Diagnosis and treatment of acute, chronic laryngitis in children (Sergiev Posad)

Laryngitis is an inflammatory disease of the larynx, which is one of the consequences of influenza, ARVI, whooping cough, scarlet fever, rhinitis, tonsillitis, and pneumonia.

With laryngitis, the vocal cords are the first to suffer - the patient’s voice becomes hoarse or disappears altogether. Breathing becomes difficult, and a so-called “barking” cough appears, which is quite painful.

Laryngitis in adults can also occur as an independent disease, for example, when the voice is overstrained (the so-called “teacher’s disease”).

It is customary to distinguish between acute and chronic laryngitis .

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Diagnosis of laryngitis in MedicCity

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3 Diagnosis of laryngitis in MedicCity

Acute laryngitis

In acute laryngitis, the disease lasts for 7-10 days. Acute laryngitis is quite rare to occur on its own. This disease manifests itself along with inflammation of the pharynx, nasal cavity, bronchi and lungs. The cause of the development of acute laryngitis is considered to be acute respiratory diseases, thermal or chemical burns, and injuries. Severe hypothermia, dry air, excessive vocal tension, existing foci of inflammation and impaired nasal breathing can also lead to laryngitis.

In advanced, severe cases, laryngitis can become life-threatening for the patient. If the pain in the throat is so acute that it is difficult for a person with laryngitis to even swallow his own saliva, you should immediately call a doctor! A tumor in the larynx can block the passage of air. You should also consult a doctor if hoarseness, hoarseness (or complete absence) of the voice does not stop 3-5 days after the onset of the illness.

Causes of laryngitis

The cause of croup is most often a viral infection:

Risk factors for developing acute laryngitis:

• decreased immunity
• general and local hypothermia
• diseases of the pharynx and paranasal sinuses
• influence of bad habits

Acute inflammation of the mucous membrane of the larynx may be a consequence of catarrhal inflammation of the nasal mucosa, paranasal sinuses (sinusitis) or pharynx (tonsillitis, pharyngitis).

Acute laryngitis develops against the background of viruses:

• ARVI
• influenza A, B, and C viruses
• parainfluenza
• adenovirus infection4

Among bacteria, common causative agents of acute laryngitis are:

• Haemophilus influenzae (H. Influenzae)
• chlamydia pneumoniae
• Moraxella catarrhalis
• pneumococcus (S. pneumoniae)5

Chronic laryngitis

If inflammation of the larynx continues for more than a month, then we are talking about chronic laryngitis . Quick diagnosis and proper treatment of the disease are very important here.

The causes of chronic laryngitis can be:

• untreated acute laryngitis;
• significant professional voice loads for teachers, artists, announcers;
• excessive smoking;
• alcoholic drinks with high alcohol content that dry out the throat;
• too hot and spicy food;
• untreated gastroesophageal reflux disease with reflux of hydrochloric acid into the esophagus and larynx.

It is very important to consult an ENT doctor if you have symptoms of inflammation of the larynx. Otolaryngologists at our clinic will help you cope with the unpleasant symptoms of laryngitis and other diseases of the ear, nose and throat.

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Consultation with an otolaryngologist in MedicCity

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Swelling of the throat, symptoms and signs

Symptoms of laryngitis may vary depending on the etiological origin.

In case of swelling caused by an infectious agent, the signs will be as follows:

• increase in body temperature to febrile levels, often with chills;
• severe symptoms of intoxication (headache and muscle pain, dizziness; in children, nausea, vomiting, development of meningeal symptoms are possible);
• sore throat;
• paroxysmal, debilitating, non-productive cough;
• hoarseness of voice;
• feeling of a lump in the throat.

The development of false croup is indicated by a paroxysmal, whistling and barking cough. Inhaling and exhaling is difficult, and the whistling sound can be heard even from a distance. The patient becomes restless and panic begins. Children are characterized by intense crying and it is difficult to calm the child down.

Hypoxia, which develops against the background of edema, is indicated by paleness of the nasolabial triangle, tachycardia, retraction of the skin into the intercostal space, and cold sweat. This condition is dangerous and requires immediate assistance.

Allergic laryngitis ranks second after infectious laryngitis in terms of frequency of occurrence. Often the disease is diagnosed in the spring, when plants are flowering.

Allergic laryngitis is characterized by:

• labored breathing;
• hoarseness of voice;
• cough.

The temperature does not rise in this condition. Often allergic swelling of the larynx is accompanied by swelling of the nasal mucosa and lacrimation.

