=Definition.=—A chronic, catarrhal inflammation of the mucous membrane
of the larynx.
=Osteopathic Etiology= and =Pathology=.—The causes of chronic
laryngitis may be numerous, but lesions of the cervical vertebræ are
the most common. The contractured cervical muscles, especially the
deep vertebral ones, are usually the result of corresponding osseous
deviations.
Other causes given under the acute form, as overuse and abuse of the
voice, inhalation of irritating substances, excessive use of tobacco
and alcoholic drinks, tumors, etc., are important etiological factors.
Thus irritations inducing acute attacks, if repeated, will result in
chronic catarrh.
The =pathological= changes as revealed by the laryngoscope are swelling
of the mucous membrane, occasional superficial erosions, and rarely
ulceration.
=Symptoms.=—The voice is usually hoarse and rough, being due to a
thickening of the vocal organs. In severe cases the voice may be
lost. There is fatigue and pain after slight use of the voice, a
sense of tickling in the larynx which produces a desire to cough, and
expectorations of viscid mucus and mucopus.
=Prognosis.=—The prognosis is sometimes unfavorable, although many
cases are cured.
=Treatment.=—The patient must learn to take care of himself properly.
He should avoid overheated rooms and the use of tobacco and alcohol,
and the throat should not be protected too much. It is a good plan to
bathe the neck every morning and night with cold water. He should avoid
loud speaking; the sound should be expelled by the abdominal muscles
and diaphragm and not by the muscles of the throat. Examine the upper
air passages carefully for any obstructions and infections that might
exist which are a source of irritation to the larynx.
Special attention should be given to the atlas, axis and third
cervical. Lesions lower down the spine may be found, for other
laryngeal nerve fibers, other than those from the superior cervical
ganglion, may be at fault. Palpate the =hyoid= to see if it is tilted
by contracted muscles, as will often be the case.
=Aphonia= is commonly caused by a dislocated atlas. The aphonia may
also be caused by swelling of the vocal cords and tissues about them
and by serous effusions of the laryngeal muscles. The larynx may be
prolapsed slightly and if raised quickly relieved. Difficult breathing
and hoarseness are occasionally very troublesome symptoms. The former
is due to an inability of the glottis to dilate, on account of swelling
of the mucous membrane of the diseased parts and from drying of the
secretions on them, thus increasing the obstruction (this is sometimes
termed pseudocroup) but expiration is easy, the stridor is from the
inspiration; the latter is due to a collection of mucus on the vocal
cords or the cords may become relaxed, swollen or roughened.
Another annoying symptom sometimes presented is pain on deglutition,
which is due to swelling of the mucous membrane of the upper laryngeal
passages and the epiglottis. In all of these annoying symptoms,
persistent, thorough, direct treatment of the larynx is of value. On
the whole, careful, continued treatment of the cervical innervation and
vascular supply of the larynx, as in the acute form, is indicated.
In all laryngeal disorders, if condition permits, hyperextend the neck
while the patient is lying supine and thoroughly relax the soft tissues
about the organ and then carefully raise it.