Hoarseness is a condition in which a person cannot speak, that is, make any sounds. This mainly occurs with pathologies of the larynx. For example, hoarseness with a cold occurs because the vocal cords become inflamed. This process is caused by bacterial or viral infections - the vocal cords, which are located between the trachea and the pharynx, are responsible for the sound that a person can make.

The main causes of hoarseness

There are several reasons that can cause this condition, they are divided into pathological and non-pathological. Pathological include: diphtheria, inflammation of the larynx, acute laryngitis, weakness of the vocal cords, laryngeal abscess and others.

With diphtheria of the larynx, in addition to a hoarse voice, a dry cough appears, and noises during breathing, edema of the subcutaneous tissue of the neck. Inflammation of the larynx or acute laryngitis - in this condition, there is a barking cough, hoarseness, wheezing. If shortness of breath appears and then the patient needs help.

Laryngitis: in most cases, this pathology is of viral origin. However, its appearance can cause staphylococcal and streptococcal infections. In addition, patients complain of fatigue, etc.

Laryngeal abscess is a rare secondary condition that occurs after trauma to the larynx, such as intubation. The patient has a sharp pain and body temperature rises.

Singer's nodules - this pathology is characteristic of people whose profession is associated with the constant use of the voice (teachers, singers, actors). With a heavy load on the vocal cords, fibrous nodules appear on them. You can delete them using the operation.

Functional disorders: more common in young women when experiencing emotional stress (adductor muscles are paralyzed). In this case, the voice may completely disappear. You can eliminate this condition if you talk to the patient and calm him down.

Non-pathological reasons include such phenomena as anxiety and stress (any psychological disorders disrupt the tone of voice, the person is too nervous at this moment).

External irritants tobacco and alcohol irritate the vocal cords and the entire throat in general. Medication also causes hoarseness. These are mainly aerosol substances and pressure reducing drugs. They dry out the mucous membrane, so the vocal cords are not lubricated enough.

A foreign body in the throat, bronchi, or trachea leads to complete loss of voice, hoarseness, and laryngeal cough. If, against the background of this, an inflammatory process in the throat is observed and the airways are clogged, then other symptoms arise: shortness of breath, cyanosis of the skin, wheezing.

In this case, you should immediately call ambulance... A hoarse voice can also be the result of birth trauma, traumatic injury to the throat against a hard object, after inserting a tube into the trachea during surgery. Also, this condition occurs in a child after prolonged crying or screaming. Teenagers can lose their voice from smoking too many cigarettes.

Symptoms of pathology

• complete or partial loss of voice;
• perspiration, itching, dryness;
• an increase in body temperature (rises due to a viral or bacterial infection);
• dry or moist cough (the most common symptom);
• chest pain (indicates that hoarseness is associated with heart problems, so the diagnosis should be more thorough);
• sharp weight loss and hemoptysis (if, in addition to hoarseness, such signs have arisen, consultation of an experienced specialist is necessary, because such a condition may indicate development);
• feeling of a foreign object in the throat (this indicates the presence of polyps on the ligaments);
• pain in the throat (often occurs with respiratory diseases).

Treatment and prevention of the disease

Hoarseness of the voice appears in the acute stage of laryngitis. In this case, the doctor prescribes medications in the form of an aerosol, or those in which there are emollient components, for example, menthol,. The aerosol should be injected with inhalation. It is impossible to "rinse out" the hoarseness, especially if it proceeds with pain.

When a vibrating sound appears during breathing, then you should see an experienced doctor, and it is better to call an ambulance.

This condition often indicates the development of croup (a common pathology in children). Before the arrival of doctors, the air in the patient's room should be humidified. If there is no humidifier, you need to use another method: turn on the hot one in the bathroom so that the patient inhales its vapors.

With a slight hoarseness, you can not worry. To eliminate it, the patient must be silent for several days. When the hoarseness does not subside throughout the crescent, then you need to go to the clinic. The doctor diagnoses the cause of the condition and prescribes effective treatment... After a while, the voice will be fully or partially restored.

Treatment can take place using various methods, namely the use of drugs, various heating physiotherapy procedures, inhalations.

Traditional medicine, herbal medicine are also good, but before using them, you should consult with your doctor. Do not self-medicate, because this can only aggravate the current situation.

The doctor will select the method of treatment on an individual basis, depending on the characteristics of the course of the disease and the general condition of the patient. Therefore, the list of prescribed drugs may differ in two patients with the same diagnosis.

First, it is necessary to establish the cause that influenced the appearance of hoarseness: it may be excessive smoking, a large amount of alcohol consumed, a cold, or voice load. Having identified these factors, it is urgent to exclude this harmful effect.

How does hoarseness manifest in a child?

This condition can be not only in an adult, but also in a child. Usually, in addition to hoarseness, there is a severe cough and sore throat. There are many reasons for this condition in children, but the main ones are as follows:

• strong tension of the vocal cords during the process of loud screaming;
• infectious pathologies of the throat and upper respiratory tract (after them complications often appear in the form of and);
• the consequences of a strong fright (this rarely happens, it goes away quickly and on its own);
• allergy to food, pollen and medications.

Symptoms of the disease usually appear after acute infectious and bacterial diseases of the throat, bronchi or trachea. The main symptoms of the disease are: a sharp loss of voice, dry cough, fever, pain and itching in the throat.

In some cases, all of these signs do not appear. Then you need to listen to the child's conversation, how he will repeat words, change the timbre and volume of the voice. If the hoarseness of the baby's voice lasts more than ten days, then it must be shown to the doctor. After finding out the reason for the hoarseness, the doctor will prescribe an effective and personalized treatment.

The first thing a small patient should do is to rest his vocal cords: you can't speak loudly for about a week, because the vocal cords are straining so much (it is better to speak calmly, but not scream).

In the apartment, it is necessary to often ventilate the rooms and do wet cleaning. In this way, the number of harmful microorganisms can be reduced. In addition, inhalation, alkaline water and aromatic oils should be used. The latter are used if the child does not have an allergic reaction.