The most dangerous allergic manifestation is Quincke's edema. It is impossible not to notice the development of pathology. Symptoms develop at lightning speed. Immediately the patient feels a slight sore throat, then breathing becomes difficult, the pharynx and larynx swell. Then the neck, submandibular space, and face change. In such cases, at the first symptoms, you should immediately call an ambulance. Within 10-20 minutes, swelling can completely block the lumen, causing suffocation.

Hoarseness of voice.

Laryngitis in children

This disease begins with a runny nose and dry cough, then the child develops a sore throat, and the voice becomes hoarse and unrecognizable. At night, the child most often begins to wheeze because the lumen of the airways narrows. He develops a suffocating cough, his face becomes pale, and the nasolabial triangle begins to acquire a bluish tint. Temperatures may rise to 40 degrees.

How to treat laryngitis in a child? The treatment regimen and medications for laryngitis should be prescribed by a doctor: many medications that are used in the treatment of laryngitis in adults can cause an allergic reaction in a child.

It is recommended to give the child plenty of alkaline drinks (warm milk, mineral water). Antihistamines and hypoallergenic syrups are prescribed to relieve irritation and inflammation of the laryngeal mucosa. Alkaline inhalations are also very effective for laryngitis in children. Parents who are faced with laryngitis in children, as a rule, even travel with an inhaler-nebulizer, which allows them to quickly stop a coughing attack in their child.

If a child develops a “barking cough,” delay is especially dangerous—spasm of the respiratory tract (“false croup”) may occur. In severe cases, progression of the disease can lead to respiratory arrest. Call an ambulance immediately!

Treatment

When treating laryngitis, the patient needs physical and vocal rest (5-7 days).

It is necessary to drink more warm alkaline liquids (milk, Borjomi), this helps with dryness and itching in the larynx. You need to gargle with weak solutions of antiseptics (furacilin, potassium permanganate, soda, boric acid, romazulan, resorcinol), as well as infusions of medicinal plants (chamomile, sage). Local use of an antibiotic (bioparox) and astringents (hydrocortisone, chymotrypsin, collargol) is possible.

Inhalations

Effectively carry out alkaline inhalations (baking soda solution, “Essentuki”, “Borjomi”, “Narzan”), sanitation of the oropharynx with solutions of Lugol, iodinol, vegetable oils (olive, apricot, peach). It is better to apply a warm compress to the neck area.

Medicines

Drug therapy includes restorative, antitussive, antihistamine, immunostimulating, antimycotic (antifungal), enzyme, and homeopathic drugs. For a viscous, hysterical cough of viral or bacterial etiology, medications that thin the sputum in the bronchi (mucaltin, bromhexine, ACC) are prescribed.

Antibiotics

The need to prescribe antibacterial drugs is determined by the doctor. This is acceptable in the case of concomitant pathology of a viral or bacterial nature. For acute and extensive inflammatory phenomena, treatment is prescribed empirically using broad-spectrum antibiotics.

What should you not do if you have laryngitis?

You should not eat food that irritates mucous tissues (hot, salty, spicy, too sweet, cold, hot, rough). You should refrain from smoking, do not drink alcohol, and do not get too cold.

Physiotherapy includes:

• therapeutic laser;
• steam inhaler (nebulizer);
• electrophoresis.

Possible complications of laryngitis

The most dangerous complication of acute laryngitis is croup

(stenotic laryngotracheitis). Its development is accompanied by the following symptoms:

• shortness of breath (it is difficult for the child to take a breath);
• wheezing, flared nostrils;
• signs of lack of oxygen (blueness of lips, mucous membranes, fingers);
• the so-called “barking” cough in a child.

If signs of croup appear, you should call an ambulance, as croup is a life-threatening condition.

In the chronic form of the disease, growths - polyps - appear on the mucous membrane, which lead to a persistent change in voice and difficulty breathing. In this case, laryngeal stenosis also develops, but, unlike croup, this happens gradually. The body does not feel an acute lack of oxygen, as it manages to adapt to a gradual decrease in respiratory function.

Polyps on the mucous membrane can eventually transform into cancerous tumors - laryngeal cancer. This occurs decades after the onset of the disease.

Diagnosis of laryngitis

The presence of laryngitis is determined by an otolaryngologist. Before this, a clinical picture is drawn up and the results of a laryngoscopic examination are studied. Laryngoscopy means a visual examination of the larynx. It can be performed using mirrors (indirect laryngoscopy) or using an endoscope (hollow tube made of optical fiber - direct laryngoscopy). Laryngoscopy can reveal swelling of the laryngeal mucosa, thickening of the vocal cords and hemorrhages. After laryngoscopy and history taking (questioning the patient), the doctor determines the form of laryngitis.

X-ray or computed tomography of the larynx and trachea will help clarify the diagnosis. However, doctors prefer laryngoscopy as the main diagnostic tool.

