A laryngocele is the name given to an outpouching of one of the two mucosal pockets that are located in pairs in the side of the larynx between the vocal fold and the pocket fold in humans. A laryngocele may be congenital or acquired during life. Because of the inflammatory processes that can take place within a laryngocele, surgical removal may be necessary.
What is laryngocele?
In humans, the larynx contains two-pair lateral protrusions of the laryngeal mucosa between the pocket and vocal folds. The protrusions are called the morgagni ventricles or ventriculi larynges. Their physiological importance probably lies in their function as resonators during speech and singing. When one of the laterally applied pockets develops a distinct bulge or outpouching resembling a hernia, in this case corresponding to a breakdown of the laryngeal mucosa, the condition is referred to as a laryngocele. Laryngocele often develop further in a cyst-like manner. Characteristic is the lining with respiratory epithelial tissue including ciliated epithelium with mucus-producing goblet cells. Depending on whether the laryngocele develops inwardly or outwardly, it is an internal or external laryngocele. Because of the limited possibilities of an exchange of substances within the laryngocele with simultaneous mucus production and the hardly existing possibility for the cilia to push the mucus and other substances to the outside, laryngocele tend to become inflamed. Therefore, they often contain not only air but also purulent secretions.
Causes
The bulging of one or both ventriculi larynges to form an internal or external or a combined laryngocele may be acquired or genetic. If genetic predisposition is present, it could be that the genetic disposition signifies a relic or a throwback to prehominid times. Howler monkeys, for example, have two outpouchings called ventriculi larynges that look very similar to laryngoceles and support their howling sounds in them as so-called howler sacs. Other genetic causes may be that in the course of an embryonic developmental disorder, the creation of the laryngeal lid (epiglottis) is associated with an obstruction of the laryngeal inlet. Acquired laryngoceles occur rather rarely. One of the causes may be chronic inflammation in the laryngeal area, for example, when the valve action of the laryngeal lid is impaired, making breathing difficult. Laryngoceles may develop in people who frequently need to build up excess pressure in the pharynx, such as glassblowers, trumpet players, or clarinetists and oboists.
Symptoms, signs, and complaints
An internal laryngocele, which forms inside the larynx, initially remains asymptomatic for a long time. In the later stages, hoarseness sets in and gradually increases. Usually a foreign body sensation is felt or the sensation of a greater accumulation of mucus that does not disappear. Rarely, there is also shortness of breath and difficulty swallowing. However, the symptoms increase rapidly in the case of acute inflammation of the laryngocele. Pain then also occurs and acute shortness of breath may develop. An external laryngocele is easier to recognize because it bulges visibly in the neck and increases significantly in volume when pressed. In advanced stages, an external laryngocele is also noticeable by increasing shortness of breath.
Diagnosis and course of the disease
While an internal laryngocele is initially asymptomatic and at most announces itself by nonspecific hoarseness, an external laryngocele is conspicuous even in its early stages. It is recognizable by a bulge in the neck, which even enlarges when air is pressed in, because it fills with air due to the slight overpressure. Final doubts about the presence of an internal or external laryngocele can be removed by the imaging procedure computed tomography. CT clearly reveals cavities that are partially filled with air. The course of the disease varies. As long as the course is asymptomatic or even completely asymptomatic, regular control is sufficient. If the course, respectively the growth of the laryngocele progresses, a critical condition due to respiratory distress may develop without treatment.
Complications
In most cases, this disease is discovered and diagnosed relatively late, because the symptoms appear late and are not particularly characteristic. For this reason, only late treatment of this disease is possible. The affected persons usually suffer from hoarseness and furthermore also from shortness of breath. In the worst case, the shortness of breath can also lead to a loss of consciousness, during which the affected person may possibly injure himself or herself by falling. Similarly, swallowing difficulties occur, so that the ingestion of food and liquids is usually no longer possible for the affected person. This may result in weight loss and, furthermore, in various deficiency symptoms. Due to the undersupply of oxygen to the internal organs, damage to the organs can also occur in the worst case. In this case, treatment is carried out by means of a surgical intervention. As a rule, there are no complications. However, the surgery must be performed immediately after diagnosis to prevent further damage. If the surgery is successful, the patient’s life expectancy is not reduced by the laryngocele.