Medicines are used when the hoarseness is caused by an infectious disease (the doctor prescribes antibiotics and antivirals). To avoid side effects, antibiotics should be taken in parallel with antihistamines.

For infectious pathologies that affect the loss of voice, symptomatic treatment is used. If the child has a fever, then antipyretic and anti-inflammatory drugs are prescribed.

Only a diagnosed cause and effective treatment under the supervision of a qualified doctor will reduce the risk of possible complications and lead to a quick recovery.

Izvozchikova Nina Vladislavovna

Specialty: infectious disease specialist, gastroenterologist, pulmonologist.

Overall experience: 35 years .

Education:1975-1982, 1MMI, san-gig, highest qualification, infectious disease doctor.

Science degree: doctor of the highest category, candidate of medical sciences.

Training:

Our expert is a laryngologist surgeon, a leading specialist, head of the scientific and clinical department of laryngeal diseases of the Federal State Budgetary Institution NKTSO FMBA of Russia, candidate of medical sciences Ibragim Nazhmudinov.

Where does the wheeze come from?

Hoarseness can appear not only with a cold or overexertion of the voice, but also against the background of allergies, ligament injuries, intoxication of the body, paralysis and paresis of the laryngeal nerve. In children, hoarseness can occur due to a congenital cyst of the larynx, the ingress of a foreign body, or with hormonal changes in the body in adolescence.

There can be more serious reasons for hoarseness. Modern clinical statistics show that oncology of the larynx occupies 20-25% of the total picture of oncological diseases in the world. These are not only benign tumors such as polyps, fibromas, nodules, cysts, papillomas, but also malignant tumors such as laryngeal cancer.

Therefore, if hoarseness appears against the background of complete health or does not go away for a long time after acute laryngitis, it is necessary to consult a specialist.

We go to the doctor

Often dangerous diseases of the larynx are mistaken for a cold, bronchitis or asthma, because the symptoms of these diseases are similar. Therefore, with persistent long-term hoarseness, patients often think that they have not recovered enough from a cold, and try to intensively heal. But if the hoarseness persists for more than two weeks, this is a reason to be wary.

To allay fears, a visit to a therapist, alas, is not enough. Only an examination by an ENT specialist, which uses special diagnostic equipment, ranging from a laryngeal mirror, which is in any clinic, and ending with methods such as laryngoscopy with a rigid endoscope, fibrolaryngoscopy, stroboscopy, will reveal the cause of the disease.

Do not delay your visit to the doctor. The fact is that many oncological diseases of the larynx at the initial stage proceed without pronounced symptoms and pain. The person does not pay attention to the slight hoarseness in his voice, and believes that this is the result of fatigue or excessive smoking. But without serious reasons such a picture cannot be.

Unfortunately, doctors often see patients with grade 3-4 cancer, who for a long time ignored their hoarseness and turned for help only when they noticed a feeling of a lump in the throat, and this is already a sign of a neglected disease that will require complex surgical treatment.

Take care of the bundles!

The risk group for diseases of the larynx primarily includes people of voice professions - teachers, actors, call-center employees, educators, lawyers, as well as employees employed in hazardous production, smokers.

In order to prevent the development of dangerous diseases, you need to follow a number of simple recommendations.

Treat colds in a timely manner. Untreated acute laryngitis, which occurs against the background of colds or infectious and inflammatory processes, often becomes chronic and can lead to the growth of benign and sometimes malignant neoplasms.

Avoid prolonged overstrain of the vocal cords; from time to time you need to give your voice a chance to rest. Therefore, if you have to talk a lot at work, try not to strain your voice at least at home.

Avoid foods and drinks that are too hot, spicy, or acidic. Such food leads to irritation and sometimes burns of the laryngeal mucosa.

Use household sprays carefully. Spray them as far away from you as possible.

Do not smoke, do not abuse alcohol.

If possible, try not to be in smoky rooms. Wear respirators when working with hazardous substances.

Take good care of your health. Do not neglect going to the doctor. Even such a natural process as teenage breaking of the voice, which is also accompanied by prolonged hoarseness, requires observation from an ENT.

Hoarseness of the voice is not just discomfort and inconvenience that interferes with communication and work. A hoarse voice can indicate a serious illness that requires prompt treatment. How to cure your vocal apparatus? What are the reasons why we don't sound? Why do wheezing or wheezing appear in the voice and how to deal with it?

Local treatment: the famous Lugol's solution, antiseptics and vitamin C gargle. From herbal tablets and remedies, calendula tincture also works well. In addition to these funds, sprays - Kameton and Ingalipt - help perfectly.

Antihistamines are connected to therapy, especially when there is a history of hoarseness without a sore throat. The choice is given to drugs that are especially effective for spasms of the larynx and bronchi: Loratadin, Zirtek, Claritin and others.

Traditional medicine for the sonorousness of the voice

Despite the availability of effective recipes for home or traditional medicine, do not forget that the first step in the event of a disease is to visit a phoniatrist. It is self-justified to try only those means that will not harm:

• Pour half a glass of anise seeds with a glass of water and simmer over very low heat for up to 15 minutes. Next, you need to add a spoonful of honey and let it simmer over the fire again. This composition is drunk one spoon at a time when it cools down. The more often you swallow a spoonful of warm (not hot!) Anise-honey broth, the faster the ligaments will come to their senses.

• Since childhood, a well-known remedy is milk and Borjomi in a warm form, the ratio is 1: 1. You can also add a spoonful of honey to the composition. The solution should wear a temperature that is close to body temperature. Cold milk is very dangerous for the voice, so warm the solution to 38 degrees.

• Brew chamomile and lavender tea, it is good if you can insist it on a steam bath. When the tea has cooled to 40 degrees, you can drink it.

• Two egg yolks, mashed with butter and sugar, are taken ¼ spoonful before meals. Very tasty medicine, but only use well-washed eggs.

• A famous means of how to return a voice is a little honey, a fresh chicken or quail egg and a spoonful of brandy, beat in a mixer. Drink 50 grams after meals 3-4 times a day.