As an additional diagnostic test, blood may be taken for a general analysis and determination of the level of leukocytes. If there is a suspicion of the development of a bacterial infection, then samples (smears) are taken from the oropharynx for study.

GBOU "NIKIO im. L.I. Sverzhevsky" of the Moscow Department of Health

Developer institution: State Healthcare Institution “Moscow Scientific and Practical Center of Otorhinolaryngology” of the Moscow Department of Health.

Compiled by: Director of the State Institution "MNPTSO" of the Moscow Department of Health, Professor A.I. Kryukov, Head of the Department of Laryngeal Microsurgery and Phoniatrics, Moscow Scientific and Practical Center of Otorhinolaryngology, Moscow Healthcare Department, Ph.D. S.G. Romanenko, senior researcher at the department of microsurgery of the larynx and phoniatrics of the State Healthcare Institution "MNPTSO" of the Moscow Healthcare Department, candidate of medical sciences. O.G. Pavlikhin, Department of Laryngeal Microsurgery and Phoniatrics of the State Healthcare Institution "MNPTSO" of the Moscow Healthcare Department Eliseev O.V.

Reviewer: Doctor of Medical Sciences, Professor V.P. Gamow

Doctor of Medical Sciences, Professor V.F. Antoniv

Purpose: The guidelines present schemes for inhalation therapy for patients with inflammatory diseases of the larynx. The methodological recommendations are intended for outpatient and inpatient otorhinolaryngologists and phoniatricians.

This document is the property of the Moscow Government Department of Health and may not be reproduced or distributed without appropriate permission.

INTRODUCTION

Inhalation therapy has been used since ancient times. Hippocrates is considered the founder of inhalation therapy. At the same time, the simplest inhalation drugs appeared. The ancestors of modern inhalation devices appeared in the 19th century and gradually improved along with the development of technological progress. In 1932, the Norwegian chemist E. Rotheim received a patent for the first aerosol apparatus. Subsequently, until now, inhalation equipment has been improved, and the range of drugs used for inhalation therapy continues to expand.

The main advantage of aerosol therapy is the ability to achieve a quick and effective therapeutic effect using a relatively small dose of the drug and a significant reduction in the negative systemic effect. During inhalation, rapid and intense absorption of drugs occurs, with an increase in the active surface and its deposition in the submucosal layer. A high concentration of the drug is created directly at the site of inflammation.

Endolaryngeal infusions are significantly less effective than aerosol therapy, because administered drugs penetrate shallowly into the tissues of the larynx due to short contact of the drug with the mucous membrane of the larynx. The use of endolaryngeal infusions is often limited by the anatomical and individual characteristics of the patient. In addition, infusions into the larynx cannot be performed several times a day. All of the above does not mean that endolaryngeal infusions should be abandoned altogether. This type of local therapy is indispensable in phoniatric and ENT practice in cases where a rapid therapeutic effect is required without deep penetration of the medicinal substance. For example, in the case of hemorrhage into the vocal fold caused by forced phonation, or acute catarrhal laryngitis, accompanied by impaired microcirculation of the vocal fold against the background of a hard attack, infusions of vasoconstrictors into the larynx (adrenaline 0.1% - 0.3 in 2 ml of physiological solution). Medicines are poured into the larynx, warmed to body temperature, drop by drop until a clinical effect is achieved: blanching of the mucous membrane, constriction of the vessels of the vocal fold. In this case, a rapid therapeutic effect is achieved and there are no side effects such as dryness of the laryngeal mucosa.

Inhalers, based on the methods of obtaining an aerosol medium, are ultrasonic, compressor, pneumatic, steam and heat-moist. When choosing a particular type of inhalation therapy, one should take into account not only the form of a particular drug, but also all parameters of the procedure (form of the drug, aerosol concentration, aerosol temperature, etc.).

Research has proven that the temperature of inhaled aerosols seriously affects the ciliated epithelium and the condition of the medicinal substance itself. High and low temperatures of inhaled solutions negatively affect the course of the inflammatory process. When the temperature of the inhaled drug is above 39-40 degrees Celsius, the function of the ciliated epithelium is suppressed (above 41 degrees it dies). Solutions with temperatures below 25 - 28 degrees are a cold irritant. The optimal aerosol temperature is considered to be 36-38 degrees. Heat-moist and steam inhalations against the background of acute laryngitis can cause the development of edema of the laryngeal mucosa with stenosis of its lumen. It should also be noted that many drugs sharply reduce or even lose their biological activity when heated to high temperatures. In this regard, we consider the use of heat-moist and steam inhalations for the treatment of inflammatory pathology of the larynx to be inappropriate. This type of therapy can be used with caution in subatrophic and atrophic processes in the larynx.

