Laryngostenosis

Laryngostenosis - obstruction or persistent narrowing of the larynx lumen, leading to difficulty or complete loss of its patency for air. Congenital laryngostenosis can be caused by an enlarged thymus gland, teratoma, and also other formations located near the larynx, and pathological changes inside it.

Acquired laryngistenosis is more often the result of disease and damage to the larynx itself, less often the symptom of infectious disease (diphtheria, typhoid and typhus, influenza, measles, scarlet fever), allergic reactions, nervous system diseases. Acute laryngostenosis develops within seconds, minutes, hours, several days. It can be caused by inflammatory inflammation of the larynx (see Krup) and non-inflammatory (allergic), as well as severe cardiac, renal failure , trauma, gunshot wounds, thermal and chemical burn of the larynx, pathological processes (inflammatory, tumor) in the organs adjacent to the larynx Tissues, impaired motor innervation of the larynx; The obstruction of the larynx lumen by a foreign body that got from outside (nut, seed, bead, etc.), or lice entered into the larynx viscous sputum, vomit masses, blood, fibrinous films. It can be a consequence of laryngospasm, the cause of which in children of the first years of life is often spasmophilia, croup , and in adults-hysteria; Incorrectly imposed tracheostomy, poor care for her and tracheotomy tube, discrepancy in the size and radius of curvature of the cannula's knee; Complications with intubation of the trachea also lead to the development of laryngostenosis. Chronic laryngocytosis develops within weeks, months, years. It can be caused by cicatricial changes in the larynx, disturbances in its motor innervation.

During laryngostenosis, the stages of compensation, decompensation and asphyxia are distinguished. The first is characterized by a slower than normal breathing rhythm, an increase in the depth of breathing, a contraction, and then loss of pauses between inspiration and exhalation, inspiratory dyspnea, and noise during inspiration during physical exertion.

In the stage of decompensation, the patient develops fear and anxiety, pallor is observed, and then the cyanosis of the skin, especially the tip of the nose, blue fingernails and mucous membranes, blue sweat, inspiratory dyspnea at rest, audible at a distance, noise during inspiration, participation in the act Respiration of the auxiliary musculature (sternocleidospermous and large pectoral muscles), occlusion of the supraclavicular, subclavian and jugular pits, retraction of the intercostal spaces and the epigastric region. In asphyxiation, frequent surface

Breathing, weakness of cardiac activity (frequent pulse of weak filling, falling of blood pressure), dilated pupils, sharp cyanosis , loss of consciousness.

Diagnosis is usually not difficult and is based on history, patient complaints, results of external examination, respiratory examination, upper airway examination and special studies. A detailed examination of the patient is possible only when he is not endangered by suffocation. Inspection of a patient whose asthma attack has ended safely or a tracheostomy has been applied is performed after improvement of his condition.

Treatment is aimed at the underlying disease and improving the patient's breathing. Mandatory hospitalization. Assign bed rest, sparing diet. The air in the room, where the patient is, should be clean and moist. The complex of treatment measures usually include distracting procedures (mustard, wrapping, hot foot baths with mustard), dehydration (infusion of solutions of glucose, calcium chloride), desensitizing (antihistamines, glucocorticoids), detoxification and restorative therapy. If conservative therapy is ineffective and stenosis goes into the stage of decompensation, tracheostomy is indicated.

The prognosis depends on the underlying disease, on the patient's condition, on his age, on the presence of concomitant diseases, on the severity and speed of development of shortness of breath