Hoarseness of the voice is called the appearance of wheezing and whistling in it, a violation of its sound, up to the inability to reproduce sounds. The cause of hoarseness can be both an infection or overstrain of the vocal cords, and exposure to poisonous, too aggressive substances. In order not to part with your voice forever, hoarseness (dysphonia) should be treated by visiting an otolaryngologist or phoniatrist.

In addition to this topic, read also.

What if at the most inopportune moment you have a hoarse voice and why did this happen? Let's try to help you.

Hoarseness occurs most often as a result of overstrain of the vocal cords or as an accompanying phenomenon with an infectious disease of the throat or respiratory tract. This problem most often occurs with artists, singers. Very often teachers become hoarse after giving several lectures in a row. Interestingly, with loss or hoarseness of the voice, a person may not feel sick: he does not have fever, feeling unwell, or headache. There can be a dry cough. This disease is called laryngitis in medicine - an inflammation of the larynx mucosa.

If your voice is hoarse, you should remember that in this case you cannot speak, even in a whisper. Because whispering strains the ligaments more than ordinary speech. Also, you shouldn't smoke during laryngitis. Try not to breathe through your mouth or drink hot or cold water. Also, while your voice is hoarse, forget about spicy and salty foods because they will tease your throat even more.

We found out what not to do. Now let's consider what to do if your voice is hoarse. For quick voice recovery, it's better to trust folk medicine... Let's look at several methods.

Traditional medicine for the treatment of hoarseness

1) The first thing to remember if you have a hoarse voice is to drink a lot of warm liquid (not hot !!!). It can be tea made from leaves or berries of raspberry, viburnum, strawberry, linden, warm fruit juices or fruit drinks. Alternate these drinks whenever possible.

2) One of the popular folk remedies for the return of the voice is to eat potatoes in their uniforms. Boil a few unpeeled potatoes and crush it straight away. After that, tilt your head over the pot, cover it with a towel and inhale the fumes from the potatoes through your mouth.

3) Very good remedy cure for hoarse voice is ordinary honey. If your voice is hoarse, you should take a spoonful of honey in your mouth and keep it for a while until you completely separate. Honey softens the vocal cords, so the likelihood of a speedy recovery will increase.

4) If your hoarseness is associated with a cold sore throat, steaming your feet will help. In this case, it is necessary to ensure that the hot water cools down for at least 20-30 minutes. Better yet, add mustard powder to the water. After this procedure, be sure to wear woolen socks. This procedure is best done at night.

5) The following recipe may also help you: a glass of milk, a spoonful of honey, a spoonful of butter, a spoonful of vodka. Mix and heat all this, but do not boil, because honey will lose its properties. Drink all this warm, and it is advisable not to eat or talk for at least half an hour. This mixture is excellent for softening the vocal cords.

Here are some effective recipes for recovering a hoarse voice. Now you know what to do if your voice is hoarse. But most importantly, remember what absolutely must not be done if your voice is hoarse and it will return very quickly.

For citation:Karpova O.Yu. Violation of the voice is a symptom of not only laryngeal diseases // BC. 1999. No. 9. P. 11

The vocal apparatus is a complex system in which the functions of the constituent parts are interconnected and controlled by the central nervous system. It consists of a primary sound generator - the larynx, the energy section - the lungs, resonators - the nasal cavity and nasopharynx, paranasal sinuses, pharynx, trachea, bronchi and articulatory section - neck muscles, tongue, soft palate, teeth, lower jaw. Violation of the normal morpho-functional structure of each of these departments adversely affects the process of voice formation and voice-leading, leads to the development of functional and organic dysphonia.

