The larynx is one of the most complex human organs. At the same time, it is also an extremely important structure - it is thanks to the larynx that we can speak, but also its function is to protect against various pollutants from getting to further parts of the respiratory tract. Diseases of the larynx - due to the fact that their symptoms may resemble, for example, a cold - are usually diagnosed quite late, which creates a risk that they will have time to lead to complications. So check what ailments should arouse anxiety, because they may be symptoms of laryngeal diseases.

The larynx(larynx, colloquially referred to in this language as the voice box) is an organ whose functions vary widely in different species. For example, in birds, the task of the larynx is to protect the respiratory tract from the entry of various foreign bodies.

In humans, the role of this organ is much more important - it is thanks to the larynx that we are able to communicate with each other using speech. This function of the larynx was already emphasized by Galen, who described this organ as "the most important structure for the formation of the human voice".

Larynx: development

The human larynx is formed from two ovules: from the buccal-pharyngeal bud (from which the epiglottis develops) and the tracheobronchial bud (from which the glottis and subglottis are formed).

The primary germ of the larynx appears around the 33rd day of fetal life. Of course, it is subject to many developmental processes that prepare this organ to perform its functions after its birth, but it should be emphasized here that the larynx plays an important role in fetal life.

Well, while in the womb, the baby - which is completely physiological - swallows some amounts of amniotic fluid. However, for this to happen properly, the larynx must function properly to prevent excessive aspiration of amniotic fluid.

Larynx: location and size

The larynx is located in front of the neck, extending between the pharynx and the windpipe. At birth, it is at a height of 2-4. the cervical vertebrae, but with time its position changes and eventually in adults the larynx is located at the level of 4-7 cervical vertebrae (the larynx is slightly higher inwomen, below for men).

The structure of the larynx resembles an upside down pyramid. The size of this organ in adults is usually 5 to 6 cm.

Larynx: structure. Laryngeal cartilage

One thing about the structure of the larynx can be said with certainty: it is quite complicated. The specific skeleton of the larynx is made of several cartilages - these are:

  • thyroid cartilage (the largest of the laryngeal cartilages, forming the skeleton of this organ from the front; it is made of two plates, which in the midline form the so-called laryngeal eminence - this is what is responsible for the occurrence of Adam's apple in men)
  • epiglottic cartilage (in terms of function, probably the most important of the laryngeal cartilages - it opens and closes the entrance to this organ)
  • cricoid cartilage (it is located in the lower part of the larynx, behind which this organ passes into the trachea)
  • tincture cartilage
  • rosacea
  • wedge-shaped cartilage

The individual cartilages of the larynx differ not only in shape, but also in the tissue they are made of. Namely, the tincture, discoid and annular cartilages consist of hyaline cartilage, the epiglottis is fibrous cartilage, and the remaining laryngeal cartilages are composed of fibro-elastic cartilage.

Larynx: structure

Larynx: articular connections

There are two - and sometimes three - articular connections within the larynx. They are:

  • ring-tincture joint
  • cricothyroid joint
  • papillary-rosal ligament (in some people it is a connection made of connective tissue, but sometimes it is an articular connection)

Larynx: ligamentous connections

There are numerous ligamentous connections between the structures belonging to the larynx itself and those adjacent to this organ. Among them, it is worth mentioning primarily:

  • thyroid-hyoid membrane (this is the connection between the thyroid cartilage and the hyoid bone above the larynx, it is additionally strengthened by the lateral and medial disc hyoid ligaments)
  • epiglottic hyoid ligament (connection between the hyoid bone and epiglottis)
  • glosso-epiglottic ligament (it runs from the root of the tongue to the epiglottis)
  • cricotracheal ligament (connection between the lowest of the laryngeal cartilages - the cricoid - and the initial part of the trachea)

The larynx has ligamentous connections with neighboring structures, but also suchthey exist within itself. The basic one in this case is the fibrous-elastic membrane, in which there are two parts:

  • quadrilateral
  • spring cone

Laryngeal muscles

Many different muscles are connected to the larynx and, as with ligamentous connections, there are muscles that extend between the larynx and other structures and the proper (internal) muscles of the larynx.

