O laryngitis ICD 10

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Acute laryngitis and tracheitis (J04)

If it is necessary to identify the infectious agent, an additional code (B95-B98) is used.

Excluded:

  • acute obstructive laryngitis [croup] and epiglottitis (J05.-)
  • laryngism (stridor) (J38.5)

Table of contents:

Laryngitis (acute):

  • NOS
  • hydropic
  • under the vocal apparatus itself
  • purulent
  • ulcerative

Excluded:

  • chronic laryngitis (J37.0)
  • influenza laryngitis, influenza virus:
    • identified (J09, J10.1)
    • not identified (J11.1)

Excludes: chronic tracheitis (J42)

Tracheitis (acute) with laryngitis (acute)

Excludes: chronic laryngotracheitis (J37.1)

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018 .

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Source: http://mkb-10.com/index.php?pid=9020

Laryngitis (ICD-10 code: J04.0)

Characterized by inflammation of the mucous membrane of the larynx. Can be acute or chronic.

Acute laryngitis often develops as one of the manifestations of an acute respiratory disease: influenza, scarlet fever, whooping cough.

In terms of general treatment measures, a gentle regimen is recommended: the patient is advised not to talk for 5-7 days, refrain from smoking, drinking alcohol, and avoid hot seasonings and spices in the diet.

Laser therapy is aimed at eliminating inflammation and swelling of the laryngeal mucosa. For this purpose, percutaneous irradiation of the larynx is performed, covering the area of ​​the subglottic space and the upper third of the trachea to the jugular fossa.

Rice. 73. Projection zones of irradiation in the treatment of acute laryngitis. Legend: pos. “1” - projection of the ligamentous and subglottic space of the larynx, pos. “2” - projection of the upper third of the trachea.

Additionally, the effects are performed on the zones of segmental innervation of the larynx located at the level of C3, NLBI in the projection of the ulnar fossa and the right carotid zone, distant irradiation with a defocused beam of the receptor zones of the neck organs in the projection of the anterior and lateral surfaces of the neck, and the inner zone of the wrist.

Rice. 74. Areas of additional contact exposure in the treatment of acute laryngitis. Legend: pos. “1” - ulnar vessels, pos. “2” — projection of the right carotid zone, pos. “3” - projection of the third cervical vertebra.

It is recommended to carry out laser therapy in combination with other methods of therapy; The complex of mandatory treatment methods must include inhalation of medicinal solutions with anti-inflammatory and anti-edematous action.

Irradiation modes for treatment areas in the treatment of laryngitis

The duration of a course of laser therapy is 5-10 procedures.

In case of a chronically ongoing disease, repeated courses of treatment are required at intervals of 3-5 weeks with mandatory anti-relapse courses of treatment during epidemics of acute respiratory infections.

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Acute laryngitis

Acute laryngitis

  • National Medical Association of Otolaryngologists

Table of contents

Keywords

List of abbreviations

OL - acute laryngitis

ARVI - acute respiratory viral infection

Ultrasound - ultrasound examination

CT - computed tomography

ABP - antibacterial drugs

UHF - ultra high frequency

Terms and Definitions

Acute laryngitis is an acute inflammation of the mucous membrane of the larynx.

1. Brief information

1.1 Definition

Acute laryngitis (AL) is an acute inflammation of the mucous membrane of the larynx [1].

Abscessing or phlegmonous laryngitis is acute laryngitis with the formation of an abscess, most often on the lingual surface of the epiglottis or on the aryepiglottic folds; manifests itself as sharp pain when swallowing and phonation, radiating to the ear, increased body temperature, and the presence of a dense infiltrate in the tissues of the larynx.

Acute chondroperichondritis of the larynx is an acute inflammation of the cartilage of the larynx, i.e. chondritis, in which the inflammatory process involves the perichondrium and surrounding tissues.

1.2 Etiology and pathogenesis

Acute inflammation of the mucous membrane of the larynx can be a continuation of catarrhal inflammation of the mucous membrane of the nose or pharynx or occur with acute catarrh of the upper respiratory tract, respiratory viral infection, or influenza. Typically, acute laryngitis is a symptom complex of ARVI (influenza, parainfluenza, adenoviral infection), in which the mucous membrane of the nose and pharynx, and sometimes the lower respiratory tract (bronchi, lungs) is also involved in the inflammatory process. It is known that the microflora that colonizes non-sterile parts of the respiratory tract, including the larynx, is represented by saprophytic microorganisms that almost never cause diseases in humans and opportunistic bacteria that can cause purulent inflammation under unfavorable conditions for the microorganism.

Microorganisms that are the main causative agents of acute forms of laryngitis include S. Pneumoniae (20-43%) and H. Influenzae (22-35%). In addition, Moraxella catarrhalis (2-10%), various types of streptococci and staphylococci are sown quite often, and much less often - representatives of the genera Neisseria, Corynebacterium, etc. The role of atypical pathogens of infections of the ENT organs (chlamydia, mycoplasmas, etc.) seems increasingly relevant. ), which, being intracellular parasites, change the course of the underlying disease, causing inflammation. It is also necessary to take into account the fact that, in both acute and chronic forms of infection of the ENT organs, microorganisms can be sown as a monoculture or in various associations.

In the pathogenesis of the development of acute laryngeal edema, an important role is played by the anatomical features of the structure of the mucous membrane of the larynx. Disruption of lymphatic drainage and local water metabolism is important. Swelling of the mucous membrane can occur in any part of the larynx and quickly spread to others, causing acute laryngeal stenosis and threatening the patient's life. The causes of acute inflammation of the mucous membrane of the larynx are varied: infectious and viral factors, external and internal trauma to the neck and larynx, including inhalation injuries, foreign body entry, allergies, gastroesophageal reflux. A large voice load is also important. The occurrence of inflammatory pathology of the larynx is facilitated by chronic diseases of the bronchopulmonary system, nose, paranasal sinuses, metabolic disorders in diabetes mellitus, hypothyroidism or diseases of the gastrointestinal tract, chronic renal failure, pathology of the separation function of the larynx, abuse of alcohol and tobacco, and previous radiation therapy [3]. ].

It is possible to develop angioedema of the larynx of hereditary or allergic origin.

