Narrowing of the larynx treatment. Emergency care at home

One of the vital systems of the body is the respiratory system. The quality of gas exchange processes and the saturation of tissues with oxygen necessary to ensure the normal gas composition of the blood depend on the health of the respiratory system. Oxygen starvation leads to asphyxia, which, in the absence of emergency assistance leads to death. The upper part of the throat performs a respiratory function, so damage to it can lead to dangerous consequences.

What is stenosis of the larynx

Pathological narrowing of the hollow channels or anatomical structures of the body is called stenosis (or stricture). Compression of the walls of the larynx, which occurs due to any reason, leads to a violation of the flow of air into the underlying sections of the respiratory system. This condition is potentially life threatening. An attack of stenosis can develop rapidly or be chronic.

At acute attack compression occurs rapidly, and the glottic lumen may close completely within a few minutes. The chronic form of the disease has less severe symptoms, but often leads to dangerous complications and significantly impairs the patient's quality of life. The method of treating pathology depends on the causes that provoked the narrowing of the walls and obstruction of the respiratory tract.

The reasons

Compression of the lumen of the larynx may be congenital pathology or be caused by local or systemic processes that occur against the background of the action of a pathogenic factor. The cause of the development of the disease is both changes in the larynx itself and in the organs adjacent to it. The most commonly diagnosed factors that provoke tracheal stricture are:

prolonged intubation (insertion of an endotracheal tube into the trachea to ventilate the lungs);
trauma due to damage to the mucous membrane during resuscitation intubation;
squeezing nearby authorities(mainly the thyroid gland, enlarged due to any reasons);
inflammatory process with a predominance of proliferation (growth) of cellular and tissue elements;
growth tumor cells;
the presence of a foreign body in the larynx;
papillomatosis of the upper respiratory tract;
the presence of scars after surgery, trauma;
allergic reaction;
subglottic edema inflammatory nature(false croup);
post-infectious conditions after past illnesses (diphtheria, measles, purulent tonsillitis, tonsillitis, perichondritis, laryngitis);
complications after a systemic infectious or bacterial diseases(syphilis, tuberculosis);
damage to the nerve endings at the entrance to the larynx, which occurred during operations or exposure traumatic nature;
uremia (urea toxicity) acute disorder kidney function);
burns of thermal, chemical or mechanical origin.

In children

Stenosis is especially dangerous for children from birth to 7 years. During this period the organs child's body not yet completely formed, and the folds of connective tissue located under the larynx during the development of the inflammatory process can swell and block the airways. Laryngeal stricture is one of the most common factors in the development of respiratory tract obstruction syndrome (airway obstruction) in children.

Stenotic attacks in a child require emergency medical measures due to their rapid development, which can lead to complete blockage of breathing. Most common causes stenosis of the larynx in children are associated with influenza and acute respiratory viral infection (ARVI). The manifestations of these diseases initial stage often accompanied by acute stenosing laryngotracheitis (croup syndrome), which provokes the development of stenosis. Other causes of pathology include:

infectious diseases belonging to the group of childhood diseases (measles, scarlet fever, whooping cough, chicken pox);
exposure to allergens;
getting into the larynx of foreign bodies;
extralaryngeal processes - hematomas, accumulation of pus, inflammation in the peripharyngeal and pharyngeal region, cervical region spine, soft tissues oral cavity;
benign diseases larynx (papillomatosis, chondroma);
inflammation of the mucous membranes (laryngitis, tonsillitis);
congenital anatomical features of the structure of the respiratory tract (friability of the submucosa).

Symptoms of stenosis of the larynx

External manifestations of the disease depend on the form, degree and root cause of stenosis. A common symptomatic sign of stricture is respiratory failure. The onset of a stenotic attack is characterized by the appearance of shortness of breath, rapid breathing, which is characterized by a whistling noisy sound. In children, the pathological process often develops at night and its onset is indicated by a “barking” cough, an altered (hoarse) voice, pallor or cyanosis of the skin.

With absence timely assistance the stages of stenosis successively and quickly replace each other, and the symptoms of the disease worsen. The hallmarks of stenosis along with the deterioration of the breathing process are:

increased heart rate;
emergence of anxiety panic attacks caused by lack of oxygen;
increased fatigue (a feeling of fatigue occurs even with minor movements);
deterioration of mood, apathy to what is happening;
severe bouts of coughing;
dizziness, drowsiness;
violations of the vestibular apparatus (manifested in a decrease in concentration, deterioration in the ability to orientate in space);
discoloration of the skin (the skin becomes pale at the initial stage of stenosis, cyanotic - during severe suffocation);
involuntary defecation and urination (occurs during the terminal stage of stricture).

Classification

Standard diagnostic classification, which aims to systematize the interpretation of data on diseases, involves the division of stenosis into groups according to certain classification criteria. Such a distribution is necessary for registering diagnoses depending on the etiology of the development of diseases and prescribing adequate treatment. By origin, all diseases are divided into congenital and acquired. Another major classification group is the nature of the course of pathology:

acute (characterized by rapid development, high risk of death due to the inability of the body to quickly adapt to conditions of lack of oxygen);
subacute (progresses quickly, but not rapidly, development time is from 1 to 3 months);
prolonged or chronic stenosis of the larynx (gradual development, moderate severity of symptoms, the body has time to adjust to the conditions of air deficiency);
complicated (leads to disruption of other organs and systems).

Due to the fact that the narrowing of the hollow structure can occur in one or more areas of the trachea and larynx, the disease, depending on the location, is classified into:

limited - the length of the narrowed area is less than 2 cm;
tracheal (or extended) - the narrowing extends to the trachea, the area of compression is more than 2 cm;
glottis - the pathological process affects only the hollow space between vocal folds located in front of the larynx;
subvocal space - the larynx is compressed, located in its lower part in front of the beginning of the tracheal tube;
anterior synechia (adhesions) - the localization of the pathological narrowing of the lumen is observed on the front of the throat;
synechia of the posterior section - the clearance is reduced on the back wall;
circular (annular narrowing) - there is a contraction of the circular muscles surrounding a certain area of the laryngeal cavity;
total - extends to all departments of the upper part of the windpipe, there is a complete or almost complete infection of the lumen.

If the tissues of the mucous membrane during the development of the disease have not undergone changes and have not lost the ability to recover, such stenosis is called limited, and when scarring, tissue damage, the nature of the changes occurring is unfavorable and the stricture is classified as widespread. Depending on the etiology of the development of the disease, the following forms are distinguished:

cicatricial stenosis of the larynx (narrowing occurs due to the formation of scar tissue at the site of the mucous membrane) - includes such subspecies as post-intubation (scar formation occurs due to prolonged forced intubation), post-traumatic (the cause of tissue deformation is trauma), post-infectious (develops after past illnesses infectious or inflammatory nature);
tumor - the catalyst for the disease is tumor neoplasms that form in the throat area;
paralytic - the development of pathology leads to the innervation of the vessels supplying blood to the larynx or trachea.

The above classification is not exhaustive due to the variety of possible primary sources of the problem. So, for example, if the pathology is provoked by an inflammatory process, the classification of stenosis according to the nature of the inflammation includes the following forms:

catarrhal;
purulent;
fibrous;
hemorrhagic;
necrotic;
herpetic;
mixed.