The external muscles of the larynx (whose role is primarily to determine the position of this organ) include:

  • inferior pharyngeal sphincter muscle
  • subglass muscle group
  • suprarenal muscles

The internal muscles of the larynx are the ones that enable the performance of the functions proper to this structure. They are divided differently, the most important, however, seems to be the division taking into account how individual of these muscles affect the larynx, and in this case the following are distinguished:

  • muscles narrowing the glottis gap: thyroid-tincture muscle, tincture muscle, lateral cricole-tincture muscle
  • muscle that expands the glottis gap: posterior ciclapillary muscle
  • muscles relaxing the vocal folds: the epiglottic epithelial muscle and the epiglottic thyroid muscle
  • muscles tightening the vocal folds: vocal muscle, cricothyroid muscle

Larynx: division into floors

The larynx is generally divided into three parts, which are:

  • upper floor (laryngeal vestibule, extending from the initial part of the larynx to the vocal folds)
  • middle level (aka glottis, it is limited by vocal folds)
  • lower floor (subglottic area below the vocal folds)

Larynx: vascularization and innervation

Laryngeal arterial vascularization comes from the laryngeal arteries: the upper (which are branches of the external carotid artery) and the lower (originating from the subclavian artery).

Venous blood from the larynx drains into the superior disc vein, from where it goes to the internal jugular vein and to the inferior disc vein, going into the left brachiocephalic vein.

The innervation of the larynx is derived from the tenth cranial nerve - the vagus nerve - donating the superior and retrograde laryngeal nerves.

Larynx: functions

The basic function of the larynx is known to everyone - it is this organ that enables people to speak. In this case, the sound is created thanks to the movements of the vocal folds located in the middle level of this organ. Influenced by the road flowingthe breathing air, these folds vibrate and, ultimately, it is thanks to this that we are able to make our voices.

Participation in the production of speech (because apart from the larynx, other structures of the body are also involved in this process) is definitely not the only function of the larynx.

The larynx also protects the respiratory tract from the ingress of foreign bodies - this is done, among others, by thanks to the fact that the cough reflex is generated in the larynx (coughing in the end - although of course it can be troublesome - is designed to remove foreign structures from the inside of the respiratory tract).

In addition, the function of the larynx is also to immobilize the chest (by closing the airways) when the situation requires it - it happens, for example, when passing a stool, vomiting or during labor.

Important
  • Laryngeal pain and burning sensation , the feeling of an obstruction in the throat, can be triggered by gastroesophageal reflux. The gastric contents return to the lower esophagus and pharynx, irritating the laryngeal mucosa and causing such discomfort. Then it is worth visiting a gastroenterologist.
  • Hoarseness ,coughing ,gruntingor sudden loss of voice may be the result of severe stress, neurological disorders. Sometimes the help of a neurologist or psychiatrist is necessary.
  • Voice loweringandhoarsenessmay be caused by hormonal imbalance, such as hypothyroidism, estrogen deficiency in postmenopausal women. You need to consult an endocrinologist or gynecologist.

How is voice formed in the larynx?

The air exhaled from the lungs sets the vocal folds, commonly known as chords, in motion on both sides of the larynx. This is how the sound is made.

At the beginning of the exhalation, the folds stick together, closing the gap of the glottis between them. Due to the pressure of exhaled air, they move apart like tight elastic bands, and then return to their original position.

The repeated opening and shortening of the strings (from several dozen to several hundred times per second) causes air vibrations and the formation of sound. However, the resulting laryngeal tone is weak and colorless.

Only when passing through the so-called resonance cavities (throat, mouth and nose), gains the appropriate color and strength.

A clear, he althy voice comes out when the vocal cords are close together, but not closed, and vibrate symmetrically at the same frequency. They must be supported by the proper work of the vocal muscles, palate, lips and tongue.

However, if something in this complicated machine is not good, we start talkingwith an "uneasy" voice.

Laryngeal examinations

Based on the interview, the doctor can initially figure out what is the cause of the ailments. So he asks, inter alia, o their type and how long they persist, o the nature and place of our work, how often we get infections, whether we breathe well through our nose. He is also interested in how often we drink alcohol or smoke, and what medications we take. Then he examines the throat and ears, checks the patency of the nose, assesses the larynx and the appearance and mobility of the vocal folds.

Sometimes it is also necessary to perform specialist examinations, e.g. stroboscopic examinations, which involve inserting a device illuminating the inside of the larynx with intermittent, i.e. stroboscopic light, into the throat. It allows you to observe the behavior of the vocal folds in slow motion.