In recent years, the arsenal of pocket inhalers has expanded. There are pocket liquid inhalers and powder inhalers. Pocket inhalers are used to administer a dosed amount of the drug into the respiratory tract. Despite the convenience of their use, the scope of use of this type of inhaler for laryngeal pathology is limited. The bulk of the aerosol settles in the oral cavity. The disadvantages of aerosol packaging include the low temperature of the resulting aerosol. Also, one of the disadvantages of aerosol cans is that as it is used, the pressure inside it decreases and the drug is not completely ejected.

Inhalation equipment.

Inhalation equipment is divided into stationary units and portable portable devices. Due to the fact that the treatment of inflammatory diseases of the larynx requires multiple inhalations throughout the day, more and more attention is being paid to portable inhalation devices.

In medical practice, nebulizers are more often used (from the Latin nebula - fog, cloud). There are two main types of nebulizers: compressor and ultrasonic. Compressor inhalers are either jet or pneumatic. A compressor inhaler is a device for converting a medicinal substance into a fine aerosol under the action of compressed air from a compressor or under the influence of compressed oxygen. In ultrasonic inhalers, atomization is carried out as a result of high-frequency vibration of piezoelectric crystals.

The results of our clinical experimental study prove that inhalation procedures performed on individual ultrasonic inhalation devices are more effective compared to inhalations performed on compressor devices. This is explained by the fact that the aerosol of ultrasonic inhalation devices is an electric aerosol. Such an aerosol, in addition to the medicinal properties of the medicinal substance itself, consists almost entirely of negatively charged particles that have an additional anti-inflammatory effect. During inhalation procedures carried out on compressor inhalation devices, in addition to negatively charged particles, positively charged particles and particles without a charge are also formed. The disadvantage of using an ultrasonic inhaler is the high consumption of the drug, since the loss of the drug also occurs in the exhalation phase.

According to the degree of dispersion, aerosols are distinguished as highly dispersed (particle size 0.05-0.1 µm), medium dispersed (particle size 0.1-1 µm) and coarsely dispersed (particle size more than 1 µm). Particles with a diameter of 8 - 10 microns usually settle in the oral cavity, 5 - 8 microns in the pharynx and larynx, 3 - 5 microns - in the trachea and bronchi, 1 - 3 microns in the bronchioles, 0.5 - 2 microns - in the alveoli. For the treatment of diseases of the upper respiratory tract, aerosols of medium and low dispersion are mainly used.

Inhalation therapy for the treatment of laryngeal diseases can be used either as monotherapy or in combination with other treatment methods. The use of inhalation therapy is indicated for patients with inflammatory pathology of the larynx, edematous laryngitis of various etiologies, vocal fold nodules, as symptomatic therapy to achieve a mucolytic effect, moisturizing the laryngeal mucosa.

Contraindications to inhalation therapy

1. Tendency to spasms of the coronary arteries
2. Condition after myocardial infarction and cerebral hemorrhage
3. Bleeding of various etiologies and susceptibility to them
4. Severe atherosclerosis of the vessels of the brain and heart
5. Spontaneous pneumothorax
6. Common bullous form of emphysema
7. Malignant neoplasms.

Rules for inhalation

1. Inhalations are carried out no earlier than 1-1.5 hours after eating or physical activity.
2. Before the procedure, the patient should not take expectorants or gargle with antiseptic solutions. It is recommended to rinse your mouth with boiled water at room temperature.
3. Smoking is prohibited before and after inhalations.
4. Inhalations should be taken sitting in a comfortable position, straight, in such a way as to ensure calm breathing. It should be taken into account that a strong forward tilt of the body during the procedure makes breathing difficult.
5. For diseases of the nose, paranasal sinuses and nasopharynx, inhalation and exhalation must be done through the nose. In case of pathology of the larynx, inhalation should be done through the mouth. After taking a deep breath through your mouth, it is recommended to hold your breath for 2 seconds and then exhale completely through your nose.
6. Breathing during inhalation should be normal, not forced. Frequent deep breathing causes hyperventilation and may cause dizziness. If dizziness occurs, it is necessary to interrupt inhalation for 1-2 minutes.

Aerosol therapy - basic principles.

Aerosols of drugs have mucolytic, anti-inflammatory, anti-edematous, antibacterial effects, and are able to maintain mucociliary clearance and regulate the degree of hydration.

Antibacterial and antifungal agents, enzymes, hormonal drugs, mucolytics, mineral waters, herbal medicines, biostimulants, and biologically active substances are administered in aerosol form.