D the vocal apparatus is a complex system in which the functions of the constituent parts are interrelated and controlled by the central nervous system. It consists of a primary sound generator - the larynx, the energy section - the lungs, resonators - the nasal cavity and nasopharynx, paranasal sinuses, pharynx, trachea, bronchi and articulatory section - neck muscles, tongue, soft palate, teeth, lower jaw. Violation of the normal morpho-functional structure of each of these departments adversely affects the process of voice formation and voice-leading, leads to the development of functional and organic dysphonia.
Many chronic diseases of organs and systems that are not part of the vocal apparatus can cause the inferiority of its function even in the absence of any changes in the larynx. This includes diseases of the lungs, cardiovascular, nervous and endocrine systems. So, chronic diseases of the organs of the chest and abdominal cavity negatively affect the voice due to a violation of the ability of the diaphragm to move normally. When even small areas of inflammation appear in the lungs, the mobility of the diaphragm decreases, as a result of which the timbre of the voice changes, its rapid fatigability appears, pains in the larynx occur, even with an insignificant voice load. A symptom of a high standing of the diaphragm and pronounced changes in the acoustic properties of the voice in pulmonary tuberculosis, even with a small primary focus, are described.
Voice disturbances are often only a symptom of a disease. Therefore, if the patient does not have any changes in the vocal apparatus, then he must be subjected to a thorough and comprehensive examination. So, for example, hoarseness of the voice can be the first symptom of diseases such as cancer of the apex of the lung and cancer of the thyroid gland, myasthenia gravis and a number of other diseases of the chest organs.
Vocal disorders are collectively called dysphonia. They are conventionally divided into functional and organic. If, during the examination of the larynx, the vocal folds and its other elements have a normal configuration, the usual color of the mucous membrane, and voice disorders come to the fore, then such diseases belong to functional dysphonia. Organic dysphonia caused by diseases of the larynx of an inflammatory nature (acute and chronic laryngitis, marginal and vasomotor chorditis, contact ulcers), neoplasms of the vocal folds (nodules, polyps, angiomas, fibromas, papillomas, intabutational granulomas, cancer) and paralysis of the larynx (peripheral and central genesis).
The larynx is a hormone-dependent organ. The vocal apparatus is under the influence of the endocrine glands, not only during the period of growth and development, but also throughout a person's life.
Voice disorders in girls during the period puberty accompanied by dryness, soreness, tingling, and sometimes sore throat, hoarseness. Such violations are most often associated with acute respiratory diseases, in connection with which the wrong treatment is carried out. In women, voice disorders can occur a few days before or immediately during menstruation, while the voice becomes dull, lowish. Therefore, during this period, women of voice-speech professions should limit their voice load. When use of contraceptive drugs due to the androgenic effect of the progesterone component - testagen, signs of voice virilization may appear. To exclude such complications, the use of these drugs should be limited to a period of up to 3 months. If the smallest changes in the timbre of the voice are detected, even without any narrowing of the vocal range, it is necessary to stop taking these drugs. At later stages, voice changes become irreversible.
IN last years for some infectious and other diseases, after severe injuries and burns, accompanied by loss of protein, they began to use anabolic steroid - nerabol, retabolil, etc. The use of these drugs can lead to voice disorders in women: voice fatigue quickly occurs, high tones from the range disappear, the voice becomes lower. Women may also develop hair on the face and legs. The onset changes very slowly regress after discontinuation of the drug.
A close relationship has been established between voice disorders and thyroid dysfunction. At the same time, there is rapid fatigue and weakness of the voice, hoarseness, narrowing of the range due to the loss of high sounds. The voice becomes muffled due to a sharp decrease in the tone of the vocal muscles. Most patients with hypothyroidism have a gelatinous edema of the vocal folds. These patients also have dryness and pallor of the skin, puffiness of the face, and pasty limbs. Treatment is hormone replacement therapy. With diffuse toxic goiter, vocal disorders are manifested by rapid periodic changes in pitch and timbre, rapid and pronounced fatigue of the voice, a feeling of "constriction" in the larynx. This is probably a consequence of an increase in the level of cholinesterase in the blood, which, through acetylcholine, inhibits the conduction of nerve impulses... Treatment is usually surgical.
Voice disorders are largely associated with dysfunction of the adrenal cortex... In case of insufficiency of its function, weakness and rapid exhaustion of the voice are observed, which is especially pronounced in the evening hours and is accompanied by a feeling of "constriction" in the larynx, up to a complete suspension of speaking. In Addison's disease, the administration of deoxycorticosterone can significantly improve the voice. With hyperfunction of the adrenal cortex, which is observed mainly with its tumors, there is a virilization syndrome in women - a voice similar to a man's appears, its range narrows.
Thus, if dysphonia appears in patients with hormonal disorders, it is useless to use inhalations and other physiotherapeutic procedures for this, the underlying disease must be treated, and as the hormonal disorders normalize, the voice will also improve.
In the pathogenesis of functional diseases of the larynx, an important role is played by concomitant vertebral pathology: cervical osteochondrosis, craniovertebral blockade, spondylodystrophy of the cervical spine, detected during X-ray and neurological examinations. So, with cervical myofascial syndrome, along with parasthesia of the pharynx, dysphagia, patients complain of hoarseness, a rough voice, rapid voice fatigue, a feeling of stiffness in the larynx. And all this against the background of sharp pain in the neck, behind the corner lower jaw, in the area of \u200b\u200bthe floor of the mouth. In this disease, painful muscular seals are revealed along the anterior and posterior surfaces of the sternocleidomastoid, chewing and wing - palatine muscles. Treatment of patients with vertebral pathology includes manual therapy, novocaine blockade and various types of physiotherapeutic and drug treatment. With professional treatment of this pathology, voice disorders quickly disappear.