Non-inflammatory laryngeal edema can occur as a local manifestation of general hydrops of the body in various forms of heart failure, liver disease, kidney disease, venous stagnation, and mediastinal tumors.

Specific (secondary laryngitis develops with tuberculosis, syphilis, infectious (diphtheria), systemic diseases (Wegener's granulomatosis, rheumatoid arthritis, amyloidosis, sarcoidosis, polychondritis, etc.), as well as blood diseases).

1.3 Epidemiology

The exact prevalence of acute laryngitis is unknown, as many patients are often self-treated with medications or use traditional remedies to treat laryngitis and do not seek medical help. Most often people from 18 to 40 years old become ill, but the disease can occur at any age.

The highest incidence of acute laryngitis was observed in children aged 6 months to 2 years. At this age, it is observed in 34% of children with acute respiratory disease.

1.4 Coding according to ICD 10

J05.0 - Acute obstructive laryngitis (croup).

J38.6 - Acute laryngeal stenosis.

1.5 Classification

  1. According to the form of acute laryngitis:

  • 2. Diagnostics

    2.1 Complaints and anamnesis

    The main symptoms of acute laryngitis are acute sore throat, hoarseness, cough, difficulty breathing, and deterioration in general health. Acute forms are characterized by a sudden onset of the disease in a generally satisfactory condition or against the background of slight malaise. Body temperature remains normal or rises to subfebrile levels with catarrhal acute laryngitis. Febrile temperature, as a rule, reflects the addition of inflammation of the lower respiratory tract or the transition of catarrhal inflammation of the larynx to phlegmonous. Infiltrative and abscess forms of acute laryngitis are characterized by severe pain in the throat, difficulty swallowing, including liquids, severe intoxication, and increasing symptoms of laryngeal stenosis. The severity of clinical manifestations directly correlates with the severity of inflammatory changes. The general condition of the patient becomes serious. In the absence of adequate therapy, neck phlegmon, mediastinitis, sepsis, abscess pneumonia and laryngeal stenosis may develop. In these cases, regardless of the cause causing acute laryngeal stenosis, its clinical picture is the same and is determined by the degree of narrowing of the airways. Sharply expressed negative pressure in the mediastinum during intense inhalation and increasing oxygen starvation cause a symptom complex, which consists of the appearance of noisy breathing, changes in breathing rhythm, retraction of the supraclavicular fossa and retraction of the intercostal spaces, forced position of the patient with his head thrown back, lowering of the larynx during inhalation and rising during exhalation [2].

    2.2 Physical examination

    In a limited form, changes are observed mainly on the vocal folds, in the interarytenoid or subglottic space. Against the background of the hyperemic mucous membrane of the larynx and vocal folds, dilated superficial blood vessels and mucous or mucopurulent secretion are visible. In the diffuse form of acute laryngitis, continuous hyperemia and swelling of the entire mucous membrane of the larynx of varying degrees of severity are determined. During phonation, incomplete closure of the vocal folds is observed, and the glottis has a linear or oval shape. In acute laryngitis developing against the background of influenza or ARVI, laryngoscopy reveals hemorrhages in the mucous membrane of the larynx: from petechial to small hematomas (so-called hemorrhagic laryngitis) [9].

    The appearance of white and whitish-yellow fibrinous plaque in the larynx is a sign of the disease transitioning to a more severe form - fibrinous laryngitis, and gray or brown plaque may be a sign of diphtheria.

    The main symptom of acute respiratory failure is shortness of breath. Depending on the severity of shortness of breath, the following degrees are distinguished:

    I degree of respiratory failure – shortness of breath occurs during physical exertion;

    II degree – shortness of breath occurs with little physical activity (slowly walking, washing, dressing);

    III degree – shortness of breath at rest.

    According to the clinical course and size of the airway lumen, four degrees of laryngeal stenosis are distinguished:

    The stage of compensation, which is characterized by slowing and deepening of breathing, shortening or loss of pauses between inhalation and exhalation, and slowing of the heartbeat. The lumen of the glottis is 6-8 mm or the narrowing of the tracheal lumen by 1/3. At rest there is no lack of breathing; shortness of breath appears when walking.

    Stage of subcompensation - in this case, inspiratory shortness of breath appears with the inclusion of auxiliary muscles in the act of breathing during physical activity, there is retraction of the intercostal spaces, soft tissues of the jugular and supraclavicular fossae, stridorous (noisy) breathing, pallor of the skin, blood pressure remains normal or elevated, glottis 3-4 mm, the tracheal lumen is narrowed by ? and more.

    Stage of decompensation. Breathing is shallow, frequent, and stridor is pronounced. Forced sitting position. The larynx makes maximum excursions. The face becomes pale and bluish, there is increased sweating, acrocyanosis, rapid and thready pulse, and decreased blood pressure. The glottis is 2-3 mm, the trachea has a slit-like lumen.

    Asphyxia - breathing is intermittent or stops completely. The glottis and/or tracheal lumen is 1 mm. Sharp depression of cardiac activity. The pulse is frequent, thread-like, and often cannot be felt. The skin is pale gray due to spasm of small arteries. Loss of consciousness, exophthalmos, involuntary urination, defecation, and cardiac arrest are noted [6].

    The acute onset of the disease with rapid progression of stenosis symptoms aggravates the severity of the patient’s condition, since compensatory mechanisms do not have time to develop in a short time. This must be taken into account when determining indications for emergency surgical treatment. Narrowing of the lumen of the upper respiratory tract in acute stenosing laryngotracheitis occurs sequentially, stage by stage over a short period of time. With incomplete obstruction of the larynx, noisy breathing occurs - stridor, caused by vibrations of the epiglottis, arytenoid cartilages, and partly the vocal cords with intense turbulent passage of air through the narrowed airways according to Bernoulli's law. When swelling of the laryngeal tissues dominates, a whistling sound is observed; when hypersecretion increases, hoarse, bubbling, noisy breathing is observed. In the terminal stage of stenosis, breathing becomes less and less noisy due to a decrease in tidal volume.

    The inspiratory nature of shortness of breath occurs when the larynx narrows in the area of ​​the vocal folds or above them and is characterized by noisy inhalation with retraction of the pliable parts of the chest. Stenoses below the level of the vocal folds are characterized by expiratory shortness of breath with the participation of auxiliary muscles in breathing. Laryngeal stenosis in the subglottic area usually manifests as mixed shortness of breath.

