Laryngeal edema refers to swelling of the submucosal tissue in areas of the larynx with looser mucosa.
Etiology
Hypersensitivity Reactions
Allergic reactions to medications, such as penicillin injections, oral potassium iodide, or aspirin, may lead to laryngeal edema. Individuals with allergic constitutions are more prone to develop allergic laryngeal edema after consuming allergenic foods such as crabs or shrimp.
Hereditary Angioneurotic Edema
This is an autosomal dominant genetic condition characterized by recurrent episodes of laryngeal edema. It is associated with a deficiency or functional defect of C1 esterase inhibitor (C1-INH) in the blood.
Infections of the Pharynx and Larynx
Conditions such as laryngeal perichondritis, laryngeal tuberculosis, peritonsillar abscess, parapharyngeal abscess, cellulitis, and other neck infections can contribute to laryngeal edema.
Trauma or Iatrogenic Injury to the Larynx
Repeated or prolonged bronchoscopy, surgical injury to the larynx, or post-radiation reactive edema can result in laryngeal swelling.
Physical or Chemical Factors
Exposure to corrosive agents, strong chemical gases, or high-temperature steam may irritate the larynx and induce swelling.
Other Causes
Systemic conditions such as heart disease, nephritis, liver cirrhosis, and hypothyroidism leading to myxedema; or the compression of the larynx by large mediastinal or neck tumors may also cause laryngeal mucosal edema.
Pathology
Areas with looser mucosa, such as the aryepiglottic folds, interarytenoid region, and epiglottis, often demonstrate submucosal fluid infiltration and interstitial edema. In infectious laryngeal edema, the exudate typically has a seropurulent character, whereas in non-infectious cases, the exudate tends to be serous.
Clinical Manifestations
The onset of symptoms is rapid. Particularly in cases of allergic or hereditary angioneurotic laryngeal edema, symptoms can progress quickly, with stridor, hoarseness, respiratory distress, and even asphyxiation developing within minutes. Facial swelling and pruritus may accompany these episodes, along with a history of recurrent attacks. Swelling in the interarytenoid region and aryepiglottic folds often causes a sensation of a foreign body in the throat and difficulty swallowing. Laryngoscopic examination reveals diffuse laryngeal mucosal edema and pallor.
In infectious cases, symptoms such as throat pain, hoarseness, stridor, and respiratory difficulty may appear within a few hours. The laryngeal mucosa is observed to be deeply red, swollen, and shiny during laryngoscopic evaluation.
Diagnosis
A detailed medical history and thorough examination of the pharynx, larynx, and overall systemic condition are used to distinguish between infectious and non-infectious laryngeal edema.
Treatment
Administration of adequate doses of glucocorticoids and spraying the pharynx and larynx with 0.1% epinephrine helps reduce swelling. Subsequent nebulized inhalation of glucocorticoids is also utilized.
Infectious cases require sufficient antibiotics, and if an abscess has formed, incision and drainage are performed.
Severe laryngeal obstruction necessitates tracheostomy.
Identification of the underlying cause allows for targeted treatment.