A laryngocele is a bulging of one of the two mucous membrane pockets, which in humans are located in pairs on the side of the larynx between the vocal folds and the pocket folds. A laryngocele can be congenital or acquired throughout life. Due to the inflammatory processes that can take place within a laryngocele, surgical removal may be necessary.
What is laryngocele?
An internal laryngocele that forms inside the larynx initially has no symptoms for a long time. In the later stage, hoarseness sets in, which gradually increases. See AbbreviationFinder for abbreviations related to Laryngocele.
In the human larynx there are two pairs of lateral protrusions of the larynx mucosa between the pocket and vocal folds. The bulges are called the Morgagni ventricles or Ventriculi larynges. Its physiological importance probably lies in its function as a resonance body when speaking and singing.
If one of the laterally located pockets develops a clear bulge or bulge that resembles a hernia, i.e. in this case corresponds to a perforation of the larynx mucosa, this is called a laryngocele. Laryngoceles often develop into cysts.
A lining of respiratory epithelial tissue including ciliated epithelium with mucus-producing goblet cells is characteristic. Depending on whether the laryngocele develops inwards or outwards, it is an internal or external laryngocele. Laryngoceles tend to become inflamed because of the limited possibility of substance exchange within the laryngocele with simultaneous mucus production and the fact that the cilia hardly have any possibility of maneuvering the mucus and other substances to the outside. Therefore, they often contain not only air, but also purulent secretions.
Causes
The protrusion of one or both laryngeal ventricles into an internal, external, or combined laryngocele may be acquired or genetic. If there is a genetic predisposition, it could be that the genetic disposition means a relic or a throwback to prehominid times. Howler monkeys, for example, have two protrusions Ventriculi larynges, which look very similar to laryngoceles and support their howling sounds as so-called howler sacs.
Other genetic causes may lie in the fact that in the course of an embryonic developmental disorder, the formation of the epiglottis is associated with a relocation of the laryngeal entrance. Acquired laryngoceles are rare. One of the causes can be, for example, chronic inflammation in the larynx area, when the valve function of the epiglottis is impaired and breathing becomes difficult. Laryngoceles can develop in people who often have to build up excess pressure in the pharynx, such as glassblowers, trumpet players, clarinetists and oboists.
Symptoms, Signs & Ailments
An internal laryngocele that forms inside the larynx initially has no symptoms for a long time. In the later stage, hoarseness sets in, which gradually increases. There is usually a foreign body sensation or a feeling of increased accumulation of mucus that does not go away. Rarely, shortness of breath and difficulty swallowing also occur.
However, the symptoms increase rapidly in the case of acute inflammation of the laryngocele. Pain then occurs and acute shortness of breath can set in. An external laryngocele is easier to recognize because it bulges visibly at the neck and increases in volume significantly when strained. In an advanced stage, an external laryngocele also becomes noticeable through increasing shortness of breath.
Diagnosis & course of disease
While an inner laryngocele initially has few symptoms and is at best announced by unspecific hoarseness, an outer laryngocele is already conspicuous in the early stages. It is recognizable by a bulge on the neck, which even increases when air is squeezed because it fills with air due to the slight overpressure.
Computed tomography imaging can eliminate any remaining doubts about the presence of an internal or external laryngocele. The CT clearly shows cavities that are partially filled with air. The course of the disease varies. As long as the course is symptomless or even completely asymptomatic, regular monitoring is sufficient. If the course or the growth of the laryngocele progresses, a critical condition due to shortness of breath can develop without treatment.
Complications
In most cases, this disease is only discovered and diagnosed relatively late, since the symptoms appear late and are not particularly characteristic. For this reason, a delayed treatment of this disease is possible. Those affected usually suffer from hoarseness and also from shortness of breath.
In the worst case, the shortness of breath can also lead to a loss of consciousness, in which those affected can possibly be injured by a fall. Difficulty swallowing also occurs, so that the intake of food and liquids is usually no longer possible for the person concerned. This can lead to weight loss and various deficiency symptoms. In the worst case, the insufficient supply of oxygen to the inner organs can also lead to damage to the organs.
The treatment is carried out through an operation. Usually there are no complications. However, the intervention must be carried out immediately after the diagnosis in order to avoid further damage. If the procedure is successful, the patient’s life expectancy will not be reduced by the laryngocele.
When should you go to the doctor?
If hoarseness, difficulty swallowing, and other signs of a laryngocele are noticed, a doctor should be consulted. If the symptoms persist for more than a week or even worsen over time, medical help is also required. In the later stages, the disease leads to acute inflammation, which must be treated immediately. External abnormalities such as the typical swelling in the neck require a medical examination.
