What is laryngeal stenosis? Stenosis is called a sharp narrowing of the larynx (or the trachea, bronchi), which impedes the passage of air to the underlying respiratory organs. As a result, an insufficient volume of air enters the lungs, and oxygen starvation occurs in the tissues. In the absence of timely medical care, this leads to cardiac arrest and death.
Laryngeal stenosis is acute or chronic. Acute stenosis of the larynx develops quickly, and the body does not have time to cope with a number of disorders caused by a lack of oxygen. The chronic form of the disease is characterized by a sluggish course. It is rarely fatal, but it can cause complications in the heart, nervous system and other internal organs. The entire body suffers from chronic oxygen starvation.
More often, stenosis is observed in children due to the fact that the lumen of the child's respiratory tract is much narrower than that of an adult. Laryngeal stenosis in adults occurs less frequently, and is more often chronic.
In this article, we will discuss in detail exactly stenosis in adults - its types, causes, symptoms and treatment.
Causes of acute stenosis of the larynx
Acute stenosis is a sudden onset of a lack of air caused by a narrowing of the larynx. The narrowing process develops within a few hours, days, less often weeks.
Acute laryngeal stenosis is not an independent disease. We can say that this is a complex of symptoms characteristic of progressive lack of air. Moreover, the reasons for this process can be very different.
Stenosis can result from various diseases of the larynx, both infectious and non-infectious.
Infectious diseases such as scarlet fever, malaria, typhoid, measles are common causes of laryngeal stenosis. Also, the cause can be infections that affect the throat in rare cases, for example, tuberculosis, syphilis. Even ordinary laryngitis can provoke an increasing narrowing of the larynx, but this occurs mainly in children.
In addition, suffocation can be the result of local exposure - mechanical damage to the mucous membrane, chemical or thermal burns, a foreign object entering the larynx, etc.
A separate group is stenosis of the larynx caused by the appearance of neoplasms - cysts, malignant and benign tumors.
Symptoms of Acute Stenosis
Timely provision of medical care for stenosis can save a person's life, so it is very important to know what symptoms indicate the development of this pathology.
In general, the clinical picture of this condition includes the following manifestations:
- noisy breathing;
- shortness of breath on inhalation - inspiratory dyspnea (if breathing is difficult at the exit, it is possible that the patient has tracheal stenosis);
- violation of the rhythm of inhalation and exhalation;
- participation in the act of breathing of auxiliary muscles - arms, shoulder girdle, etc .;
- sinking of the supraclavicular fossae and intercostal spaces;
- change in voice - hoarseness, hoarseness;
- anxiety, feeling of fear;
- increased heart rate;
- in the later stages - blue discoloration of the face (especially lips, nose tip), fingertips, sweating, disruption of the gastrointestinal tract and bladder.
Thus, the symptoms of laryngeal stenosis are a typical picture of gradually increasing suffocation. Depending on the stage of the pathological process, some symptoms will differ.
Stages of acute stenosis
The pathological process of narrowing the lumen of the respiratory tract develops in several stages. Depending on the symptoms, you can determine which stage is observed in the patient at the moment.
Laryngeal stenosis degrees and their symptoms:
- The first stage is characterized by slight disturbances in breathing. So, the inhales become heavier and deeper, and the exhales are sharp. With little physical exertion (cleaning, walking), shortness of breath occurs.
- The second stage has such manifestations as noisy breathing during exertion and at rest, regular shortness of breath, pale skin. Many patients have high blood pressure. To restore the fullness of breathing, the patient unconsciously uses the muscles of the chest and shoulder girdle.
In the third stage, the patient experiences significant breathing difficulties. He is constantly worried about shortness of breath. To alleviate his condition, the patient takes a forced position - for example, sitting, or throwing his head back. Breathing in the third stage is frequent, shallow, noisy, with a whistling sound on inhalation. The skin becomes pale, bluish. The heart rate increases, while the blood pressure, on the contrary, decreases. The patient feels anxious, sweats more than usual.- The fourth stage of stenosis is terminal. In the absence of emergency medical care, suffocation occurs. Symptoms of the fourth stage: constant shortness of breath, irregular breathing, frequent weak pulse, pale skin, convulsions. Loss of consciousness, involuntary emptying of the bladder and rectum, cardiac arrest, and death are possible.
In the third stage, the patient experiences significant breathing difficulties. He is constantly worried about shortness of breath. To alleviate his condition, the patient takes a forced position - for example, sitting, or throwing his head back. Breathing in the third stage is frequent, shallow, noisy, with a whistling sound on inhalation. The skin becomes pale, bluish. The heart rate increases, while the blood pressure, on the contrary, decreases. The patient feels anxious, sweats more than usual.The first manifestations of stenosis are caused by the body's attempt to restore normal breathing and compensate for the lack of oxygen (for example, assisted breathing movements). Late manifestations are due to pathological changes caused by oxygen starvation.
Treatment of acute stenosis
If symptoms of laryngeal stenosis and an increasing feeling of lack of air are detected, an ambulance should be called. Remember that this condition can be fatal.
The type of treatment for stenosis depends on the stage of the pathological process. In the early stages (1-2), they are often limited to taking medications (without surgery). To increase the lumen of the larynx, anti-inflammatory drugs are used - antihistamines and corticosteroids. Also, the patient is prescribed dehydration therapy aimed at getting rid of excess fluid in the body. If the stenosis is caused by infection, taking large doses of antibiotics on time is important. The most effective is complex treatment, including both drugs of etiological action (antibiotics, antifungals) and symptomatic (decongestants, corticosteroids, etc.).