Inflammatory diseases of the larynx

The problem of voice restoration in patients with inflammatory diseases of the larynx is one of the most difficult and urgent in laryngology. This is due to the prevalence of the disease, which reaches 61.2 cases per 10,000 population (Yu.S. Vasilenko, 1995).
Distinguish between acute and chronic inflammatory diseases of the larynx. Of the acute, the most common are acute catarrhal laryngitis and lining laryngitis in children.
Acute catarrhal laryngitis quite rarely occurs as an independent disease. Usually it is a symptom of ARVI and infectious diseases such as measles, scarlet fever, whooping cough. The cause of acute laryngitis is an infection, the causative agents of which saprophyte in the larynx and are easily activated under the influence of a number of exogenous and endogenous factors. Exogenous factors include general or local hypothermia, alcohol abuse, excessive voice load, exposure to vapors, dust, gases and other occupational hazards. Endogenous factors include dysfunctions of the autonomic nervous system, metabolic disorders, decreased immunity and diseases such as rheumatism, tuberculosis and others, in which there is an increased sensitivity of the laryngeal mucosa even to mild stimuli.
Patients complain of hoarseness up to aphonia, a feeling of dryness, sore throat, dry cough. General state remains good, the temperature rarely rises to subfebrile numbers. Laryngoscopy reveals hyperemia and edema of the laryngeal mucosa, drying out of lumps of mucus on its surface. Treatment includes: 1) voice mode - the patient should be silent or speak in a soundless whisper, since with a formed whisper, the load on the vocal apparatus is 2 - 3 times greater than with spoken speech; 2) a diet with the exception of cold, hot, spicy and salty foods, alcoholic beverages; 3) alkaline-oil inhalation; 4) antihistamines.
Usually, with the right treatment, the voice is restored in 7 to 10 days. Particular attention should be paid to people with a voice profession. They can start working (regardless of the duration of treatment) only after elimination of inflammation in the larynx and full restoration of voice function.
With various acute infectious diseases, certain changes in the larynx can be detected. In some cases, these are the usual catarrhal laryngitis (scarlet fever, whooping cough), in other cases, the changes are pathognomonic. These include: enanthema with measles, pustules with smallpox, fibrinous deposits of a dirty gray color with diphtheria, perichondritis with typhus, ulcers with typhoid fever and others. The course of the inflammatory process in the larynx largely depends on the patient's condition and the severity of the underlying disease. Treatment is primarily general. Local has no peculiarities, those measures are used that correspond to this form of the disease of the larynx of a non-acute infectious nature. Especially carefully it is necessary to monitor patients who develop edema, perichondritis, necrosis in the larynx, so as not to miss time for emergency intervention (intubation or tracheotomy).
In children from acute inflammatory diseases of the larynx, in some cases, lining laryngitis (or false croup) occurs. In this disease, narrowing of the larynx occurs in the subglottic region due to inflammatory edema. The development of sublining laryngitis is facilitated by the narrowness of the lumen of the larynx and a pronounced loose submucosal layer in the sublining region in children of the first years of life. Usually these children suffer from allergic diseases.
The clinical picture is usually of the same type. The attack begins suddenly at night. There is a paroxysmal barking cough, acrocyanosis, inspiratory dyspnea, retraction of the compliant areas of the chest and epigastric region. The attack lasts from several minutes to half an hour, then the child sweats a lot, falls asleep, and in the morning he wakes up in a normal state. Because seizures can recur, parents need to be taught how to provide first aid to their child. The child should be picked up and tried to calm him down. The air in the room should be humidified, for which you can bring the child into the bathroom and let hot water out of the shower; a hot foot bath is recommended. Give the child a warm drink from a spoon. With laryngospasm, a gag reflex should be induced by pressing with a spoon on the root of the tongue. Since there is edema in the subglottic region, antihistamines are prescribed in the form of microclysters, rectal suppositories or injections. If the attack is delayed and the listed measures are ineffective (and this sometimes happens when an attack develops against the background of a cold), medical assistance is required: prednisolone is injected intravenously at the rate of 1 - 2 mg per 1 kg of body weight. After this, the child's condition usually improves rapidly.
Separately, one should dwell on acute stenosing laryngotracheobronchitisin children. This disease always occurs against the background of a viral infection. Gradually, hoarseness joins the usual clinical picture, then dry, and then a cough with phlegm; signs of stenosis of the larynx gradually increase: inspiratory dyspnea and retraction of the pliable areas of the chest, acrocyanosis, the child can only be in a semi-sitting position. The disease develops within a few days against the background high temperature... In these cases, urgent hospitalization of the child in a specialized ENT department is indicated.
Chronic laryngitis usually occurs under the influence of the same reasons as acute inflammation, if they were not eliminated in a timely manner and continued their harmful action for a long time. These reasons include the following factors: constant breathing through the mouth; chronic sinusitis (especially purulent); chronic diseases of the lower respiratory tract (bronchitis, bronchiectasis, tuberculosis); occupational hazards (dust, vapors, gases); sudden temperature fluctuations, excessive dryness or humidity; improper use of voice when singing and speaking; smoking and alcohol abuse. Chronic diseases of cardio-vascular systemleading to stagnation of blood and lymph in the neck, also lead to chronic laryngitis.
However, recognizing the role of individual factors in the development of chronic laryngitis, it was found that each of the harmful substances is much less likely to lead to a disease of the larynx than their combination.
There are three main forms of chronic laryngitis: catarrhal, hypertrophic and atrophic.
When chronic catarrhal laryngitis patients complain of slight hoarseness, rapid voice fatigue, sore throat, frequent coughing with mucous sputum. During an exacerbation, these phenomena intensify. With laryngoscopy, moderately pronounced hyperemia and edema of the laryngeal mucosa are determined, with phonation - incomplete closure of the vocal folds. During the period of exacerbation, treatment is the same as for acute catarrhal laryngitis. The prognosis is favorable, if you exclude the reasons that led to the onset of this disease.
Chronic hyperplastic laryngitis characterized by the proliferation of both the epithelial and submucosal layers. Distinguish between diffuse and limited form of hyperplastic laryngitis. In the diffuse form, there is a uniform thickening of the laryngeal mucosa, most pronounced in the area of \u200b\u200bthe vocal folds. Sometimes the vocal folds are covered with hyperplastic vestibular folds. The limited form manifests itself in the form of singing nodules, leukoplakia, pachydermia and hyperkeratosis. One of the constant symptoms of all forms of hyperplastic laryngitis is hoarseness, the severity of which depends on the stage, form and duration of the disease. The diagnosis is made on the basis of characteristic laryngoscopic signs.
People with hyperplastic laryngitis often have bacterial, inhalation, or food allergies. So, in case of edematous hyperplasia of the vocal folds (Reinke-Gaek edema), increased sensitivity to inhalation allergens (nicotine) prevails, in diffuse forms of hyperplastic laryngitis, great importance is attached to bacterial allergies, and food allergy can in some cases lead to hypertrophy in the area of \u200b\u200bthe inter-head space.
In the diffuse form of hyperplastic laryngitis, conservative treatment is usually carried out: injecting anti-inflammatory and hormonal drugs into the larynx, quenching the mucous membrane of the larynx with silver nitrate. With limited forms of hyperplastic laryngitis, surgical treatment is indicated. It is desirable to carry out operations with direct subanesthetic microlaryngoscopy. Hyperplastic epithelium, leukoplakia, pachydermia, polyposis changed mucous membrane of the larynx. Histological examination of remote formations in 1 - 3% of cases reveals the initial signs of laryngeal cancer. Limited hyperplastic laryngitis in the form of foci of keratosis is a precancerous condition. Therefore, these patients should be under compulsory dispensary supervision. Since almost all of these patients are smokers, it is very important at this stage to convince them to quit smoking, thus, if possible, preventing the transition of hyperplastic laryngitis to laryngeal cancer.
Chronic atrophic laryngitis may occur in persons working in chemical industries who have suffered laryngeal diphtheria, who were in the zone of increased radiation, in patients with diabetes mellitus and renal failure. Usually, an atrophic process in the larynx accompanies the same process in the nose and throat.
Patients complain of dry and sore throat, hoarseness, coughing with crusts, sometimes streaked with blood, in some cases there is difficulty in breathing due to partial closure of the larynx lumen with dried crusts. With laryngoscopy, a dry and thinned mucous membrane of the larynx, covered with crusts, is determined, mainly in the area of \u200b\u200bthe vocal folds and in the inter-scion-like space.
Treatment is mainly symptomatic: alkaline-oil inhalations, lubrication of the mucous membrane of the larynx with Lugol's solution, infusion of vegetable oils into the larynx, except for sea buckthorn, vitamins A, E, K, B1, iron preparations, biostimulants (aloe, ATP, vitreous), proserin electrophoresis and diadynamic currents to the larynx region. The disease is difficult to treat, but it is quite possible to alleviate the condition of patients.
In the development of chronic inflammatory changes in the larynx, the value of the release of the contents of the stomach and esophagus into the lower parts of the pharynx has been established. At the same time, diffuse catarrhal, infiltrative inflammatory changes in the mucous membrane of the larynx, as well as local trophic and hyperplastic changes in the region of its posterior third, were noted. The indicated organic changes in the mucous membrane of the larynx in this group of patients with secondary laryngitis are facilitated by the violation of the immune resistance system, revealed during the study of the state of general humoral and local immunity.
Currently, the participation of the immune system in the formation of chronic inflammation of the laryngeal mucosa is generally recognized. There is evidence of the effective use of the phytopreparation "Erakond" in the treatment of these diseases, which regulates reparative processes and has a pronounced anti-inflammatory and immunomodulatory effect. The drug is administered by infusion into the larynx.

