Laryngitis

Definition of Laryngitis

Laryngitis is an inflammation of the larynx that occurs for many reasons. Inflammation of the larynx often occur as a result of using too much noise, exposure to dust, chemicals, smoke, and other pollutants, or as part of an upper respiratory tract infection. Possible Laryngitis also be caused by infection isolated that only the vocal cords. Laryngitis is an inflammation of the larynx is also caused primarily by viruses and can be caused by bacteria.

Based on his journey, laryngitis is divided into two (Acute and chronic laryngitis).
Acute laryngitis is an inflammation of the larynx / larynx-tracheal-bronchial. Acute laryngitis is an acute inflammation of the larynx caused by viruses and bacteria that lasts less than 3 weeks. Acute inflammation of the larynx, generally a continuation of rinofaringitis (common cold).

Acute laryngitis in children can cause airway obstruction, whereas in adults is not as fast as in children.

II. Pathophysiology Laryngitis.

Almost all of this is the virus that cause inflammation. Possible secondary bacterial invasion. Laryngitis is usually accompanied rhinitis or nasopharyngitis. Onset of infection may be associated with exposure to sudden temperature changes, dietary deficiencies, malnutrition, and no immunity.

Laryngitis is common in winter and are easily transmitted. This is in line with immune deficiencies as well as the prevalence of the virus increased. Laryngitis is usually preceded by pharyngitis and upper respiratory tract infections more. This will result in irritation of the upper respiratory tract mucosa and stimulates the mucus glands to produce excess mucus that clogs the airways. These conditions will induce severe coughing that can cause irritation of the larynx. And spur inflammation in the larynx. This inflammation causes pain as spending on chemical mediators that if excessive blood will stimulate increased body temperature.



III. Etiology Laryngitis.

1. Acute laryngitis may occur from the continuation of respiratory tract infections such as influenza or the common cold.

Infection with influenza viruses (types A and B), parainfluenza (type 1,2,3), rhinovirus and adenovirus. Other causes are Haemophilus influenzae, Branhamella catarrhalis, Streptococcus pyogenes, Staphylococcus aureus and Streptococcus pneumoniae.


2. This disease can occur due to changes in the season / weather.

3. Excessive use of voice.

4.Trauma.

5. Chemical material.

6. Smoking and drinking alcohol.

7. Allergy.



Clinical manifestations

Acute laryngitis.

In acute laryngitis usually cause by a virus infection. Bacterial infections such as diphtheria also may be the cause, but it is uncommon. Acute laryngitis may also occur to any disease or after you recover from an illness, such as colds, flu or pneumonia.

1. Acute laryngitis may occur from the continuation of respiratory tract infections such as influenza or the common cold. Infection with influenza viruses (types A and B), parainfluenza (type 1,2,3), rhinovirus and adenovirus. Other causes are Haemophilus influenzae, Branhamella catarrhalis, Streptococcus pyogenes, Staphylococcus aureus and Streptococcus pneumoniae.

2. This disease can occur due to changes in the season / weather.

3. Excessive use of voice.

4.Trauma.

5. Chemical material.

6. Smoking and drinking alcohol.

7. Allergy.



Chronic laryngitis

Cases often occur in chronic laryngitis include constant irritation occurs due to excessive use of alcohol, heavy smoking or reflux of stomach acid flowing back into the esophagus and throat. Gastroesophageal Reflux Disease (GERD).

Chronic laryngitis is inflammation of the mucous membrane of the larynx is located in the upper respiratory tract, if there is less than 3 weeks is called acute and called chronic when it occurs more than 3 weeks.
Some patients may have experienced recurrent attacks of acute laryngitis, exposed to dust or fumes irritating or use voice is not appropriate in the context of neuromuscular. Smoking can cause laryngeal edema and erythema.

Specific Chronic laryngitis

Specific Chronic laryngitis Included in specific chronic laryngitis laryngitis is tuberculosis and laryngitis luetika.

a. Tuberculosis laryngitis.

The disease is almost always due to pulmonary tuberculosis. Typically post-treatment, pulmonary tuberculosis cured but still settled tuberculosis laryngitis. This happens because the structure of the laryngeal mucosa attached to the cartilage and vaskularisasinya were not as good as the lungs so that when the infection has hit its governance, the cartilage can be prolonged.

In the clinical manifestations of tuberculosis laryngitis consists of four stages, namely :

1. Stadium infiltration.
posterior laryngeal mucosa swelling and hyperemia, can the vocal cords. Tubercles formed in the submucosa that appear bluish spots. Tubercles enlarged and some adjacent tubercles unite so that the top of the mucous stretched so that one day it will burst and ulcers.

2. Stadium ulceration.
ulcers that arise in end-stage dilated infiltration. The ulcer is removed, essentially felt very painful.