    In patients with obstruction of the larynx by an inflammatory infiltrate due to an abscess of the epiglottis, against the background of an acute pain symptom, the first complaints appear are the inability to swallow, which is associated with limited mobility of the epiglottis and swelling of the posterior wall of the larynx, then, as the disease progresses, difficulty breathing appears. Obstruction of the glottis can occur very quickly, which requires the doctor to take emergency measures to save the patient’s life.

    2.3 Laboratory diagnostics

    It is recommended to conduct a general clinical examination, including a clinical blood test, a general urine test, a blood test for RW, HBS and HCV antigens, HIV, a biochemical blood test, a coagulogram; is performed at the preoperative stage in all patients with OA entering for surgery.

    Recommendation strength level B (evidence level IV).

    Comments: Standard laboratory testing during hospitalization [5].

    It is recommended to conduct a histological examination of the laryngeal mucosa.

    Strength of recommendation: C (level of evidence: III).

    Comments: The ciliated epithelium loses cilia or is rejected, the deeper layers of cells are preserved (they serve as a matrix for epithelial regeneration). With a pronounced inflammatory process, metaplasia of the ciliated columnar epithelium into squamous epithelium can occur. Infiltration of the mucous membrane is unevenly expressed, the blood vessels are tortuous, dilated, and overflowing with blood. In some cases, their subepithelial breaks are determined (usually in the area of ​​the vocal folds).

    2.4 Instrumental diagnostics

    It is recommended to conduct an endolaryngoscopy examination of the larynx using flexible or rigid endoscopes.

    Recommendation strength level A (evidence level I).

    Comments: The study allows us to determine the nature of the pathological process, its localization, level, extent and degree of narrowing of the airway lumen [7].

    The picture of acute laryngitis is characterized by hyperemia, swelling of the laryngeal mucosa, and increased vascular pattern. The vocal folds are usually pink or bright red, thickened, and the glottis during phonation is oval or linear with accumulation of mucus. In acute laryngitis, the mucous membrane of the subglottic part of the larynx may be involved in the inflammatory process. With subglottic laryngitis, a roller-like thickening of the mucous membrane of the subglottic part of the larynx is diagnosed. If the process is not associated with intubation trauma, its detection in adults requires urgent differential diagnosis with systemic diseases and tuberculosis. With infiltrative laryngitis, significant infiltration, hyperemia, an increase in volume and impaired mobility of the affected part of the larynx are determined. Fibrinous deposits are often visible, and purulent contents are visible at the site of abscess formation. Severe forms of laryngitis and chondroperichondritis of the larynx are characterized by pain on palpation, impaired mobility of the cartilage of the larynx, possible infiltration and hyperemia of the skin in the projection of the larynx, against the background of pain and a clinical picture of a general purulent infection. An epiglottis abscess looks like a spherical formation on its lingual surface with translucent purulent contents with severe pain and difficulty swallowing.

    3. Treatment

    3.1 Conservative treatment

    Systemic antibacterial therapy is recommended for severe intoxication and the presence of significant inflammatory phenomena in the larynx (diffuse swelling of the laryngeal mucosa, the presence of infiltration) and regional lymphadenitis.

    The strength of the recommendations is A (level of evidence I).

    Comments: Systemic antibacterial therapy for acute laryngitis is also prescribed in the absence of effect from local antibacterial and anti-inflammatory therapy for 4–5 days, with the addition of purulent exudation and inflammation of the lower respiratory tract [8].

    Carrying out antibiotic therapy on an outpatient basis is not an easy task, since the irrational choice of the “starting” antibiotic prolongs the course of a purulent infection and leads to the development of purulent complications. Antimicrobial therapy for acute laryngitis in cases of severe inflammation is prescribed empirically - amoxicillin + clavulanic acid**, macrolides, fluoroquinolones.

    Local antibacterial therapy is recommended.

    The strength of the recommendation is B (level of evidence II).

    Comments: Local antimicrobial therapy includes endolaryngeal infusions with hydrocortisone emulsion**, peach oil and an antibacterial drug (erythromycin, gramicidin C, streptomycin, amoxicillin + clavulanic acid** can be used) [7, 8].

    It is recommended to prescribe local antihistamines [11].

    The strength of the recommendation is B (level of evidence II).

    Comments: In the allergic form of angioedema of the larynx, it is quite easily relieved by injections of antihistamines acting on both H1 receptors (diphenhydramine**, clemastine, chloropyramine**) and H2 receptors (cimetidine, histodil (not registered in the Russian Federation and not used) 200 ml IV) with the addition of glucocorticosteroids (60-90 mg prednisolone** or 8-16 mg dexamethasone** IV)

    Inhalation therapy is recommended.

    Strength of recommendation: B (level of evidence III)

    Comments: Inhalations with corticosteroids, antibiotics, mucolytics, herbal preparations with anti-inflammatory and antiseptic effects are used, as well as alkaline inhalations to eliminate dryness of the laryngeal mucosa. The duration of inhalation is usually 10 minutes 3 times a day. Alkaline inhalations can be used several times a day to moisten the mucous membrane of the respiratory tract [3, 9].

    3.2. Surgery

    Surgical treatment is not recommended for uncomplicated OA [4, 10, 11].

    The strength of the recommendation is I (level of evidence A).

    It is recommended to carry out emergency surgical interventions for complicated forms of OA.

    Strength of recommendation: C (level of evidence II)

    Comments: In case of complications such as phlegmon of the neck or mediastinitis, combined surgical treatment is performed using external and endolaryngeal access.

    It is recommended to perform tracheostomy or instrumental conicotomy in case of clinical picture of acute edematous-infiltrative laryngitis, epiglottitis, abscess of the lateral wall of the pharynx, lack of effect from conservative treatment and increasing symptoms of laryngeal stenosis (the method of tracheostomy is presented in Appendix D).

    The strength of the recommendation is C (level of evidence IV).

    3.3 Other treatment

    Physiotherapy is recommended.

    The strength of the recommendation is C (level of evidence IV).