Sometimes a computed tomography (layered image of the larynx) and a histopathological examination (microscopic analysis of the collected tissues) are performed.

Don't do that
  • Do not smoke and avoid smoky rooms. Tobacco smoke damages the lining and increases the risk of cancer.
  • Do not abuse alcohol, limit the consumption of strong coffee and tea. They irritate and dry the mucosa.
  • Do not drink or eat food that is very cold or very hot. They damage the throat mucosa.

The most common diseases of the larynx

Diseases of the larynx have symptoms that are usually similar:

  • dry mouth
  • hoarseness
  • change the sound of the voice

The first sign that your larynx is not right is usually a bothersome dry throat. Then there is tickling, difficulty swallowing, and finally pain or hoarseness.

In general, we blame these symptoms for a cold, but they can have a completely different background. Therefore, in the event of disturbing symptoms, you need to see a doctor so that he can find out what is the cause of the ailments.

The method of treatment depends on the nature of the problem. Sometimes it is enough, for example, to quit smoking for laryngeal diseasesandto go away. Other times you need to take medications, physical therapy or surgery.

  • Acute laryngitis

Acute laryngitis is usually caused by viruses, less often by bacteria. Often accompanied by infections of the upper respiratory tract. Inflammatory changes can affect the vocal cords as well as other parts of the larynx.Symptoms:hoarseness, foreign body sensation in the throat, stuffy nose, cough, elevated temperature. In the case of a bacterial infection - purulent discharge appears.Treatment:you need to save your voice, moisturize the air, take inhalations and drink a lot. Sucking agents and pain-relieving syrups are helpful. If the bacterial inflammation persists after a few days, it is administeredantibiotic.

  • Chronic condition of laryngitis

The cause of the disease may be repeated acute laryngitis, excessive use of the voice, e.g. by teachers, smoking, excessive drinking of alcohol, as well as being in polluted or overheated air.

The risk of getting sick increases when several factors overlap. Irritation of the larynx usually causes changes in the vocal cords - hypertrophic (thickening of the strings) or atrophic (atrophy of the mucosa).

Unfortunately, untreated chronic laryngitis sometimes leads to precancerous conditions.

Symptoms:hoarseness, worsening with talking, smoking, etc., dry cough, grunting, scratching or burning. Sometimes the voice disappears.Treatment:you need to eliminate the cause of the disease: quit smoking, save your voice, learn to breathe the diaphragm and keep the nose open (e.g. surgery on a crooked septum). Relief is provided by expectorant syrups and preparations reducing the viscosity of secretions and preventing dryness of the larynx. It is also a good idea to gargle with mixtures with vitamins A and E or a decoction of chamomile or sage. Inhalations with soda or with the addition of essential oils (e.g. eucalyptus or pine) and calcium-iodine iontophoresis give good results. Climatic treatment in the mountains or at the seaside is advisable.

  • Laryngeal edema

Usually they develop from an allergic background. They can also be a consequence of an injury or inflammation of the larynx.Symptoms:hoarseness or whistling or breaking voice, increasing shortness of breath.Treatment:the most dangerous areallergic swelling that comes on suddenly and can cause suffocation. Therefore, when the reason is an allergy - steroids and antihistamines are administered intravenously. Swelling as a result of inflammation is treated with anti-inflammatory drugs or antibiotics. If breathing difficulties are severe, a tracheotomy should be performed. The tracheal cartilage is incised (under anesthesia) and a tube is inserted that allows you to breathe without the larynx and pharynx.

  • Laryngeal polyps

Polyps of the larynx are the most common benign nodules of the larynx. They may appear on one or both of the vocal folds. They are usually the result of excessive vocal effort and smoking.Symptoms:Voice disorders ranging from hoarseness to complete silence. If a large polyp or so-called pedunculated (on a leg) trapped in the glottis, may cause rapid dyspnea.Treatment:when the changes do not hinder breathing, it is usually recommended to save voice, inhalation and iontophoresis. Large and pedunculated polypsis removed using a laryngoscope. If voice hygiene is not respected, they may reappear.