Degrees

Manifestations of stricture depend on the age of the patient, his general condition and level of activity. AT medical practice to determine the degree of the disease, the generally recognized Mayer-Cotton classification is used, where the severity of airway obstruction acts as a classification feature. The division of stenosis into groups depending on the severity is justified by the need to prescribe specific treatment for each classification subgroup. There are 4 degrees of the disease, characterized by their characteristic features:

	Anatomical features	State characteristic
Compensated	The narrowing of the lumen occurs within 30% of the norm, the glottis narrows to 6-8 mm	Satisfactory. Indicators of blood pressure and body temperature correspond to the norm, consciousness is clear, difficulty in breathing appears during physical exertion, physical activity
Subcompensated		Moderate severity. Changes in blood pressure during the slightest load, there are noises during breathing, the frequency of inhalations and exhalations increases, the pulsation slightly quickens
decompensated	The degree of obstruction reaches 71-99%, the narrowing of the glottis occurs up to 2-3 mm	Heavy. Blood pressure indicators decrease, the pulse rate significantly exceeds the norm (or becomes threadlike), confusion occurs, any movement leads to severe shortness of breath, which forces the patient to take sitting position
Asphyxia (suffocation)	The lumen of the larynx narrows by 99-100%, its size does not exceed 1 mm, or it is completely blocked	Extremely heavy. Blood pulsation is difficult to determine, consciousness is absent, breathing is weak, shallow, in the absence of emergency assistance, breathing stops completely

Complications

Persistent narrowing of the lumen between the glottis makes it difficult for air to pass into the bronchi, which leads to a significant deterioration in the patient's well-being. In chronic stenosis, congestion, which leads to the accumulation of sputum in the respiratory tract and an increased risk of developing bronchitis and pneumonia. One of the most dangerous complications stricture in children is acute stenosing laryngotracheitis, which is expressed in constant swelling and spasm of the walls of the throat.

Stenosis of the larynx in adults leads to an increase in the load on the pulmonary circulation and the heart (right section), which causes the formation of pulmonary hypertension. Other possible complications of the disease include:

dysfunction of all internal organs due to chronic oxygen starvation;
decompensation of the body (disruption of the work of adaptive mechanisms, loss of the ability to resist pathogenic agents that have entered the body) - infectious or viral diseases hard to bear;
death due to suffocation (in the absence of timely medical care).

Diagnostics

The typical clinical picture of stenosis is the reason for the diagnosis. During initial examination the patient, which occurs by taking an anamnesis, palpation of the laryngeal region, visual identification of signs of stricture, a differential diagnostic method is used to exclude the possibility of such pathologies as asthma, laryngospasm, etc. The main purpose of examining a patient is to determine the cause that led to the development of the disease, which is achieved by application of the following diagnostic methods:

CT scan larynx - a detailed study of the organs and tissues of the neck, is carried out in case of suspected tumor formations or in the absence of convincing results of other diagnostic methods;
laryngoscopy - an instrumental method of visual examination of the vocal cords and mucous membrane of the throat, performed using an endotracheal tube, helps to determine the degree of narrowing of the glottis;
x-ray - x-ray chest helps to exclude the presence of heart pathologies that have symptoms similar to stenosis;
magnetic resonance imaging (MRI) - the study of anatomical structures in the axial, frontal and sagittal planes, due to which the presence of inflammatory processes, tumor formations, pathology of the mucous membranes and lymph nodes is accurately determined;
ultrasound procedure(ultrasound) - during the diagnosis, adjacent to the larynx are examined internal organs(more often - the thyroid gland) for the presence of pathologies in them;
fibrolaryngoscopy is an endoscopic examination used in otolaryngology to visualize areas of the larynx that are inaccessible during visual inspection, the procedure consists in introducing a special device equipped with a video camera into the larynx (the image is displayed on the monitor screen);
bacteriological research- the study of biomaterial (smear from the pharynx) in order to identify viral or infectious agents.

Urgent care

The life of the patient depends on the timeliness of the assistance provided in an acute attack of stenosis. The development of stricture can occur rapidly and there will be several minutes left before the onset of asphyxia, during which the patient should be given first aid before the arrival of the ambulance team. The algorithm of actions when the first symptoms of suffocation appear is to sequentially perform the following steps:

call for emergency medical assistance;
restriction of the patient's motor activity (an adult patient should be asked to take a sitting position, and it is recommended to take the child in his arms);
elimination of puffiness (application antihistamines in tablet form);
normalization emotional state patient (it is important to reassure the patient, as panic attacks exacerbate breathing problems)
securing income fresh air(ventilation of the room, release from clothes restricting movement);
air humidification by hanging damp sheets, turning on hot water in indoors(in the bathroom), inhalation with a nebulizer (during inhalation, agents such as saline, soda solution, Pulmicort).

Treatment of stenosis of the larynx

The tactics of the prescribed treatment of pathology depends on the patient's condition, stage and cause of the disease. Applied therapies include:

medicinal methods elimination of the symptoms of the disease, which depend on the provoking cause;
tracheotomy (for critical conditions);
intubation (non-invasive procedure for widening the lumen using a special tube);
surgical intervention with an instrumental method or with a laser (used to treat chronic or congenital form);
inhalation using humidified oxygen;
physiotherapy procedures (quartz tube, electrophoresis).

The purpose of drug therapy is to alleviate the patient's condition, eliminate the pronounced symptoms of hypoxia. The main prescribed drug groups of drugs are:

	Preparations	Daily dosage, number of doses per day (times)	Course duration, days	Mode of application
Glucocorticosteroids	Prednisolone			Intravenously
	Hydrocortisone			Intravenous, intramuscular
	Dexamethasone	Up to 80 mg 3-4		Intravenously
Antihistamines	Loratadine			Intravenously
	clemastine			Intravenous, intramuscular
	cetirizine			oral
Antibacterial	Cefixime
	Amoxicillin	20-40 mg/kg, 3		Intramuscular
	Cefuroxime	750-1500 mg, 2-3		oral
Non-steroidal anti-inflammatory drugs, antipyretics	Paracetamol	10-15 mg/kg, 1-3	one time
	Ibuprofen	10-30 mg/kg, 1-3	one time
	Ketorolac			Intramuscular
Anticholinergics				Intravenously, intramuscularly, orally
Bronchodilators	Aminophylline	3-10 mg/kg, 2-3
tranquilizers	Diazepam			Intravenously

To relieve swelling in the case of an allergic disease, apply antihistamines. Medicines must have quick action due to the rapid development of the attack and not cause side effects that aggravate the patient's condition. One of the effective medicines of the new generation is Levocetirizine:

name: Levocetirizine;
characteristics: 2nd generation antihistamine, belonging to the group of histamine antagonists, the active substance levocetirizine dihydrochloride inhibits the migration of eosinophilic granulocytes (pro-allergic), thereby reducing the manifestation of an allergic reaction, has an anti-exudative effect, the drug helps to quickly eliminate reporting, the drug can cause nausea, dryness in mouth, pain in epigastric region, short-term visual disturbance;
indications: allergic reactions, rhinitis, idiopathic urticaria, angioedema;
contraindications: pregnancy, lactation period, galactose intolerance, childhood up to 6 years;
method of administration: tablets are taken orally 1 time per day, daily dose is 5 mg (1 tablet), the time of admission is morning (on an empty stomach or with food);
advantages: no pronounced sedative effect, rapid anti-allergic action;
disadvantages: the presence of side effects.