    Comments: Laser therapy provides a good therapeutic effect - laser radiation of the visible red range of the spectrum (0.63-0.65 microns) in continuous mode with a mirror attachment D 50 mm (mirror-contact method of exposure).

    Superphonoelectrophoresis according to Kryukov-Podmazov is highly effective.

    It is recommended to adhere to a protective treatment regimen.

    The strength of the recommendation is C (level of evidence IV).

    Comments: It is also necessary to remember that for any inflammatory disease of the larynx it is necessary to create a protective mode (voice mode), recommend that the patient talk a little and in a quiet voice, but not in a whisper, when the tension of the larynx muscles increases. It is also necessary to stop eating spicy, salty, hot, cold foods, alcoholic beverages, and smoking. In the stage of convalescence and in cases where intense phonation is one of the etiopathogenetic factors in the development of hypotonic disorders of vocal function as a result of inflammation, phonopedia and stimulating therapy are indicated [4].

    4. Rehabilitation

    It is recommended to observe a phoniatrist for patients in voice professions after suffering from acute illness until the voice is completely restored.

    The strength of the recommendation is B (level of evidence III).

    Comments: Patients who have undergone surgical interventions are observed until the clinical and functional state of the larynx is completely restored for an average of 3 months, with examinations occurring once a week in the first month and once every 2 weeks, starting from the second month.

    The period of incapacity for work depends on the patient’s profession: for people in vocal professions, they are extended until voice function is restored. Uncomplicated acute laryngitis resolves within 7-14 days; infiltrative forms - about 14 days.

    5. Prevention and clinical observation

    Prevention of chronicity of the inflammatory process of the larynx consists of timely treatment of acute laryngitis, increasing the body's resistance, treatment of gastroesophageal reflux disease, infectious diseases of the upper and lower respiratory tract, quitting smoking, and maintaining a voice regime.

    6. Additional information affecting the course and outcome of the disease

    With the development of acute laryngitis, it is necessary to limit the vocal load. Eating hot, cold and spicy food, alcoholic beverages, smoking, and steam inhalation is prohibited. Constant humidification of the air in the room using special humidifiers and taking antiviral drugs are recommended.

    In uncomplicated forms of laryngitis, the prognosis is favorable; in complicated forms with the development of laryngeal stenosis, timely specialized care and surgical treatment will help save the patient’s life.

    Criteria for assessing the quality of medical care

    Level of evidence

    Convincing Level of Recommendations

    An endolaryngoscopy examination was performed

    Treatment with antibacterial drugs, systemic and/or local (depending on medical indications and in the absence of medical contraindications)

    Therapy was performed with inhaled glucocorticosteroids and/or inhaled mucolytic drugs (depending on medical indications and in the absence of medical contraindications)

    Treatment with systemic antihistamines and/or systemic glucocorticosteroids was performed (for angioedema, depending on medical indications and in the absence of medical contraindications)

    Absence of purulent-septic complications

    Bibliography

    Vasilenko Yu.S. Diagnosis and treatment of laryngitis associated with gastroesophageal reflux / Ros. otorhinolaryngology. 2002. - No. 1. — P.95-96.

    Daynyak L. B. Special forms of acute and chronic laryngitis / Bulletin of Otorhinolaryngology. 1997. - No. 5. — P.45.

    Vasilenko Yu.S., Pavlikhin O.G., Romanenko S.G. Features of the clinical course and treatment tactics for acute laryngitis in voice professionals. / Science and practice in otorhinolaryngology: Materials of the III Russian scientific and practical conference. M., 2004. - S..

    Otorhinolaryngology. National leadership. Brief edition / ed. V.T. Palchuna. M.: GEOTAR-Media, 2012. 656 p.

    Carding PN, Sellars C, Deary IJ et al. Characterization of effective primary voice therapy for dysphonia / J. Laryngol. Otol. 2002. - Vol. 116, No. 12. - P..

    Kryukov A.I., Romanenko S.G., Palikhin O.G., Eliseev O.V. The use of inhalation therapy for inflammatory diseases of the larynx. Guidelines. M., 2007. 19 p.

    Romanenko S.G. Acute and chronic laryngitis", "Otorhinolaryngology. National leadership. Brief edition / ed. V.T. Palchuna. - M. - :GEOTAR-Media, 2012 - P..

    Strachunsky L.S., Belousov Yu.B., Kozlov S.N. Practical guide to anti-infective chemotherapy. – M.: Borges, 2002:.

    Klassen TP, Craig WR, Moher D, Osmond MH, Pasterkamp H, Sutcliffe T et al. Nebulized budesonide and oral dexamethasone for treatment of croup: a randomized controlled trial // JAMA. – 1998; 279:.

    Daikhes N.A., Bykova V.P., Ponomarev A.B., Davudov Kh.Sh. Clinical pathology of the larynx. Atlas guide. — M. — Medical information agency. 2009.- P.160.

    Lesperance MM Zaezal GH Assessment and management of laryngotracheal stenosis. / Pediatric Clinics of North Amrica.-1996.-Vol.43, No. 6. P..

    Appendix A1. Composition of the working group

    Ryazantsev S.V., MD, professor, member of the National Medical Association of Otorhinolaryngologists, no conflict of interest;

    Karneeva O.V., MD, professor, member of the National Medical Association of Otolaryngologists, no conflict of interest;

    Garashchenko T.I., MD, professor, member of the National Medical Association of Otorhinolaryngologists, no conflict of interest;

    Gurov A.V., MD, professor, member of the National Medical Association of Otorhinolaryngologists, no conflict of interest;

    Svistushkin V.M., MD, professor, member of the National Medical Association of Otorhinolaryngologists, no conflict of interest;

    Abdulkerimov Kh.T., MD, professor, member of the National Medical Association of Otorhinolaryngologists, no conflict of interest;

    Polyakov D.P., Ph.D., member of the National Medical Association of Otorhinolaryngologists, no conflict of interest;

    Sapova K.I., member of the National Medical Association of Otolaryngologists, no conflict of interest;

    Appendix A2. Methodology for developing clinical guidelines

    Target audience of these clinical recommendations:

    General practitioners (family doctors).

    Table P1. Levels of evidence used

    Large, double-blind, placebo-controlled studies, as well as data from meta-analyses of several randomized controlled trials.