The use of inhalation therapy makes it possible to reduce the intake of antibacterial and other drugs, significantly increase the effectiveness of treatment, and reduce the manifestation of systemic and side effects of other drugs.

One of the necessary conditions for normal phonatory activity of the vocal folds is sufficient moisture in the mucous membrane of the vocal folds. Dryness of the laryngeal mucosa can be caused not only by an inflammatory process, but also by side effects of the use of medications such as topical corticosteroids for bronchial asthma, desensitizing drugs, etc. This is especially important for patients with vocal professions. The use of inhalation therapy with mineral water or saline in these cases will help neutralize the side effects of these drugs, improve voice quality and accelerate epithelization processes after endolaryngeal interventions.

Recently, the attitude towards the use of oil inhalations has changed. The purpose of oil inhalation is to cover the mucous membrane with a thin protective and softening layer. The duration of oil inhalations is on average 5-8 minutes. In 5 minutes, 0.25 g of oil is converted into an aerosol. According to numerous studies conducted in recent years, it has been established that inhaled oil entering the alveoli contributes to the development of alveolitis and the destruction of surfactant. Therefore, this method of treatment, which was widely used in the past, is currently recommended not to be used.

When carrying out inhalation therapy, it is necessary to adhere to a certain sequence of use of medicinal substances. The presence of a large amount of sputum and crusts on the surface of the mucous membrane prevents the absorption of inhaled substances. In these cases, treatment should begin with inhalation of mucolytic drugs and only after that, after 20-30 minutes, aerosols of other drugs should be prescribed. If severe dryness of the mucous membrane of the oropharynx and larynx appears after the use of inhaled corticosteroids, inhalation with saline or mineral water is indicated to moisturize the mucous membrane.

When planning inhalation therapy, one should adhere to the principle of sequential use throughout the day of medications with different pharmacological activities and directions and selection of individual treatment regimens depending on the nature, severity and stage of inflammation.

Medicines for nebulizer aerosol therapy.

Antibacterial drugs.

The high effectiveness of antibacterial and antifungal drugs when applied topically in the treatment of inflammatory pathology of the larynx has long been known. However, before starting inhalation, you should especially carefully collect an allergy history. There are known cases of anaphylactic shock during an inhalation procedure with antibacterial agents. Previously, inhalations with streptomycin, penicillin, tetracycline, chloramphenicol and oleandomycin were often prescribed. Currently, inhalations of 2 ml of a 0.01% solution of miramistin or 2 ml of a 1% solution of dioxidine mixed with 3 ml of saline are most often used in practice. The antibiotic Fluimicil, which also has a mucolytic effect, has shown high therapeutic effectiveness. For inhalation, use ½ bottle of the drug for inhalation, 2 times a day. It is possible to use other antibacterial agents, which are prescribed in accordance with the result of a microbiological study. The average duration of therapy is 5 days.

Antifungal drugs

For the treatment of laryngeal mycoses, in addition to general antifungal and anti-inflammatory therapy, inhalations of 3000 units/ml of nystatin are used. The solution is prepared before use: 75 mg of nystatin sodium salt powder in 5 ml of distilled water once a day. The sodium salt of levorin is also used, 200,000 units per inhalation. The course of treatment usually lasts 12-15 days. Just as with any other pathology of the larynx, inhalations with antifungal drugs, if necessary, alternate with inhalations with proteolytic enzymes, saline or mineral water.

Corticosteroids.

Inhaled corticosteroids have anti-edematous and anti-inflammatory effects. Inhalation of corticosteroids is used for all inflammatory diseases of the larynx, especially those accompanied by swelling of the mucous membrane. Mixtures of hydrocortisone hemisuccinate 25 mg or prednisolone 15 mg or dexamethasone 2 mg in 3 ml of saline are used. Inhalations are prescribed 2 times a day. In case of severe swelling of the laryngeal mucosa - up to 4 times a day. The duration of treatment depends on the dynamics of inflammatory changes. For chronic inflammatory processes, the course of treatment averages 10 days. A side effect of these drugs is dryness of the laryngeal mucosa. In patients with inflammatory diseases of the larynx, especially after surgery, this may slow down the epithelization process. In this regard, after inhalation of a corticosteroid, it is possible to inhale saline solution or mineral water after 10-15 minutes.

Proteolytic enzymes.

Aerosols of proteolytic enzymes have a mucolytic effect and improve mucociliary clearance. Enzyme preparations have a local anti-inflammatory and anti-edematous effect. The use of proteolytic enzymes in the form of inhalations is especially indicated for the treatment of laryngitis, accompanied by the formation of dense fibrin films or crusts, with subglottic laryngitis against the background of systemic diseases, with atrophic laryngitis.