Movement disorders of the larynx

Motor disorders in the muscular system of the larynx occur either in the form of a sharp increase in their function, or, conversely, a weakening and complete suppression of it. An increase in the reflex excitability of the neuromuscular apparatus of the larynx is more common in childhood in the form of diseases such as spasmophilia, rickets, whooping cough, and others. It is expressed in fits of convulsive closure of the glottis, which can be repeated many times. Laryngospasm can appear as a result of reflex irritation of the larynx by a foreign body, from the use of cauterizing agents, inhalation of irritating gases. In other cases, laryngospasm may be of central origin, such as in hysteria, epilepsy, tetanus. Treatment should be directed at the underlying disease. Laryngeal paresis and paralysis can be myopathic and neurogenic ... Myopathic paresis and paralysis arise as a result of inflammatory changes in the internal muscles of the larynx. These phenomena can be observed in acute and chronic laryngitis, some infectious diseases (diphtheria, influenza, typhoid, tuberculosis), a large voice load. In myopathic paralysis, the process involves mainly the constrictors of the larynx; the laryngoscopic picture depends on which muscle or muscle group is affected. So, against the background of influenza, paresis of the vocal muscles often develops, and the glottis acquires a fusiform shape. As a result of incomplete closure of the vocal folds, the voice in these patients is weakened, has a hissing character.
Due to the increased air consumption, shortness of breath develops during prolonged and tense conversation. If you do not start treatment in a timely manner, then the voice may remain hoarse for a long time. Neurogenic paralysis of the larynx are central and peripheral. And the central ones, in turn, are subdivided into organic and functional. Organic central paralysis of the larynx occurs with brain lesions (tumors, hemorrhages, syringomyelia, acute poliomyelitis, tick-borne encephalitis, syphilis). At the same time, isolated paralysis of the larynx does not happen, they are usually combined with the defeat of the IX, XI and XII cranial nerves, which is revealed by neurological examination. In the case of signs of laryngeal stenosis, tracheotomy and treatment of the underlying disease are indicated.
Functional central paralysis larynx occur in neuropsychiatric disorders, due to a violation of the interaction between the process of excitation and inhibition in the cerebral cortex. Hysteria is a prime example. One of the manifestations of movement disorders in hysteria may be difficulty in breathing, associated with the paradoxical closing of the vocal folds on inspiration. As a rule, these changes occur in young women with a labile nervous system who have previously had colds. Usually, the diagnosis was made: bronchospasm, laryngospasm, uncontrolled bronchial asthma and treatment with bronchodilators and hormones was unsuccessful. The duration of the disease can range from a few hours to 10 years or more.
Differential diagnosis between true stenosis of the larynx and respiratory disorders in hysteria, requiring a diametrically opposite approach to treatment, causes certain difficulties in some cases. It is characteristic that during the day, in the presence of strangers, these patients have noisy stridor breathing, but when the patients are distracted during a conversation, breathing becomes more free. It is characteristic that patients breathe quite calmly during sleep. With laryngoscopy, periods when the vocal folds on inspiration are located almost at the midline (lumen 1-2 mm at a rate of 14-16 mm) alternate with the divergence of the vocal folds in full, which never happens with organic stenosis of the larynx. In the study of the function of external respiration, despite the apparent difficulty in breathing, hyperventilation is revealed in patients, which is so characteristic of hysteria.
A hasty diagnosis, when momentary symptoms are taken into account without taking into account its dynamics, can lead to an unjustified decision to perform a tracheotomy. With this type of stenosis, tracheotomy is impractical. Moreover, it can only aggravate the manifestation of hysteria. Subsequent decannulation, given the psychogenic cause of the disease, will be extremely difficult. These patients will never die of suffocation, and their treatment should be carried out only in a neuropsychiatric hospital (hypnosis, drug hypnosis, etc.).
Peripheral paralysis arise as a result of damage to the laryngeal nerves, primarily the lower laryngeal or recurrent. Due to the peculiarities of the passage of the recurrent laryngeal nerve in the chest cavity and on the neck, its conduction may be disturbed when various organs are affected. Since the left recurrent laryngeal nerve enters the chest cavity, numerous pathological processes in this area can lead to its compression (aneurysm of the aortic arch, dilated cardiomyopathy, cancer of the left lung apex, tumors and cysts of the mediastinum, tuberculous infiltrates, enlarged lymph nodes, etc. ). Various processes in the neck can also lead to compression or injury to the nerve (esophageal, trachea, thyroid cancer, neck injury, subclavian artery aneurysm, thyroid surgery). If a patient has a limitation of the mobility of the left half of the larynx, first of all, it is necessary to make a tomography of the lungs and mediastinum, and then an X-ray examination of the esophagus and trachea, ultrasound of the thyroid gland. With unilateral paralysis of the larynx, patients complain of pronounced hoarseness, sometimes aphonia, shortness of breath when talking, difficulty in coughing up phlegm. With laryngoscopy, the vocal fold usually occupies an intermediate position; with phonation, a gap of about 2 - 3 mm remains between the vocal folds. Because of this, pronounced voice disorders are observed. Treatment is aimed either at bringing the paralyzed vocal fold to the midline (Teflon insertion into the vocal fold, suturing of the vocal fold at the midline, reinervation of the laryngeal constrictor muscles), or at compensatory insertion during phonation of the healthy vocal fold beyond the midline to close with the paralyzed vocal fold (voice and breathing exercises, acupuncture, stimulating physiotherapy procedures). If unilateral laryngeal paralysis occurs after surgery on the thyroid gland, as a rule, as a result of removal of the nodular goiter and the voice disappears immediately after surgery, treatment aimed at restoring voice function can be started as early as 1-2 weeks. Using reflexology in combination with forced voice exercises, we usually managed to achieve a significant improvement in vocal function in 2 weeks, and after discharge the patients could start working. In cases where the start of treatment was postponed for 3-6 months or more, atrophy of the paralyzed vocal fold often developed. In these cases, the prognosis for voice restoration is poor. With bilateral paralysis of the larynx, observed, as a rule, with neck injuries and operations on the thyroid gland, patients complain of severe difficulty breathing, with a practically unchanged voice. There is often an idea that if the voice is not changed, then the disease is not associated with the larynx. And in these patients, difficulty breathing is often associated with heart disease or lung disease and inadequate treatment is carried out, so tracheotomy has to be done for urgent reasons. The treatment of these patients is only surgical and is a variety of plastic operations aimed at fixed expansion of the lumen of the glottis. The voice after these operations deteriorates, but it becomes possible to get rid of the constant wearing of a tracheotomy tube.