    Small randomized and controlled studies in which statistical data are based on a small number of patients.

    Non-randomized clinical trials on a limited number of patients.

    Development of a consensus by a group of experts on a specific problem

    Table A2 - Recommendation strength levels used

    Strength of evidence

    Relevant types of research

    Evidence is Convincing: There is strong evidence for the proposed claim.

    High-quality systematic review, meta-analysis.

    Large randomized clinical trials with low error rates and consistent results.

    Relative strength of evidence: there is sufficient evidence to recommend the proposal

    Small randomized clinical trials with mixed results and moderate to high error rates.

    Large prospective comparative but non-randomized studies.

    Qualitative retrospective studies on large samples of patients with carefully selected comparison groups.

    Insufficient evidence: The available evidence is insufficient to make a recommendation, but recommendations may be made based on other circumstances

    Retrospective comparative studies.

    Studies on a limited number of patients or on individual patients without a control group.

    Personal unformalized experience of developers.

    Procedure for updating clinical recommendations

    Clinical guidelines will be updated every 3 years

    Appendix A3. Related documents

    Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 905n “On approval of the procedure for providing medical care to the population in the field of otorhinolaryngology.”

    Order of the Ministry of Health of the Russian Federation dated December 28, 2012 No. 1654n “On approval of the standard of primary health care for acute nasopharyngitis, laryngitis, tracheitis and acute mild upper respiratory tract infections.”

    Order of the Ministry of Health of the Russian Federation dated November 9, 2012 No. 798n “On approval of the standard of specialized medical care for children with acute respiratory diseases of moderate severity.”

    Appendix B. Patient management algorithms

    Appendix B: Patient Information

    With the development of acute laryngitis, it is necessary to limit the vocal load. Eating hot, cold and spicy food, alcoholic beverages, smoking, and steam inhalation is prohibited. Constant humidification of the air in the room using special humidifiers and taking antiviral drugs are recommended.

    Appendix D

    Urgent tracheostomy should be performed with careful adherence to surgical technique and comply with the principles of maximum preservation of tracheal elements. The operation is performed under local anesthesia with 20–30 ml of 0.5% novocaine or 1% lidocaine under the skin of the neck. Standard styling with a cushion under the shoulders is not always possible due to severe difficulty breathing. In these cases, the operation is performed in a semi-sitting position. A median longitudinal incision is used to dissect the skin and subcutaneous fatty tissue from the level of the cricoid cartilage to the jugular notch of the sternum. The superficial fascia of the neck is dissected layer by layer strictly along the midline. The sternohyoid muscles are pushed apart bluntly along the midline (linea alba of the neck). The cricoid cartilage and the isthmus of the thyroid gland are exposed, which, depending on the size, moves upward or downward. After this, the anterior wall of the trachea is isolated. The trachea should not be isolated over a large area, especially its side walls, because in this case, there is a possibility of disruption of the blood supply to this section of the trachea and damage to the recurrent nerves. In patients with normal neck anatomy, the thyroid isthmus is usually displaced superiorly. In patients with a thick, short neck and a retrosternal location of the thyroid gland, the isthmus is mobilized and shifted downwards behind the sternum by transversely dissecting the dense fascia at the lower edge of the cricoid cartilage arch. If it is impossible to displace the isthmus of the thyroid gland, it is intersected between two clamps and sutured with synthetic absorbable threads on an atraumatic needle. The trachea is opened with a longitudinal incision from 2 to 4 half rings of the trachea after anesthesia of the tracheal mucosa with 1-2 ml of 10% lidocaine solution and a test with a syringe (free passage of air through the needle). If the situation allows, then a permanent tracheostomy is formed at the level of 2 - 4 half rings of the trachea. The size of the tracheal incision should correspond to the size of the tracheostomy cannula. Increasing the length of the incision can lead to the development of subcutaneous emphysema, and decreasing it can lead to necrosis of the mucous membrane and adjacent tracheal cartilage. A tracheostomy cannula is inserted into the tracheal lumen. It is preferable to use tracheostomy tubes made of thermoplastic materials. The main difference between these tubes is that the anatomical bend of the tube makes it possible to minimize the risk of complications associated with irritation caused by contact of the distal end of the tube with the tracheal wall. The tracheostomy remains until breathing is restored through natural pathways.

    Immediately after the operation, sanitary fibrobronchoscopy is performed to avoid obstruction of the lumen of the trachea and bronchi with blood clots that got there during the operation.

    In urgent situations, when the stenosis is decompensated, the patient undergoes an emergency conicotomy to ensure breathing. The patient lies on his back, a cushion is placed under the shoulder blades, and the head is tilted back. Palpable is the conical ligament, located between the thyroid and cricoid cartilages. Under aseptic conditions, after local anesthesia, a small skin incision is made above the conical ligament, then the conical ligament is pierced with a conicotome, the mandrel is removed, and the tracheostomy tube remaining in the wound is fixed by any available method.

    In the absence of special instruments and severe obstruction of the larynx at the level of the vocal folds, it is justified to insert 1-2 thick needles with a diameter of about 2 mm (from the infusion system) into the palpable part of the cervical trachea at the level of 2-3 tracheal rings strictly along the midline. This air gap is enough to save the patient from asphyxia and guarantee his transportation to the hospital [10].

    Source: http://medi.ru/klinicheskie-rekomendatsii/ostryj-laringit_14137/

    Acute laryngitis

    ICD-10 Category: J04.0

    Content

    Definition and general information [edit]

    Acute laryngitis is an acute inflammation of the larynx of any etiology. Phlegmonous (abscessing) laryngitis is acute laryngitis with the formation of an abscess in the area of ​​the lingual surface of the epiglottis or aryepiglottic folds.

    Acute laryngitis, according to world statistics, occurs in 1-5 patients per 100 thousand people per year.

    Forms of acute laryngitis: catarrhal, edematous, edematous-infiltrative, phlegmonous (infiltrative-purulent), subdivided into infiltrative, abscessive and chondroperichondritis of the cartilage of the larynx.