Acute laryngeal stenosis requires prompt medical care. Saluretics or osmotic diuretics are used to relieve swelling. Furosemide is one of the most prescribed drugs during stricture attacks, due to its rapid decongestant action:

name: Furosemide;
characteristics: a potent saluretic, the active substance of the drug, reacting with sodium and chlorine ions, disrupts their reabsorption, due to which the excretion of potassium, calcium and magnesium from the body increases, hypotension, dehydration, hypokalemia, dizziness, convulsions are common side effects;
indications: edematous syndromes different origin, post-traumatic edema, intoxication, pulmonary edema;
contraindications: insufficiency of renal or hepatic function, pregnancy (1st and 3rd trimesters), low levels of potassium, sodium in the blood;
method of application: the drug is administered parenterally (intravenously or intramuscularly) 1-2 times a day, the maximum daily dose for adults is 240 mg, for children - 6 mg per 1 kg of body weight;
advantages: fast-acting effect;
Disadvantages: Concurrent use of other drugs is contraindicated.

Treatment of children

An attack of stenosis in a child requires the immediate elimination of asphyxia and elimination respiratory failure. The prognosis of the treatment of the disease depends on the timeliness of detection and the correctness of determining the signs of stricture. Assigned therapeutic measures are determined based on the stage and cause of the onset of symptoms of suffocation. Mild forms of the disease (stages 1 and 2) involve drug treatment in a hospital regime under constant medical supervision.

Medicines during the treatment of an ailment in children are prescribed based on the results of the diagnosis and determination of the cause of the development of the disease. Can be used during therapy following groups medicines:

anti-inflammatory - Panadol, Propyphenazone;
antipyretics - Nurofen, Paracetamol;
antihistamines - Fenistil, Zirtek, Zodak, Suprastin;
antibacterial - Ampicillin, Tetracycline, Streptomycin;
glucocorticoids - Prednisolone, Ketoconazole.

Due to the high sensitivity of the child's body to all kinds of allergens, an allergic reaction is a common cause of an asthma attack. In this case, antihistamines are used to eliminate the symptoms. One of the drugs with a long-term antiallergic effect is Zodak, which is prescribed for children from 6 years of age:

name: Zodak;
characteristics: a new generation drug with a prolonged effect, influencing early phase allergic reaction, the active substance cetirizine dihydrochloride does not affect the physiological effects of serotonin in the body, therefore it does not cause sedative action, side effects occur in rare cases and consist in drowsiness or, conversely, excessive activity, dry mouth and urinary retention;
indications: symptomatic treatment allergic diseases(urticaria, rhinitis, conjunctivitis);
contraindications: insufficiency of kidney function;
method of application: the preferred form of the drug is tablets, taken orally, 0.5 pcs. 2 times a day;
benefits: rare side effects;
disadvantages: not suitable for the treatment of children under 6 years of age.

If the child's condition is complicated by the appearance of severe swelling of an allergic or other nature, he is prescribed dehydration therapy. To remove excess fluid from the body, catabolism products and toxins formed in conditions of painful shock, the use of osmotic diuretics is recommended, which do not affect the enzymes of the renal tubules. One of these drugs is Mannitol:

name: Mannitol;
feature: strong osmotic diuretic, promotes an increase in the osmotic concentration of blood, causing the movement of fluid from tissues into vascular bed, has a less pronounced natricretic effect than drugs of other groups, in large doses may cause side effects such as indigestion, hallucinations;
indications: high blood pressure, edema various etiologies, congestive glaucoma;
contraindications: dysfunctional disorders of the kidneys, severe violations blood circulation;
method of application: the drug is administered intravenously in the form of a 10-20% solution, the maximum daily dose is 180 g;
Benefits: high efficiency, absence negative impact on renal function;
disadvantages: constant monitoring of the water-salt balance is required.

Along with drug therapy performance of inhalation actions is shown. These measures contribute to the normalization respiratory function and the resumption of natural gas exchange in the lungs. Inhalation is carried out in a hospital. In the presence of inhalation devices (nebulizer), it is permissible to perform the procedure at home. Manipulations should be carried out at intervals of 8 hours, it is recommended to use pure oxygen or a special Pulmicort solution as the basis for inhalation.

At the stage of decompensation urgently a tracheotomy is performed to restore normal gas exchange and stabilize cardiac activity. With asphyxia (at the terminal stage), a number of resuscitation measures are performed (intracardiac administration of adrenaline, artificial ventilation of the lungs, etc.) and conicotomy is performed. At all stages, it is important to limit the motor activity of the child. For this purpose, sedative drugs are used (Droperidol, Phenibut, Pantogam).

Treatment of the disease in a hospital

Patients who are in serious condition or if their well-being has not improved after drug therapy are shown to carry out emergency measures. Surgical intervention and postoperative monitoring of the patient's condition is carried out in a hospital. The type of intervention is prescribed based on the severity of symptoms, the localization of the pathology and the presence of concomitant ailments. The main methods of the operation are:

	Indications for carrying out	The essence of the operation	Possible Complications
Tracheostomy	Acute and chronic stenosis, severe hypoxia, persistent respiratory dysfunction	The intervention is performed by layer-by-layer incision of the skin, opening the tracheal cartilage and installing a tracheal dilator	Bleeding, emphysema, trauma to the esophagus, vein, posterior wall of the trachea, aspiration pneumonia (blood entering the bronchi), damage to the pharyngeal mucosa, tracheal rupture, asphyxia
thyrotomy	Acute and chronic form of an infectious disease	Dissection of the thyroid cartilage located in the neck
Cricoconicotomy	emergency measure with an acute attack of suffocation	Dissection of the conical ligament located between the cricoid and thyroid cartilage with tracheostomy tube fixation
Cricotomy	Prevention of death from asphyxia, performed in case of impossibility of tracheostomy or ntubation	Opening of the larynx followed by dissection of the narrowed part (arc) of the cricoid cartilage
Intubation		Introduction through the mouth or nose into the trachea of the endotracheal tube using a laryngoscope

Forecast

The effectiveness of the treatment of pathological narrowing of the larynx depends on a number of factors, which include the causes and form of the disease, the adequacy and timeliness of the prescribed therapeutic measures. If the attacks of stenosis were stopped in time, the prognosis for recovery is favorable, but complications after the treatment (especially after surgery) are not excluded.

After the elimination of the symptoms of the acute phase of the disease, it is necessary to carry out further treatment diseases that provoked an attack. If the causative factor is a viral or bacteriological agent, in further patient will be subject frequent illnesses infectious nature (laryngotracheitis, bronchitis, otitis media, sinusitis, etc.). After insertion of endotracheal tubes, early or late complications in the form of scarring of tissues damaged during surgery or pathologies of organs adjacent to the larynx.

If the stenosis was not recognized in time, the disease can become chronic, which is fraught with the development of stable hypoxia. The consequence of not receiving the required amount of oxygen is a decrease in the body's immune defenses, the development concomitant diseases and the formation of irreversible suppurative processes (bronchiectasis).