3. Stadium perikondritis.
Ulcer deepened so as to kartuilago larynx mainly arytenoid and epiglottis, causing cartilage damage.

4. Stadium tumor formation. Fibrotuberkulosis formed on the posterior wall, the vocal cords and subglotik.

 b. Laryngitis Luetika.

Chronic inflammation is rarely found in 4 stages Lues most associated with chronic laryngitis is Lues tertiary stage where the formation gummas which sometimes resembles a laryngeal malignancy. If the rupture will occur guma typical ulcers are ulcers are very deep, brimmed with hard bottom, dark red with yellowish exudate. The ulcer is painless but spread quickly.



V. Complication


Complications that can occur, namely chronic laryngitis. In addition, voice changes can occur if these symptoms occur rasping sound during 2-3 weeks. The sound changes can be caused by acid reflux or exposure to irritants. It is risky to cause malignancy on the vocal cords.


VI. Classification

Laryngitis is classified into two types :

1. Acute laryngitis.

Acute laryngitis caused by bacterial or viral infection, excessive use of voice, inhalation of environmental pollutants. Acute laryngitis is characterized by afonia or missing sounds and chronic cough. These symptoms are aggravated by environmental conditions cool and dry.


2. Chronic laryngitis.

Chronic laryngitis is characterized by persistent afonia. In the morning, sore throat but usually improves in warmer temperatures. Sore throat and cough worse back by noon. Coughing can also be triggered by cold air or cold drinks. In patients who have allergies, uvula will look rosy.
Chronic laryngitis may occur after repeated acute laryngitis, and can also be caused by chronic diseases upper tract urinarisu, smoking , Exposure to irritants that are constant, and excessive alcohol consumption. Signs of this are chronic laryngitis sore throat insignificant, hoarseness, and there is edema of the larynx.

Signs and Symptoms of Laryngitis


Signs and symptoms of laryngitis may include :

• Hoarse,
• Sound weak or loss of voice.
• Itching and rough in the throat.
• Pain in the throat.
• dry throat
• hacking cough.
• Difficulty breathing (in children).

Treatment

Generally, this disease does not need to be hospitalized, but no indication was admitted to hospital if :

- Patients under 3 years of age.

- Looks toxic, cyanosis, dehydration or axhausted.

- Diagnosis of patients is still unclear.

- Inadequate home care.



Therapy



1. Resting talk and speak for 2-3 days.

2. If the patient may be given oxygen tightness 2 l / min.

3. Break.

4. Inhaling warm steam and drops of mint oil can arise when there is a blockage in the nose, or the use of saline (0.9% saline) that is packaged in the form of a nasal spray.

5. Medikamentosa : Paracetamol / antipyretic if the patient is no fever, if there are symptoms of pain killer medication can be administered anti-pain / analgesic agents, nasal congestion can be administered as a nasal decongestant phenylpropanolamine (PPA), ephedrine, pseudoephedrine, napasolin can be administered in oral form or spray.
Namely adequate antibiotic treatment :

Ampicillin 100 mg / kg / day.
intravenous, or chloramphenicol divided into four doses: 50 mg / kg / day. intravenously, divided into 4 doses or third generation cephalosporin (cefotaxime or ceftriaxone) can then be given intravenous corticosteroids such as dexamethasone, with a dose of 0.5 mg / kg / day divided into 3 doses, administered over 1-2 days.

6. Suctioning mucus from the throat or larynx , if management does not work, do endotracheal or tracheostomy when it happened airway obstruction.


Prevention

- Don't smoke, avoid cigarette smoke because smoking will make a dry throat and cause irritation of the vocal cords.

- Drink plenty of water because fluids will help keep mucus found in the throat is not too much and is easy to clean.

- Limit even refrain from using alcohol and caffeine to prevent dry.

- Don't clear your throat to throat clearing for clearing his throat will cause an abnormal vibration of vocal cords.

- Improve and cleared his throat swelling will also cause the throat to produce more mucus.


X. Supporting investigation

1. AP radiographs of the neck: it can seem subglottic tissue swelling (Steeple sign). This sign was found in 50% of cases.

2. Laboratory examination : blood picture can be normal. If accompanied by secondary infection, leukocytes can be increased.

3. In an indirect laryngoscopy examination will be found laryngeal mucosa very swollen , hyperemia and no visible swelling of the membrane as well as subglottic namely connective tissue swelling on the conical elastikus which will appear below the vocal cords.



Assessment Theory

I. Patient identity.

1. Disease History.

This includes the main complaints begin before there is a complaint to fever, nausea, vomiting, spasms, bapil, and pain when swallowing and speaking.


2. Past medical history.

Clients feel nausea, vomiting, fever, spasms, cough, painful swallowing whether there is a relationship with the illness earlier.


