ACUTE AND CHRONIC DISEASES OF PHARYNX AND LARYNX

LEARN THE PRINCIPLES OF DIAGNOSIS AND TREATMENT OF ACUTE AND CHRONIC DISEASES OF THROAT�

The Parynx.

Clinical Anatomy

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The pharynx is a muscular tube that connects the oral and nasal cavity to the larynx and oesophagus.

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It begins at the base of the skull, and ends at the inferior border of the cricoid cartilage (C6). The pharynx is comprised of three parts (superior to inferior):

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• Nasopharynx
• Oropharynx
• Laryngopharynx

Nasopharynx

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• The nasopharynx is found between the base of the skull and the soft palate. It is continuous with the nasal cavity, and performs a respiratory function by conditioning inspired air and propagating it into the larynx.

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• This part of the pharynx is lined with respiratory epithelium; ciliated pseudostratified columnar epithelium with goblet cells.

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• The posterosuperior nasopharynx contains the adenoid tonsils, which enlarge between 3-8 years of age and then regress.

Clinical Relevance:

Enlarged Adenoid Tonsils

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• The adenoid tonsils can become pathologically enlarged due to viral infections of the upper respiratory tract. In the case of recurrent infections, they can become chronically enlarged. When enlarged, the adenoids can obstruct the opening of the Eustachian tube – which is located close to the adenoid tonsils in the nasopharynx.
• Chronic obstruction of the Eustachian tube prevents the equalising of pressure in the middle ear with the atmosphere and normal drainage of fluid. This can lead to chronic otitis media with effusion, colloquially known as glue ear. In this condition, the static fluid and negative pressure in the middle ear provide the ideal environment for infection.

Oropharynx

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The oropharynx is the middle part of the pharynx, located between the soft palate and the superior border of the epiglottis.

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It contains the following structures:

• Posterior 1/3 of the tongue.
• Lingual tonsils – lymphoid tissue at the base of the tongue.
• Palatine tonsils – lymphoid tissue located in the tonsillar fossa (between the palatoglossal and palatopharyngeal arches of the oral cavity).
• Superior constrictor muscle.

Oropharynx

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• Waldeyer’s ring is the ring of lymphoid tissue in the naso- and oropharynx formed by the paired palatine tonsils, the tubal tonsils, the adenoid tonsils, and lingual tonsil.

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• The oropharynx is involved in phases of swallowing.

ANATOMY OF THE PALATINE TONSILS

• Paired, sit in tonsillar sinus.
• Limited anteriorly by palatoglossal arch, posteriorly by palatopharyngeal arch, laterally by superior pharyngeal constrictor.
• Enclosed in a fibrous pseudocapsule.

ANATOMY OF THE PALATINE TONSILS

• 10-30 crypts.
• Innervation from sphenopalatine ganglion via lesser palatine and glossopharyngeal nerves.
• No afferent lymphatics, efferents drain to upper deep cervical lymph nodes.

IMMUNOLOGY AND FUNCTION

• Part of secondary immune system.
• No afferent lymphatics.
• Exposed to ingested or inspired antigens passed through the epithelial layer.
• Immunologic structure is divided into 4 compartments: reticular crypt epithelium, extra follicular area, mantle zone of the lymphoid follicle, and the germinal center of the lymphoid follicle.

IMMUNOLOGY AND FUNCTION

• Membrane cells and antigen presenting cells are involved in transport of antigen from the surface to the lymphoid follicle.
• Antigen is presented to T-helper cells..
• T-helper cells induce B cells in germinal center to produce antibody.
• Secretory IgA is primary antibody produced.
• Involved in local immunity.

LARYNGOPHARYNX�

• The most distal part of the pharynx, the laryngopharynx is located between the superior border of the epiglottis and inferior border of the cricoid cartilage (C6). It is continuous inferiorly with the oesophagus.
• It is found posterior to the larynx and communicates with it via the laryngeal inlet, lateral to which one can find the piriform fossae.
• The laryngopharynx contains the middle and inferior pharyngeal constrictors.