If the symptoms occur in connection with laryngitis, the responsible doctor must be informed. Parents who notice signs of a laryngocele in their infant are best informed by the pediatrician. A bulging of the mucous membrane pockets is relatively harmless, but if left untreated it can cause serious organ damage. Therefore, as soon as the first signs appear, a specialist should be consulted who can clarify the symptoms and, if necessary, initiate the necessary treatment measures directly. In addition to the family doctor, the ENT doctor or an internist can be consulted. In the case of advanced diseases in childhood, physiotherapy is usually also necessary.
Treatment & Therapy
If a laryngocele produces noticeable symptoms that lead to serious shortness of breath, treatment is urgently indicated. Since no drug treatment is known that would lead to the regression of a laryngocele, the only options left are surgical ectomy or marsupialization in the case of an external laryngocele. The laryngocele is opened and the edges of the wound fixed so that they cannot initially close in order to achieve constant drainage.
Marsupialization is used when complete removal is not indicated, for example because the risk of vocal cord injury is too high. Depending on the diagnosis and localization of the laryngocele, the intervention can also be carried out minimally invasively by removing the tissue using a laser or other suitable methods.
If inflammation occurs in the laryngocele, the progression of the disease can be significantly accelerated, so that a critical condition can quickly develop, which requires immediate surgical intervention. In most cases, speech therapy is recommended after laryngeal ectomy to restore normal voice with the help of speech therapy.
Outlook & Forecast
The prognosis of the laryngocele is favorable. In most cases, the disease can be completely cured with various treatment methods. The challenge lies in the diagnosis. Due to the difficulty and complexity of the circumstances, this often takes place very late, so that the person concerned has been suffering from the impairments for a long time. For this reason, the probability of a subsequent disturbance must be taken into account when making the prognosis.
Due to the disturbances in breathing activity, anxiety-provoking moments or even panic attacks can occur. In addition, the hoarseness leads to states of emotional distress in some patients. Therefore, mental illnesses can occur that develop through the laryngocele.
With an early diagnosis and appropriate treatment, the administration of medication usually leads to a regression of the impairments. In the further course, a freedom from complaints is to be expected. In some cases surgical intervention is necessary. These usually proceed without complications. However, there are risks or side effects associated with any surgery. If irregularities occur during the procedure, these can delay the healing process or, in particularly severe cases, lead to secondary problems.
Speech therapy exercises and training should be used to improve long-term speech. These can also be carried out independently and independently by the patient outside of the offered therapy.
Prevention
There are no known preventive measures for patients who develop a laryngocele due to a genetic disposition, apart from the recommendation to monitor themselves and also to have non-specific symptoms such as hoarseness clarified. Even for people who do not have any special genetic prerequisites for the development of a laryngocele, there are also no preventive measures that could prevent the disease or make it unlikely. At best, the risk of acquiring a laryngocele can be reduced slightly by avoiding repetitive compression.
Aftercare
In most cases, sufferers of this disease have little or no special follow-up care available. As a rule, these are also very limited, so that the disease should first and foremost be diagnosed quickly and, above all, early so that there are no further complications or a further deterioration in the symptoms. Self-healing cannot occur here, so that those affected by this disease should consult a doctor at the first signs and symptoms.
In most cases, the patients are dependent on a surgical procedure, which can alleviate the symptoms. After such a procedure, the person concerned should definitely rest and take care of his body. Efforts or stressful and physical activities should be avoided in order not to unnecessarily burden the body.
Furthermore, speech therapy measures are also appropriate so that the children can develop normally. The help and intensive support of the children by their own parents is also necessary in order to support the support process. As a rule, the life expectancy of those affected does not decrease as a result of this disease.
You can do that yourself
As a rule, a doctor must be consulted with this disease in any case. Self-help options are therefore only available to the patient to a very limited extent. The disease cannot be directly prevented either.
In the case of urgent shortness of breath, care should be taken to ensure calm and, above all, regular breathing as part of the illness. If the person concerned loses consciousness due to the breathing difficulties, an ambulance must be called in any case. Until the arrival of the emergency doctor, the person concerned must be given emergency ventilation and placed in a stable lateral position. A doctor should be consulted immediately in the event of an infection in order to avoid further complications. Even after surgical removal, the patient should take it easy.
In some cases, speech therapy may also be necessary. The person concerned can also restore the voice picture himself through various exercises. Friends and family can also support the patient and thereby speed up recovery. As a rule, the treatment leads to a positive course of the disease. The patient’s life expectancy is also not reduced by the disease.