Stenosis of the larynx is extremely dangerous for a person, because its development leads to problems with breathing and suffocation of the patient. The disease is typical for both adults and children. How to recognize and get rid of pathology?

What is stenosis of the larynx

Stenosis of the larynx leads to blockage of the airways and suffocation

Stenosis is partial or complete narrowing of the airways, resulting in breathing problems. During the development of pathology, other functions are also violated - protective and voice.

In adult patients, the disease depends on the state of the body. In some people, stenosis develops slowly and secretly, in others, manifestations are rapidly increasing - poor breathing and oxygen deficiency.

In children, stenosis proceeds in the same way as in adult patients, but the body of babies is more difficult to tolerate pathology. Parents should monitor the condition of the child, provide him with conditions for recovery. Most often, pathology appears in preschool children.

Video about the disease

Disease classification

The clinical picture depends on the form of stenosis. Combining a large number of types of disease common factors, there are two main forms of pathology:

acute;
chronic.

The acute form of stenosis is characterized rapid development and flow. Pathology appears suddenly, the patient's respiratory function is sharply disturbed. In some cases, stenosis develops within a month.

In the acute form, all the functions of the larynx suffer, since the body cannot quickly respond to the changes that have occurred. The acute phase is dangerous, because when the airways are narrowed, the protective mechanism does not work, which can cause respiratory arrest.

If the disease develops for a long time, then the body has time to activate defense mechanisms. This does not mean that the disease has disappeared - the patient's oxygen level in the blood and tissues decreases. Such a course is typical for chronic form, during which the airways change gradually. The duration of development of the chronic type of stenosis is more than 1 month.

Also, pathology is divided into forms, depending on the cause of the development of the disease:

paralytic stenosis. Pathology occurs when there are problems with the conduction of a nerve impulse. This occurs when a tumor of a neighboring organ develops or during compression of a nerve related to the larynx.
tumor stenosis. The reason for the formation of the presented form is a tumor in the larynx.

There are also cicatricial stenoses of the following types:

Post-infectious. Occurs after an infection.
Post-intubation. It is formed after prolonged use of the artificial lung ventilation system (with the introduction of a special tube into the trachea) or after resuscitation.
Post-traumatic. The reason for the formation is a trauma to the larynx or a surgery.

Depending on the localization of the pathological narrowing, the following types are distinguished:

pathology of the subvocal space;
stenosis of the glottis;
posterior stenosis - affected back wall larynx;
anterior stenosis - the anterior wall of the larynx is involved in the pathological process;
extended view - the pathological process extends to the trachea;
total view - stenosis is formed in all parts of the organ;
circular stenosis - with circular compression of the tube of the larynx, a narrowing occurs.

According to the nature of the changes that have occurred, such forms are distinguished as:

limited - the disease is represented by a favorable course, the restorative function is not impaired;
common - scarring occurs, tissues are damaged, the prognosis is unfavorable.

Causes

lead to stenosis of the larynx various factors- from trauma and intervention of a surgeon to an allergic reaction and diseases of the organ.

acute form

The development of acute stenosis occurs in the following cases:

on hit foreign object into the respiratory tract;
after inhalation of vapors of caustic substances;
as a result of the development of an allergic reaction;
with trauma to the larynx or mechanical compression;
as a result of the development of an infectious-inflammatory process (diphtheria, scarlet fever, measles).

In children, stenosis often occurs after prolonged intubation. Premature babies after birth cannot always breathe on their own, so doctors resort to the help of an artificial breathing system. A tube is passed into the trachea, which can injure the larynx. The incubation type is also characteristic of older people who experience breathing problems and need to carry out such a procedure frequently.

Chronic form

The chronic form has its own causes of formation and risk factors:

severe illness and hereditary pathologies that lead to immunodeficiency;
development in the region of the larynx of formations of a benign and malignant nature;
the occurrence of an inflammatory process in the perichondrium (a complication of perichondritis of the larynx);
thyroid surgery and damage to the pharyngeal nerve.

Symptoms and signs at different stages of the condition

At the first signs of stenosis of the larynx, you should seek medical help.

Manifestations of stenosis depend on the stage of development of the condition and the age of the patient. The compensation stage in adults is characterized by the following features:

deep and rare breathing;
the occurrence of shortness of breath while walking, and in some at rest;
slow heartbeat;
the presence of short pauses between inhalation and exhalation.

Stage 2 (partially compensated) is characterized by manifestations:

at rest, shortness of breath occurs;
the skin turns pale;
breathing becomes noisy and wheezing;
behavior changes (general arousal);
it becomes difficult to inhale;
the chest is retracted during breathing;

During the development of stage 3 (decompensated), the following symptoms appear:

going down blood pressure;
sweating increases;
the skin tone changes (a pale bluish tint appears, sometimes the cheeks remain reddish);
shortness of breath occurs at rest and during exercise;
breathing quickens (becomes shallow).

During decompensation, the patient tries to take comfortable posture: lie down or sit down.

The last stage is asphyxia (suffocation), in which the following symptoms occur:

frequent pulse, which may not be palpable;
pale gray skin tone;
intermittent breathing (complete stop is possible);
loss of consciousness;
convulsions;
involuntary bowel movements and urination.

Children have some differences - at rest, the signs do not appear. In the first stage, the respiratory rhythm changes. Shortness of breath often occurs during screaming or crying. With incomplete compensation, the behavior of the child changes: he is restless, capricious, often cries. As with adults, there is noise during breathing.

At the stage of decompensation, the child throws back his head, his eyes open wide. The patient is frightened, often asks for help. Trying to make breathing easier also leads to a desire to get into a comfortable position. During this stage, children tire quickly. As a result of tissue hypoxia (insufficient oxygen supply), arrhythmia (violation of the heart rate) or tachycardia (increase in the frequency of contractions) occurs.

At the stage of suffocation, the baby is exhausted. Facial features are sharpened, blood pressure is reduced, the phalanges of the nails turn black. Convulsions occur during exercise.

Diagnostics

If symptoms of stenosis of the larynx occur, you should immediately consult a doctor. The doctor analyzes the patient's complaints, paying attention to such points as:

the presence of shortness of breath;
nature of breathing;
the presence of concomitant diseases (previously or at the moment), which could cause the formation of stenosis.

During the examination, the doctor feels the neck for tumors and evaluates for signs of respiratory failure. To clarify the diagnosis, such methods are used instrumental diagnostics, how:

Also used and laboratory facilities diagnostics. A swab is taken from the pharynx, which is sent for research. This is necessary to identify the nature of microorganisms if an infectious disease has become the cause of the formation of stenosis.

Treatment

Providing first aid at home

Treatment of stenosis is a necessary measure, but the acute form of the pathology develops rapidly. How to help the patient before the arrival of the doctor?