Laryngeal neoplasms

Among diseases of the larynx, a significant place are occupied by benign tumors... They are more often diagnosed in persons of voice-speech professions, who usually notice even minor changes in voice faster and turn to a laryngologist. Benign neoplasms of the larynx often develop against the background of chronic laryngitis. These include fibromas, angiomas, angiofibromas, cysts, papillomas. All these tumors, with the exception of papilloma, grow slowly, sometimes over several years and are characterized by a smooth surface, the presence of a pedicle, the absence of infiltrating growth and metastases. The subjective feelings of patients with benign neoplasms are different. The nature and degree of disorders are determined by the localization, size and degree of tumor mobility. Voice disorders are often exacerbated by inflammation in the larynx. If the neoplasm has a wide base hoarseness is persistent. If the tumor is on the pedicle and descends into the lining space, then the vocal folds close tightly and hoarseness does not occur. In cases where the tumor is pinched between the vocal folds, there is a sudden interruption of the voice during conversation. Difficulty breathing occurs rarely, only with rapidly growing laryngeal papillomas. The diagnosis is made on the basis of laryngoscopy data. Treatment for benign laryngeal neoplasms is surgical. After that, all patients, especially people with a voice-speech profession, should undergo phonopedic therapy.
Of malignant neoplasms the most common cancer is the larynx. Risk factors are smoking, alcohol abuse, voice overload, occupational hazards (dust, soot, aniline dyes, radioactive substances). Precancerous conditions include all types of dyskeratosis (hyperplasia, leukoplakia, keratosis, pachydermia), degenerative proliferative processes (contact ulcers and granulomas), all benign tumors. Localization distinguishes cancer of the upper (vestibule), middle (vocal folds) and lower (subglottic) parts of the larynx. More often, the upper section is affected by a cancerous tumor, less often the middle and even less often the lower section. In cancer of the vestibule of the larynx, the earliest symptom is painful or painless dysphagia. Since the voice does not change with this localization of cancer, diagnostic errors often occur (pharyngitis, tonsillitis, pharyngeal neuroses are treated, but without effect). Therefore, for such complaints, examination of the larynx should be mandatory. When the vocal fold is damaged by a cancerous tumor, the main complaint is hoarseness, which should force the patient to see a doctor. But there is an opinion that a hoarse voice in a smoker is a normal condition, and patients are in no hurry to consult a doctor about this.
In case of cancer of the lining department, the main complaint is difficulty breathing, and this, as a rule, manifests itself already at the 2nd - 3rd stage of the disease.
Laryngoscopy, microlaryngoscopy, fibrolaryngoscopy, stroboscopy and tomography of the larynx are used to diagnose laryngeal cancer. Treatment for cancer of the larynx is combined: surgical and radiation. In cases where the tumor has grown into the surrounding tissue, tracheotomy and chemotherapy are performed.

Functional dysphonia

In recent years, the number of people with functional diseases of the larynx has sharply increased, which, according to many researchers, is associated with an increase in the load on the nervous system and the human psyche. Diseases of the larynx, which impede speech communication, reduce working capacity and pose a threat to professional unfitness. Specialized care for these diseases contributes to the restoration of voice function and the return of people to work. A decrease in the sonority of the voice, the appearance of hoarseness or the absence of a voice is usually considered a sign of a disease of the larynx. However, indirect laryngoscopy in some patients with a changed voice does not reveal organic changes in the larynx. Such disorders are considered functional. Dysphonies are subdivided into hypotonic, hypertonic, and spastic. Functional aphonia are divided into paretic and spastic, and phonasthenia - into acute and chronic. Voice and speech production is carried out due to the coordinated activity of the respiratory, vocal and articulatory apparatus, the interaction of which is provided and controlled by the cerebral cortex. Functional dysphonias occur when this coordination is impaired in any area and are manifested by many subjective symptoms, which are divided into two main groups: general neurological and local disorders. The general neurological includes the patient's peculiar behavior: anxious and gloomy experiences, depression, fear of an unfavorable outcome of treatment, increased irritability, instability of mood, irascibility, sometimes apathy, sleep disturbance. Local manifestations are characterized by voice changes, sensory and secretory disorders. Functional voice disorders are observed in persons weakened by various somatic and infectious diseases, suffering from chronic diseases of the upper respiratory tract, as well as using the wrong technique of phonation and breathing. Let's consider some forms of functional disorders of the voice.