�FUNCTION OF PHARYNX

• The pharynx moves food from the mouth to the esophagus.
• It also moves air from the nasal and oral cavities to the larynx.
• It is also used in human speech; pharyngeal consonants are articulated here.

ADENOTONSILLAR DISEASE

• Adenotonsillar disease (adenoiditis and recurrent tonsillitis) is a prevalent otolaryngologic disorder aetiologically based on chronic inflammation triggered by a persistent bacterial infection.
• Major divisions are:
• Infection/inflammation
• Obstructive
• Neoplasm

CLINICAL EVALUATION

• Acute Tonsillitis
• Chronic Tonsillitis
• Obstructive Tonsillar Hyperplasia

ACUTE TONSILLITIS (ANGINA)

Angina is an acute tonsillitis of the palatine tonsils and mucous membrane caused by infection or irritation.

• This disease is most often caused by viruses, and only about 10 - 15% of angina in adults has a bacterial etiology (even less often fungal) and requires antibiotic treatment.

CLINICAL EVALUATION

Viral

• Lower grade fever
• Lower WBC, Lymphocytic shift
• Less tonsillar exudate

Bacterial

• Higher WBC,
• Granulocytic shift
• More exudative

ACUTE TONSILLITIS

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Other signs and symptoms of acute tonsillitis include:

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• Difficulty swallowing saliva
• Drooling
• Ear pain with swallowing
• Bad breath
• Tonsil surface may be bright red or have a grayish-white coating (exudate).
• Lymph nodes in the neck may be swollen.
• Fever

CLINICAL EVALUATION

• Strep throat is a specific type of infection caused by the Streptococcus bacteria. Strep tonsillitis can cause secondary damage to the heart valves (rheumatic fever) and kidneys (glomerulonephritis). It can also lead to a skin rash (for example, scarlet fever), sinusitis, pneumonia, and ear infections

CLINICAL EVALUATION

• The Epstein-Barr virus causes acute mononucleosis and can lead to a very severe throat infection characterized by the rapid enlargement of the tonsils, adenoids, and lymph nodes of the neck. It also causes extreme malaise and tiredness. The sore throat and gland swelling can last for one week to a month and does not respond to the usually prescribed antibiotics.

DIFFERENTIAL DIAGNOSIS

• Infectious mononucleosis

(EBV)

• Scarlet Fever
• Corynebacterium diptheriae
• Malignancy

Infectious mononucleosis should be suspected if a sore throat and malaise persist despite antibiotic treatment, and a white cell analysis and Paul–Bunnell test are indicated.

MEDICAL THERAPY

• First Line
• Penicillin/Cephalosporin for 10 days
• Injectable forms for noncompliance
• Macrolides (Penicillin allergy)
• Erythromycin/Clarithromycin 10 days
• Azithromycin (12mg/kg/day) 5 days

COMPLICATIONS �OF TONSILLITIS

• Cervical Adenitis
• Neck Abscess
• Peritonsillar abscess
• Intratonsillar abscess
• Lemierre’s syndrome

PERITONSILLAR ABSCESS� (QUINSY)

• A peritonsillar abscess (PTA) is a collection of pus located between the fibrous capsule of the tonsil and the superior pharyngeal constrictor muscle.

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• The most commonly held theory is that PTA occurs secondary to the penetration of bacteria from the tonsillar crypts through the tonsillar capsule into the peritonsillar space.

PERITONSILLAR ABSCESS (QUINSY)

Abscess formation outside tonsillar capsule

• Signs and symptoms:
• Fever
• Sore throat
• Dysphagia/odynophagia
• Drooling
• Trismus
• Unilateral swelling of soft palate/pharynx with uvula deviation

TREATMENT �OF PARITONSILLAR ABSCESS

• The treatment of paratonsillar abscess

consists in the abscess opening and

antibacterial treatment.

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• The abscess is opened in the place

where inflammatory infiltration is bulging

the most or, in case of an anterosuperior abscess, along the imaginary line between the base of the uvula and the last grinder tooth of the lower jaw on the border between the medium and the upper third of this line.