    Etiology and pathogenesis[edit]

    Acute inflammation of the mucous membrane of the larynx can be a continuation of catarrhal inflammation of the mucous membrane of the nose, pharynx, or occur with acute inflammation of the upper respiratory tract, ARVI, or influenza. Often the disease is associated with general or local hypothermia. The cause of the disease may be injury, inhalation of caustic or hot fumes, heavily dusty air, overstrain of the vocal folds, smoking and alcohol abuse. As an independent disease, acute catarrhal laryngitis most often occurs as a result of activation of the saprophytic flora of the larynx under the influence of the above local and general factors.

    Clinical manifestations[edit]

    The onset of the disease is characterized by complaints of the sudden appearance of hoarseness, soreness, rawness and dryness in the throat. The temperature remains normal or rises to low-grade levels, and against the background of acute respiratory viral infection and influenza it rises to febrile levels. The patient complains of acute pain that intensifies when swallowing, it is especially pronounced when the inflammatory infiltrate is localized in the area of ​​the lingual surface of the epiglottis and the aryepiglottic fold. There may be a cough with thick mucous sputum. The general condition suffers, malaise and weakness appear. At the same time, at the beginning of the disease, a dry cough begins, and then a cough with sputum. Violation of the voice-forming function is expressed in the form of varying degrees of dysphonia, up to aphonia. In some cases, breathing becomes difficult, which is caused by the accumulation of mucopurulent crusts in the upper respiratory tract.

    Acute laryngitis: Diagnosis [edit]

    The diagnosis is made based on complaints and laryngoscopy data.

    Physical examination: external examination, palpation of the larynx, indirect laryngoscopy. In all forms of laryngitis, examination reveals hyperemia, swelling and swelling of the laryngeal mucosa. Hyperemia of the mucous membrane is often diffuse, especially in the area of ​​the vocal folds. There you can also see pinpoint hemorrhages in the thickness of the mucous membrane. The vocal folds are well mobile, their closure is incomplete. As the disease progresses, mucus appears in the larynx, which dries out and then turns into crusts. When such a crust is torn off from the mucous membrane during a cough, rapid hemoptysis may occur.

    Instrumental and laboratory research methods

    Indirect microlaryngoscopy allows you to examine the accessible parts of the larynx using a microscope.

    Panoramic videolaryngoscopy consists of using a special laryngoscope with 70 or 90° optics and simultaneous magnification and video recording of the functioning larynx.

    Fibrolaryngoscopy allows using a flexible endoscope to examine all levels of the organ, including the subvocal section, as well as, if necessary, the lumen of the trachea and main bronchi.

    Direct laryngoscopy is a more complex therapeutic and diagnostic study, performed under anesthesia, necessarily in a specialized hospital. In addition, X-ray studies can be carried out in the form of tomography of the larynx, CT and nuclear magnetic resonance, aimed mainly at identifying poorly visible infiltrates in the lower parts of the larynx.

    Blood tests: with the development of purulent forms of laryngitis, pronounced neutrophilic leukocytosis is determined in the blood up to 10-15x10 9 /l and higher, a shift of the formula to the left, a sharp increase in ESR domm/h.

    With edematous-infiltrative laryngitis, inflammation can occur in a diffuse and limited form. Depending on the location of the process, signs of laryngeal stenosis may occur. Palpation of the anterior surface of the neck in the projection of the larynx is often painful. Regional lymph nodes are often enlarged. During laryngoscopy, the mucous membrane of the larynx is hyperemic, the infiltrate is usually located on the lingual surface of the epiglottis or occupies its entire lobe. Often the swelling is localized in the area of ​​the scoop or aryepiglottic fold, less often in the area of ​​the vestibular fold. In a significant proportion of cases, in addition to infiltration, there is also round-shaped edema in the form of a light gray formation. It can block the entire infiltrate from view. The mobility of individual elements of the larynx is reduced. Due to edema and infiltration, the lumen of the larynx narrows, which depends on the location and extent of the inflammatory infiltrate. If the lumen of the larynx narrows, a feeling of constriction and difficulty breathing appear, i.e. signs of laryngeal stenosis.

    In the absence of treatment, as well as with a high degree of virulence of the pathogen, acute edematous-infiltrative laryngitis can develop into a purulent form - phlegmonous laryngitis.

    Phlegmonous laryngitis (infiltrative purulent laryngitis) is a diffuse, diffuse purulent inflammation of the larynx, occurs with high fever, chills, difficulty breathing, pain that increases with swallowing, and is accompanied by dysphonia or aphonia. Purulent inflammation can spread beyond the larynx to deep and superficial accumulations of fatty tissue.

    Laryngoscopy reveals significant infiltration with swelling in various parts of the larynx, hyperemia of the mucous membrane, and a sharp narrowing of the lumen of the organ. After 4-5 days, a purulent fistula may form and the abscess may empty. The mobility of the epiglottis and arytenoid cartilages is limited. As the purulent-inflammatory process spreads to the neck tissue, skin hyperemia, dense infiltration, and severe pain on palpation appear. The patient notes pain when turning the head, limited mobility due to painful infiltrates in the neck area.

    Differential diagnosis[edit]

    In adults, various forms of acute laryngitis should be distinguished from the initial form of tuberculosis, laryngeal cancer, and specific lesions. In addition, differential diagnosis is carried out with diphtheria of the larynx, which occurs in three stages: dysphonic, stenotic and asphyxia stage. The development of the disease is characterized by the presence of fibrinous films and a rapid increase in the clinical picture of laryngeal stenosis. Toxic and hypertoxic forms of diphtheria develop at lightning speed and are accompanied by swelling of the soft tissues of the neck. Edema may spread to the soft tissues of the chest. In addition to diphtheria, inflammatory damage to the larynx should be taken into account in diseases such as influenza, scarlet fever, and typhus.

    Acute laryngitis: Treatment[edit]

    Elimination of the inflammatory focus of infection in the larynx, restoration of vocal function, prevention of chronicity of the inflammatory process.

    Indications for hospitalization

    Treatment of acute laryngitis is carried out mainly on an outpatient basis.

    Patients with acute edematous-infiltrative, infiltrative-purulent (phlegmonous) laryngitis, abscess processes in the larynx are subject to hospitalization, regardless of the severity of the general condition and the severity of the manifestation of dysfunction of the larynx. They need constant monitoring so that, if necessary, all necessary measures to restore breathing, including tracheostomy, are carried out in a timely manner. That is why, most often, already at the prehospital stage, patients are shown the administration of glucocorticoids, desensitizing and antibacterial agents.

