In pediatric medical practice, there are a number of pathological conditions that require emergency medical care. One of these pathologies is laryngeal stenosis.
What it is?
Severe narrowing of the larynx is called stenosis. This pathological condition can occur at any age. Usually, the development of the disease occurs rapidly. A variety of reasons can lead to the development of stenosis. This pathology is most dangerous in newborn babies and infants.
The larynx is the organ responsible for the appearance of the voice. The vocal cords, which are located inside this anatomical element, take an active part in this. Narrowing or stenosis of the glottis that is normally present in the larynx, and leads to the appearance in the child of dangerous symptoms of respiratory disorders.
Some doctors also use other terms denoting this pathological condition in babies. They also call this narrowing stenosing laryngotracheitis or acute laryngeal stenosis. These terms largely explain the essence and mechanism of the development of adverse symptoms in a baby.
Babies have several functional and anatomical features of the development of their body. This explains the mechanism of development of pathological narrowing of the glottis.
The mucous membranes lining the respiratory organs are well supplied with blood and are closely associated with lymphoid formations. This leads to the fact that any infection that has entered the body can lead to the development of a strong narrowing of the glottis.
The abundance of lymphoid tissue in the submucosal space of the vocal apparatus contributes to the development of severe edema and swelling of damaged tissues in a sick baby.
Such manifestations are especially dangerous in babies. at the age of 2-6 months of life. In this case, the course of the disease can be extremely unfavorable. Without timely medical assistance, the baby may even die.
The larynx in children is rather small and resembles a "funnel" in shape. The location of the vocal cords in babies is not at all the same as in adults. They are somewhat higher among them.
The diameter of the glottis in babies is also slightly smaller. This contributes to the fact that stenosis of the larynx develops in them much faster and is dangerous by the development of the most dangerous complications.
During its development, the disease can sequentially spread to several adjacent anatomical elements. The process begins with the glottis. Then he goes to the sub-vocal space and the anterior wall of the larynx. In this case, doctors talk about an extended pathological narrowing. The involvement of the posterior wall of the organ in the pathological process leads to the development of posterior stenosis.
If the tissues of the larynx are damaged in a circle, then such a clinical variant of the disease is called circular narrowing. In this case, the course of the disease is already noticeably worsening.
A huge process causes development total stenosis. This condition is extremely dangerous, as it leads to the development of immediate acute respiratory failure. Without the provision of medical care, such a pathology can even lead to death.
Causes
A variety of reasons can lead to the development of pathological narrowing of the glottis. Their impact can be different in duration, in some cases only a short and intense impact is enough.
The severity of adverse symptoms largely depends on the underlying cause, which led to the development of this pathological condition in the child. The most common causes of stenosis in a baby are infectious pathologies. A variety of bacteria and viruses can lead to their development.
Stenosis is becoming a fairly common complication acute laryngitis. This pathological condition, as a rule, is caused in children by staphylococcal or streptococcal flora. Much less often, viral infections lead to the appearance of adverse symptoms of laryngitis.
The development of pathological narrowing of the glottis in babies is often led parainfluenza, scarlet fever, diphtheria, influenza, typhus and others infectious pathologies. These diseases are also dangerous by the development of a pronounced intoxication syndrome, which is manifested by an increase in body temperature in a child and the development of severe general weakness.
Traumatic injury larynx can also lead to the development of dangerous symptoms of acute respiratory failure in the crumbs. This pathological condition in newborn babies is facilitated by incorrectly performed childbirth.
Operations on the thyroid gland can cause dangerous complications in the baby, manifested by the development of a strong pathological narrowing of the glottis.
In the smallest patients, the cause of laryngeal stenosis is also quite often ingestion of foreign objects into the respiratory tract... Even a small detail of a toy that the baby twirls in his hands can close the lumen of the child's bronchus.
This feature is due to the rather narrow lumen of the bronchi in babies. An object trapped in the respiratory tract can lead to asphyxia - a pronounced narrowing of the larynx and a complete cessation of breathing. In this case, emergency medical care is required in order to save the child's life.