When should you see a 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 in the course, medical help is also needed. In the later stages, the disease leads to acute inflammation, which must be treated immediately. External abnormalities such as the typical swelling of the neck require medical clarification. If the symptoms occur in connection with laryngitis, the responsible physician must be informed. Parents who notice signs of a laryngocele in their infant are best advised to inform the pediatrician. Although an outpouching of the mucous membrane pockets is relatively harmless, it can cause severe organ damage if left untreated. Therefore, at the first sign of the disease, the child should consult a specialist who can clarify the symptoms and, if necessary, initiate the necessary treatment measures. In addition to the family doctor, the ENT specialist or an internist can be consulted. In the case of advanced diseases in childhood, physiotherapy is usually also necessary.
Treatment and therapy
If a laryngocele produces noticeable symptoms that lead to serious shortness of breath, treatment is urgently indicated. Since there is no known drug treatment that would lead to regression of a laryngocele, the only remaining remedy is surgical ectomy or marsupialization in the case of an external laryngocele. The laryngocele is opened and the edges of the wound are fixed so that they cannot close initially to achieve permanent drainage. Marsupialization is used when complete removal is not indicated because, for example, the risk of vocal cord injury is too high. Depending on the diagnosis and location of the laryngocele, the procedure can also be minimally invasive by ablating the tissue using a laser or other appropriate methods. If inflammation develops in the laryngocele, the progress of the disease can be significantly accelerated, so that a critical condition can quickly develop, requiring immediate surgical intervention. In most cases, logopedic treatment is recommended after laryngocele ectomy in order to regain the normal voice pattern with the help of logopedics.
Outlook and prognosis
The prognosis of laryngocele is favorable. The condition can be completely cured with a variety of treatments in most cases. The challenge lies in making the diagnosis. This often takes place very late due to the difficulty and complexity of the circumstances, so that the affected person already suffers from the impairments for a long time. For this reason, the probability of a subsequent disorder must be taken into account when making the prognosis. Due to the disturbances of the respiratory activity, anxiety-inducing moments or even panic attacks may occur. In addition, hoarseness leads to states of emotional distress in some patients. Therefore, psychological disorders can occur, which are formed by the laryngocele. With an early diagnosis and appropriate treatment, there is usually already a regression of the impairments through the administration of medication.In the further course, freedom from symptoms can be expected. In some cases, surgical interventions are necessary. These usually proceed without complications. Nevertheless, there are risks or side effects associated with any surgery. If irregularities occur during the operation, these can cause a delay in the healing process or, in particularly severe cases, lead to secondary disorders. Logopedic exercise sessions and training should be used to improve long-term speech. These can be performed by the patient independently and on his or her own responsibility outside of the offered therapy.
Prevention
For patients who develop a laryngocele because of a genetic predisposition, there are no known preventive measures other than the recommendation to observe oneself and also to have nonspecific symptoms such as hoarseness clarified. For persons who do not have any particular genetic predisposition for the development of a laryngocele, there are also no preventive measures that could prevent the disease or make it unlikely. At most, the risk of acquiring a laryngocele can be slightly reduced by avoiding repetitive pressing.
Follow-up
In most cases, few, if any, special measures of aftercare are available to affected individuals with this condition. As a rule, these are also very limited, so that first and foremost a quick and, above all, an early diagnosis of the disease should be carried out, so that it does not come to further complications or to a further worsening of the symptoms. Self-healing is not possible, so that the person affected by this disease should see a doctor at the first signs and symptoms. In most cases, the patients are dependent on a surgical intervention, through which the complaints can be alleviated. After such an operation, the affected person should in any case rest and take care of his body. Efforts or stressful and physical activities should be refrained from in order to avoid unnecessary strain on the body. Furthermore, measures of a speech therapy are also appropriate, so that the children can develop usually. The help and intensive support of the children by their own parents is also necessary in order to support the development process. Usually, the life expectancy of the affected person is not reduced by this disease.
This is what you can do yourself
As a rule, a doctor must be consulted in any case with this disease. Possibilities of self-help are thus only very limited available to the patient. The disease can likewise not be prevented directly. In the case of urgent shortness of breath, care should be taken to ensure calm and, above all, regular breathing during the course of the disease. If the affected person loses consciousness due to the breathing difficulties, an emergency doctor must be called in any case. Until the arrival of the emergency physician, the affected person must be given emergency artificial respiration and placed in a stable lateral position. Especially in case of inflammation, a doctor should be consulted immediately to avoid further complications. Even after surgical removal, the patient should take it easy. In some cases, logopedic treatment may also be necessary. In this case, the affected person can also restore the voice pattern himself through various exercises. Friends and family can also support the patient in this process and thereby possibly accelerate recovery. As a rule, treatment leads to a positive course of the disease. The patient’s life expectancy is also not reduced by the disease.