• The cut is not made very deep because a greater blood vessel can be damaged.

DIFFUSE PHLEGMON

Diffuse infection of the cervical fat is called diffuse phlegmon.

• It is a severe inflammatory disease requiring an urgent surgical intervention.
• The clinical course of the phlegmon is acute.

It can be located in any fat tissue space of the neck.

DIFFUSE PHLEGMON

• The peculiarities of the anatomical neck structure promote rapid extension of suppurative process from one fat tissue space to another and even to mediastinum, skull cavity, axillary region, infraclavicular fossa and the anterior thoracic wall.

CHRONIC� TONSILLITIS

• Chronic tonsillitis is a persistent infection of the tonsils.
• Repeated infections may cause the formation of small pockets (crypts) in the tonsils, which harbor bacteria.
• Frequently, small foul-smelling stones develop within these crypts.
• These stones (tonsilloliths) may contain high quantities of sulfa. When crushed, they give off the characteristic rotten egg smell, which causes bad breath.
• They may also give a patient the sense of something caught in the back of the throat.

• Peritonsillar abscess unresponsive to medical management and drainage documented by surgeon, unless surgery performed during acute stage
• Persistent foul taste or breath due to chronic tonsillitis not responsive to medical therapy
• Chronic or recurrent tonsillitis associated with streptococcal carrier state and not responding to beta-lactamase resistant antibiotics
• Unilateral tonsil hypertrophy presumed neoplastic

CHRONIC TONSILLITIS

The following are the true signs of chronic tonsillitis:

• Hyperaemia and roller-shaped thickening of palatine arch edges.
• adhesions between the tonsils and the palatine arches.
• Loosened and sclerotic tonsils.
• Presence of purulent masses and liquid pus in the tonsil lacunas.
• Regional lymphadenitis - enlargement of retromaxillary lymphatic nodes.

LAVAGE OF PALATINE TONSIL

• lavage of palatine tonsil lacunas with disinfecting solutions
• suction of lacuna contents

Conservative treatment is taken as different courses two times a year (in spring and autumn).

TONSILLECTOMY

Current clinical indicators are:

• 3 or more infections per year despite adequate medical therapy.
• Hypertrophy causing dental malocclusion or adversely affecting orofacial growth documented by orthodontist.
• Hypertrophy causing upper airway obstruction, severe dysphagia, sleep disorder, cardiopulmonary complications.

SURGICAL INDICATIONS

• Relative
• Obstructive airway with cor pulmonale
• Severe dysphagia
• Failure to thrive
• Absolute
• Recurrent acute tonsillitis
• Chronic tonsillitis
• Obstructive Sleep Apnea
• Peritonsillar Abscess
• Halitosis
• Suspected Neoplasia/ Tonsillar hyperplasia

TONSILLECTOMY

Tonsillectomy

• Tonsillotome.
• Cold dissection with snare.
• Monopolar/bipolar electrocautery.
• CO2 or KTP laser.
• Hemostasis with packing, electrocautery, sutures.

OBSTRUCTIVE TONSILLAR HYPERPLASIA

• Snoring and other symptoms of sleep disturbance
• Muffled voice
• Dysphagia

TONSILLOTOMY

ANATOMY OF THE ADENOIDS

• Single pyramidal mass of tissue based on posterior-superior nasopharynx
• Surface folded without true crypts
• Blood supply – ascending palatine branch of facial artery, ascending pharyngeal artery, pharyngeal branch of internal maxillary artery
• Innervation – n.glossopharyngeal and n.vagus
• No afferent lymphatics, efferents drain to retropharyngeal and upper deep cervical nodes

ACUTE ADENOIDITIS

Symptoms include:

• Purulent rhinorrhea
• Nasal obstruction
• Fever
• Associated Otitis Media

Adenoiditis: Inflammation of the adenoids, often from infection. Bacteria or viruses may cause adenoiditis.

