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Symptoms and Treatment of a Common Complaint
Among the throat affections laryngitis in one or other of its forms is very common. It includes certain types of croup and various forms of chronic over-strain.
lnflammation of the larynx occurs in two main forms, acute and chronic laryngitis, the former often associated with rapid swelling known as oedema of the glottis and also with spasm of the muscles operating the vocal cords, and the latter occurring as the so-called simple chronic laryngitis as well as a tuberculous or a syphilitic infection.
Acute Laryrigitis.
Acute laryngitis may arise in the course of a simple oold, perhaps beginning with running at the nose. The inflammation of the mucous membrane that accompanies such a cold spreads from the back of the nose into the pharynx, thence to the upper opening of the larynx, and in severe cases through the larynx to the windpipe.
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The symptoms are loss of voice, pain in the throat and an irritable, ineffective, barking cough. Perhaps associated with it is a slight deafness due to involvement of the Eustachian tubes,. which form a connecting passage between the ear and the throat. Such a train of symptoms implies a general acute inflammation of the back of the throat -a combined pharyngitis and laryngitis- which is the condition generally found.
If examined with the laryngoscope the folds of mucous membrane bounding the upper opening of the larynx are seen to he red and swollen, and the vocal cords themselves are dull and pinkish in colour instead of being greyish and shining. This state of congestion of the upper part of the larynx hampers the muscles that move the cords, and the latter, themselves sharing the swelling to a slight extent, are unable to vibrate clearly. The voice may be lost.
The treatment consists in resting the larynx by talking as little as possible. It will be wiser to keep the patient in bed during the height of the attack and a bronchitis kettle will be found to relieve the harsh, dry feeling in the throat.
The tube of a laryngeal spray apparatus has a shaxp bend at the end to direct the spray down into the larynx. The patient takes a deep breath each time the bulb is compressed.
Pain and hoarseness are usually benefited by hot or cold applications to the neck. A strip of lint is wrung out of water, applied, and covered with gutta-percha tissue and a bandage.
Acute larngitis is prone to affect those who coddle their throats. A course of gradua' exposure and hardening of the neck will often cure their tendency to throat troubles. Recnrreot attacks of laryngitis may also indicate that the tonsils require attention.
Oedema of the Glottis
Sudden swelling of the mucous membrane of the larynx is known as oedema of the glottis and sometimes occurs in the course of an acute laryngitis; but it may accompany diphtheria, cellulitis of the neck or any disease involving the opening of the larynx into the throat.
Such acute and dangerous swelling affects mainly the loose tissue passing from the larynx to the epiglottis (q.v.), known as the aryteno-epiglottic folds, and not the cords themselves, which are precluded from great swelling by the close attachments of their mucous membrane. Nevertheless, the swelling around the opening of the larynx is sufficient to allow closure of the air aperture; the symptoms rapidly become urgent, and the patient's face more and more swells from inefficient aeration of the blood in the lungs.
Treatment must be prompt, and medical attention summoned before the condition becomes so serious.
The last resort is to puncture the larynx through the neck (See Tracheotomy ), but this can sometimes be avoided by spraying the throat with cocaine. Pending the arrival of the doctor the patient should suck pieces of ice and an ice bag may be applied to the neck. Failing this, sips of very hot water and hot applications to the neck may he tried in the hope of reducing the obstructive swelling.
Chronic Laryngitis
Chronic simple laryngitis may follow an acute attack but more often it is due to over-indulgence in tobacco, especially the inhaling of cigarette smoke excessive use of a the voice and the chronic drinking of raw spirits. The main symptoms arc huskiness of the voice, a frequent desire to clear the throat and the constant hawhing of muco-pus, as in laryngitis generally, there is often an associated pharyngitis. There are frequent. acute attacks which only hardly subside into a condition of relaxed throat.
On examination with the laryngoscope the mucous lining of the throat is often seen to be streaked with pus and its blood vessels stand out protninently; the vocal cords lack their normal, finely cut, shiny appearance.
The treatment is first of all to discontinue tobacco and spirits, temporarily at least, and to rest the voice. Spraying or brushing the throat with glycerin of tannin is often of value in helping to remove the thickening and restore tone.
Syphilis is prone to attack the throat both in the secondary and tertiary stages of the disease. This form of laryngitis is referred to under the heading Syphilis.
Laryngeal tuberculosis is one of the most distressing complioations that accompany consumption (q.v.).
Cancer of the larynx is fairly common in the middle aged and elderly. It may begin in a small nodule on one of the vocal cords. Chronic hoarseness in and after middle age calls for prompt examination.
By the use of a forehead mirror light is reflected to the back of the throat and on to a little mirror held there which lights up the inter:or of the larynx. An image of this is seen on the mirror in the throat.
LARYNGOSCOPE. This is an instrument used for examining the interior of the larynx. In its simpiest form it consists of a small mirror mounted at an angle on a long stem and a light which can be concentrated upon it. The mirror is usually circular in form and made in various sizes, but is small enough to be placed in the throat behind the back of the tongue.
The source of light is either a small bright lamp worn on the forehead of the observer, or a concave mirror, also worn on the forehead, for the purpose of concentrating light from some other source.
In undergoing an examination of the throat it is most important that the patient should breathe quietly and easily, as otherwise a full examination will be impossible. The procedure should not cause any distress, though nervous patients often begin to retch at the slightest touch of the mirror against the back of the throat. In such it may be necessary first, to spray the throat with cocaine.