Laryngeal stenosis

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About the disease

Laryngeal stenosis is a pathological narrowing of the lumen of the larynx, which prevents the normal passage of air through the respiratory tract. The development of the disease is most often preceded by inflammatory processes, trauma, and infection. Acute laryngeal stenosis manifests itself in the form of difficulty breathing, changes in voice, or a feeling of shortness of breath, especially during physical activity.

Treatment depends on the cause and extent of the stenosis and may include medications, surgery, or specialized breathing apparatus.

About the disease
a sore throat

Causes of acute laryngeal stenosis in adults

  • Allergic reactions to food
  • Complications after a sore throat, flu or diphtheria
  • Presence of tumors
  • Throat injuries, burns

Causes of acute laryngeal stenosis in children

Acute throat stenosis in children is caused by the following factors:

  • Congenital malformations, such as poor development of the respiratory muscles
  • Prolonged use of mechanical ventilation devices, which leads to damage to the respiratory tract
  • Infectious diseases (parainfluenza viruses, scarlet fever, measles and a complicated form of chickenpox)

Another reason is the structural features of the respiratory tract in children. In children, the larynx has a conical shape, is shorter and has a narrow lumen, which increases the risk of stenosis. Active work of the mucous glands can aggravate the situation. Even a minor inflammatory process causes a noticeable narrowing of the airways and makes breathing difficult.

General information

Stages of the disease

The following stages of development of laryngeal stenosis are distinguished:

  1. Initial. Mild shortness of breath, hoarseness, paroxysmal cough (attack of stenosis) and rapid fatigue appear, which are easily confused with ordinary fatigue. This condition persists for 30-80 minutes, goes away on its own or becomes more severe
  2. Subcompensation. The patient experiences increasing anxiety and shortness of breath. The situation is aggravated by a reduction in the lumen of the larynx to 5 mm. There is a risk of suffocation that requires immediate intervention
  3. Decompensation. The patient experiences a critical narrowing of the glottis up to 2-3 mm, which is accompanied by hoarseness and difficulty breathing. Without timely medical care, the disease can cause death
  4. Terminal stage. Asphyxia occurs, in which the glottis almost completely closes. This dangerous condition requires urgent treatment

Classification of the disease

Depending on the causes and nature of the manifestations, laryngeal stenosis is classified into 3 types:

  1. Septic – develops against the background of an infectious lesion (viral, fungal, bacterial infections). It appears gradually, which allows for timely diagnosis and initiation of treatment
  2. Allergic - characterized by a sharp increase in symptoms and severe respiratory problems due to an allergic reaction. Requires immediate intervention
  3. Mixed - combines signs of acute infections and allergic reactions. Requires an integrated approach to treatment

The allergic type is considered the most common. Allergens can include medications, insect bites, pet hair, and food.

Depending on the severity, the disease is divided into three types:

  • 1st degree stenosis- mild narrowing of the larynx, symptoms are barely noticeable or absent
  • 2nd degree stenosis – moderate narrowing accompanied by noticeable respiratory disturbances
  • 3rd degree stenosis - severe narrowing that causes significant respiratory problems and requires urgent treatment

If the condition worsens significantly, the skin of the face becomes pale blue, the pulse quickens, and flushing of the cheeks is observed.

Depending on the characteristics of the course, two forms of the disease are distinguished:

  • Acute stenosis - manifested by pronounced symptoms of shortness of breath and suffocation. Requires immediate medical attention
  • Chronic stenosis – characterized by periods of exacerbation and remission. Symptoms may gradually worsen

Chronic diseases of the larynx account for about 7.7% of all cases of diseases associated with the ENT organs. The development of cicatricial stenosis of the larynx and trachea most often lies in the long-term use of artificial ventilation, which occurs in 0.2-25% of cases. Among patients who have had a tracheostomy, problems with stenosis occur in 67% of cases.

Signs of laryngeal stenosis

Symptoms of laryngeal stenosis increase as the disease progresses.

At the initial stage of laryngeal stenosis, the disease is characterized by the following symptoms:

  • Mild shortness of breath with moderate physical activity
  • Fast and deep breathing
  • Wheezing when inhaling
  • Change in voice timbre (roughness, hoarseness)

The glottis narrows gradually, causing shortness of breath to become constant and independent of physical activity.