Enlarged adenoids: In children, the adenoids can get larger because of infection or reasons that are unclear. Very large adenoids can interfere with breathing or with the flow of mucus.

CHRONIC ADENOIDITIS

Symptoms include:

• Persistent rhinorrhea
• Postnasal drip
• Malodorous breath
• Associated otitis media >3 months
• Think of reflux

Signs and Symptoms

• Obligate mouth breathing
• Hyponasal voice
• Snoring and other signs of sleep disturbance

ADENOIDECTOMY

Current clinical indicators are:

• 4 or more episodes of recurrent purulent rhinorrhea in prior 12 months in a child <12. One episode documented by intranasal examination or diagnostic imaging.
• Persisting symptoms of adenoiditis after 2 courses of antibiotic therapy. One course of antibiotics should be with a beta-lactamase stable antibiotic for at least 2 weeks.
• Sleep disturbance with nasal airway obstruction persisting for at least 3 months.

SURGICAL INDICATIONS

Adenoidectomy

Absolute

• Airway obstruction w/ cor pulmonale
• Failure to thrive

Relative

• Chronic Nasal Obstruction
• Recurrent/ Chronic Adenoiditis
• Recurrent/ Chronic Sinusitis
• Recurrent acute otitis media/ Recurrent COME

ADENOID SURGERY IN CHILDREN

THE LARYNX. ANATOMY

• The larynx is a structure of cartilage that connects the throat to the windpipe.
• It is found in the front of the neck and houses the vocal cords, producing speech sounds and contributing to respiration.

THE LARYNX. ANATOMY

It consists of three sections:

• Supralarynx: This section includes the top portion of the larynx and houses the vestibular folds, known as the false vocal cords.
• Larynx: Refers to the middle portion of the larynx, which contains the vocal folds, or true vocal cords.
• Sublarynx: This section makes up the bottom part of the larynx that connects to the trachea.

THE LARYNX. ANATOMY

The larynx contains two types of soft tissue folds:

• Vestibular folds: Also known as false vocal cords, these sit on top of the vocal folds and protect the larynx. As their name suggests, these folds do not produce sound.
• Vocal folds: These soft tissue folds are the true vocal cords. They project from the inner walls of the larynx and cross over each other. Various muscles control the movement of the vocal cords.

THE LARYNX. ANATOMY

INNERVATIONS' OF LARYNX

1. n.vagus

2. n. laryngeus superior (а - upper branches,

b -lower branches);

3. recurrent laryngeal nerve

THE LARYNX. FUNCTION

The larynx plays a vital role in breathing and speech.

Breathing

• The membranes and cartilages that make up the larynx protect the lower respiratory tract. The epiglottis and vestibular folds seal off the larynx during swallowing. This closure prevents food from entering the trachea, which can lead to choking.

THE LARYNX. FUNCTION

Speech

• The central muscles of the larynx and the posterior cricoarytenoid muscle spread the vocal cords to help maximize the passage of air to and from the lungs.
• When a person speaks, the laryngeal muscles pull the vocal cords together, building air pressure in the larynx.
• The vocal cords vibrate as air from the lungs rushes past them. These vibrations create sound waves, which the mouth shapes into words.

ACUTE LARYNGITIS�

Acute laryngitis is catarrhal inflammation of mucous membrane, sub mucous layer and internal muscles of larynx.

ACUTE LARYNGITIS�

Etiology:

• respirator viruses, bacterial (coccal) flora.

Provoke`s factors :

• thermal factor;
• alcohol, smoking;
• overload of voice;
• dust, gases.

CLINICAL PICTURE �OF ACUTE LARYNGITIS�

• Characterized by an outbreak at the good common state of patient or small indisposition.
• The temperature of body remains normal or a little rises
• Feeling of dryness, burning, maring, tickling, foreign body appears in a larynx
• A cough is dry, then moist.
• Hoarse.