Emergency care when signs of acute stenosis appear is aimed at distracting the patient. Be sure to call an ambulance and provide:

Warm drink. The patient is provided with a warm liquid with alkali. Suitable mineral water or milk with baking soda - 1 tsp. soda per glass.
Access to fresh air. It is necessary to remove the respiratory obstruction associated with clothing (loosen tie or collar). Be sure to open windows to let in fresh air.
Air humidification. Humid air relieves suffocation - just hang wet towels in the room.
Inhalations. The procedure is also aimed at alleviating the patient's condition. For the manufacture of the composition 2 tsp. baking soda is dissolved in 1 liter of liquid. Inhalation of such vapor leads to improved breathing and cough relief.
Warm baths. Taking a bath calms the patient. The duration of the procedure is 10 minutes, the water temperature is not higher than 38 °C.

Medical therapy

For the treatment of stenosis, a conservative technique is used. Medicines and their dosage are selected only by a doctor, based on the age of the patient, his physiological characteristics and the causes of the pathology. The use of medicines on their own is strictly prohibited. Similar treatment will lead to disastrous results: increased suffocation, oxygen starvation and death.

Apply means traditional medicine also not recommended. Many components cause an allergic reaction, which, when signs of laryngeal stenosis appear, is extremely dangerous for the patient's health. In addition, such recipes are of secondary importance, get rid of stenosis using only folk technique, will not work.

Conservative tactics are used for stages 1 and 2 of laryngeal stenosis. At the compensated stage appoint:

Antihistamines (Suprastin, Fenistil, Diazolin) and glucocorticosteroids (Prednisolone). They are prescribed when stenosis occurs as a result of allergies. Medicines of this group eliminate edema and inflammation.
Bronchodilators. Aminophylline is used in tablet form.
Enterosorbents (Polysorb, Enterosgel). Used for food allergies.
Antibacterial drugs (Cefazolin, Amoxicillin, Cefuroxime) are used to eliminate the infection that caused the disease (tonsillitis, laryngitis, tonsillitis).
Antitussive drugs (mucolytics). Used Acetylcysteine, Ambroxol.
Anticongestants (Nafazolin and Naphthyzinum). Medicines eliminate the swelling of the mucous membrane and narrow the blood vessels.

If diphtheria is suspected, antidiphtheria serum is administered according to the method of Bezredka A.M.

During the development of partially compensated stenosis of the larynx, the following methods of treatment are resorted to:

Antihistamines. Apply Clemastine or Chloropyramine intravenously or intramuscularly.
Antitussives.
Hormone therapy. Assign Ingacort, Hydrocortisone and Prednisolone.
infusion therapy. The introduction of intravenous glucose-novocaine solutions (ratio of novocaine and glucose 1: 1) and glucose-salt solution (calcium gluconate and glucose).

Valerian, a tincture of valerian, familiar to everyone, has a calming effect. It is also used during the treatment of laryngeal stenosis.

To alleviate the patient's condition, inhalations are used:

1 tsp baking soda is dissolved in warm water(1 glass);
with difficult separation of mucus, 1 ampoule of Lazolvan per 10 ml of saline is used;
Naphthyzine 0.1% is used together with 10 ml of saline.

Medications in the photo

Operation

With the development of stages 3 and 4, doctors resort to emergency intervention - only an operation can save the patient's life. At stage 3, a tracheotomy is performed - the introduction of a tube into the trachea. This step makes breathing easier for the patient. If the patient has suffocation (stage 4 stenosis), then before the tracheotomy, the larynx is dissected - conicotomy.

The operation is not complete without preparation. Before the intervention, anesthesia is used - a solution of novocaine 1% with an admixture of adrenaline. A tube is inserted into the incision of the trachea and fixed with a bandage. Tracheostomy is not worn for longer than 3 days.

Installation of a tracheostomy tube, tracheostomy, will allow the patient to breathe freely

In addition to tracheotomy and conicotomy, other methods of surgical intervention are used:

Cricotomy. The operation is aimed at dissecting the arch of the cricoid cartilage.
thyrotomy. During the intervention, the thyroid cartilage is dissected.
Intubation. The technique is characterized by the introduction of a tube into the larynx. The method of treatment is used for the short-term nature of stenosis (respiratory pathology, convulsions). The tube is not left for more than 3 days. Otherwise, short-term stenosis will become persistent.

Surgical intervention is also indicated in the chronic form of stenosis. To eliminate the pathology, the larynx is expanded and stretched. In addition, an operation is prescribed, during which the resulting tumors and scars are excised. With paralysis of the larynx, they resort to removing the vocal cord and cartilage adjacent to it.

Possible complications and consequences

With the chronic development of stenosis, oxygen starvation occurs, because of this, many patient systems suffer, including the cardiovascular and nervous systems.

Often, patients experience a violation of the rhythm of breathing, and this can be a prerequisite for the occurrence or. Lack of treatment only exacerbates the situation, increasing the likelihood of developing chronic bronchitis and bronchiectasis (irreversible lung enlargement).

The presence of a respiratory disease in stenosis impairs the efficiency of the patient's defense mechanisms. The body cannot adapt to the created conditions, and the patient's condition worsens.

Complications also occur after surgery:

Postoperative aerophagia develops (swallowing air, which leads to belching).
A hasty incision when inserting the tube leads to trauma to the trachea.
Incorrect placement of the tube leads to injury to the isthmus of the thyroid gland or esophagus. There is bleeding.
Bleeding leads to aspiration pneumonia because blood enters the respiratory tract.
The erroneous selection of a tracheotomy tube and its incorrect wearing adversely affect the function of breathing.

Prevention measures

Prevention is extremely important, since this condition is easier to prevent than to treat both it and the complications that have arisen. The following recommendations must be observed:

get rid of bad habits(smoking) and prohibit others from smoking indoors;
prevent insect bites - to avoid allergies;
follow a diet and regimen;
reduce the content of allergens in the room (ventilate the room, often carry out wet cleaning);
use medicines carefully and only after being prescribed by a doctor;
change their place of residence in case of poor environmental conditions.

Stenosis of the larynx is dangerous with the onset of suffocation and respiratory arrest. Relatives of a sick person need to master the rules of first aid, and healthy people need to avoid exposure to provoking factors that can lead to swelling of the larynx and the development of pathology.

Today, with timely diagnosis, it is possible to prevent and cure almost any disease. The diagnosis of stenosis of the larynx is made with partial or complete narrowing of the lumen of the larynx, which leads to difficulty breathing in an adult or child, as a result of which a doctor prescribes treatment. There are only two stages of the disease: chronic and acute. In the acute course of the disease, you should immediately seek help from a specialist. Refusal of treatment can lead to a serious threat to a person's life.

What is stenosis of the larynx

Diagnosis Stenosis is the process of narrowing of the larynx, which can lead to obstruction of the passage of air. The disease is divided into two types according to the nature of development: acute and chronic. The causes of acute stenosis can be attributed to both inflammatory diseases of the throat and physical injury. Pathological narrowing of the larynx may occur due to:

allergic reaction;
infectious disease;
hits foreign body in the throat, after which it may swell;
due to the tumor process;
SARS;
false croup.

The disease has the following varieties: cicatricial stenosis, stenosis of the extrathoracic respiratory tract, etc. For example, the cicatricial type is a complication of infectious diseases (abscess, lupus, etc.), injuries (burns, blunt injuries, wounds) that provoke cicatricial obstruction of the larynx and the development of a syndrome of chronic insufficiency of the respiratory function of the larynx. Sometimes the cause of cicatricial stenosis can be surgical intervention.