With 2nd degree laryngeal stenosis, additional symptoms occur:

  • Accelerated movements of the chest
  • Visible retractions between the ribs when breathing
  • Increased heart rate
  • Cold sweat

Patients may experience a pronounced feeling of anxiety, which is especially true for children. Difficulties with breathing in a supine position force patients to take a vertical body position.

The following symptoms are typical for stage 3 laryngeal stenosis:

  • Weak and thready pulse
  • Drop in blood pressure
  • Rare and intermittent breathing
  • Pale skin, cyanosis
  • Pupil dilation

In addition, patients experience convulsions and loss of consciousness is possible. Lack of timely medical care at this stage of stenosis leads to death.

Diagnostics

In case of acute onset of laryngeal stenosis, it is necessary to call an ambulance. Based on the clinical examination and patient complaints, doctors determine the severity of the condition and develop a treatment plan.

People suffering from subacute or chronic forms of stenosis should make an appointment with an ENT doctor. Depending on the underlying cause of the disease, consultation with an allergist, oncologist or pulmonologist may be required.

At the first stage of diagnosis, the otolaryngologist will collect anamnesis and find out possible causes of the disease, for example, allergies or infections. The pharynx is examined using a laryngoscope. To detect tumors or foreign bodies, the area under the jaw is palpated.

To confirm the diagnosis, the following studies are additionally prescribed:

  • Functional breathing test
  • Endoscopy of the respiratory tract
  • Ultrasound of the thyroid gland
  • Computer tomography or magnetic resonance imaging of the larynx and neck
  • Bacteriological examination of a throat smear
  • General blood test

The data obtained allows the doctor to determine the degree of narrowing of the pharynx and identify the cause of the disease.

First aid for laryngeal stenosis

Before the ambulance arrives, it is important to take actions that will improve the patient’s condition and make breathing easier.

You need to act calmly and confidently, following a clear algorithm:

  1. Place the patient in a sitting position. This will make breathing easier and help reduce the severity of symptoms
  2. Provide an influx of fresh air by opening a window or vent. Adequate oxygen is necessary to maintain heart and brain function
  3. Eliminate unnecessary activity. In a state of panic or anxiety, a person may move restlessly, which will increase breathing problems.
  4. Monitor breathing and heart rate until medical personnel arrive to quickly describe the general condition of the victim

Keep calm and encourage the patient by speaking soothing words. Emotional support reduces the level of panic and stress, stabilizes the condition and makes breathing easier.

Treatment methods for narrowing of the glottis

The treatment regimen for laryngeal stenosis depends on the factor that provoked the narrowing of the throat.

In case of an allergic origin of the disease, doctors prescribe intravenous corticosteroids. For injuries and abscesses, surgery is required. For laryngeal stenosis of degrees 2 and 3, inhalations with adrenaline, intramuscular injections of dexamethasone, or the use of drugs for inhalation through a nebulizer are prescribed. If there is a threat to life, the patient is transferred to intensive care, where intubation or tracheostomy is performed to restore patency of the airway.

If laryngeal stenosis in adults occurs against the background of acute respiratory viral infection, therapy is aimed at eliminating the symptoms of a cold. The course includes:

  • Inhalations with soda
  • Anti-inflammatory and painkillers
  • Desensitizing drugs

At high temperatures, the use of specialized antipyretics is recommended.

Important! If the condition worsens significantly, more intensive treatments are needed, such as inhaled epinephrine, bronchodilators and oxygen therapy to reduce the load on the respiratory system and make breathing easier.

To strengthen the body's defenses, drugs that stimulate the production of interferon (Kagocel) and immunomodulators, for example, Polyoxidonium, are used. These drugs help to quickly relieve symptoms and increase interferon levels, providing a long-term protective effect.

For stage 1 laryngeal stenosis, outpatient treatment is possible. Therapy involves the use of anti-inflammatory and antihistamine drugs, diuretics to reduce swelling, as well as methods to facilitate breathing and reduce hypoxia. These include inhalation of humidified oxygen or medications, as well as special breathing exercises to improve ventilation.

