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Full text of "Diseases Of The Nose Throat And Ear"

CHAPTER 33
ACUTE LARYNGOTRACHEAL INFECTIONS

ACUTE LARYNGITIS

This is a viral or bacterial inflammation of the larynx, which very commonly
presents as part of a generalized upper respiratory infection. On many
occasions it may also occur as part of a lower respiratory tract infection. It
occurs more often in smokers and other people with altered laryngeal states,
such as those working in polluted atmospheres. Overuse of the voice does not
cause it but merely brings it to light sooner.

DIAGNOSIS. Nowadays the diagnosis is easy because anyone who becomes
dysphonic or aphonic during a cold or with an acute bronchitis has almost
certainly got acute laryngitis. Formerly, however, much greater care had to be
taken with the diagnosis since the febrile illness and upper or lower respiratory
infection could well be diphtheria, tuberculosis or syphilis. The average
laryngologist, in this country, will now see one such case every 2 or 3 years,
but in developing countries the practising laryngologist will have to keep
all these conditions in mind.

The present-day diagnostic error is to miss an underlying cordal carcinoma
during an upper respiratory infection especially where the 'laryngitis' persists
for some weeks, or to miss a vocal cord paralysis in a lower respiratory
infection secondary to a bronchial carcinoma, or left-sided heart failure.

Thus in all cases of hoarseness the larynx must be seen if the problem
persists for more than a week or two. In acute laryngitis the whole larynx is
reddened as are the normally white vocal cords (Plate VII, 2). If the condi-
tion is severe then the cords and false cords will be oedematous and pus
will be seen in the interarytenoid region and perhaps even around the
epiglottis.

TREATMENT. If a cold is sufficiently severe to cause laryngitis it is
probably advisable for the patient to have a few days of bed rest and voice
rest, since going to work and straining the voice will not only prolong the
hoarseness but may permanently scar the thyro-arytenoid and vocalis muscles.
This is particularly important in actors and singers. During a laryngitis the
muscles and spaces are infiltrated by round cells and if the normal healing
processes are not allowed to take place under rest conditions, then the musck
will scar causing permanent damage. This may not be obvious in the average
person, but it will certainly be noticed by a singer or actor.

Since the vast majority of these cases are due to virus infections antibiotics
play no useful role, unless there is secondary infection in which case
ampkillin would be the drug of choice. Steam inhalations, sweetened by the
smeU of menthol or tincture of benzoin, are comforting and should be used.
If there is pain simple salicylic acid analgesics are usually enough, but if