Tile riff. lunatic and gouty diathesis, pstrie and hepatic disorders, the abuse of alcoholic beverages. and all the factors tnunit-rated under the heading, of Acirri.: CA 1,AllYNGITIS may act as causative factors when exposure to them is prolonged.
Dry larynritis has been ascribed to many affections. In some cases it is but a manifestation of a general atrophic process involving the mucous membrane of the upper respiratory tract and may thus be identified through the presence of Lowenberg's bacillus.
In the very few cases that I have met with, dry laryngitis, when not accounted for by a naso-pharyngeal affection or syphilis, was found associated with a gouty diathesis. The infraglottic space seems to be the favored region for the formation of the greenish crusts observed in this condition.
Chronic inflammatory disorders of the larynx are more frequently observed in men than in women, doubtless because the former are more exposed to the eti ological factors outlined than the latter. Smoking and drinking is a prolific in direct cause, as stated, and these habits are most generally indulged in by the male sex. Chronic laryngitis can occur at all ages.
Case of chronic self-inflicted ulceration of the throat by means of nitrate of sil ver or nitric acid. F. Semon (Illed. Press and Circ., :fan. 30. '94).
Chronic laryn,,itis may be divided into three classes, as follows: 1. Systemic, in connection with valvular disease of the heart, cirrhosis of the liver, alcoholism, gout, etc. These eases are but part of a large lesion. and little special atten tion need be paid to the local trouble in the larynx. 2. With nasal disease, which may act in three ways. extension of the catarrh by continuity of surface, by irritation from the discharges, and by mouth -breathing eaused by nasal ob struelions. lit caf:cs t he first indica tion is lo treat, the nasal lesion thor oughly. 3. In small number of cases I he inflammation is limited to the larynx.
The eases limy also be classified as to the part of the larynx most affected as follows:- /. Lftrilmfliix chrwfico .,o/prrifir.
the upper part of the larynx contains umelf loose tissue, inflammation of the same is accompanied by considerable swelling. The vocal cords may be quite
overhung by the false cords. Applica tions of a fine-pointed galvatiocautery under cocaine and suprarenal alla.silieT,ia have given good results. This form is often difficult to diagnosticate from tuberculous la ryngit is.
2. Laryngitis ehronica inertia. When the true cords are principally affected, mild cases can be eured by resting the voice and painting with a. silver P,olution (30 grains to the ounce). Where the congestion is limited to the anterior por tions of the cords, it is advisable to give antisyphilitic remedies, even in the ab sence of history or other symptoms of syphilis. In singers faulty voice-produc tion must be rectified before they again take up their vocation. Hinorrltages are not very infrequent, due to enlarged vessels on the cords. If the cords are much swollen potassium iodide shofild be exhibited.
3. Laryngitis chronica inferior. The subg,lottic regions are often neglected, owing, to difficulty of m:pection. Thor ough cocaine am:esthesia of the larynx renders it easy to inspect and treat these regions, and a methodical treat ment (too often neglected) of the sub glottic space will assist materially in the eure of obstinate eas,,es. N. At. }faring (lirit. Med. dour., 30, 1902).
Pathology.—Dilatation of the blood vessels, through paresis of the vaso motors, interstitial infiltration which may lead to hypertrophy and thickening, are the main pathological features at tending a case of uncomplicated chronic pharyngitis. The superficial vessels tend to become varicose, tortuous veins being observed, especially in regions—such as the ventricular bands, the interarytenoid membrane, etc.—where the tissues are lax. The glandular elements take an unusually active part in the inflainmatory process of some cases, constituting what has been termed a "glandular laryngitis." Rounded sessile projections, differing but slightly from the neighboring tissues in color, have been called "chorditis tuberosa" or "trachoma of the larynx," but these are probably but mere localized hypertrophies, strictly associated with chronic laryngitis. The tissues beneath the vocal bands often take part in the inflammatory process.