3. Family Disease History.

This includes how the health of the family, if the family members who suffer from infectious diseases.


II. Health History and Childbirth.

1. Prenatal
Nutritional state mother during pregnancy, infectious diseases suffered by mother during pregnancy, psychological Pregnant women, the use of herbs and drugs.


2. Natal.

Covering the current state of birth, labor, abnormalities that obtained the trauma of childbirth.


3. Post natal.

Abnormalities in babies, infants circumstances, immunization obtained.



III. Growth history of laryngitis

Growth include Weight, Height. Progress includes psychosocial development of fine and gross.

IV. Immunization history.
Covering immunization Hepatitis, Measles, Polio.

V. Nutrition History.
Breast milk and include the provision of supplementary feeding as well as the types of food additives are given.


VI. Patterns of Health Functions.

1. Governance patterns of perception and healthy life.
The response of patients about health and hygiene habits that are less keep covering , healthy management patterns in everyday life . How often Client bathing, brushing teeth and Client action if ill.


2. The pattern of nutrition and metabolism.
In general, people with laryngitis appetite decreases and their difficulty in swallowing.

3. Patterns of elimination.
Elimination patients sometimes experience constipation while on impaired urinary elimination not only the color of urine to brown.

4.Rest and sleep patterns.
At rest and sleep will decrease due to laryngitis patients with shortness of breath and pain when swallowing talk.

5. Activity and exercise patterns.
In patients with laryngitis will be impaired because they have bedrest as well as nausea, vomiting, fever and pain that makes the activity decreases.

6. Patterns of perception and self-concept.
It usually occurs anxiety in the patient to a state of illness, the psychological impact, and changes in self-concept as: body image, self ideal.

7. Sensory and cognitive patterns.
Covering body image, self systems, identity confusion, depression and patients' knowledge about the disease.

8. The pattern of the relationship role.
How is the role of the patient in the patient's family includes relationships with family and others.

9. Patterns of relationship stress.
Usually, patients often daydreaming and anxiety over the state of the disease.

10. The pattern of values ​​and beliefs.
Usually patients are impaired in terms of worship for the patient to be treated so that their activity was helped by family.



Medical management

1. Speech and voice breaks for 2-3 days.

2. Inhalation of moist air.

3. Avoid irritation of the larynx and pharynx (eg, smoking, spicy foods, or drink iced).

For the medical treatment of children given penicillin antibiotics, 3x50 mg / kg. When allergies can be replaced erythromycin or basitrosin can be given cortisol to cope with edema. Installed an endotracheal tube or tracheostomy tube if there is a blockage of the larynx.


 Supporting investigation

Smear from the larynx to the culture and resistance tests in case of prolonged or frequent residitif.

How is the diagnosis ?

To ensure laryngitis doctor will examine the inside of the larynx of patients by studying their reflections through a special glass. Examination in this way can show vocal cords red, inflamed and sometimes bleeding with enlarged edges and pointy , Doctors also checked the discharge and in severe cases will be conducted breeding tests on the liquid.


Nursing Diagnosis and Intervention

Impaired sense of comfort : acute pain and inflammatory processes.

Intervention :

- Please note the change in the characteristics of pain.

- TTV observation.
Take action to improve the sense of comfort (give change of position, relaxation techniques / distraction and minimizing disturbed stimulus).

- Collaboration : analgetik as indicated.



Hyperthermia bacterial infection Haemophilus Influenzae.

Intervention :

- Observation of body temperature, especially TTV.

- Describe efforts to tackle hyperthermia on the family by giving a cold compress using thin clothes and drink plenty when hyperthermia.

- Collaboration; Give antipyretic therapy as indicated.



Risk Ineffective breathing pattern and inflammation of the larynx

Intervention :

- Assess the speed and depth of breathing and movement of the chest, lung auscultation, record a decrease in additional breath sounds and voices.

- Use pillows to maintain open airway.

- Give the right position by elevating the head or put in a sitting position.

- Explain to patients / families on actions that facilitate business spirit like position Fowler / semi-Fowler.

- Collaboration; Increased humidity and the provision of additional O2 etc.



The risks to an imbalance in nutrition less than body requirements decrease and convenience mouth oral input.

Intervention :

- Assess nutritional status in patients.

- Give soft foods that do not stimulate stimulus sore mouth / larynx.

- Monitor patients and food every time after eating.

- Collaboration ; Forward parenteral fluid therapy.


Family processes, Interrupted patient's illness and hospitalization.

Intervention :

- Dig a family feeling and the problems that occur during hospitalization.

- Give a concern and needs of the elderly patient information and support.

- Involve the family during treatment.

- Tell us about the treatment carried out in accordance with the child's family knowledge.







Read also :

- How to treat migraine headaches.

- How to treat neck pain.

- Easy way to treatment chest pain.