Treatment.—The treatment of symp tomatic laryngitis does not differ from that of acute laryngitis or cedema of. the larynx when the local manifestations are such as to warrant assimilation with these disorders. As a rule, the laryngeal mani festations of infectious diseases are slight, but the possibility of complications in this direction should always be borne in mind, owing to the rapidity with which they may prove fatal when untreated.
Chronic Laryngitis.
Symptoms.—As a result of frequently repeated attacks of acute laryngitis, or of continued exposure of the larynx to con ditions capable of maintaining a pro longed hypennmia of the larynx, a chronic catarrhal process is developed. Exacerbations of hoarseness, a sensation of rawness and heat, and the presence in the laryngeal cavity of secretions—mu coid or muco-purulent—giving rise to a constant desire to "hem" constitute the main symptoms of this condition.
Chronic laryngitis is most frequently met with in sing,ers. Hoarseness in these represents the most important symptom; it may be continuous or occur only after a few bars have been sung. This is usually accompanied by a feeling of local fatigue, heat. and constriction. The voice is usually lowered in pitch and may be veiled, muffled, or complete aphonia may exist. Pai-n is sometimes complained of. Cough provoked by sensation of itch ing or pricking frequently occurs as a prominent symptom. Slight hmmor rhage and blood-expectoration are occa sionally noted.
In some cases these symptoms present themselves upon the least exposure, dis appearing after a few days. As the at tacks are repeated, however, they. become more resistant to therapeutic measures, and the local disorder becomes perma nent symptomatically as well as patho logically. Hoarseness is then continu ous. Warm weather, however, is apt to bring temporary relief.
The laryngoscopical appearances vary considerably, and are proportionate to the degree of active inflammation. The evidences of local hypermmia are never theless always present, and vary from a slight arborescent and light pink tinge suggestive of congestion to a bright-red hue indicative of violent inflammation. The epiglottis is also congested, enlarged vessels coming over its posterior surface, while the aryteno-epiglottic folds appear thickened, the tumefaction involving the entire larynx in marked cases. The sur
face is irregular and sometimes quite bosselatecl. The general redness is not so marked as in some cases of acute laryn gitis; it is apt to assume a brownish or violet coloration. The vocal bands are also more or less congested; the conges tion may either be limited to a small por tion of their surface or involve their en tire arca. Small masses of stringy cream like mucous are frequently to be seen forming films when the glottis is opened.
Sometimes the vocal bands appear re laxed and their thickened edges do not seem to come accurately together, an elliptical opening being occasionally ob served between them. This want of parallelism is due to muscular paresis, affecting usually but one side.
Shallow abrasions of the epithelial covering are occasionally met with, especially in the interarytenoid space. Deeper ulcerations sometimes leading to periehondritis have been observed by various clinicians.
The secretions are sometimes very copious, especially when, in the latter part of an active exacerbation of vocal disability, the patient tries to use his voice. This condition is termed "laryn gorrheea" by some authors.
The terms "dry laryngitis" and "laryn geal ovena" have been given to a condi tion occasionally met with, in which the secretion, besides being muco-purulent, is prone to adhere firmly to the mucous surfaces and to become partly desiccated in this situation. The dry crusts formed, by impeding the free passage of air, give rise to more or less dyspncea, while the breath is rendered feetid. Laryngoscop ically examined, the larynx appears red and dry, with greenish crusts closely ad hering to parts adjoining the vocal cords either above or below.
Case in which the green secretion al most occluded the tracheal lumen, caus ing marked stridor. Knit (Jour. Amer. Med. Assoc., Apr. 15, '93).
singers, officers, huck sters, etc., who are called upon to use the voide excessively, chronic laryngitis may occur as a primary affection, but in per sons who do not usc their vocal organs professionally, the primary cause can usually be traced to some disorder of the adjoining cavities, nasal, naso-pharyn geal, and pharyngeal. A dusty or smoky atmosphere may induce chronic laryn gitis, but the other portions of the upper respiratory. tract are involved in the in flammatory process.