertion of a special tube that conducts air into the lungs) should be performed. If necessary, artificial ventilation of the lungs can be carried out.
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".