    Common treatment methods include reflex destenosis - contrast baths for the hands and feet. General therapy is performed at home or in severe cases in hospital with the establishment of a voice regime, following a gentle diet, excluding cold, hot and irritating foods, and smoking. Low-intensity laser radiation, as well as thermal procedures and light therapy, have been successfully used to treat acute laryngitis. Superphonoelectrophoresis is carried out with prednisolone and augmentin, alternating procedures every other day.

    Surgical treatment - with the development of abscess forms of acute laryngitis, the abscess is opened using endolaryngeal or external access.

    Along with surgical treatment for the development of purulent-necrotic forms of acute laryngitis, powerful antibacterial therapy is carried out in combination with detoxification and symptomatic treatment. In treatment, the leading place is occupied by β-lactam antibiotics: amoxicillin + clavulanic acid, ampicillin + sulbactam, III-IV generation cephalosporins.

    In cases where the pathogen is unknown, but streptococcal etiology is suspected, treatment begins with intravenous ampicillin at a dose of 2.0 g 6 times a day. Among the semisynthetic broad-spectrum penicillins resistant to β-lactamases, the most effective are amoxicillin + clavulanic acid and ampicillin + sulbactam - these drugs also have antianaerobic activity. If anaerobes are identified or suspected among the pathogens, metronidazole 500 mg intravenously in a 100 ml bottle is added to the combination. As a rule, III-IV generation cephalosporins are widely used: ceftriaxone is prescribed intravenously at 2.0 g 2 times a day; cefotaxime 2.0 g intravenously 3-4 times a day; ceftazidime also intravenously at 3.0-6.0 g per day in three doses. Cephalosporins are not recommended to be combined with other antibiotics, but combination with metronidazole is possible.

    In addition to antibacterial and anti-inflammatory therapy, detoxification therapy is carried out when treating purulent forms of acute laryngitis. The latter is necessary to relieve systemic inflammatory response syndrome, correct rheological disorders and microcirculation disorders.

    Therapy for edematous laryngitis is divided into general and local (intralaryngeal infusions and inhalations). The following drugs have a pronounced anti-edematous and anti-inflammatory effect: glucocorticoids, antihistamines, diuretics. General therapy includes broad-spectrum antibiotics and mucolytics. It should be borne in mind that antihistamines should not be prescribed simultaneously with mucolytics, since their action is opposite.

    In addition to drug therapy and surgical treatments, patients are shown: laser and magnetic laser therapy, intravenous or extracorporeal laser or ultraviolet irradiation of blood.

    Treatment of acute laryngitis in infectious and somatic diseases is based on preventing the generalization of infection and secondary infection, including purulent-inflammatory lesions of the larynx. Inhalations of anti-inflammatory and antimicrobial drugs and broad-spectrum antibiotics are used.

    Consists of dynamic outpatient observation by an otolaryngologist.

    Prevention[edit]

    Timely diagnosis and treatment of diseases of the upper and lower respiratory tract. Elimination or minimization of the influence of the above unfavorable factors form the basis for the prevention of inflammatory diseases of the larynx.

    Other [edit]

    With timely and correct treatment of the disease, a complete cure occurs. In advanced cases, the outcome is unfavorable due to deformation of the laryngeal cartilage and the development of chronic stenosis of the organ. The greatest effectiveness is observed when treated in the early stages of the disease.

    Source: http://wikimed.pro/index.php?title=%D0%9C%D0%9A%D0%91-10:J040

    Acute laryngitis: features and symptoms of the disease, comprehensive treatment

    Acute laryngitis is an inflammatory process of the mucous membrane of the throat or trachea. Occurs against the background of bacterial and viral infections. Pathogens often parasitize the mucous membrane and become especially active under the influence of endogenous and exogenous factors.

    Acute laryngitis

    The pathogen invades the mucosa, which leads to desquamation of epithelial cells and death of cilia. With severe and prolonged inflammation, the ciliated epithelium may change to flat.

    The mucous membrane is infiltrated unevenly. The capillary network overflows with blood. Tears may appear in the vocal cord area.

    In ICD-10 the disease is designated J04.0

    The etiology of the disease is often associated with saprophytic infection of the larynx. It is quickly activated under the influence of external factors. Some other inflammatory diseases of the larynx can also support inflammation. For example:

    Acute laryngitis can be:

    Catarrhal

    Occurs when opportunistic microflora are activated. Among the most common pathogens are β-hemolytic streptococcus, pneumococcus, influenza and parainfluenza viruses, and rhinoviruses. Acute catarrhal form is accompanied by impaired blood circulation in the mucous membrane, its swelling and redness.

    Symptoms of the disease boil down to hoarseness, a feeling of tickling, and discomfort. Body temperature rises to 37.5 degrees. The person feels weak, lethargic and has headaches. If the catarrhal form lasts more than 3 weeks, then doctors talk about its transition to chronic.

    Subglottic

    This form is characterized by pronounced swelling under the vocal folds. It develops mainly in children aged 2 to 6 years, especially prone to laryngospasm. The child wakes up with a bout of barking cough and difficulty breathing. The skin becomes bluish. Accessory muscles begin to take part in breathing. The latter becomes whistling. Stenotic manifestations can last from several minutes to half an hour.

    Combined with tracheitis

    Develops in preschool children, more often in boys. It is characterized by a barking cough and hoarseness of voice. Laryngotracheitis is caused by inflammation and obstruction of the upper respiratory tract. Laryngitis is characterized by swelling of the larynx and trachea, blockage of the narrowed lumen, and fibrinous deposits. This form is more severe than the previous one, as it can lead to a threat to the patient’s life. There are 4 stages of disease development:

    • Compensation. Respiratory failure occurs only during physical exertion.
    • Subcompensations. Symptoms of deficiency also appear at rest. Accessory muscles are involved in breathing. The pulse becomes rapid, the skin turns pale.
    • Decompensation. Breathing is intermittent, the pulse is thready, the skin is pale gray. Consciousness is absent in most cases.

