Stenosis of larynx

Stenosis of the larynx is a significant decrease or complete closure of its lumen. There are acute and chronic stenoses of the larynx. Acute stenosis can occur suddenly, lightning fast or develop gradually over several hours. Observed with true and false croup, acute laryngotraherones in children, edema of the larynx, phlegmonous laryngitis, chondroperichondritis, foreign body, trauma (mechanical, thermal, chemical), bilateral paralysis of the posterior pericotter-cuspidal muscle. Chronic stenoses are characterized by a slow development of narrowing of the larynx lumen and its resistance. However, in the period of chronic laryngeal narrowing under unfavorable conditions (inflammation, trauma, hemorrhage, etc.) acute stenosis of the larynx can quickly develop. Chronic stenoses arise on the basis of Cicatricial changes in the larynx after trauma, chondroperichondritis, scleroma, in diphtheria, syphilis, and tumors.

Symptoms, the course depends on the stage of stenosis. Stage 1 - compensation - is accompanied by a loss of a pause between inspiration and exhalation, an extension of inspiration, a reflex decrease in the number of breaths and a normal ratio of the number of respiratory movements and pulse. The voice becomes hoarse (with the exception of stenoses caused by paralysis of the lower-ground nerves), inhalation produces stenotic noise, audible at a considerable distance. Stage II - decompensation: all the signs of oxygen starvation clearly appear, dyspnoea is intensified, bluish covers and mucous membranes assume a cyanotic hue, with inspiration there is a sharp drag of the intercostal spaces, supra- and subclavian pits, the jugular fossa. The patient becomes restless, rushes, becomes covered with cold sweat, breathing becomes more frequent, respiratory noise increases. Stage III - asphyxia (choking) - characterized by a fall in heart activity, breathing is rare and superficial, the pallor of the skin becomes more intense, the patients become listless, indifferent to the surrounding, the pupils are dilated, there comes a persistent stop of breathing, loss of consciousness, involuntary departure of feces and urine. To assess the degree of stenosis, the size of the lumen of the glottis is most significant. However, with a slow increase in stenosis, the patient sometimes satisfactorily cope with breathing with a narrow laryngeal lumen.

When establishing the diagnosis, stenosis of the trachea, respiratory distress due to lung and heart diseases should be excluded.

Treatment. With any disease of the larynx, if the risk of stenosis is not ruled out, the patient should be urgently hospitalized in order to take all necessary measures in time to prevent asphyxia. In the compensation stage, it is still possible to restore breathing by therapeutic methods (mustard plasters on the chest, hot foot baths, oxygen inhalation, morphine drug medications, dehydration therapy, cardiac drugs). In the stage of decompensation and asphyxia, tracheostomy should be performed immediately (in recent years, prolonged intubation has been successfully used), with diphtheria stenosis, intubation. In the event of stopping breathing after the opening of the trachea, artificial ventilation is performed. In patients with chronic stenosis treatment should be directed to the underlying disease (tumor, scleroma, etc.). In cicatricial stenoses, bougie and surgical methods of treatment are used-laryngo- and tracheostomy with excision of scar tissue.