Definition.—Chronic catarrhal inflammation of the larynx.
Etiology.—Repeated attacks of acute laryngitis may finally result in the chronic form, though continuous use of the voice, especially in the open air, is the most common cause. The inhalation of tobacco-dust is also a not uncommon cause, cigar-makers frequently being sufferers from this disease.
Pathology.—The mucous membrane is red or violet-colored, is thickened and sometimes presents a granular appearance. The vocal cords share in the alteration, while erosion of the mucous membrane, with occasional ulceration, is a rare condition.
Symptoms.—Chronic laryngitis usually comes on slowly and insidiously, the patient being hardly aware that he is suffering from a serious disease until it is confirmed. The first symptom is soreness of the throat when speaking, with a sense of constriction, slight alteration of the voice, cough, and expectoration, which comes on after slight exposure, or overexertion of the larynx. These symptoms are ameliorated in a short time, and the patient thinks it is only a slight cold, from which he is recovering. As time passes, however, the attacks become more frequent, last longer, and do not so readily disappear.
When the disease is fully established, there is a constant uneasy sensation in the region of the larynx; the voice is seriously altered, and there is a constantly annoying cough, with expectoration. The expectoration is at first scanty and mucous; but as the disease advances it is muco-puriform, sanious, concreted into lumps, or consists of almost pure pus. Hemorrhage occurs in the latter stages, sometimes in very large quantities.
If the throat is examined, we notice the evidence of chronic inflammation of the fauces, pharynx, epiglottis, and we reasonably suppose that the mucous membrane of the larynx corresponds in appearance; with the laryngoscope we are enabled to view the internal surface of the larynx, and determine its condition quite accurately.
A person suffering from "ministers' sore-throat," or chronic laryngitis, is very subject to cold, and every change in the weather or slight exposure is followed by an increase of the disease. A very important part of the treatment of every case, therefore, will be directed to obviate this.
The impairment of the general health is usually in direct ratio to the severity of the local affection. At the commencement, the patient complains simply of debility, with some failure of the digestive organs, and sometimes torpor of the secretions. When it has progressed for some months, he is unable to attend to business; there is loss of flesh and strength; there is marked impairment of the digestive functions and of the excretion.
Frequently the system becomes so depressed that tubercles are deposited in the lungs, the symptoms of phthisis are developed, and the disease runs a rapid course to a fatal termination.
Diagnosis.—We diagnose chronic laryngitis by the unpleasant sensations in the region of the larynx, the cough, and by inspection of the throat, and the absence of physical signs of other diseases of the respiratory apparatus.
Prognosis.—Ministers' sore-throat can be readily cured in the majority of cases, if the person will give the vocal organs rest; usually from four to twelve months will be required. The prognosis in confirmed laryngitis is not favorable, as but few have the patience necessary to persist in the use of remedies until a cure is effected. It can be cured, but it requires time and perseverance; otherwise the disease is as fatal as confirmed phthisis.
Treatment.—The treatment will be both local and systemic, A careful examination is to be made, and if there be an elongated uvula or enlarged tonsils, these conditions must be corrected if we are to derive the best results from medication.
The chief remedies that specifically influence the larynx are specific collinsonia, stillingia, penthorum, potassium bichromate, calcium sulphide, and sanguinaria. Where the tissues are congested and dusky, collinsonia will be found a reliable agent. Add one dram to water four ounces, and give a teaspoonful every three hours.
Penthorum.—Where the tissues are dry, with violet color, penthorum will be the agent, one or two drops every three or four hours.
Potassium Bichromate.—Where, the voice is hoarse, and where there is loss of voice, the second trituration of potassium bichromate in two or three grain doses will be efficient.
Sanguinaria.—Where there is a tickling sensation in the larynx, causing an almost constant, hacking cough, use sanguinaria.
Stillingia.—The hoarse, husky voice will require stillingia; the tincture may be used, but the stillingia liniment, I think, gives the better results. One drop on sugar every one, two, or three hours.
Calcium Sulphide.—Where the expectoration is of a muco-purulent character, calcium sulphide, second trituration, will be found to give goad results.
When there is great irritability, causing a hard cough, with loss of sleep, a quarter of a grain of codein should be given till the irritability subsides.
It seems almost superfluous to say, the patient must rest the voice while undergoing the treatment. Local measures are very important, and consist of gargles, sprays, and packs to the throat. Where the tissues of the pharynx are involved and show the same dusky hue as the larynx, a gargle of hamamelis will be found useful. If ulceration be present, listerine is beneficial used in the same way.
The most successful local treatment, however, is that obtained by the use of the spray. The small hand-spray atomizer may be used, though better results follow the use of the steam or compressed-air atomizer. The remedies used will be selected with reference to the condition of the part affected, and will be sedative, stimulant, narcotic, tonic, and astringent. Where there is irritation with dryness, and a tenacious secretion of viscid mucus, an infusion of lobelia will be found beneficial. When there is an irritable cough, preventing rest, vinegar of opium and lobelia is a useful spray. If the tissues are lax, and a tonic is needed, hydrastis may be used, or an astringent solution of tannic acid, alum, or an infusion of red-oak bark or yellow root, as used by the early Eclectics. For ulceration, potassium or iodin may enter the mixture. The physician has a large field of remedies from which to select, and if he be careful as to the condition of the larynx, he can select the remedy with a great deal of confidence.
The cold pack at night, with a dry binder pinned snugly around the throat, followed by flushing the throat and chest with cold water in the morning, will do much to prevent taking cold.
A change of climate is nearly always beneficial; an ocean voyage or residence in the pine woods for a few weeks, often accomplishes wonders. Smoking and the use of alcoholic liquors are to be positively forbidden.