Symptoms

The main symptoms of the disease depend on the stage of the disease. Temperature in most cases may be absent. Doctors divide the disease itself into 4 stages, in which such signs of stenosis are noted:

stage of compensation. At this stage, symptoms such as falling out of a pause between inhalation and exhalation become noticeable, the inhalation becomes longer, the number of breaths becomes rare, the voice begins to wheeze, noise appears on inspiration, and the heart rate decreases.
subcompensation stage. During this stage, the following symptoms are observed: signs of hypoxia, shortness of breath increases, when inhaling, retraction of the intercostal spaces, jugular, supraclavicular and subclavian fossae is noticeable, the mucous membrane and skin become bluish, the patient behaves uneasily, appears cold sweat, breathing becomes more frequent, the noise intensifies.
stage of decompensation. When inhaling, the larynx begins to move down, and when exhaling upwards, breathing becomes noisy, the face is pale, cyanosis begins to appear, cyanosis of the lips, fingertips, nose, the pulse quickens, the ability to fully breathe becomes critically difficult.
Stage of suffocation or asphyxia. Cardiac activity falls, breathing is rare and intermittent (reminiscent of Cheyne-Stokes syndrome), the skin becomes pale gray, the pupils are wide. This is the last stage of stenosis, in which the patient becomes lethargic, does not show activity, loses consciousness, breathing stops, eyes bulge (exophthalmos), involuntary urination and excretion of feces. The pulse is thready, cardiac activity falls, death occurs.

Acute stenosis

As a rule, acute stenosis in children is formed within one month. His symptoms come on suddenly compensatory mechanisms fail to form. The body is not able to adapt so quickly to difficult breathing and lack of oxygen, as a result, all its processes and functions suffer. If you do not quickly seek help, the disease can provoke a fatal outcome of the patient.

Chronic

different forms diseases manifest themselves in their own way. The chronic course of the disease is characterized by the slow development of symptoms that parents do not always pay attention to. During the gradual onset of symptoms human body adapts to respiratory disorders and lack of air. The cause of the chronic form can be: cicatricial narrowing of the trachea, tumor processes, development of granulomas, impaired innervation of the laryngeal fissure.

Symptoms in children

The main symptoms of the disease in a child proceed like general signs. The disease is divided into four stages with similar characteristics for adults and children:

Stenosis of the 1st degree in a child:

noise is heard in breathing when inhaling;
shortened pause between inhalation and exhalation;
moderate retraction of pliable places in the chest area;
slight cyanosis of the nasolabial triangle;
expansion of the nostrils;
hoarse voice;
may arise purulent inflammation, catarrhal laryngitis;
the lumen of the larynx is narrowed by ¼ - ⅓.

Stenosis of the second stage:

the child is naughty, may be lethargic;
noises in breathing;
swelling of the wings of the nose;
neck muscles tense;
the larynx moves synchronously with exhalation and inhalation;
skin is moist, pinkish or pale;
when inhaling, tachycardia is observed;
constriction of the larynx by ½.

Stenosis in children of the third stage:

serious condition;
apathy, anxiety, fear;
shortness of breath with prolonged inspiration with noise;
retraction of the supraclavicular and thoracic fossae;
pause between inhalation and exhalation;
cyanosis of the nasolabial triangle, fingertips, lips;
pale skin, cold sweat;
constriction of the larynx by almost ⅔.

Stenosis in children of the fourth stage:

serious condition;
pale gray skin;
cyanosis;
the temperature is lowered;
pupils are wide;
convulsions;
involuntary urination, fecal discharge;
breathing is frequent, intermittent;
thready pulse;
drop in cardiovascular activity;
cardiac arrest, respiratory arrest may occur;
constriction of the larynx by more than ⅔.

The reasons

Acute constriction of the larynx is not separate species disease, but is considered a symptom complex that occurs as a complication of various pathological phenomena. The most important causes of pathology are infectious diseases:

measles;
malaria;
scarlet fever;
syphilis;
tuberculosis;
flu, etc.

Local exogenous causes of occurrence include: foreign bodies of the larynx, mechanical and chemical injuries of the larynx, gunshot wounds, medical manipulations. Local endogenous factors due to which the disease can develop include:

congenital defects;
inflammatory processes;
tumors;
paresis of the larynx;
thyroid problems.

Classification

The disease can last as: acute, subacute, protracted, complicated. Further, it is divided into four stages: compensated stenosis, subcompensated, decompensated, asphyxia. According to the location of the inflammatory process, such types of the disease are distinguished as:

epiglottitis;
supraglottic laryngitis;
subglottic laryngitis;
laryngotracheitis;
laryngotracheobronchitis.

Stenosis can be classified according to the nature of the inflammation. Allocate the following forms diseases as the pathology develops:

catarrhal;
fibrinous;
purulent;
ulcerative necrotic;
hemorrhagic;
herpetic;
mixed.

Diagnostics

Through history, clinical picture illness and examination can be carried out general diagnostics pathology. The doctor must find out in detail the symptoms, the time, the circumstances under which they occur, the dynamics of the development of the disease, its nature. The first thing they pay attention to during examination: shortness of breath, retraction of certain places in the chest area, changes in voice, cough, cyanosis.

First aid

As soon as the first symptoms appear, parents should immediately provide first aid to the child, and it is worth calling an ambulance team. Even if a person helped the patient cope with an attack and all the symptoms have disappeared, it is worth waiting for the arrival of specialists. Before the ambulance arrives, use following methods:

Arrange the patient reclining, try to stop the panic, which may be accompanied by an attack of stenosis.
Take off too warm clothes, ventilate the room.
Press with a spoon on the root of the tongue.
Make an inhalation with saline, mineral water Or let the hot water faucet breathe steam.
Rub the calves of the legs, you can make a bath with hot water - steam the legs. This will help drain blood from the upper body.
Give the patient an antihistamine.
In a very serious condition, you need to inhale with a glucocorticosteroid (Hydrocortisone, Pulmicort) or give an injection of Prednisolone.

Treatment

Therapy for stenosis is successful in the first and second stages of the disease. The doctor prescribes medications, in some cases it is necessary to apply therapy according to a certain system and under the supervision of a specialist at the hospital. An indicative list of treatments includes:

glucocorticosteroids, desensitizing, antihistamine drugs in injections, later they are taken in the form of tablets;
antibacterial drugs in injections, if an infectious component is present;
NSAIDs at high temperature;
administration of antidiphtheria sera;
applications sedatives if there is a problem in the form of patient anxiety.

In the third stage of the disease, hospitalization is carried out or the patient is transferred to intensive care. Doctors prescribe direct laryngoscopy followed by nasotracheal intubation, stay in a steam-oxygen tent until respiratory failure is relieved, and continue the therapy indicated in the second stage. At the fourth stage of the pathological process, resuscitation measures are taken.

Treatment of the disease in a hospital

In the first two stages of the disease, treatment is carried out in a hospital. Dehydration therapy is carried out for edema, antihistamines, corticosteroids are prescribed. In the presence of inflammatory processes, massive antibiotic therapy, anti-inflammatory drugs are prescribed. In diseases such as diphtheria, it is necessary to administer a specific serum.