Laryngoscopy:

TREATMENT �OF ACUTE LARYNGITIS

• Voice rest: This is the single most important factor. Use of voice during laryngitis results in incomplete or delayed recovery. Complete voice rest is recommended although it is almost impossible to achieve. If the patient needs to speak, the patient should be instructed to use a "confidential voice;" that is, a normal phonatory voice at low volume without whispering or projecting.

TREATMENT �OF ACUTE �LARYNGITIS

• Steam Inhalation: Inhaling humidified air enhances moisture of the upper airway and helps in the removal of secretions and exudates.
• Avoidance of irritants: Smoking and alcohol should be avoided. Smoking delays prompt resolution of the disease process.
• Dietary modification: dietary restriction is recommended for patients with gastroesophageal reflux disease. This includes avoiding caffeinated drinks, spicy food items, fatty food, chocolate, peppermint.

TREATMENT �OF ACUTE �LARYNGITIS

• Medications: Antibiotics prescription for an otherwise healthy patient with acute laryngitis is currently unsupported; however for high-risk patients and patients with severe symptoms antibiotics may be given.
• Fungal laryngitis can be treated with the use of oral antifungal agents such as fluconazole. Treatment is usually required for three weeks period and may be repeated if needed.
• Mucolytics may be used for clearing secretions.

STENOSIS OF LARYNX�

• STENOSIS of larynx is narrowing of larynx, resulting in difficulty of breathing through it.
• STENOSIS of larynx, similarly as well as its edema is not an independent nosologic unit.
• This pathology can be the display of different diseases of larynx.

STENOSIS OF LARYNX�

Acute stenosis

• is quickly occuring (during a few seconds, minutes, hors or days)

CLASSIFICATION

Chronic stenosis

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• develops during a few weeks, months or years.

CAUSES OF �ACUTE STENOSIS OF LARYNX

• Edema.
• Foreign bodies of larynx and large foreign bodies at the entrance in to gullet.
• Acute laryngotracheitis at children.
• Diphtheria of larynx.
• Laryngospasm.
• Trauma of larynx.

CAUSES OF �CHRONIC STENOSIS OF LARYNX

• Tumors and cysts of larynx.
• Infectious granulosums is gummatous syphilis of larynx, tuberculosis of larynx, scleroma.
• Cicatricial changes as a result of the chondroperichondritis of larynx, burns, traumatic damage, gunshot wounds, protracted intubation, during ALV or prolonged intubation at children connected with acute laryngotracheitis; sometimes – after tracheostomy, especially at the children of junior age.

CAUSES OF �CHRONIC STENOSIS OF LARYNX

• Innate pathology of larynx (at membranes and etc).
• Bilateral paralyses of sublaryngeal nerves.
• Such paralysis can be the result of carried Acute

Respiratory Virus Infections; intraoperational trauma during a strumectomy, when both recurrent nerves are intersected.

CLINICAL PICTURE �OF STENOSIS OF LARYNX

CLASSIFICATION

Main symptom is inciter shortness

• - the 1th stage is the stage of the compensated breathing or compensation;
• - the 2th stage is the stage of incomplete compensation of breathing, or subindemnification;
• - the 3th stage is the stage of decompensation of breathing, or decompensation;
• - the 4th stage is the stage of asphyxia, or terminal stage.

CLINICAL PICTURE �OF STENOSIS OF LARYNX

TREATMENT �OF STENOSIS OF LARYNX

I. The such patient must receive intravenously:

Sol. Glucosae 40% 20,0

Sol. Calcii chloridi 10% 10,0

Sol. Acidi ascorbinici 5% 5,0

Sol. Euphyllini 2,4 % 5,0-10,0

Sol. Prednisoloni 60-90 мг

ІІ. Intramuscularly injected are:

Sol. Dimedroli 1% 2,0

(Sol. Pipolpheni 2,5% 2,0)

ІІІ. Diuretics (furosemid).

ІV. Abducent procedures are conducted: hot footbaths, mustard plasters on a thorax and gastrocnemius muscles.

V. Inhalations by water-wet oxygen.

TREATMENT �OF STENOSIS OF LARYNX

VI. At the inflammatory edema of larynx it is necessary to conduct dissection of abscess in larynx or organs connected with it.