For adults with developed laryngeal paresis after surgery and in the absence of respiratory failure, conservative treatment is provided. It involves taking antibiotics, hormonal and angioprotective drugs, as well as drugs to improve metabolism and neuroprotection.

Physiotherapy procedures also play an important role in restoring the functions of the larynx. To restore the functions of the larynx, UHF therapy and electrophoresis with anti-inflammatory and regenerating drugs are indicated.

осмотр горла, ребенок

Treatment of stenosis in a child

Stenosis in children is a serious condition that requires a careful and competent approach to treatment. Depending on the degree of the disease, stenosis in a child can manifest itself with various symptoms, ranging from mild difficulty breathing to critical life-threatening conditions.

To begin with, it is important to establish the causes of stenosis in the child. In the case of an acute form of the disease, doctors most often resort to prescribing corticosteroids and anticholinergic drugs aimed at relieving inflammation and swelling. Laryngeal stenosis in children is often accompanied by hypoxia, so after stabilization of the child’s condition, humidified oxygen inhalations are prescribed.

Important! Symptoms of laryngeal stenosis in a child can significantly worsen the quality of his life, so do not delay contacting a doctor.

If the disease is mild (1st degree stenosis in a child), then treatment is carried out on an outpatient basis. In more severe cases, hospitalization is necessary. Non-steroidal anti-inflammatory and antihistamine drugs, mucolytics and alkaline inhalations are used for treatment. For bacterial infections, antibacterial agents are used.

Pay attention! If conservative treatment does not bring the desired result or in case of acute asphyxia, surgical intervention is required.

For children over 8 years old, puncture conicotomy is indicated. For chronic scarring laryngeal stenosis in children, treatment may include endoscopic operations such as balloon dilation or laser microsurgery.

After treatment of stenosis, the child begins an equally important stage - rehabilitation. He is recommended to have a gentle regimen, regular examinations by an ENT doctor and avoidance of vocal stress. It is important to limit the consumption of foods that can irritate the throat mucosa.

Stenosis in laryngitis

Stenosis with laryngitis is a serious complication that occurs as a result of an acute inflammatory process in the larynx. This condition is especially dangerous for children, since their airways are narrow, and even minor swelling causes significant breathing difficulties.

Treatment for stenosis should begin as early as possible to prevent the development of serious complications. For grade 1 and 2 stenosis, treatment of laryngitis is usually conservative and includes inhalation, the use of anti-inflammatory and expectorant drugs, as well as corticosteroids to reduce swelling of the mucous membrane. It is important to provide moist, cool air to reduce swelling and improve breathing.

For grade 3 stenosis, when there is significant narrowing of the airways, hospitalization and oxygen therapy may be required. In critical cases where upper airway stenosis and intrathoracic airway stenosis develop, surgery is performed to ensure airway patency.

In children, stenosis due to laryngitis is often accompanied by a strong cough, which is characterized by a rough “barking” sound. This is due to inflammation and swelling in the larynx area, which leads to a narrowing of the airways.

Acute laryngitis with laryngeal stenosis can progress rapidly, especially in young children. Early initiation of treatment helps to avoid the progression of the disease to a more severe form and the development of complications.

How is an appointment with an otolaryngologist at K+31?

During the initial appointment, the doctor questions the patient in detail about complaints, clarifies the history of the disease, and lifestyle. Next, a thorough visual examination of the pharynx is performed.

Our medical center is equipped with modern expert-class diagnostic equipment, and our staff includes highly qualified and experienced doctors who are always ready to help.

Our doctors
Sadikov
Ilya Sergeyevich
Head of the Clinic for Otorhinolaryngology, Otorhinolaryngologist
Tetzoeva
Zalina Muratovna
Head of the department of otorhinolaryngology, otorhinolaryngologist
Lapshina
Anastasia Andreevna
Otolaryngologist, audiologist
Lopatin
Andrew Stanislavovich
Chief Specialist in Otorhinolaryngology
Portnyagina
Maria Pavlovna
Audiologist-otorhinolaryngologist
Kaspranskaya
Galina Rustemovna
Otorhinolaryngologist, otoneurologist, audiologist
Budeikina
Liliya Sergeevna
Otorhinolaryngologist, phoniatrist
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