Congenital tracheal diseases can also lead to the development of a severe narrowing of the glottis in the child. In this case, unfavorable clinical signs of stenosis appear already in newborn babies already in the first hours after birth.
As a rule, the treatment of pronounced anatomical defects in the structure of the larynx is carried out only with the help of surgical operations. The decision on the need for the operation is made by the operating pediatric otolaryngologist.
Allergies can also manifest in a child by the development of severe stenosis of the larynx. In most cases, this condition is caused by the ingress of allergens by airborne droplets.
Food and Chemicals become a common cause of the development of a pronounced narrowing of the glottis in a child. To improve breathing in this case, it is required to completely exclude the ingress of allergens into the child's body and the appointment of antihistamines or hormonal drugs. Allergic pathologies, according to statistics, most often develop in babies aged 5-12 years.
Purulent formations which appear in the neck, can also go to the inner parts of the larynx, thereby causing severe inflammation there. This leads to the fact that the child's lumen of the glottis narrows and breathing is significantly impaired. The course of purulent diseases, as a rule, is quite severe and proceeds with the development of the most unfavorable symptoms.
In some cases, surgical treatment is required to eliminate the ulcers in the neck.
Kinds
In their practice, doctors use a wide variety of classifications, which include a huge variety of different clinical variants of the disease.
By the time of the onset of adverse symptoms, all stenoses can be acute and chronic. For the first time, the narrowing of the glottis in a baby as a result of exposure to various reasons is called acute. Usually its course is the most dangerous and quite often complicated by the development of acute respiratory failure.
A subacute process is said to be if adverse symptoms persist for 1-3 months. The prognosis of the course of this clinical type of disease is usually more favorable. With the right treatment, all symptoms usually disappear completely. In some cases, chronic inflammation may occur.
If the pathological narrowing of the glottis in a baby persists for more than three months, then in this case, doctors are already talking about a chronic process. Usually, this clinical variant of the disease appears in babies with some kind of congenital anomalies in the structure of the respiratory tract.
A secondary pathology that contributes to the preservation of the narrowed lumen of the glottis can also lead to the development of a chronic variant of laryngeal stenosis in a child.
Children's otolaryngologists also distinguish several clinical forms of the disease. Each of them has its own characteristics in the development and degree of manifestation of adverse symptoms.
In their practice, doctors use a wide variety of tables, which contain the main features of the development of each form of a given pathological condition.
Given the reason that led to the narrowing of the glottis, all stenoses can be divided into the following groups:
- Paralytic. They occur in babies a little more often than in adults. As a rule, they develop in children who have undergone surgery on the thyroid gland or in the area of other formations on the neck. Pathological narrowing in this case occurs due to damage to the vocal nerve during surgical treatment.
Some babies may develop post-intubation stenosis, which occurs after improper tracheal intubation.
- Cicatricial. They can occur both after traumatic effects and after operations on the neck. Traumatic damage to the mucous membranes during surgical incisions leads to the formation of a lot of scar tissue. Such scars constrict the glottis, which contributes to a change in its diameter. Long-term ongoing infectious diseases can also lead to the development of cicatricial changes in the child.
- Tumor. They are an extremely unfavorable option for the development of the disease. The narrowing of the glottis in this case develops as a result of the proliferation of tumor tissue. Severe papillomatosis of the larynx is also a provoking cause of the development of large neoplasms, which, during their growth, cause a change in the lumen of the glottis.
- Allergic... They manifest themselves in babies with individual sensitivity to the development of allergies. A wide variety of allergens can provoke stenosis of the larynx. The most common in children are: insect bites, inhalation of plant pollen, certain chemicals and food.
Symptoms
The severity of clinical signs of pathological narrowing of the glottis can be very different. It depends on many initial factors:
- the age of the child;
- the presence of concomitant chronic diseases;
- the cause that led to the narrowing of the larynx.
