SEROUS AND PHLEGNIONOUS CEDILSIA OF THE GLOTTIS By (edema of the glottis is meant an (edematous swelling of the sub MUCOUS cellular tissue of the larynx, and the intermuscular cellular tissue of thr vocal cords. This may be of a serous or inflammatory nature.
Serous infiltration of the submucous cellular tissue, occurs mainly as a complication of certain general diseases, such as c.hronic nephritis. It may be the first symptom of this condition. It occurs also with acute nephritis and heart troubles. It is also produced by stasis, through tumors compressing veins in the neck. The cedeina caused by the administration of iodide of potash should also be considered. Alartning (edema has occurred after small doses of iodide.
The inflammatory ridema is more common than the serous variety. Part of the cases belonging in this class, have been des.cribed under the name subinucous phlegnionous laryngitis. Inflammatory (rdenia, is the result of inflammatory, or ulcerative local processes, of not only the larynx, but the surrounding tissues as well. It occurs most fre quently after laryngeal injuries (foreign bodies and burns), or with ulcers of the larynx. it also complicates periehondritis, erysipelas, phlegmon of the neck, and infectious diseases.
The usual location of the disease is in the aryepiglottic folds and epiglottis, ntore rarely in the vocal cords, interarytenoid fold and petio lus. The oedema complicating constitutional conditions, is more apt to be symmetrical than the oedema due to local conditions.
oedema of the epiglottis, the epiglottis and the connective tissue around the base of the tong:ue, are swollen. The examining finger feels the cedematous epiglottis. and a swelling on either side of it. The condition may be directly inspected if the tongue is pulled forward. The mucous membrane is reddened. Serum is not always evacuated when an incision is made. Pain in swallowing may be
present with this variety of oedema, but rarely difficulty in breathing or hoarseness. (Edema of the aryepiglottic folds, is most important, because it may assume such proportions that the laryngeal lumen \rill be seriously occluded, causing alarming dyspncea or suffoca tion. CEdema in other parts of the larynx is not so apt to embarrass respiration.
can be made with the finger or by laryngoscopy. The serous or inflammatory nature of the diseased parts may be recog nized by their color. The heart and urine should be examined.
A beginning phlegmonous oedema, cannot be differentiated from a severe laryngitis by laryngoscopy, but by the history, and by its course. It is sometimes impossible to differentiate a phlegmonous oedema from perichondritis.
The prognosis depends upon the cause and severity of the oedema.
will depend upon the cause of the condition. When due to iodide of potash its administration should be stopped at once. ID cases of nephritis, injections of pilocarpine or syringe full or a I per cent. solution) are best, and will sometimes cause the oedema to disappear in a short time. Heart troubles should be treated.
Local there is no danger of suffocation, ice in the mouth and cold compresses will be useful. The author has had no experience with adrenalin applications. When dyspncea is great, scarification may be resorted to, but it will rarely be found effective. When pus is suspected, a deep incision is better than scarification. When difficulty in respiration is very great, intubation may be tried first, followed if necessary, by tracheotomy. The oedema is not relieved by intubation, and it only serves until tracheotomy can be performed. After tracheotomy the oedema may be treated locally.