The drugs are diluted in physiological solution or distilled water: Chymotrypsin – 3 mg in 1 ml, Trypsin 3 mg in 1 ml, Chymopsin 5 mg in 1 ml. Lysozyme is used in the form of a 0.5% solution; 3-5 ml of solution are consumed per 1 inhalation. Inhalations are prescribed 1-3 times a day for 7 days. Enzyme preparations can cause allergic reactions, and therefore they should be used with great caution.

Mucolytics and mucoregulators.

Mucolytics and mucoregulators are used for inflammatory diseases of the larynx to liquefy secretions and facilitate mucociliary clearance. Acetylcysteine ​​is used in the form of a 20% solution, 2-4 ml 3-4 times a day. In therapeutic dosage it has a good mucolytic effect. In high dosages, it suppresses the activity of ciliated cells of the bronchial mucosa and mucociliary clearance. An undesirable effect of acetylcysteine ​​is a reflex cough due to local irritation of the respiratory tract. Increases the tendency to bronchospasm, so it is recommended not to use it in patients with concomitant pulmonary pathology. Fluimicil antibiotic is a drug with antibacterial and mucolytic effect. Dosage used: ½ bottle for 1 inhalation 2 times a day. Lazolvan is a metabolite of bromhexine, which has a bronchosecretolytic and expectorant effect. Improves the rheological properties of sputum, reduces its viscosity and adhesive properties, and normalizes mucociliary clearance. Lazolvan is used in a dosage of 4 ml 2-3 times a day, then 2 ml 3-4 times a day in pure form or diluted with saline 1:1. The course of treatment is 7 days.

To enhance the mucolytic effect and moisturize the laryngeal mucosa, the clinic successfully uses sodium chloride 0.9% isotonic solution 2-3 ml per inhalation, sodium bicarbonate 2% solution 2-3 ml per inhalation. Inhalation of saline solution can be used for a long time as a symptomatic remedy for dry laryngeal mucosa.

The main components of mineral water are sodium, calcium, magnesium, chlorine, iron, and radon. Potassium iodide increases the amount of mucus and thins it. Magnesium carbonate increases mucus secretion, sodium carbonate reduces mucus secretion and thins it. Salt-alkaline waters reduce the feeling of dryness and cough irritation. Mineral waters containing hydrogen sulfide cause vasodilation and a short-term increase in temperature, while the function of the ciliated epithelium is activated. Mineral waters with a salt concentration of up to 150 mg/l are used. According to our data, medium-mineralized waters have the best therapeutic effect: Essentuki No. 17, Slavyanskaya.

For many years, herbal preparations that have anti-inflammatory, bactericidal, and mucolytic effects have been successfully used in the treatment of inflammatory diseases of the larynx. Only mixtures of drugs approved in the Russian Federation are allowed for inhalation

1. Pharmaceutical mixture: Eucalyptus (leaf) 15.0, Salvia officinalis (leaves) 20.0, Chamomile (flowers) 10.0, Peppermint (herb) 10.0, Scots pine (buds) 15.0, Elecampane tall (roots) 20.0, Common thyme (herb) 10.0,
2. Pharmaceutical mixture: Menthol 0.71g, Eucalyptus tincture 35.7, glycerin 35.7, Ethyl alcohol 100 ml.

It is possible to use chamomile infusion, a mixture of aloe extract 5 ml, Kalanchoe juice, plantain, rose hip extract, 10% solution of white natural honey. To reduce swelling of the mucous membrane and secretion of mucus, inhalations with astringents are prescribed, a decoction of oak bark, sage, infusion of St. John's wort or immortelle flowers. A good therapeutic effect was noted when using humisol 2.0 and pelloidin. Clinical data indicate the moisturizing and reparative effect of these drugs by improving microcirculation. When using multicomponent herbal preparations and honey, an allergy history should be collected with special care.

We have developed treatment regimens for inflammatory diseases of the larynx using inhalation therapy. Inhalation therapy is used in complex treatment, including antibacterial, anti-inflammatory, desensitizing agents, physiotherapy, enzyme therapy, and microsurgical interventions. As monotherapy, inhalation treatment is indicated for mild forms of inflammatory diseases of the larynx.

Scheme of inhalation therapy for acute catarrhal laryngitis, exacerbation of chronic catarrhal laryngitis:

1. Mixture: Miramistin 0.01% - 2.0 + Saline solution 2.0 ml + Dexamethasone solution 2 mg. Inhale 2 times a day for 10 minutes.
2. Saline solution 5.0 or Mineral water 5.0 20 minutes after inhalation of Miramistin and Dexamethasone. In case of increased dryness of the mucous membrane of the larynx, as well as for people in vocal professions, it is possible to use inhalations of mineral water or saline solution as a moisturizer up to 6 times a day. Inhalation duration is 5-10 minutes.

