Stenosis of the larynx is a dangerous condition in which a partial or complete narrowing of its lumen occurs. This makes it difficult for oxygen to pass into the lungs, which can cause hypoxia( strangulation) in the patient. To the child with symptoms of stenosis of the larynx, the ambulance leaves first of all, since after the appearance of the first signs of pathology, the account of his life goes on for hours. Among children with diagnosed stenosis, the number of deaths is very high.
- Causes of
- Forms of
- Symptoms of
- Degrees of
- Emergency care
- How to treat
- How to prevent
Causes of
Various factors affect the development of stenosis of the larynx. They are divided into groups of infectious and non-infectious origin.
Infectious causes:
- Viral diseases( adenovirus, ARVI, influenza, etc.).
- Complications of infectious diseases: diphtheria, scarlet fever, syphilis, measles, tuberculosis, malaria, typhus.
- Inflammatory process( formed due to primary disease: laryngeal tonsillitis, lining and phlegmonous laryngitis, erysipelas, laryngotracheitis, chondroperichondritis of the larynx).
- Diseases of the trachea, larynx, esophagus.
- Purulent processes in the peripheral space, guttural region, cervical soft tissue of the oral cavity.
Non-infectious causes:
- Allergic reaction - in children it can occur on honey, inhalation with coniferous plants, chemical preparations.
- Hitting a foreign object, laryngospasm, traumatic damage to the larynx.
Forms
Depending on the speed of the current and the causes of the appearance, acute and chronic stenosis of the larynx is isolated. In the first case, narrowing of the lumen develops very quickly and threatens not only the health, but also the life of a small patient. The acute form includes sudden stenosis, when there is a short-term breathing disorder( from a few seconds to 3 or more minutes).Rapid stenosis in children is a dangerous condition that can lead to death.
The chronic form develops over 3.5 months. This acquired or congenital narrowing of the larynx disrupts normal breathing and arises as a result of changes in the tissues of the larynx. Often observed against a background of benign formations and scarring of the larynx.
to table of contents ^Symptoms of
Stenosis begins with a common cold. At first the baby becomes restless, there is a slight cough, the body temperature rises. A few days may be signs of a viral infection and nothing more. But very quickly the situation changes, sometimes within a few hours the child develops suffocation. The main danger is that the larynx disease manifests itself at night, when the parents are asleep. As a consequence, there is a risk that the baby will die.
Once the disease begins to progress, the child:
- Loses the ability to speak and play any sounds.
- Skin color due to lack of oxygen acquires a cyanotic shade.
- Breathing becomes frequent and difficult.
- A barking cough appears.
- The voice grows saggy, sits down.
Degrees
Stenosis of the larynx in children is divided into the following degrees:
- 1 degree( compensation) is characterized by a change in the voice, a slight violation of breathing, which normalizes in a calm state. The respiratory rhythm can change at any load: the pauses between inhalation and exhalation become shorter. During crying, the child has shortness of breath.
- 2nd degree( incomplete compensation) - the state is defined as the average. The child becomes anxious, the skin pales, breathing is complicated, noisy, hypoxemia may manifest.
- 3 degree( decompensation) - the state is considered heavy. The child shows fright, excitement, shortness of breath. Skin covers are pale, lips and fingertips turn blue, cold sweating, slow heartbeat. Only a doctor can save a child.
- 4 degree( asphyxia) - the extreme degree of the disease, which is characterized by shallow breathing. The child ceases to participate in life processes. Skin is very pale, blood pressure drops sharply, there may be seizures, loss of consciousness, spontaneous urination and defecation. Without medical assistance, the child will not survive.
Emergency care for
Before the ambulance arrives, it is necessary to follow the recommendations:
- Calm the child and put him in a comfortable position.
- Remove hot clothes and ventilate the area.
- Make inhalation with sodium chloride( saline solution), mineral water or breathe steam at an open tap with hot water.
- Press the tip of the spoon on the root of the tongue.
- Rub caviar or make a foot bath with hot water( thus providing a flow of blood from the upper body).
- Give the child an antihistamine. In a difficult situation, inhalation with a glucocorticosteroid( Pulmicort, Hydrocortisone) or an injection of Prednisolone.
How to treat
For the therapy, you need to identifythe cause of stenosis of the larynx. The goal of the treatment is to stop the symptoms of suffocation.
Medical treatment in the first two stages of stenosis includes:
- Antiviral and anti-inflammatory drugs in case of edema of the larynx in ARVI.
- Antibiotics, eliminating the root cause of stenosis - infection of the larynx.
- Antihistamines for the removal of edema of the laryngeal mucosa. Glucocorticoids, synthetic - Prednisolone.
- Corticosteroids( steroid hormones).
- Anti-convoestants( Nafazolin, Naphthyzin), removing the swelling of the mucous membrane and narrowing the vessels.
- Dehydration therapy.
In some cases, the child is placed in a special chamber, where he artificially receives oxygen.
At the stage of decompensation( 3rd degree), urgent tracheotomy is required - an operative intervention that restores respiratory function.
In asphyxiation( grade 4), urgent conicotomy is shown - dissection of the conical fold. After the operation resuscitation is carried out: intracardiac injection of adrenaline, ventilation of the lungs, intravenous glucose with insulin. Thyrotomy( dissection of the thyroid cartilage) and cryotomy( dissection of the arc of the cricoid cartilage) can also be performed.
With short-term stenosis due to convulsions, trauma, breathing pathology, intubation is performed( introduction of a thin tube into the larynx).A tube for small children can be left in the larynx no more than 4 days, adults - no more than 10 days. Otherwise, the procedure can cause persistent stenosis.
to contents ^How to prevent
If the stenosis is still manifested, then you should immediately seek help from a doctor. The first symptoms require specialist advice:
- Pulmonologist and otolaryngologist.
- Allergist( allergic stenosis in children is possible) and neurologist.
- Oncologist.
- In emergency situations - resuscitator.