VІI. At 3th and 4th stages of stenosis artificial renewal of patency of respiratory tracts is always used. There are only two such methods: intubation and tracheostomy.

TRACHEOSTOMY

• Emergency tracheostomy may be a difficult operation, particularly if done under local anesthetic when a general anesthetic with intubation is not practical.
• An opening into the trachea through the cricothyroid membrane offers a simpler and more direct relief for upper respiratory tract obstruction.

INDICATION� FOR TRACHEOSTOMY

• Warning of asphyxia
• Draining of respiratory tracts
• Prolonged intubations.

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CLASSIFICATION

• upper tracheostomy;
• middle tracheostomy;
• lower tracheostomy.

• By its topographical relation to the isthmus of the thyroid gland, this operation may be superior, median and inferior.
• Adults usually undergo superior tracheotomy, while on children ill with diphtheria the inferior one is performed.

COMPLICATION OF TRACHEOSTOMY

• Bleeding.
• Emphysema of hypoderm, pnevmotoraks, pnevmomediastinum.
• A stop of breathing is during the section of trachea.
• Wound of gullet.
• A festering tracheobronchitis after operation.

ACUTE OBSTRUCTING�LARYNGOTRACHEOBRONCHITIS AT CHILDREN

Acute obstructing laryngotracheobronchitis (laryngotracheobronchitis acuta) is the widespread disease at children, which develops as the display of ARVI, and is accompanied by the obstruction of larynx, trachea and bronchial tubes; in this connection it is dangerous for life of child.

• The child first develops a febrile URI followed days later by the classic croupy cough; the cough is usually nonproductive and worsens at night.

• Usually, croup is self-limited, but if significant edema develops, progressive airway difficulty may ensue.

ETIOLOGY OF�ACUTE OBSTRUCTING�LARYNGOTRACHEOBRONCHITIS AT CHILDREN

CLINICAL PICTURE:�

• Change of voice.
• Rough «barking» cough .
• Difficulty of breathing as a result of:

a) to the edema and infiltration;

b) to the spasm of muscles;

TREATMENT OF ACUTE OBSTRUCTING�LARYNGOTRACHEOBRONCHITIS

• Organization.
• Treatment 1 and 2 st. of stenosis of larynx.
• A vapotherapy is under awning.
• Prolonged intubation and tracheostomy.
• Decanulation

TREATMENT OF ACUTE OBSTRUCTING�LARYNGOTRACHEOBRONCHITIS

• If symptoms worsen, aerosolized epinephrine treatments and high-dose corticosteroids are used to prevent further progression of the edema.

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• If impending airway obstruction develops, intubations or tracheotomy is required to secure the airway and permit adequate pulmonary toilet.

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• Antibiotics are indicated for secondary bacterial infection, which may be caused by staphylococci, streptococci, or pneumococci.

TREATMENT OF ACUTE OBSTRUCTING�LARYNGOTRACHEOBRONCHITIS

• Application of interferon, antiinfluenza gamma-globulin

Antibiotics. (Intramuscularly)

Intravenously :

Sol. Glucosae 20% 10-20 ml

Sol. Calcii chloridi 10% ml per 1 year;

Sol. Aс. ascorbiniсі 5% 1 ml per 1 year;

Sol. Euphyllini 2,4% 0,2 ml per 1 кg;

Sol. Prednisoloni 2-3 mg per 1 кg.

• Intramuscularly injected : Sol. Dimedroli 1% 1,0
• Distracting procedures (hot foot-baths, mustard plasters on a thorax) and inhalations are very effective. In the complement of mixtures for inhalations antihistaminic, spasmolytic preparations and proteolitic enzymes are injected

TREATMENT OF ACUTE OBSTRUCTING�LARYNGOTRACHEOBRONCHITIS

• Treatment is directed at reducing the edema, thinning the secretions, and in severe cases, establishing an airway.
• Intensive humidification and hydration are begun to help thin the secretions and soften the crusts in the airway.