The course of treatment is 7-10 days.

Scheme of inhalation therapy for acute edematous laryngitis, exacerbation of chronic edematous-polyposis laryngitis:

1. Dexamethasone 2 mg in 3 ml of saline 2 times a day for 10 minutes. With severe swelling of the laryngeal mucosa, inhalations can be used up to 4 times a day.
2. Saline solution 5.0 ml or mineral water 5.0 ml after inhalation of a corticosteroid after 10 - 15 minutes, as well as during the day if the laryngeal mucosa is dry. Inhalation duration is 5-10 minutes.

The course of treatment for acute inflammation is 3-7 days, for chronic inflammation – 7-10 days.

Scheme of inhalation therapy for infiltrative phlegmonous, abscessing laryngitis, exacerbation of chronic hyperplastic laryngitis:

1. When crusts and dense fibrinous plaque form, therapy begins with inhalation of a mucolytic or proteolytic enzyme. Use 2-4 ml of 20% Acetylcysteine ​​solution 3-4 times a day or 4 ml of Lazolvan diluted 1:1 with saline solution. Use 3 mg of Chymotrypsin or trypsin 3 mg, chymopsin 5 mg in 1 ml of saline, or 0.5% lysozyme solution, 5 ml 2 times a day, then 2 ml 3-4 times a day in pure form or diluted with saline 1: 1.
2. After 10 minutes - Fluimicil antibiotic ½ bottle 2 times a day. If the fungal nature of the disease is identified, inhalation therapy with antifungal drugs is carried out. Inhalation duration is 10 minutes.
3. After 15-20 minutes - Dexamethasone 2 mg in 3 ml of saline 2 times a day. Inhalation duration is 10 minutes.
4. 5.0 ml of saline or 5.0 ml of mineral water 4 - 6 times a day: 10 - 15 minutes after inhalation of the corticosteroid and an additional 2-4 times during the day, depending on the amount of viscous sputum or crusts on the mucous membrane of the vocal folds . Inhalation duration is 10 minutes.

The course of treatment is 7-10 days. In case of chronic hyperplastic laryngitis, inhalations with mineral water or saline 2-4 times a day are prescribed for up to 2-3 weeks in order to moisturize the laryngeal mucosa and reduce the viscosity of the secretion.

Scheme of inhalation therapy for chronic subatrophic and atrophic laryngitis:

1. 3 mg of Chymotrypsin or trypsin 3 mg, chymopsin 5 mg in 1 ml of saline, or 0.5% lysozyme solution 5 ml 2 times a day then 2 ml 3-4 times a day in pure form or diluted with saline 1:1 . Inhalation duration is 10 minutes.
2. 5.0 ml of saline solution or 5.0 ml of mineral water 4 - 6 times a day for 10 days or for a long time 2 times a day. Inhalation duration is 10 minutes.
3. Inhalation with 2.0 ml of pelloidin or humisol 2 times a day. It is possible to use honey inhalations. Inhalation duration is 10 minutes. 10 procedures are prescribed for a course of treatment.
4. Inhalation with a ready-made pharmaceutical mixture of medicinal herbs 2 times a day after the end of the previous course of therapy for 10 days (with very significant crust formation). Inhalation duration is 10 minutes.

Long-term, regular use of inhalations with mineral water or saline 2-4 times a day is recommended in order to moisturize the laryngeal mucosa and reduce the viscosity of the secretion until remission of the disease.

Scheme of inhalation therapy for acute laryngitis after endolaryngeal intervention:

1. In the first days after surgery, inhalations of antibacterial drugs are used: 2 ml of 0.01% miramistin solution or 2 ml of 1% dioxidine solution mixed with 3 ml of saline. Fluimicil antibiotic ½ bottle of the drug for inhalation, 2 times a day.
2. Inhalation of dexamethasone 2 mg in 3 ml of saline 2 times a day for 5-7 days.
3. With increased formation of fibrin films, inhalation of 3 mg of Chymotrypsin or trypsin 3 mg, chymopsin 5 mg in 1 ml of physiological solution, or 0.5% lysozyme solution, 5 ml 2 times a day, then 2 ml 3-4 times a day in pure water, is added to the treatment. form or diluted with saline solution 1:1. Inhalation duration is 10 minutes.
4. 5.0 ml of saline solution or 5.0 ml of mineral water 4 - 6 times a day for 10 days or for a long time 2 times a day. Inhalation duration is 10 minutes.
5. If the mucous membrane of the larynx remains dry and epithelialization processes slow down, inhalations with pelloidin or humisol 2.0 are prescribed 2 times a day. 10 procedures are prescribed for a course of treatment.