Complications

In chronic stenosis, stagnation can be noted - sputum, which provoke frequent bronchitis and pneumonia. In patients with a tracheostomy, the incoming air does not go through the stages of possible warming, cleaning, which may accompany tracheitis and tracheobronchitis. All diseases of the respiratory tract against the background of chronic stenosis will proceed in complex, protracted forms. Pulmonary hypertension may develop cor pulmonale.

Forecast

If you seek help at the initial stage of the disease, carefully monitor the general health of the child, the prognosis will be favorable. With timely treatment and the implementation of all recommendations, the patient's health can be quickly restored. If you seek help for acute stenosis of the throat, the prognosis for the development of the disease depends on the qualifications of the medical staff and the equipment of the hospital. In no case should you start the disease, since the fourth stage threatens lethal outcome, especially for small child.

Prevention

To prevent the disease, it is necessary to maintain a healthy lifestyle. Prevention consists in following the basic recommendations, which are described below:

take precautions when taking medicines that can cause an allergic reaction and lead to difficulty breathing;
ensure the maximum absence of allergens in the life of a person who is predisposed to stenosis;
avoid injury to the larynx, inhalation of hot or dangerous vapors;
if an operation (tracheotomy) was performed, it is necessary to regularly examine the ENT.

Video

Stenosis of the larynx in adults and children is manifested partially or completely. This pathology refers to the pathological narrowing of the larynx.

If the pathology develops over a short period, provoking general hypoxia, then the doctor makes a diagnosis of "acute stenosis". What is stenosis of the larynx, presented in a chronic form? This pathology develops slowly, but differs from the acute form in its persistence.

If the lumen narrows gradually and slowly, the body can adapt to the reduced intake of air masses. Stenosis of the larynx, which develop in a short period, threatens the life of the patient.

Causes of pathology in adults:

prolonged IVH,
larynx injury after surgery, wounds,
traumatic brain injury contributes to the development of paralysis of the larynx,
thyroid tumors are common causes of laryngeal stenosis,
complication of purulent inflammation,
allergy - at the same time the patient's larynx swells,
a consequence of a thermal or chemical burn.

Causes of stenosis in children:

in children under 3 years old, the pathology in question develops against the background of laryngotracheitis, which is viral nature. Causes of laryngotracheitis - influenza, parainfluenza,
anatomical features - in children, unlike adults, there is a funnel-shaped larynx with a small lumen and large quantity glands,
cerebral hemorrhage after birth injury,
cyst.

The reasons congenital disease with a normal structure of the organ, they are associated with a violation of the ligaments between the centers of respiration and swallowing at the level of the brain. With stenosis of the larynx, the position may be disturbed this body(omission). Additional causes of illness:

prolonged resuscitation with artificial ventilation of the lungs - if the child was born prematurely or a severe pathology was detected,
respiratory tract damage
complication of SARS,
consequences of a purulent inflammatory process in the larynx,
alkali or acid inhalation,
tumor.

Clinical picture

Chronic and acute stenosis of the larynx depends on the age and condition of the patient, the level of his activity, the degree of narrowing of the organ. If the child was born prematurely, while there is problematic breathing, then pediatricians perform multiple intubations. Such manipulations are the main causes of laryngeal stenosis in newborn premature babies.

The chronic process is caused by several pathologies - this is a disturbed innervation of the organ, scars and a tumor, an infectious granuloma. Taking into account the period of formation, there are:

acute clinic (formed within 1 month) - occurs suddenly, which prevents normal development compensatory mechanisms,
chronic clinic - is formed during 1 month.

Taking into account the cause of the development of pathology, there are the following forms:

Pathological - due to a violation of the innervation of the organ.
Cicatricial - this form of the disease is classified into post-traumatic, post-intubation, post-infectious.
Tumor.

According to the degree of prevalence and localization, anterior, posterior, circular, extended, total and compensated stenosis of the larynx is distinguished. There are 4 stages:

compensation stage - deep breathing, in which the pauses between exhalation-inhalation are shortened,
stage of partial compensation - noisy breathing in which breathing is difficult. The intercostal spaces are retracted. Skin covering turns pale. Subsequent symptoms of the disease increase rapidly. Therefore, with ineffective conservative therapy at stage 2 stenosis of the larynx is carried out surgical intervention. This method of treatment is aimed at restoring patency in the respiratory system,
stage of decompensation - the patient is in a serious condition, often in a semi-sitting position and his head thrown back. Breathing becomes noisy, and the larynx moves as much as possible up and down,
stage of suffocation - there is a sharp fatigue, drowsiness. Intermittent breathing is observed. The patient may lose consciousness, involuntarily urinate.

Diagnostic and therapy methods

To diagnose stenosis of the larynx, the doctor analyzes the complaints and anamnesis of the disease. Then carried out general inspection sick. The doctor feels the neck for the presence of a tumor formation. If stenosis of the larynx is suspected, laryngoscopy is indicated. This diagnosis determines the degree of narrowing of the organ and possible cause development of pathology.

Endoscopic diagnosis is carried out using an endoscope. This technique determines the prevalence and localization where the larynx narrows. The doctor examines the functionality external respiration. If the diagnosis is difficult, a radiological examination (MRI, CT) is performed. Based on the data obtained, an appropriate treatment of laryngeal stenosis is carried out.

Shortness of breath is the main symptom of the disease. When it appears, a qualified health care. To humidify the air, wet bedding is hung in the room. You can rub your hands and feet.

Patients with an acute form and CD are hospitalized. Treatment is prescribed taking into account the cause of the disease. If the pathology was provoked by an allergy, then antihistamines and glucocorticoids are taken. The action of the latest medicines is aimed at relieving swelling and inflammation.

If a foreign body is present in the larynx, it is removed. With infectious stenosis, medications are indicated that relieve swelling. At the same time, they take medications that make breathing easier. If the airway has recovered, then antibacterial or antiviral therapy is performed.

Additional therapies

Stenosis of the larynx - what it is should be known to those at risk of respiratory pathologies. When choking, a tracheotomy is performed. This manipulation is as follows: the doctor cuts the front surface of the neck. With the help of a tube inserted into the cavity, the patient breathes. If necessary, intubation is performed. In this case, the doctor inserts a tube into the larynx, which expands its lumen. The tube is removed after 24 hours.

If the stenosis is chronic or congenital, surgery is indicated. The manipulation is as follows: the surgeon excised scars and tumor from the larynx, implants stents. You can treat a paralyzed larynx by removing the vocal cord with cartilage. Most often, this operation is performed using a laser.

The complications of the disease include:

disruption of the NS, heart and vascular system,
against the background of a respiratory infection, decompensation develops, in which the body is unable to adapt to the conditions of this pathology,
fatal outcome.

To prevent the development of stenosis of the larynx, it is recommended to diagnose and treat in a timely manner. URT diseases, infectious processes. Throat injury must be avoided. Do not breathe acrid smoke, alkalis and acids. It is forbidden to inhale hot air.

When operating on the larynx, the doctor must use a gentle method, avoiding prolonged intubation. The imposition of a tracheostomy is carried out only on urgent indications in order to restore respiratory function. After surgical treatment, patients are regularly observed by an otolaryngologist.

Stenosis of the larynx leads to impaired breathing and insufficient air permeability to the lungs. If the patient does not receive emergency assistance pathology leads to death.

