LARYNGITIS, inflammation of the mucous membrane of the larynx. There are three chief varieties—acute, chronic and oedematous. The larynx is also liable to inflammation in tubercu losis and syphilis.
This may be independent or an extension from the nasal or bronchial mucous membrane. The chief causes are "catching cold," excessive use of the voice either in speaking or singing, inhalation of irritating particles, vapours, etc., and swallowing very hot fluids or corrosive poisons. It may also occur in measles and influenza. As a result of the inflammation there is a general swelling of the parts about the larynx and the epiglottis, the result being a narrowing of the channel for the entrance of the air, and to this the chief dangers are due. The symptoms vary with the intensity of the attack ; there is first a sense of tickling, then of heat, dryness and pain in the throat, with some difficulty in swallowing. There is a dry cough, with expectoration later; phonation becomes painful, while the voice is husky, and may be completely lost. In children there is some dyspnoea. In favour able cases, which form the majority, the attack abates in a few days, but the inflammation may become oedematous and death may occur suddenly from an asphyxial paroxysm. Many cases of acute laryngitis are so slight as to make themselves known only by hoarseness and the character of the cough, nevertheless in every instance the attack demands serious attention. In children the question of diphtheria must not be lost sight of. The treatment is rest ; no talking must be allowed. The patient should be kept in bed, in a room at an even temperature, and the air saturated with moisture. An ice-bag round the throat gives much relief, while internally diaphoretics may be given, and a full dose of Dover's powder if there be much pain or cough.
This follows repeated attacks of the acute form and is nearly always accompanied by granular pharyn gitis. It is common in people who habitually over-use the voice, and causes the hoarse voice of street sellers. The constant inhala tion of irritating vapours, such as tobacco smoke, may also cause it. There is usually little or no pain, only the unpleasant sensa tion of tickling in the larynx, with a constant desire to cough. The treatment consists in stopping the cause, where known, e.g., the smoking or shouting, and local application of astringents.
This is a very fatal condition, which may occur though rarely, in acute laryngitis. It is far more commonly seen in syphilitic and tuberculous conditions of the larynx, in kidney disease, in certain fevers, and in cases of cellu litis of the neck. The larynx is also one of the sites of Angeioneu
rotic oedema. There are all the symptoms of acute laryngitis on an exaggerated scale. The dyspnoea, accompanied by marked stridor, may arise and become dangerous within an hour. The mucous membrane round the epiglottis is enormously swollen.
The treatment is ice round the throat and scarification of the swollen parts; should that not relieve the symptoms, tracheotomy must be performed immediately.
This is practically always asso ciated with phthisis. The mucous membrane is invaded by the tubercles, which first form small masses and later caseate and break down. The first indication is hoarseness, or, in certain forms, pains on swallowing. Cough is, as a rule, a late symptom. A sudden oedema may bring about rapidly a fatal termination. The general treatment is that for phthisis; locally, the affected parts may be removed by one or a series of operations, generally under local anaesthesia, or they may be treated with some destructive agent such as lactic acid. The pain on swallowing can be best alleviated by painting with a weak solution of cocaine. The condi tion is a very grave one ; the prognosis depends largely on the associated pulmonary infection—if that be extensive, a very small amount of laryngeal mischief resists treatment and vice versa.
Invasion of the larynx in syphilis is very common. It may occur in both stages of the disease and in the inherited form. In the secondary stage the damage is super ficial, and the symptoms those of a slight acute laryngitis. The injury in the tertiary stage is much more serious, deep ulcers, which in healing form strong cicatrices, may produce stenosis of the air-passage requiring surgical interference. Occasionally a fatal oedema may arise. The treatment is that of the primary condition. (See VENEREAL DISEASES.) Paroxysmal Laryngitis, or Laryngismus Stridulus.—This is a nervous affection of the larynx that occurs in infants. It ap pears to be associated with adenoids and rickets. The disease con sists of a reflex spasm of the glottis with complete occlusion of the air-passages. The attacks, which are recurrent, cause acute as phyxia. They may cease for no obvious reason, or one may prove fatal. The whole attack is of such short duration that the infant has either recovered or succumbed before assistance can be called. After an attack, careful examination should be made, and the adenoids, if present, removed by operation.