The course of treatment is 7-10 days. If the inflammatory process is prolonged, inhalations with saline or mineral water are prescribed 2-4 times a day for a long period.

Treatment of inflammatory diseases of the larynx should be comprehensive. When planning therapy, the individual characteristics of the patient should be taken into account: age, duration of the disease, nature of the voice load, characteristics of professional activity, the presence of concomitant pathology. Only treatment tactics based on the principles of an individual approach, stages, and combined treatment methods can rehabilitate a patient with laryngeal pathology.

How to relieve throat swelling with laryngitis

The main complication of laryngitis is false croup or laryngospasm. The condition is dangerous, especially if the attack occurs in a child. If laryngospasm develops, you must call an ambulance.

At the pre-medical stage, the following rules must be followed:

• During an attack, it is important not to panic; against the background of this condition, the spasm will worsen even more. If a child is having a seizure, he needs to be picked up and calmed down as quickly as possible.
• If you have laryngospasm, you should not lie down; it is better to sit or stand on your feet. In an upright position, the airways open better.
• Ventilate the room, go out onto the balcony if possible, if there is no frost.
• Alkaline drinking relieves spasms well for children and adults. For this, it is best to use Borjomi or Esentuki mineral water. If water is not at hand, you should heat the milk, add a pinch of soda and drink in small sips.
• Inhalations with a nebulizer with alkali or saline are effective for swelling of the larynx. If you don’t have a nebulizer, you can simply go into the bathroom, open the hot water and breathe in the steam.

If you have an antihistamine at home (Suprastin, Tavegil, Eden) and antispasmodics (Drotaverine, No-shpa), you can take these medications according to the patient’s age and weight. Antihistamines will remove reactive edema and prevent its further development. Antispasmodics will relieve spasms, thereby improving patency in the organ. Despite the criticality of the situation, it is impossible to exceed the permissible dose in order to avoid an overdose.

Inhalation with a nebulizer.

Help with stenotic laryngotracheitis in children

Acute stenosing laryngotracheitis is a very serious and unpredictable condition. Most often occurs as a result of a viral infection in children with allergies. The main symptoms are lack of air, wheezing, anxiety, and a “barking” cough. It is noteworthy that this condition is present only when the child is in a horizontal position; when it changes (the baby gets up, sits down), the attack either becomes less intense or stops altogether.

First aid for stenotic laryngotracheitis in children:

• warm mustard foot bath or mustard plasters on the calf muscles;
• vasodilator nasal drops;
• inhalation with soda;
• warm drink (milk with soda);
• antihistamine, ground into powder.

If you suspect the onset of stenosis, immediately call an ambulance.

First aid for Quincke's edema

At the first signs of Quincke's edema, you should call a doctor. But before the ambulance arrives, you need to take some measures:

• Stop contact with the allergen, lay the baby down and elevate the limbs.
• If the swelling is caused by an insect bite, a cold compress is applied to the bite site.
• The child needs to be given plenty of fluids to improve microcirculation and remove the allergen from the body. Children over three years old can be offered alkaline drink, Narzan or Borjomi.
• You can give absorbent drugs, such as activated carbon, smecta or enterosgel.

Antiallergic and antihistamine drugs can be given to a child only after consultation with a doctor.

If allergic reactions occur frequently and the child has already had angioedema, ask the doctor to show what drug should be administered to the child and where the medicine should be administered.

It is better to hospitalize the child so that in a hospital setting the reasons that led to Quincke's edema can be identified.

Causes

Depending on the causes of the disease, appropriate treatment is prescribed.

Biological reasons - the pathogen enters the mucous membranes of the body. Their role is often played by viruses, less often by bacteria that form colonies (cocci) and fungi.

Chemical causes - inhalation of harmful substances and gases that can destroy the mucous membrane of the larynx, for example, tobacco smoke. In addition to inhalation, chemical burns are also possible.

Chemical causes may also include an acute allergic reaction, which destroys the mucous layer of the larynx down to the submucosal layer.

The rarest cause is injuries to the larynx, in which it is quite easy to damage the protective layer.

Preventive actions

The best prevention will be strengthening the immune system and timely treatment of colds. Don't forget about seasonal flu vaccination, regular walks in the fresh air, morning exercises and good nutrition. Maintain a sleep and rest schedule.

If you still have questions and need specialist help, make an appointment. The doctor will tell you how to treat chronic laryngotracheitis in a child and how to help the baby at the first signs of stenosis. Sign up on the website and by phone.

Related services: Children's consultation