The disease may be acute or chronic course. At serious condition the patient, when it is impossible to restore normal breathing in a short time, an emergency tracheostomy is performed.

What is stenosis of the larynx

Acute stenosis of the larynx is a sharp narrowing of the larynx, in which the flow of air into the lungs is significantly hindered or becomes completely impossible.

Depending on the degree of constriction, there is either a partial violation of breathing, or a complete stop.

Cicatricial stenosis of the larynx has a chronic course and occurs mainly after its injury, which leads to scarring of the tissues. The condition develops gradually, and treatment most often begins before the moment when a threat arises for the life of the patient.

At timely detection symptoms and the development of the pathological process, it is possible, even in the acute form of the disease, to provide the patient with timely assistance.

In adults, the symptoms of laryngeal stenosis are as follows:

noisy breathing;
difficulty in inhaling and exhaling - this difficulty is especially pronounced on exhalations;
failure of the rhythm of breathing;
breathing with the involvement of the shoulder girdle or arms in order to facilitate the passage of air;
pronounced retraction of areas between the ribs;
retraction of the dimples above the collarbones;
hoarseness of voice;
acute sense of fear;
anxiety;
increased heart rate;
blue face and fingers, profuse sweat, disruptions in work Bladder and intestines - appear in last stage when acute oxygen starvation develops, which, without urgent medical assistance, leads to death within a few minutes.

With pathology, the state of suffocation increases gradually over some time. To save the life of the patient, it is important to call an ambulance at the first sign of pathology, and before the arrival of doctors, provide the patient with the necessary medical care.

The reasons

The narrowing of the lumen of the larynx occurs for the following reasons:

inflammation of the larynx;
false or true croup;
acute stage of laryngotracheobronchitis;
phlegmous laryngitis;
allergic edema of the larynx;
a tumor process in the throat, leading to swelling and narrowing of the lumen of the throat;
chondromicrychondritis;
viral infections affecting the throat;
syphilis;
malaria;
tuberculosis of the lungs, especially at the time of a coughing fit.

In rare cases, a pathological condition can be triggered by a foreign body entering the throat and trauma.

Most often, pathology occurs in premature babies who have been on a ventilator for a long time, and in persons for whom it was used due to illness, especially if its tube was inserted through the mouth without an incision in the trachea.

Degrees of stenosis of the larynx

Doctors distinguish 4 stages of stenosis of the larynx.

Respiratory failure is not severe. The patient inhales more deeply and heavily. Exhalation is abrupt. Even from slight physical exertion, shortness of breath develops. Stenosis of the larynx of the 1st degree does not require surgical treatment and is eliminated in most cases quite effectively.
At the 2nd degree of stenosis of the larynx, breathing becomes noisy, and at the same time, not only during movements, but also at rest. Shortness of breath is constant. The skin on the face is quite pale. Often there is increased blood pressure against the background of moderate oxygen starvation. When breathing, the muscles of the shoulder girdle are involuntarily involved. Stenosis of the larynx of the 2nd degree is regarded as a dangerous condition that requires urgent medical attention, but for now you can do without surgery.
At grade 3, breathing is seriously difficult. Shortness of breath is very strong, not passing. A person takes a forced position in which breathing becomes easier. Breathing is not deep and very frequent. Whistling sounds are well heard on exhalation. The pulse continues to rise seriously, and the pressure drops. There is profuse sweating and great anxiety in the patient. Medical intervention is urgently needed. Surgical treatment is possible.
The last terminal stage, in which, if immediate medical assistance is not provided, death occurs. The patient has a disturbed respiratory rhythm, the pulse becomes weak, but frequent, the skin is pale with blue. A convulsive state quickly develops and loss of consciousness occurs, accompanied by emptying of the bladder and intestines. After that comes death. Emergency surgical treatment. The incision of the larynx is carried out in any conditions and without anesthesia, for which there is no time.

In the early stages pathological condition, symptoms are associated with increased attempts by the body to restore normal level oxygen in the blood. In the later stages, changes appear that occur against the background of severe oxygen starvation.

Treatment of stenosis of the larynx

Laryngeal stenosis is less common in adults than in children due to anatomical features structures of the larynx. Symptoms of the pathological condition, regardless of age, are the same.

Acute treatment

Acute stenosis of the larynx, the treatment of which is not always surgical, at stages 1 and 2, and sometimes at the 3rd, can be eliminated with drugs. Treatment of laryngeal stenosis is carried out in a hospital, and the following means are used:

corticosteroid anti-inflammatory drugs;
antibiotics;
antihistamines;
psychotropic drugs - if there is an acute panic feeling.

If foreign objects are found in the throat, they are removed immediately. If suffocation has developed due to diphtheria, then the patient requires the introduction of anti-diphtheria serum.

Treatment of the chronic form

Treatment of the chronic form of the disease is carried out depending on the causes of its occurrence. If there are tumors, then without their removal, the narrowing of the larynx cannot be eliminated.

With chronic infectious lesions, after determining the pathogen (this requires taking a swab from the throat), treatment is carried out with antibiotics or antifungal drugs.

When there are scars in the larynx, they can be carried out surgical removal. If they are small and fresh enough, then physiotherapy is possible.

The patient must be under constant surveillance at an ENT doctor, since scars tend to increase in size and thicken, from which the lumen of the larynx will narrow.

For persons suffering from a chronic form of stenosis, laryngitis and other sore throats are especially dangerous, since they can develop an acute form of pathology in a short time.

Chronic stenosis of the larynx increases the risk of heart disease and hypertension against the background of a constant lack of oxygen in the blood.

Urgent care

Acute stenosis, the treatment of which begins late, is highly likely to end in death. As soon as symptoms of respiratory failure have been noticed, it is necessary to call an ambulance.

Prior to the arrival of doctors, emergency care for stenosis of the larynx should be provided urgently. With it, the following actions are necessary:

giving antihistamines, if possible - the funds not only help with swelling due to allergies, but also relieve swelling in general;
ensuring a sitting position;
humidification of the air in the room, for which wet sheets are hung;
inhalation with a solution of soda (1 tablespoon of soda is taken for 1 liter of boiling water) and at the same time a hot foot bath for 15 minutes;
giving warm alkaline water if the patient can drink.

AT emergency cases, if acute suffocation has developed, a tracheostomy may be required even before the arrival of doctors.

This should be done only if it is otherwise impossible to save the life of the patient. Usually, doctors in such a situation help by guiding the actions by phone. Such first aid for stenosis of the larynx should be carried out with a sharp knife or razor blade.

Prevention

It is possible to prevent stenosis of the larynx with timely and competent preventive measures. The main recommendations for this are:

timely treatment of inflammatory diseases of the throat;
if treatment within 5 days does not bring results, or, despite therapy, the patient's condition continues to worsen, an urgent visit to the doctor is required;
prevention of throat injuries;
Avoiding very hot food or drinks
to give up smoking;
prevention of inhalation of toxic and caustic vapors;
avoiding the presence of a breathing tube in the throat for more than 3 days, if there are no vital signs for this.

If acute stenosis has already begun to develop, you should immediately call an ambulance. It is from the efficiency of actions and the speed of obtaining qualified assistance the life of the patient depends largely.