Acute Catarrhal Laryngitis.
Synonyms:—Catarrhal laryngitis; acute endolaryngitis; pseudo-croup.
Definition:—An acute inflammation of the mucous lining of the larynx, accompanied with loss of voice, hoarseness, cough and painful deglutition, with a sense of constriction in the throat and respiratory passages.
Etiology:—While this disease may occur primarily, it is more apt to follow an attack of coryza, or an inflammation of the post-nasal passages, which occurs from exposure and atmospheric changes, or from the result of the inhalation of irritating gases, or impure air; also from the presence of foreign bodies in the larynx, from local injury, or traumatism and from over use of the voice. It also occurs as the result of constitutional infection at times, especially in those who are of a weak constitution. It may result from the cigarette habit, from the smoking of strong tobacco, and from the use of alcoholic drinks. Any irritating substance which will induce hyperemia of the mucous membranes will conduce to its occurrence. It is not uncommon with children who persistently breathe through the mouth. It occurs from diphtheritic infection more often than is supposed.
Symptomatology:—An early indication is pain in the throat. This may be preceded for a few hours by a slight chilliness, and if the temperature be taken, it will be found to register one and a half or two degrees above normal. Occasionally, however, there is slight malaise with indisposition to exertion. The disease being quite insidious in its development. In yet another class of cases there is a sudden rise of the temperature with every evidence of local inflammation and marked hoarseness or complete aphonia. With this, there is dry skin, flushed face, frequent and hard pulse, with considerable embarrassment of the respiration. In a few cases there is edema of the larynx, which results in extreme dyspnea. The dryness of the mucous membranes is a partial cause for the sensation of tickling in the throat to which the cough is attributed. The cough is at first dry, harsh and somewhat spasmodic in character. Later as the disease progresses there is considerable expectoration, the cough becoming correspondingly looser, but this does not relieve the difficulty in swallowing which persists, sometimes becoming extremely severe. If complete aphonia be not present the voice may be very hoarse and the hoarseness persists and is often intractable to treatment. There is a characteristic soreness of the throat which in many cases amounts to excruciating pain, sometimes producing spasms if irritated to any extent. An examination of the throat upon inspection under a strong light will show the whole larynx to be red, profoundly congested, and a considerable tendency to edema.
The membranes are swollen and tumefied and there is some swelling and redness also both of the epiglottis and of the trachea. As secretion is established the membrane is covered with mucus.
Diagnosis:—The characteristic phenomena of this disease are the extreme hoarseness or aphonia with the extreme sensitiveness of the throat amounting to pain. In laryngismus stridulus there is an absence of fever. In membranous laryngitis there is the membranous exudate which induces the peculiar difficult breathing, which differs materially from that of acute catarrhal laryngitis.
Prognosis:—It is seldom that serious results occur from this condition as it is amenable to treatment, and quite easily managed. The prognosis therefore can be said to be good in favorable cases. If there is edema the case becomes comparatively serious, and prognosis in childhood is by no means as good as in adult cases.
Treatment:—In the treatment of these cases the patient should be put to bed in a room in which the atmosphere is kept persistently charged with watery vapor. Measures should be adopted also, by means of which the patient will inhale steam freely, two or three times within the twenty-four hours. The steam may be charged with acetic acid vapor, menthol, eucalyptus or the tincture of benzoin. An application should be made to the throat of libradol or some other plastic dressing and heat applied for six or eight hours. Afterward, if the condition is not relieved, hot, wet compresses should be applied for a short time. Cold applications should be avoided except, perhaps, in milder cases, but even in these heat will be of greater service. The throat should be protected subsequent to this treatment by warm, dry flannels until recovery is complete. The use of the hot mustard foot bath is of great efficacy in its derivative influence and in producing free perspiration. From the first inauguration of the treatment the patient should be protected from atmospheric conditions and changes in temperature. Drafts and extremely dry air must be studiously avoided, as well as an atmosphere charged with dust or any noxious or irritating substance.
The use of aconite and collinsonia at the onset with small doses of belladonna will be of much service. Later if secretion does not become established, belladonna may be discontinued and small doses of jaborandi should be used in its stead. These remedies may be continued for several days with highly beneficial results. Collinsonia should be continued in perhaps ten minim doses every two or three hours. In some cases there is a rheumatic tendency strongly marked. In these macrotys, potassium acetate or sodium salicylate may be given freely with good results. Nitric acid has an immediate effect upon hoarseness. A drop or two of diluted acid may be dropped on a square of loaf sugar and held in the mouth until it has dissolved or from five to ten minims of the diluted acid may be taken internally every two hours, diluted in a sufficient quantity of water. Often at the onset of the disease this will relieve the hoarseness and embarrassment of breathing in a superior manner. In an occasional case there will be sharp, quick, cutting pains in the throat with the rheumatic symptoms which will indicate the use of bryonia, when this remedy should then be given. The use of medicated sprays or inhalations is of much service or the chloretone inhalant, albolene, or a simple salt solution with boric acid will be found serviceable during the course of the disease. For the hoarseness and cough ipecac, lobelia, sanguinaria and the ammonium chlorid will be found beneficial when prescribed in harmony with the exact indications.