Symptoms become more intense as the glottis narrows. So, doctors distinguish several stages of development of this pathological condition:
- 1 degree. With a narrowing of 1 degree, the baby's breathing is disturbed. This clinical variant of the disease is also called compensated, as it has a very good prognosis. At this stage of the disease, the baby's voice formation is impaired. The child's voice becomes hoarse.
- 2nd degree... The narrowing of the 2nd degree is accompanied by more striking unfavorable symptoms. This variant of the disease is called subcompensated. The baby becomes overly excited, breathes more often, his skin becomes bright red. Respiratory movements in this case become clearly visible from the side.
Some parts of the chest, which are located between the ribs, "sink" in the baby.
- 3 degree. The most unfavorable variant of the development of this pathological condition is a 3 degree narrowing. This form of the disease is also called decompensated. In this state, the child can be either extremely excited or completely inhibited. The skin begins to turn pale, and the area of the nasolabial triangle and lips acquire a blue tint. In the most severe cases, the child may even completely lose consciousness.
Asphyxia
The most extreme stage of the development of the disease is called asphyxia. This is the most dangerous condition, especially for babies. This pathology is characterized by a complete cessation of breathing. In the absence of oxygen supply, brain cells begin to die.
If you do not provide emergency assistance, then the baby can die of acute respiratory and heart failure.
Urgent care
Parents should remember that the appearance in a child of signs of breathing disorders is an emergency indication for to call an ambulance... This must be done before taking any attempts and actions to quickly relieve the seizure that has arisen.
After calling the ambulance, parents should first of all try to calm down and in no case panic! A "cold" mind is a prerequisite for helping your baby in such a difficult situation.
While waiting for the doctor, try to calm the baby down. To do this, you can take the child in your arms. Monitor your baby's condition constantly. Open all vents and doors in the nursery to provide fresh air and oxygen to the room. In the cold season, put on a warm blouse and pants on your child so as not to catch a cold.
First aid from the parents consists only in carrying out non-specific actions that will be aimed at some improvement in the child's well-being.
Babies who develop laryngeal stenosis due to severe infectious diseases occurring with a high temperature can be given antipyretic and anti-inflammatory drugs. Such first aid is used only with persistent febrile condition.
To reduce airway swelling and improve breathing, antihistamines... Such funds include: "Claritin", "Suprastin", "Loratadin", "Zirtek" and many others. They are usually used for 5-7 days. Longer use of drugs must be discussed with the attending physician.
Treatment
Therapy for stenosis of the larynx is carried out only by the attending physician. In most cases, this pathological condition is treated in a stationary setting. For this, a whole range of different medicines is used.
With a more severe course of the disease, the baby is hospitalized to the intensive care and resuscitation department... If the cause of the pathological narrowing of the glottis is a bacterial infection, then antibacterial agents with a wide spectrum of action must be added to the treatment regimen.
The frequency of use, the daily dosage, the route of administration and the duration of the course of antibiotic therapy are chosen by the attending physician.
In some chronic forms of stenosis, to improve breathing, sick babies are given special inhalations. For this, as a rule, alkaline preparations or isotonic sodium chloride solution are used. The number of procedures required can be very different. Usually, 12-15 inhalations are performed to achieve a positive effect.
In severe cases of laryngeal stenosis, glucocorticosteroids have a positive effect. The dosage of dexamethasone is selected individually, taking into account the age and weight of the sick baby.
With a lighter course, hormonal agents in the form of inhalation and aerosols. "Pulmicort" allows you to improve the indicators of external respiration and helps to improve the general well-being of the child.
During the acute period of the disease, all sick babies are recommended follow a special diet... The basis of such a therapeutic food is fermented milk products, as well as vegetables and fruits. All dishes are steamed, baked or boiled. Fatty and difficult to digest foods from the children's menu are completely excluded.
After the acute period of the disease, a complex of rehabilitation measures is carried out. It is necessary to eliminate residual symptoms and improve the overall well-being of the baby.
Hiking to the salt cave, various physiotherapy procedures and hardening are excellent methods to restore breathing and strengthen the baby's immunity.
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