=Definition.=—An acute inflammation of the mucous membrane of the
larynx with infiltration of serous fluid into the submucous tissue.
=Etiology.=—This is a very serious affection. It may occur in
connection with acute laryngitis, though rarely, and occasionally with
chronic diseases of the larynx, as tuberculosis and syphilis. It may
be a complication of some acute infectious disease like diphtheria,
scarlet fever, or erysipelas of the face. It sometimes occurs suddenly
in the course of Bright’s disease. Lesions as in acute laryngitis are
predisposing factors.
=Pathologically=, there is marked swelling of the epiglottis. The
swelling can very easily be felt with the fingers. The mucous membrane
is tense and changed in color. There is infiltration of a serous or
sero-purulent fluid into the loose connective tissue of the larynx.
The arytenoepiglottic folds are greatly involved, and they may be
swollen to such a degree that they almost meet.
=Symptoms.=—Extreme dyspnea and stridulous respiration. Hoarseness of
the voice and later aphonia. There is a feeling of intense oppression
or suffocation. Evidence of dyspnea, anxious face, blue lips,
protruding eyes and retraction of the base of the chest occur. The
sternocleidomastoid muscle is very prominent.
=Diagnosis.=—This is not difficult. The history of the case,
laryngoscopic examination, and the swollen epiglottis which can be
easily felt with the fingers make diagnosis easy.
=Prognosis.=—Generally unfavorable. At any time it is extremely grave,
but with prompt and vigorous treatment recovery is possible.
The duration varies from a few hours to several days.
=Treatment.=—One must attend strictly and carefully to the laryngeal
innervation, as in acute catarrhal laryngitis. Obstruction to the
superior or inferior thyroid, facial, internal jugular or innominata
will cause tumefaction and edema of the larynx and adjacent tissues.
Also, enlargement of the lymphatics about the larynx and salivary
glands may produce edema of the laryngeal region; consequently,
particular care should be taken of the various tissues about these
vessels and of the innervation from the cervical spine, so the veins
are not obstructed or the lymphatic channels disordered, so that
infiltration of the tissues may be further prevented.
The most prominent symptom is laryngeal dyspnea and this depends
altogether upon the swelling of the soft parts. If the swelling is
great and the disorder cannot be removed, suffocation will follow.
In such cases, besides giving direct treatment over the larynx,
introducing a finger into the mouth, and reaching clear back under the
roof of the soft palate, with a firm, downward, outward and sweeping
movement on either side, relax the soft tissues. The persistent use of
small pellets of ice, held far back in the mouth, will be found very
beneficial; also, application of the ice-bag, provided the edema is of
inflammatory origin.
If one is not able to control the rapid infiltration of the larynx and
glottis when such cases arise, tracheotomy or intubation should be
performed at once. When edematous laryngitis is due to diseases of the
heart, lungs and kidneys, treatment of the primary disease should be
given in addition to the local treatment.