PROGNOSIS.—Except in slight cases death is more apt to take place than recovery. If tracheotomy has saved the patient from impending death, ultimate prognosis is still unfavorable in severe cases. In idiopathic, traumatic, and syphilitic cases the prognosis is of course better than in others in which we have to face grave dangers of the underlying disease as well. The remaining laryngeal stenosis after recovery makes the prognosis bad as to the doing away with the tracheotomy-tube, although it is far more favorable at the present day than it was previous to Schrötter's success with dilating measures.
TREATMENT.—Throughout the disease the patient's general health and strength must be carefully attended to, tonics and stimulants used according to circumstances, and the underlying condition of secondary perichondritis, such as syphilis, etc., treated secundum artem. Locally, the treatment during the first stage must be antiphlogistic, by leeches, ice, etc., and soothing, especially by inhalations. Afterward, abscesses must, if accessible by means of the laryngoscope, be opened. Artificial feeding, through either an oesophageal or a rectal tube, may become necessary. Schrötter's hard-rubber tubes may be inserted to conduct air to the lungs, but tracheotomy, not laryngotomy, must be performed if, in spite of this tubage, suffocation threatens.
The methodical dilatation of post-perichondritic laryngeal stenosis requires special bougies, catheters, hard-rubber tubes, pewter plugs, and dilators which are not to be found in the ordinary armamentarium of a medical practitioner; but the proper and frequently successful use of these can be acquired with patience and perseverance when a case of the kind presents itself for treatment.
Chronic Laryngitis.
DEFINITION, SYNONYMS, AND CLASSIFICATION.—Under the name chronic laryngitis are brought together a number of different diseases of the larynx which have the character in common that they are more or less inflammatory and chronic in their course. The various conditions of chronic inflammation of the mucous membrane (chronic laryngeal catarrh) prominently belong to this category, but the chronic inflammation of every other constituent tissue of the larynx, except cartilage and perichondrium, is included.
The synonyms refer mostly to individual etiological and other factors not applicable to all cases, as clergymen's laryngitis, phthisical laryngitis, and many of the designations of different classes.
Chronic laryngitis frequently involves more than one tissue, but usually one prominently. Histologically, the following kinds of chronic laryngitis have been distinguished: viz. catarrhal, when simply or principally the mucous membrane is affected; granulous or glandular, when the muciparous glands; submucous or parenchymatous, when the connective tissues underneath the mucous membrane are prominently implicated; and muscular, when there is chronic inflammation of the muscular tissue. According to the seat, there will be supraglottic, glottic, and infraglottic chronic laryngitis. There have also been described atrophic, hypertrophic, and polypoid chronic laryngitis; dry and blenorrhoeic or hypersecreting chronic laryngitis; simple, fetid or ozænic, and ulcerative; phlebectasis laryngea, trachoma, etc.
ETIOLOGY.—Chronic laryngitis is caused in many ways. Frequently it follows uncured or neglected acute laryngitis. It is apt to occur in persons whose avocations or habits lead them to strain or otherwise abuse their vocal organ, to work in an impure or irritating atmosphere, or to use tobacco or alcohol excessively; and it may depend upon or be an extension of chronic inflammation of either the naso-pharyngeal or tracheo-bronchial mucous membrane. Secondarily, it accompanies all long-continued laryngeal affections, such as phthisis, syphilis, lupus, etc. Males suffer more often than females, and middle-aged persons more often than either children or the very old. Boys at the time of puberty are liable to become affected.
SYMPTOMATOLOGY.—The diseases comprised under the collective name of chronic laryngitis give rise to various symptoms, of which the chief are morbid sensations in the region of the larynx and alteration of the voice. Unless ulceration have occurred, the morbid sensations hardly amount to pain, except on acute exacerbation from catching cold or after long-continued use of the voice. They consist in a sense of dryness or of pressure, in a tickling or in an unnatural feeling that cannot be definitely described in words. Though not acute, they are sufficient to make the patient constantly conscious of their existence and to induce fruitless efforts at clearing the throat, etc. The alteration of the voice varies from occasional unsteadiness or veiling, or a loss of power or purity of tone, to different degrees of hoarseness, dysphonia, and even aphonia. In singers and public speakers the disease interferes sometimes with professional vocal efforts only, ordinary conversation not being affected. The voice is best, sometimes worst, after a night's rest, and in either instance changes after moderate use for worse or better as the case may be; but long-continued exercise is always harmful. The voice is comparatively easily fatigued, and then the vocal organ becomes positively painful.
In addition to the two chief and constant symptoms there are others that may or may not be present, and which sometimes assume even greater prominence than the modification of the voice. Thus, secretion, which in most cases is very slight, glassy grayish, and viscid, is occasionally very abundant, yellowish, or darkish, or more rarely still mixed with streaks of blood and in clumps, though not sticky or dried into scabs, and is sometimes so fetid that the patient's breath is exceedingly malodorous. Cough, which in most cases is either absent or comparatively trifling, barking, or hacking, occasionally is the most troublesome of all the symptoms. Dysphagia is sometimes present even in simple or mild cases. In severer cases, in the later stages, especially in syphilitic and phthisical chronic laryngitis, swallowing becomes painful and difficult, or even impossible. Dyspnoea occurs only from accumulations of phlegm in the larynx, and is then lessened after expectoration, or it may depend upon the diminished lumen of the laryngeal cavity on account of thickening of the walls, as it is especially apt to do in subglottic chronic laryngitis, or on account of so-called polypoid hypertrophies in simple cases, gummata or cicatricial tissue in specific cases, etc. Dyspnoea may become so urgent as to require tracheotomy.