In the later stages of laryngeal stenosis, drug treatment is not always effective. If the symptoms of suffocation are rapidly increasing, the patient needs a tracheotomy.
This is an operation, the purpose of which is to provide oxygen to the patient's lungs. In some cases, tracheotomy helped save a person's life. The operation consists in creating an opening in the trachea through which oxygen can enter the bronchi and lungs. It is worth noting that if the patient is threatened with death, such an operation is performed in any conditions, often without prior anesthesia.
In some cases, tracheal intubation is used instead of tracheotomy. The process involves inserting a flexible tube into the respiratory tract. The operation is performed without incisions, through the mouth opening. It should be noted that tracheal intubation has several disadvantages. Firstly, the presence of the tube in the throat for more than three days is contraindicated (ischemia of the mucous membrane occurs). Second, intubation is one of the factors that significantly increase the risk of mucosal scarring.
After tracheotomy or intubation, the patient is prescribed medication - antihistamines, corticosteroids and other anti-inflammatory drugs.For the first three days, antibiotics are injected directly into the respiratory tract, as well as mucolytics (drugs that thin mucus in the respiratory tract and promote its elimination).
Physiotherapeutic procedures - electrophoresis, phonophoresis - also give a good effect after the operation.
Chronic laryngeal stenosis
Chronic stenosis of the larynx is called a gradually increasing narrowing of the lumen of the larynx. Narrowing of the lumen of the respiratory tract, which develops and progresses for more than a month, is usually called chronic.
The patient may not notice a gradual decrease in the fullness of breathing, while all internal organs suffer significantly from hypoxia.
The lumen of the larynx narrows as a result of the formation of persistent morphological changes in the mucous membrane - scars. Cicatricial stenosis of the larynx can have various causes. In most cases, changes in the morphology of the mucosa occur as a result of the following pathological processes:
- the appearance of cysts and other benign or malignant neoplasms;
- chronic inflammation of the larynx (chronic laryngitis);
- injuries (and more often several injuries) of the throat;
- chondroperichondritis (inflammation of the cricoid cartilage of the larynx);
- burns of the laryngeal mucosa (hot food, chemicals);
- toxic neuritis of the larynx or trachea;
- scarring of the mucosa as a result of prolonged tracheal intubation (more than 4 days);
- scarring due to tracheotomy performed with violations of the operation technique;
- transferring a severe form of syphilis of the larynx, tuberculosis, etc.
A feature of chronic stenosis is its sluggish nature. The body manages to some extent to adapt to the conditions of constant lack of oxygen. Thus, the main life-supporting functions are preserved. At the same time, oxygen starvation leads to significant disruptions in the work of many organs, primarily the brain, heart, and lungs. The lack of oxygen affects the growing child's body especially negatively, but it also brings many health problems to adults.
With prolonged inadequate supply of oxygen, the speed of the brain cells decreases, and rapid fatigability is observed.
Violation of the intensity of breathing leads to sputum retention in the airways. In the warm, humid conditions of the respiratory tract, sputum becomes a favorable breeding ground for bacteria. As a result, patients with chronic stenosis often suffer from bronchitis and pneumonia.
Lack of oxygen in the tissues increases the stress on the heart. Its cavities increase to compensate for the low oxygen saturation of the blood by its volume.
Treatment of the chronic form
The type of treatment is selected depending on the cause of the laryngeal stenosis. So, in the presence of neoplasms, it is necessary to get rid of them. If the cause of stenosis is a chronic infection, antibiotics (or antifungal drugs, depending on the type of infection) are required, etc.
In the presence of cicatricial changes in the mucous membrane, the question arises of their surgical removal. If the changes are small, surgery is not required. The patient is prescribed physiotherapeutic procedures for the throat, as well as decongestants, anti-inflammatory drugs. At the same time, the patient should be regularly examined by an otolaryngologist, since cicatricial changes can increase and thicken.
Patients with chronic stenosis should bear in mind that during laryngitis, stenosis can become acute.
Cicatricial stenosis of the larynx requires surgical treatment if the scars are bulky, blocking the lumen of the respiratory tract. First of all, they resort to stretching the larynx with a special device (dilator). The stretching process takes about six months. This approach is not always effective. If dilation does not work within six months, the patient is recommended to undergo surgical treatment. There are many types of operations for this purpose. In recent years, laser operations have become widespread. In any case, the type of surgery is selected by the attending physician.
Prevention
Are there ways to prevent this condition? Indeed, the risk of its development can be significantly reduced if you follow these recommendations:
- to treat laryngitis, tracheitis, sore throat in time;
- if you are faced with a sore throat that is difficult to treat, consult your doctor (perhaps there is an infection that is atypical for the throat - syphilis, tuberculosis, fungus);
- avoid throat injuries;
- do not drink too hot drinks, do not swallow scalding food;
- avoid inhaling contaminated air, smoke, toxic gases, and hot steam;
- for intubation, insist that the flexible tube is removed no later than 3 days;
- if you have had surgery on your vocal cords, trachea, etc., visit your otolaryngologist regularly.
If you suspect that you have already started stenosis, do not refuse medical attention. Depending on your condition, visit an otolaryngologist or call your doctor at home. In some cases, the narrowing of the lumen of the larynx develops rapidly - then you should immediately call an ambulance. Remember that speed of your actions can save lives.
