Chronic laryngeal stenosis - Causes, Symptoms, Diagnosis and Treatment
Chronic laryngeal stenosis - Occurs gradually narrowing of the larynx, accompanied by a progressive decrease in the number of air entering the respiratory ways to slow the development of hypoxia. The leading symptoms of chronic laryngeal stenosis are dyspnea and inspiratory different in severity hoarseness. Diagnosis of chronic stenosis of the larynx is to conduct mikrolaringoskopii, phonation studies, CT larynx, analysis of blood gas composition, X-ray of lungs, EKG, etc. With regard to chronic stenosis of the larynx is possible to use a variety of surgical procedures and medication treatment, the choice of which is dictated by the cause of stenosis and emerged cardiopulmonary complications.
Chronic laryngeal stenosis
acute laryngeal stenosis, time to trigger mechanisms to compensate for the reduced flow of air to breathe. In response to the reduced oxygen content in the blood include haemodynamic, respiratory, blood and tissue adaptive reactions.
Respiratory compensatory mechanism is quickening and deepening of breathing, participation of auxiliary muscles. Hemodynamic mechanism is realized by increasing the heart rate, increase vascular tone, blood output from the depot, thereby increasing blood flow and cardiac output improves blood flow to vital organs. Blood adaptive mechanism is characterized by an increased ability to hemoglobin oxygen saturation, increased erythropoiesis and yield of red blood cells from the spleen. At the heart tissue adaptive response is an increase in the ability of tissue to absorb oxygen from the blood, if necessary, move to partially anaerobic type of metabolism.
neuropathic paresis of the larynx. In turn, ankylosis of the ring-arytenoid joints associated with the transfer of infectious or traumatic arthritis. Bilateral neuropathic paresis of the larynx, causes chronic stenosis of the larynx, can be caused by bilateral damage innervating laryngeal nerves (with toxic goiter, autoimmune thyroiditis, thyroid enlargement due to iodine deficiency disorders, diverticula, and tumors of the esophagus, bilateral cervical lymphadenitis, the operations on the thyroid gland) their toxic lesion (at various poisoning, typhus and typhoid fever, tuberculosis, and others. infections) or have a central origin (for neurosyphilis, brain tumors, syringomyelia, botulism, hemorrhagic stroke, ischemic stroke, severe traumatic brain injury).
The cause of chronic stenosis of the larynx may be its scarring after injuries, burns, long-term presence of a foreign body in the throat. Chronic stenosis of the larynx can result in the progressive growth of a benign tumor of the larynx, cancer of the larynx, its specific diseases (syphilis, tuberculosis, scleroma).
Chronic laryngeal stenosis can have a secondary character and develop after an acute stenosis. Thus, chronic stenosis of the larynx is often seen in connection with the violation of performing tracheostomy technique. For example, the introduction of the tracheostomy tube through an incision in the trachea of the first ring, not 2-3-th, it relates to the cricoid cartilage and is the cause of his hondroperihondrita leading to stenosis. Wrong choice of wearing or tracheostomy tube for a long time can also cause chronic stenosis of the larynx.
Otolaryngology distinguishes 4 stages of chronic stenosis of the larynx: compensated, subcompensated, and decompensated stage of asphyxia. However, in the case of chronic stenosis of larynx, unlike acute, and condition of the patient depends on the adaptability of the organism to hypoxia occurring.
The resulting in chronic stenosis of the larynx glottis narrowing leads to disturbances of breathing and phonation (phonation). Disorders of the respiratory function are manifested difficulty inhaling, t. E. Inspiratory dyspnea. Depending on the stage of chronic laryngeal stenosis shortness of breath can only occur when the patient's physical effort (compensated stenosis) or at rest, too (sub- and decompensated stenosis). Marked inspiratory dyspnea accompanied by participation in the respiratory movements more muscles, inspiratory retraction intercostal spaces and jugular holes, by drawing the epigastric region. Disorders of phonation appear different, depending on the height of the constriction of the larynx, the degree of hoarseness. In some cases there is aphonia - the complete lack of voice.
Chronic laryngeal stenosis accompanied by the development of respiratory failure obstructive nature. Increasing hypoxia leads to compensatory tachycardia and hypertension. From chronic oxygen deficiency in the first place it is suffering a brain that appears memory impairment, distraction patient, sleep disorders. Due to the accumulation of carbon dioxide in the blood of a headache, and nausea.
bronchitis and pneumonia. In patients with a tracheostomy air entering the trachea does not pass the procedure of warming, moistening and biological treatment, which is normally carried out in the upper airways. As a result, they often have tracheitis and tracheobronchitis. Bronchitis in chronic stenosis of the larynx are mostly chronic. Inflammatory diseases of the lung occur in the form of prolonged stagnation or pneumonia, lead to the development of bronchiectasis. Increased pressure on the pulmonary circulation and right heart in patients with chronic laryngeal stenosis leads to the development of pulmonary hypertension and the formation of pulmonary heart.
otolaryngologist primarily conducts mikrolaringoskopiyu, in which the tumor can be detected and laryngeal foreign body, her scarring and congenital malformations. If necessary during endoscopic biopsy mikrolaringoskopii produce larynx. Subsequent histological study material gives information about the nature occurring morphological changes of the walls and throat muscles.
Equally important in chronic stenosis of the larynx is the study of vocal function: fonetografiya and timing of maximum phonation. Elektroglottografiya Stroboscopy and allow us to estimate the degree of active and passive mobility of the vocal cords.
In the course of establishing the etiology of chronic laryngeal stenosis may need to perform CT of the larynx, thyroid ultrasound, MRI and CT scan of the brain, bacteriological examination of smears from the pharynx, esophagus radiography. The degree of hypoxia and hypoxemia measured at the study of the gas composition and blood CBS. For the diagnosis of cardiopulmonary complications of chronic stenosis of the larynx is carried out X-ray of lungs, EKG, echocardiogram.
parafaringealnoy removal of the tumor. When tumors of the vocal cords is carried outside and endolaryngeal hordektomiya. Removing large or malignant tumors requires subsequent reconstructive plastic larynx. When tumors of the thyroid gland, leading to chronic laryngeal stenosis due to compression of laryngeal nerves, perform subtotal resection of the thyroid or thyroidectomy. According to the testimony of conducting operations to remove tumors of the esophagus. If you can not eliminate the cause of chronic laryngeal stenosis perform a tracheostomy.
Along with surgical treatment is carried out medical therapy of chronic stenosis of the larynx with anti-bacterial, anti-inflammatory, decongestants, glucocorticosteroid, antihistamines. The fight against hypoxia is done by regular oksigenobaroterapii. Additional drug treatment of chronic stenosis of the larynx is carried out in accordance with the underlying disease or develop complications of stenosis.