  • Vocal nodules (singing nodules)

Vocal nodules (singing nodules) are small growths that form on both vocal folds. They are formed as a result of chronic inflammation, most often as a result of overloading the vocal folds - in singers, teachers, speakers.Symptoms:hoarseness, a feeling of throat in the larynx.Treatment: you should restrict speaking. Rehabilitation involving exercises in voice emission is also needed. It is essential to master the art of diaphragm-costal breathing, which allows you to manage the exhaled air without straining your vocal cords. In addition, all factors that may irritate the larynx must be eliminated. Calcium-iodine iontophoresis brings good results. If left untreated, "soft" nodules can become fibrotic and turn into "hard" nodules. They are removed with a laryngoscope.

  • Papillomas of the larynx

Probably caused by a virus. They appear on the vocal cords, but can also extend to the trachea.Symptoms:hoarseness, dyspnoea.Treatment:therapy depends on the patient's age and the aggressiveness of the disease. In children, autogenous vaccines that strengthen the immune system, antiviral vaccines, interferon are usually used. In adults, papillomas are more often removed by microsurgery. Unfortunately, they like to grow back. Sometimes they become malignant (the tumor grows quickly then and is covered with white keratinized epithelium), therefore people who have been diagnosed with the disease should be under the constant supervision of a specialist.

  • Laryngeal granulomas

Laryngeal granulomas are inflammatory changes, most often caused by gastroesophageal reflux, excessive vocal effort, and chronic cough.

  • Leukoplakia

Leukoplakia (white keratosis) is a white or gray-white spot on the laryngeal mucosa, mainly on the vocal folds. These changes are often referred to as calluses (pachydermia), keratosis or hyperkeratosis. In most cases, patients with leukoplakia are tobacco smokers, often also abusing alcohol. Various types of HPV viruses and gastroesophageal reflux are highly likely to contribute to the pathogenesis of leukoplakia. Leukoplakia may be accompanied by other clinical changes - chronic hypertrophic laryngitis, polyps, edema, papillomas, granulomas.

  • Laryngeal cancer

Laryngeal cancer affects mainly men aged 55-65, mainly smokers (they are ill 40 times more often). The soonerthe detected disease, the greater the chances of treatment success. If the disease is treated at an early stage of development, therapy is 98% successful. cases.Symptoms:begins with gradually increasing hoarseness. Over time, the timbre of the voice changes, the patient has a feeling of obstruction in his throat, he clears his throat, feels pain when swallowing, which may radiate to the ear. At an advanced stage, shortness of breath, coughing, hemoptysis appear, and the lymph nodes in the neck become enlarged. The symptoms persist despite anti-inflammatory treatment.Treatment:The type of therapy depends on the place and stage of the disease. The doctor may choose to use radiation or surgery. It involves the removal of the lesion or the complete removal of the larynx. Then, a tracheotomy tube is permanently inserted in the trachea through which the patient will breathe.

In this case, speech rehabilitation under the guidance of a speech therapist and phoniatrist is also necessary. If the patient does not master the so-called replacement speech, the doctor may consider using a speaking device - the so-called voice prosthesis, i.e. electronic larynx.

You must do it
  • Limit spicy spices and spicy foods. They are harmful just like alcohol.
  • Drink 2.5 liters of fluid a day. This way you will moisturize the throat mucosa. If your hoarseness is caused by a cold, you will find relief from drinking still mineral water, chamomile or linseed infusion, or a alcoholic solution.
  • Humidify the air in the apartment and avoid being in rooms with air conditioning.
  • Save your vocal cords. Try to speak in a normal voice, don't shout or whisper.
  • Breathe through your nose. If it is obstructed, remove the obstacles (e.g. operate on a bent septum).
  • Learn to breathe the diaphragm. You will put less strain on the vocal cords.
  • Avoid upper respiratory infections. They are conducive to diseases of the larynx.

Diseases of the larynx and breathing problems

Due to the narrowing of the glottis, air has limited access to the lungs. While inhaling, we hear a characteristic whistle in the larynx and gasp for air.

The reasons for reducing or closing the lumen of the glottis may be different:

  • lesions of the larynx (edema and growths)
  • appearance of a foreign body (e.g. fruit stone stuck, choking on saliva or food)
  • burn
  • cut
  • allergy

In the event of sudden dyspnea, medical attention must be sought as soon as possible. Restricting the air supply to the lungs can even result in death.

Note!An ENT consultation requires voice problems that last longer than three weeks.

Laryngitis

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ENT