STENOSIS OF THE LARYNX Stenoses of the larynx are extra- and intralaryngeal in nature. The former are also known as compression stenoses; they are pro duced by compression of the larynx by a goitre, lymphatic glands, abscesses, etc. Syphilis, laryngospasm, cicatrices following opera tions, more rarely,' tuberculosis, and congenital malformations, may also cause stenosis.
prolonged audible inspiration is one of the main symptoms of laryngeal stenosis. The thorax becomes widened, and there is a drawing in of the epigastrium and the intercostal spaces. During inspiration, the larynx sinks, the accessory muscles of respira tion (the sternocleidomastoidei, the omohyoidei, the pectorales, serrati and rhomboideth are brought into play, the alre nasi are dilated, and the face becomes pale. Later respiration is increased, the face is cyanotic, and there is a cold sweat.
The attack may finally end in death by suffocation, There is a marked inspiratory stridor, while expiration, during which the larynx rises again, is easy and noiseless.
Laryngeal stenosis differs from traeheal stenosis by the movement of the larynx and the inspiratory stridor, which may he palpated, and by the bending backwards of the head.
Expiratory stridor is rare in laryngeal stenosis, while it is charac teristic of traeheal stenosis. The head is bent forward in tracheal ste nosis. The severity' of the sy-mptorns depends upon the extent and situation of the stenosis, and the rapidity of its development; the more rapidly the stenosis develops, the more severe are the symptoms.
What aids to diagnosis has the physician who is called to attend such a case, and cannot examine the child's larynx? The history of the case is important although not always exact. If a positive history of a foreign body or burn is obtained, the diag nosis is evident. When the history of swallowing a corrosive substance cannot be obtained, then precious illnesses, and the rapidity of the onset of the stenosis, are important. The onset is rapid in cases of phlegmon of the neck, inflamed glands, licemorthages in thyroid cysts, retropharyngeal abscesses, large foreign bodies in the cesophagus, foreign boles in the larynx, burns in the larynx, pseudocroup, (edema, diphtheria, perichondritis, ulcers, in acute infectious diseases, and spasm of the glottis. It is slow in tumors ffncluding goitre), congeni tal malformations, new growths, chronic ulceration (tuberculosis, syphilis), cicatrices folloning chronic ulcerations, after perichonciritis, and after intubation and tracheotomy.
The further liistory as to whether the stenosis developed suddenly or only rapidly is of importance.
Sudden stenoses point to foreign bodies, burns, pseudocroup, and spasms of the glottis, while those developing less suddenly point to (-edema of the larynx and chphtheria.
A sudden occlusion of the glottis may also be eaused by peduncu latecl new growths.
It must also be determined whether there have been any previous illnesses, such as measles, scarlet fever, typhoid fever, whooping-cough, and other acute infectious diseases, which cause false croup, ulcers, perichondritis, nephritis or cedema of the glottis, or whether the child has rachitis nit]) which spasm of the glottis occurs. If there have been previous attacks, the diagnosis of false eroup is probable. Congenital hoarseness points to congenital malformations, papillomata, or syphilis. An eruption coming on soon after birth also suggests syphilis. The neck should be examined for glands, goitre, tumors, phlegnion, or for an abscess connected with the laryngeal cartilages. In such cases, a. diag nosis of compression stenosis et- perichondritis can be made; it must be remembered however, that an endolaryngeal stenosis may exist in conjunction with the goitre. If fever, which cannot be traced to any other disease is present, it is suspicious of either diphtheria, acute catarrh with pseudoeroup, abscess or periehondritis. The latter conditions would be the more probable if pressure against the larynx produces pain.
An examination of the heart, urine, and osseous system should also be made. I3y this the possibility of cudema of the glottis or spasm of the glottis may be determined. A long-continued discharge froni the nose is rather suggestive of a chronic laryngitis. A discharge that. has only been going on for a short time, points to acute laryngitis or diphtheria.
Skin eruptions are valuable aids to the diagnosis particularly in suspected syphilis. Finally the mouth should be examined. Burns about the lips, the mucosa of the mouth or tongue, point to a similar state of affairs in the larynx. Diphtheritic deposits on the tonsils, pillars of t.he fauces, uvula, or pharynx, will of course deride the diagnosis of the laryngeal condition. The same is true of syphilitic ulceration.
The diOital examination will decide the presence of an cedenta of the larynx or retropharyngeal abscess. A direct inspection of a portion of the larynx is most useful.
The description of the methods of examination in eases of laryngeal stenoses, has, at the same time, pointed out the importance of the symptoms in arriving at a cllagnosis.
The last resorts in the treatnient of stenoses are intubation stud tracheotomy.