    Clinical picture of acute laryngitis:

    Causes, provoking factors

    The main cause is viruses that cause acute infectious diseases. Often the cause can be overstrain of the ligaments and various mechanical irritations. In normal condition, the vocal cords work easily and elastically. When inflamed, they become rough and swollen. The voice becomes hoarse and sometimes disappears completely.

    Among the causes and provoking factors are:

    • Formation of ulcers in the vocal cords.
    • Tumors and neoplasms.
    • Chronic diseases.
    • Vocal cord paralysis.
    • Age-related changes.

    Symptoms

    Acute laryngitis occurs in several stages:

    • First. Hyperemia of the mucous membrane appears.
    • Second. The vessels dilate and leukocytes infiltrate.
    • Third. Exudate appears. It can be mucous or purulent, sometimes with blood particles.
    • Fourth. Intoxication leads to swelling of the mucous membrane of the vocal cords.

    The photo shows the symptoms of laryngitis

    In adults

    Dryness, burning, tickling and scratching appear in the larynx. Sometimes this is accompanied by a sensation of a foreign body. A dry cough appears. The timbre of the voice changes, it becomes rough and hoarse. It is possible to develop aphonia, when a person can only speak in a whisper. The disease lasts 7-10 days. In adults, the temperature rarely rises to 37.5 degrees.

    In children

    In children under 7 years of age, acute laryngitis proceeds according to a different scenario. Inflammation can provoke false croup. Swelling covers most of the larynx, periodic attacks appear. Symptoms include:

    Diagnostics, research methods, necessary tests

    To make an accurate diagnosis, the doctor must collect anamnesis and conduct additional examinations.

    Blood and urine tests are prescribed, and a study is conducted to determine the presence of an inflammatory process in the body. At the same time, the number of leukocytes and ESR are noted.

    Instrumental diagnostics are not required for this form. The exception is stenosing laryngitis. In this case, direct laryngoscopy is prescribed. The picture is represented by edema, hyperemia of the mucous membrane, narrowing of the lumen of the larynx by 50-75%. With fibrous laryngitis, a whitish coating is visible, and with hemorrhagic laryngitis, small hemorrhages are visible.

    If the diagnosis is suspicious, then an x-ray is prescribed. When carrying out differential diagnosis, diphtheria, erysipelas, syphilis, and allergic edema are excluded.

    Laryngoscopy reveals swelling, diffuse hyperemia of the mucous membrane, thickening and hyperemia of the vocal cords. Pieces of mucus appear on the top of the vocal cords. With the flu, there are hemorrhages on the mucous membrane. If a bacterial nature is suspected, a bacteriological examination of the discharge and rinsing from the

    Treatment

    Treatment in most cases depends on the form of laryngitis.

    General recommendations

    It is necessary to adhere to a gentle regime: try to speak less, including in a whisper.

    Keep your neck warm by wrapping it in a towel or scarf made from natural fibers. When speaking, you should speak while exhaling.

    Spicy, cold and hot foods are completely excluded from the diet. Smoking and drinking alcohol are also not recommended.

    If thick, viscous sputum appears, expectorants are prescribed. It is recommended to drink warm alkaline water, compotes, and herbal teas.

    Medication

    Drugs with different properties are prescribed:

    • Antibacterial therapy. Relevant for protracted form or purulent nature. Additionally, sulfonamide drugs are prescribed.
    • Cough remedies. For a non-productive cough, medications are prescribed that suppress the cough center. For wet coughs, expectorants and mucus thinners are prescribed. Lazolvan, Ambrobene, Mukaltin.
    • Antihistamines. Prescribed if there is a tendency to edema.
    • Antiviral agents. If laryngitis is viral in nature.

    Folk remedies

    If you have laryngitis, do not forget about traditional medicine recipes. Inhalation of string and violet will improve the condition. For infusion, take one spoon of each herb. You need to brew 500 ml of boiling water. You need to insist for a minute. You should breathe in the vapors of the infusion. The course consists of procedures.

    Restore your voice with a cocktail made from anise seeds (100 g), a glass of water, a tablespoon of cognac and two tablespoons of honey. The components are mixed and taken 1 teaspoon several times a day.

    How to treat laryngitis with folk remedies, watch our video:

    Features of treatment during pregnancy

    Pregnant women are more often prescribed treatment in a hospital setting. This allows you to monitor the baby's condition. It is necessary to increase the volume of warm drinks. Chamomile, pine buds, and calendula can be prescribed for inhalation. Marshmallow root has a good effect, which relieves swelling and inflammation.

    Physiotherapy

    In the first phase of the disease, which is characterized by a dry cough and sore throat, UHF procedures are prescribed. It is possible to use mustard plasters on the soles. The administration of a lytic mixture relieves pain well. Only a doctor can make it from a solution of hydrocortisone, diphenhydramine, novocaine and saline. In the second phase, inhalations with soda and mineral water are prescribed.

    In the third stage, attention is paid to the restoration of the vocal cords. Vibromassage and electrophoresis with calcium are prescribed to the damaged area.

    Possible complications

    In the absence of treatment, acute laryngitis transitions into a chronic form of the disease. With laryngotracheitis, the risk of suffocation remains due to swelling of the larynx. Purulent forms can lead to:

    It is also possible to develop cicatricial deformation of the larynx and damage to cartilage tissue. Clinically, this is manifested by constant hoarseness of the voice, cough, and breathing problems.

    How dangerous is laryngitis in children and how to recognize the first symptoms, says Dr. Komarovsky:

    Prevention

    Among the preventive measures:

    1. Hardening.
    2. Timely treatment of any infections.
    3. Maintaining bed rest.
    4. Fight bad habits.
    5. Playing sports.

    It is necessary to wash your hands with soap, use disposable wipes and do not touch the nasal and oral cavity with dirty hands. Try not to overcool your body, especially your legs. Pay attention to protecting your vocal cords. You are less likely to get sick if your home maintains normal levels of humidity and temperature.

    Forecast

    Usually the disease ends without causing consequences for the body. But in advanced stages there is a risk of developing a chronic form. This can negatively impact your quality of life.

    Source: http://gidmed.com/otorinolarintologija/zabolevanija-lor/bolezni-gorla/laringit/ostryj-lechenie.html