DIFFERENTIAL DIAGNOSIS

• Diphtheria.
• Foreign bodies of larynx .
• Asthma.
• Stenosis of larynx at to scarlatina, windy pox.
• Uremia.
• Papilomatosis of larynx.

LARYNGEAL DIPHTHERIA

• Laryngeal diphtheria is very uncommon; however, outbreaks of diphtheria have recently been reported in eastern Europe, believed to be due to low immunization rates.

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• It is caused by Corynebacterium diphtheriae and generally affects individual solder than 6 years of age. A febrile illness of slow onset associated with sore throat and dysphonia is followed by progressive airway obstruction.

LARYNGEAL DIPHTHERIA

• The organism causes an exudative inflammatory response of the mucous membranes, which results in a thick, gray-green, plaque-like membranous exudate over the tonsils, pharynx, and larynx.

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• Characteristically, the exudate is difficult to dislodge, and it bleeds when it is removed. Cultures and smears are obtained for confirmation of the diagnosis.

LARYNGEAL CHONDRITIS�

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An inflammatory process in a larynx can spread on perichondrium and cartilage, because of what develops to the chondroperichondritis larynx.

Clinic

A patient complains about pain in the area of larynx, with swallowing pains, increase of body temperature, hoarseness, difficulty of breathing. The state of patient is severe. There are smoothi of contours of larynx, some increase of volume of neck, bulging of cartilages and acute pains at palpation, fuctuation and cervical lymphadenitis comes to lung sometimes.

LARYNGEAL QUINSY�

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Under the term «laryngeal quinsy» (angina laryngea) we understand acute heterospecific inflammation of lymphadenoid tissue of larynx.

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Etiology: bacterial (coccal) flora.

LARYNGEAL QUINSY�

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Clinical picture – characterized by considerable worsening of the common state of patient, the temperature of body rises to 38-39 °С.

• Palpation of region of larynx can be painful.
• The regional lymphatic knots of neck are multiplied, and become painful at palpation.
• At laryngoscopy hyperemia and infiltration of mucous membrane of epiglottis, aryepiglottis, pre-entrance and vocal folds of pear-shaped pockets are marked.

TREATMENT OF LARYNGEAL QUINSY�

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• Patients with a laryngeal quinsy are prescribed a powerful antibacterial therapy.
• Prescription of dehydratational therapy is obligatory, as there is the threat of development of stenosis of larynx.
• For diminishing of edema of larynx we prescribe intravenously a 40% solution of glucose, 10% solution of calcium of chloride, 60-90 mgs of prednisolone, diuretics (lasics, verospiron), antihistaminic drugs intramuscularly (diphenhydramine hydrochloride, pipolphen, suprastin and other).
• It is possible to use distracting procedures - hot foot-baths.

PHLEGMONOUS LARYNGITIS�

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Under phlegmonous laryngitis (laryngitis phlegmonosa) we understand the acute inflammatory disease of larynx, at which a purulent process spreads not only in to a submucous layer but also in muscles, copulas of larynx, and sometimes perichondrium and cartilages engaged in this process (abscesses can appear in area of epiglottis, aryepiglottis folds, arytenoid cartilages).

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Etiology: bacterial (coccal) flora.

PHLEGMONOUS LARYNGITIS�

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Clinic

The disease begins acutely. Patients complain about a general weakness, malaise, broken, pharyngalgias, fervescence. Great pains are marked at the development of abscess on epiglottis and aryepiglottic folds. If an inflammatory process is localized in the area of glottis, hoarseness, difficulty of breathing appear.

TREATMENT OF PHLEGMONOUS LARYNGITIS�

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• Treatment of phlegmonous laryngitis includes application of large doses of antibiotics of wide spectrum of action.
• At the discovery of abscess it is necessary to open it by a laryngeal knife.
• At the developing acute stenosis the urgent tracheostomy is routined.
• At abscesses on neck or in mediastinum the abscesses of neck must be opened mediastinotomy, must be performed.