Hypotonic dysphonia - a decrease in the muscle tone of the vocal folds. The main causes of this disease are voice load during or after ARVI, tonsillitis, bronchitis, tracheitis; vegetative-vascular dystonia, hormonal dysfunctions, stressful situations. Patients complain of rapid voice fatigue, hoarseness, and a decrease in the strength of the voice. The mucous membrane of the larynx and trachea is without inflammatory changes, the vocal folds are mobile, their tone is reduced, during phonation, a non-closure of about 1 mm is noted. Laryngostroboscopy reveals sluggish, weakened vibrations of the vocal folds. The maximum phonation time has been shortened. Usually, treatment includes the use of drugs aimed at increasing the tone of the muscles of the vocal folds: tinctures of eleutherococcus, aralia, ginseng root; anticholine-esterase drugs - proserin, galantomin; electrophoresis of proserin and sinusoidal modulated currents to the larynx region, acupuncture. It is obligatory to formulate correct breathing, speech and vocal phonopedics.

Hypertensive dysphonia - increasing the tone of the vocal muscles. It develops with a forced, forceful manner of speaking and singing, especially in a noisy environment. There is a constant overstrain of the abdominal muscles, jerky movement of the diaphragm, tension of the muscles of the face and neck, accompanied by swelling of the veins of the neck. The main complaints of patients: hoarseness, pain in the larynx, pharynx and neck, a constant desire to cough up mucus and phlegm, fatigue of the voice, periodic laryngospasm. The voice of patients is sharp, piercing, with a metallic tinge, sounds tense. Noteworthy is the tight closure of the vocal folds during phonation. The following types of treatment are usually used: intranasal novocaine blockade, electrophoresis with euphyllin on the larynx region, low-frequency magnetic field on the paravertebral region. In the treatment of these patients, we successfully used intradermal novocaine blockade in the Zakharyin-Ged zone in the larynx region. Breathing exercises and phonopedic exercises were gradually connected.

Spasmodic dysphonia - neurodynamic phonation disorder, expressed in excessively intense activity and discoordination of the internal and external muscles of the larynx, as well as the respiratory muscles. The onset of spastic dysphonia is most often associated with mental trauma and stress overload, but in some cases it can occur in persons who have previously experienced acute infectious diseasessuch as the flu. The voice of patients with spastic dysphonia is monotonous, low, with different overtones, tense-squeezed phonation, often accompanied by grimaces, tension of the muscles of the neck and face. Many sufferers prefer to speak in a whisper. When singing, crying, laughing and after drinking alcoholic beverages, the voice becomes normal. Treatment of patients with spastic dysphonia presents significant difficulties. The leading role in the treatment is played by the prescriptions of a neuropsychiatrist, combined with a strict voice mode. From physiotherapeutic procedures, aminophylline electrophoresis is prescribed to the larynx region. The use of acupuncture is effective. The development of physiological phonation respiration and the formation of a new mechanism of voice formation are of great importance. With the ineffectiveness of conservative treatment in severe cases, they resort to cutting or crushing the recurrent laryngeal nerve on one side. In functional aphonia, vocal disorders are based on hysterical disorders. The disease occurs suddenly in persons with a labile nervous system under the influence stressful situations... Patients complain of a feeling of a "lump" in the throat, "sticking" of mucus, but the main thing is aphonia. They seek to emphasize the severity of their illness, express disbelief in the possibility of recovery and restoration of their voice. Hysterical subjects often have relapses of aphonia. Functional aphonia can also develop in persons who have had acute inflammatory diseases of the larynx or exacerbation of chronic laryngitis. During the period when they communicate in a whisper, the wrong mechanism of voice formation is fixed. Functional aphonia is characterized by the absence of a sonorous voice, while loud coughs and laughter are sonorous. The laryngoscopic picture is variable. Some doctors are of the opinion that if a person has lost their voice, then the best treatment is silence. In the case of inflammatory changes in the larynx, this is justified, but for a short time, and in case of functional aphonia, treatment should be started as early as possible. According to our data, the most effective method treatment of functional aphonias is acupuncture, thanks to which it is usually possible to restore the voice in 1 - 3 sessions, without additional drug treatment. For the treatment of patients with functional diseases of the larynx, the methods used for the treatment of organic diseases of the larynx are not suitable. And the treatment of this group of patients, as a rule, is carried out by specially trained otolaryngologists and phoniatrists. In the clinic of ear, nose and throat diseases, MMA them. THEM. Sechenov, the problem of treating patients with functional diseases of the larynx has been studied since 1985. Along with the use of various methods of treatment, the high efficiency of acupuncture has been proven in the treatment of patients with this pathology. Simplicity of the method, cost-effectiveness, absence of toxic and negative side effects on the body, the possibility of using both in inpatient and outpatient conditions give us the opportunity to recommend this method of treatment for functional diseases of the larynx, which allows in a short time to save the patient from prolonged suffering associated with the absence or pronounced impairment of the voice. In addition, reflexology helps to normalize the activity of the nervous system, and breathing and vocal exercises help to strengthen the neuromuscular apparatus of the larynx, eliminate a defect in phonation breathing and lead to coordination of the activity of individual parts of the vocal apparatus. The effectiveness of acupuncture in the treatment of various, especially functional diseases has been proven by centuries of practice. Currently, many doctors have received special training and are proficient in reflexology techniques. These are mainly therapists and neuropathologists. There are only a few specialists in otorhinolaryngologists. In our opinion, acupuncture of ENT patients should be dealt with by an otorhinolaryngologist who is well versed in his specialty. Only in this case, he can adequately solve the question of whether only acupuncture is indicated, or it must be combined with traditional methods of treatment, and dynamic observation of the patient will help to adjust the treatment.