LARYNGITIS AND KINDRED DIS ORDERS.
Definition and Varieties.—The term "laryngitis" means inflammation of the larynx; but to properly distinguish the various inflammatory disorders to which this organ is liable, several types of laryn gitis are recognized: Acute laryngitis, ill which the mucous membrane alone is supposed to be inflamed; oedema of the larynx, in which the deeper tissues be come infiltrated; symptomatic laryngitis, in which cedema and phlegmon may com plicate acute laryngitis as a result of microbic infection; chronic laryngitis, in which any of the lesions of inflammatory origin observed in the foregoing varieties have assumed chronicity. These types include several disorders to which indi N dual nanns e bt.sen given, but they appear to represent but stages or degrees of the classical forms.
Acute Laryngitis.
Symptoms.—Acute laryngitis in the n ajoritv of eases is the result of the tem Irarv extension of a chronic catarrhal roLess existing in neighboring tissues, e=peeially the nose, the pharynx, or the t lit professional singers, for in stance. constant traveling, with its at tending variations in climate and tem peratnre, frequent exposure to dust and smoke, etc., generally keep up catarrhal disorder of the naso-pharyngeal tract. The hyperminia thus induced readily ex tends by continuity of tissue to the vocal oremns under the influence of any undue exposure, dampness, cold, or any factor capable of irritating the laryngeal sur faces. The larynx in such cases may- be said to be predisposed to a mild form of catarrh which appears more or less fre quently. In such cases the subjective symptoms mainly consist in a constant desire to "hern' and a feeling of constric tim at the throat. The voice is altered in quality and pitch; it becomes gruff, and hoarseness, more or less marked, f )1lows. Under the influence of proper treatment and rest the local hypera2mia quickly subsides, but the continued use of the voice prolongs the inflammatory process and tends to permanently com promise the integrity of the organ as an instrument.
A laryngoscopical examination some times yields but little evidence of inflam mation, the interarytenoid space alone showing s14.dit hyperwmia. In the vast majority of cases, however, the entire larynx shows congestion, the vocal bands being. distinctly red. Much faith cannot be placed upon these signs, in the case of male singers, how-ever, the vocal banclq being frequently pink- and even red in the normal state; but in women, local redness usually means active congestion, unless the patient be addicted to excess ive use of alcoholic drink-s.
In persons in whom the voice is not subjected to more than ordinary uses, an attack of acute rliinitis frequently pre cedes the laryngeal disorder. When, however, the laryngitis is primary, hoarseness usually occurs as the first symptom, though slight chilliness occa sionally alluded to is a premonitory sign.
The voice is lowered in pitch, a pricking sensation is experienced in the larynx, which causes backing and aggravation of the local congestion. There is usually some cough, slight dyspneea, and occa sionally some pain during deglutition. There may be a slight rise of tempera ture. The expectoration, at first jelly like and viscid, becomes more copious. As this proceeds, the hoarseness becomes more marked and persists for some days, sometimes weeks.
When examined laryngoscopically the larynx is found inarkedly congested. The entire laryngeal membrane may be in volved, or the congestion may be limited to the vocal bands and the intra-aryte noid tissues, the redness gradually fad ing off toward the upper portion of the laryngeal walls., except posteriorly.
Some cases of acute laryngitis are at ' tended by ht-emorrhagic symptoms, the expectoration of blood usually following violent coughing. Besides the usual laryngeal manifestations, there is gener ally to be found a circumscribed patch, the seat of rupture of a superficial vessel. In some cases there is no expectoration of blood, but the vocal bands show a red spot, or localized ha2morrhagic infiltra tion. It sometimes shows itself inde pendently of a catarrhal condition as a result of undue strain in using the voice. I rt is probable, however, that a latent catarrhal process is always present in such cases, and that the vascular walls are inordinately weak.
Case of acute hwmorrhagie laryngitis and record of several cases hitherto pub lished. Cardonne (11 Progresso Medico, Apr., 'SS).
'hemorrhagic laryngitis is an acute catarrh of the larynx, accompanied by hternorrhage of the inflamed mucous membrane, owing to certain peculiar conditions, local or general. La Placa (Archivii Ital. di Larin., Oet., 'SS).
Case of litemorrliagic laryngitis in a healthy woman, 30 years of age, two months gone in pregnancy. Attention called to the fact that three out of six cases reported by Strtibing occurred in females during pregnancy or shortly after. Treitel (Deut. med.-Zeit., Feb. 9, '91).
Laryngeal hwmorrhage may be of rheu matic origin. Immobility- of the vocal cord, with consequent huskiness, is one of the commonest manifestations of the larynx. G. Hunter Mackenzie (Edin burgh Med. Jour., Dec., '94).
Laryngitis lintorrliagica attributed to the great swelling and hypetTlasia of the niucous membrane, the increase in size and number of the vessels, the lessened re sistance of their walls, and the frequent and periodically increased blood-pressure from coughing, hawking, etc.
Every idiopathic laryngeal catarrh is entitled to be termed "laryngitis litnor rhagica," which, without external cause, and with intact mucous membrane, is ac companied by limorrhages on or into the mucous membrane. S. Salzburg (Jour. of Laryn., etc., Oct., '97).
(See colored plate.)