Laryngitis is an extremely frequent problem in this period of sudden changes in temperature: we have gone from an almost spring-like climate to a winter cold, especially in the first and last hours of the day, and these sudden changes can lower the immune system, thus giving room for a classic inflammation of the upper respiratory tract. But what are we talking about when we refer to laryngitis?
Laryngitis is an inflammatory process that mainly affects the mucous membranes and can take on an acute form, lasting less than three weeks and which does not cause permanent anatomical alterations of the larynx itself, or chronic: after three weeks, the pathology becomes chronic and can lead to a permanent modification of the laryngeal structure. The causes are mainly of an infectious and viral nature, only to a lesser extent bacterial or fungal. In some cases, laryngitis can instead derive from a widespread problem, such as gastroesophageal reflux. Less frequent is laryngitis due to inhalation of toxic gases. Among the main causes of chronicity is cigarette smoking, accompanied by alcohol abuse and sinusitis.
The acute symptomatology
The symptoms of acute laryngitis are varied. The main one is a constant sense of discomfort and pain in the throat, clearly accentuated when coughing is done, especially in the case of concomitant involvement of the trachea or when swallowing food and saliva. Dry cough, initially irritable and insistent, followed after a few days by a productive cough with emission of phlegm and possible enlargement of the lymph nodes in the neck. Fever, generally not high, general malaise and asthenia (feeling of tiredness), dysphonia (hoarseness) or complete aphonia (the voice becomes hoarse and lowers or disappears completely) may also occur: those affected suddenly become unable to make sounds and to speak. In some cases, dyspnea (difficulty breathing) may occur, with the characteristics of laryngeal inspiratory dyspnea. This can induce suffocation crises during laryngospasm, a typical clinical situation of young children favored by the small size of the larynx at that age and destined to resolve spontaneously with growth.
In chronic phenomena, the symptoms are represented by a sense of discomfort in the throat with the absence of a real pain typical of acute laryngitis. The distinguishing feature can be considered a persistent hoarseness that conveys a hoarse voice. Another classic symptom is the persistent irritative cough, especially in children allergic to substances constantly present in the house (house dust mites and animal dandruff) which over time can also become catarrhal. Over time, a thickening of the vocal cords can also occur with the possibility of the formation of polyps on them which further alter the timbre of the voice. on the other hand, respiratory difficulty is rarer, which is more typical in cases of acute laryngitis.
Getting to the diagnosis
The diagnosis of laryngitis is formulated first of all through an initial examination of the airways, generally conducted with the use of rigid or flexible optical fibers. Fibrolaringoscopy is performed by introducing a flexible tube into the nose: this tube, traveling along the airways, reaches the vocal cords and explores them thanks to a microcamera which makes it possible to view the larynx in order to achieve a better diagnostic judgment. The development of technology has also led to the production of fibrolaryngoscopes with a microchip at the tip, which are even more effective in resolving internal images. Then there are sophisticated diagnostic systems such as Narrow Band Imaging, an optical image technology that manages to trace the vascularization of the mucosal surface and proves to be very useful in the early diagnosis of neoformations of the upper aero-digestive tract (VADS).
Finding the diagnosis and choosing the treatment: pharyngitis and tracheitis, so the less experienced risk misunderstanding
For an inexperienced person, laryngitis, pharyngitis and tracheitis can be confused. In reality, recognizing them is not only essential for identifying the right treatment, but also for remaining serene when the first symptoms appear.
Pharyngitis, in fact, is the classic “sore throat”. A disorder that is generally associated with either a viral cause or a bacterial cause.
This leads to inflammation of the pharynx, which is the first tract of the respiratory system. The pharynx is generally divided into three areas: the nasopharynx, which represents the upper part of the pharynx and communicates with the nasal cavities; the oropharynx, the median part, in communication with the oral cavity; the hypopharynx, the lower part, which connects with the esophagus through the upper oesophageal orifice. Like laryngitis, pharyngitis also differs between acute and chronic: in the first case, the onset is sudden and resolves quickly; in the second, the appearance is progressive and the persistence is more long-lasting. The most common symptoms are: pain, difficulty swallowing, redness and swelling. In some cases it can cause fever and cough, which can manifest itself in a dry or oily form. Sore throat can also be caused by external factors and bad habits, specifically exposure to cold air, sudden changes in temperature, air that is too dry or too humid and smoke.
Tracheitis, on the other hand, is inflammation of the duct through which the air we breathe passes. The trachea is a sort of tube made up of cartilage rings that starts from the base of the larynx; in the lower part it divides into two branches, called bronchi, connected directly to the lungs. The origin of tracheitis can be bacterial or allergic, with reactions to mites, dust and pollen. The symptoms are varied: from a rattle when breathing, which can resemble a whistle, to the classic cough, passing through a sense of oppression or burning in the chest and difficulty breathing, the latter especially in the most serious cases.
Tracheitis can be particularly serious in children, where it can manifest with severe respiratory distress and require immediate treatment and hospitalization. There are also some cases of tracheitis due to very rare reasons: a foreign body gets stuck in the trachea, triggering an inflammatory process, a case that occurs above all in children and requires immediate intervention; an excess, over the years, of cigarette smoke, which is a strong irritant of the respiratory tract and which favors the development of chronic tracheitis; irritant inhalations, coming from occupational or environmental pollution.
In all three cases (laryngitis, pharyngitis, tracheitis), an examination of the respiratory tract is sufficient for the doctor to formulate the diagnosis. Only in this way can the ideal treatment be chosen, whether it is based on NSAIDs or, in cases with an ongoing infection, based on antibiotics, to reduce the impact of the pathology and resolve it in the shortest possible time.
The importance of protecting the voice: the vocal cords must be protected with phonatory rest
The pharmacological treatment of laryngitis must be carried out only if indicated by your trusted doctor, who will develop an ad hoc therapy after having carried out the visits and tests necessary to reach the diagnosis.
Protect the voice
In acute laryngitis many treatments are symptomatic and therefore in case of catarrh the use of mucolytics to dissolve it is fine. The rest of the vocal cords becomes fundamental by observing the three rules of the voice: speak without raising your voice, don’t talk much and don’t speak fast, and all this because the problem is partly muscular and the fatigue of the vocal muscles does not help to recover better condition. If the voice does not return to normal, although the cause is still muscle fatigue, it is very useful to carry out a speech therapy cycle to improve the use of the muscles of the voice and those of breathing (the diaphragm in particular) and to learn to speak and to breathe correctly during phonation. Corticosteroids are good for reducing edema and inflammation. If a bacterial infection is suspected or diagnosed, antibiotics should be given. In the presence of gastroesophageal reflux, antacid therapy is essential. Smoking and alcohol must be totally eliminated from the patient’s daily habits otherwise any therapy implemented to resolve laryngitis, especially chronic and degenerative ones, is in vain.
With the children
In pediatric laryngitis, the use of cortisone avoids dyspnoea and in particular nocturnal dyspnoea, which can worsen and put the little patient’s life at risk. In cases where dyspnea does not resolve, orotracheal intubation or tracheostomy is required.
© breaking latest news