Diseases of the oral cavity, pharynx, larynx, and trachea, and related driving advice
It is simple for physicians to advise against driving when a severe disease is diagnosed.
The difficulty arises when faced with apparently trivial and common diseases, such as those occurring in the mouth, pharynx, and larynx.
These are conditions with multiple head and neck symptoms and having a great general impact on patient mood.
Irritability, fatigue, and an increased self-interest occur, as well as a loss of interest in the environment.
This, combined with the effect of medication, work load, and inadequate night rest, makes these patients highly vulnerable and prone to cause a traffic accident.
Oral cavity and pharynx
Acute pharyngotonsillitis starts suddenly with high fever, chills, asthenia, and malaise. It is associated with odinophagia, earache, and headache
Gingivostomatitis causes moderate pain irradiating to the entire head, but that may become unbearable. Fever and malaise occasionally occur.
Infectious dental processes cause severe pain, swelling, neuralgia, and headache. Surgery is sometimes required for tooth extraction and alveolar cleaning.
Viral or bacterial parotitis and submaxillitis are characterised by swelling and malaise. Surgical procedures prevent driving until the physician reports that driving may be allowed based on a good clinical course.
Costen’s syndrome results from microtrauma to the temporomandibular joint in mouth occlusion changes. This syndrome causes ear symptoms including blocked ear, tinnitus, vertigo and itching, headache, and joint pain.
- Patients must not drive in the acute phase, until clinical improvement occurs and no symptoms exist.
Larynx and trachea
Acute laryngitis during an infectious disease causes cough, dysphonia, and dyspnoea in the acute stage as complication of the infectious condition. Worsening of laryngitis causes stridor and chest tightening, and may cause painful dysphagia.
Epiglottitis is usually secondary to tonsillitis or a sinusal suppurative condition. Patient has high temperature, malaise, dyspnoea, and dysphagia
Quincke’s angioneurotic oedema occurs as an acute, severe dyspnoeic condition requiring urgent treatment in the setting of a general allergic condition in predisposed patients. Other laryngeal oedemas with a similar picture occur in renal, endocrine, and rheumatic diseases, and in drug toxicities.
Acute traumatic laryngitis due to laryngeal cartilage fracture frequently occurs in traffic accidents because of the direct action of the driving wheel on thyroid cartilage. Dyspnoea occurs because of oedema, emphysema, and haematoma. This is a severe condition requiring urgent treatment to open the airway and achieve fracture reduction.
Laryngitis due to fume aspiration causes severe oedema and breathing difficulties, requiring urgent treatment.
Laryngeal tumours and radiation therapy may cause oedema and difficult breathing leading to patient anxiety.
Laryngeal or cough-induced syncope is characterised by the occurrence of a tickling sensation in the larynx, with coughing fits after which the subject immediately falls to the floor with loss of consciousness and flushing of the face lasting 40 to 50 seconds, after which spontaneous recovery occurs. Seizures and/or sphincter relaxation sometimes occur. The condition may be repeated if cough persists. Patients usually have bronchitis and circulatory problems.
Submucosal vocal chord bleeding causes sudden laryngeal spasm, preceded by dysphonia. Bleeding may recur when the patient tries to speak in the first few days. Voice rest is recommended.
- Driving is not recommended when symptoms exist.
Object aspiration from the lips or mouth may cause death from suffocation.
In the larynx, severe symptoms initially occur due to suffocation, cough fits, distress, and apnoea. If the foreign body is tolerated, laryngeal dyspnoea, cough, pain, hoarseness, and chest tightening occur.
The inhalation phase of tracheobronchial foreign bodies is very dramatic and may even result in syncope and sudden death. If the foreign body is tolerated, marked dyspnoea, chest tightness, and wheezing are seen.
If the event occurs while driving, total lack of vehicle control may have dramatic consequences. The driver should be helped and taken to an emergency department.
- No objects that may be aspirated because of their size should be chewed or sucked.
- If the event occurs while driving, total lack of vehicle control may have dramatic consequences. The driver should be helped and taken to an emergency department.
Laryngeal spasm leads to an immediate episode of suffocation due to a sensitive-vegetative reflex induced by different causes.
- If the event occurs while driving, vehicle control may be very difficult.
- Sharp manoeuvres should be avoided, and the vehicle should be stopped.
- Predisposed patients should avoid air conditioning inside the vehicle and should not smoke.
This results from laryngeal retraction due to an infectious or traumatic scarring process, and often causes dyspnoea and chest tightening greatly limiting the ability to drive.
- Patients wearing tracheostomy cannulas should check that they are clean and adequately fixed before starting to drive.
- In long distance travel, a dry atmosphere should be avoided inside the vehicle, because this promotes secretion retention and tracheitis.
- In these cases, frequent stops to drink plenty of fluid are mandatory, and should be advised to patients.
Acute tracheitis is characterised by dry cough, expectoration, difficult breathing, and burning pain.
- Vehicle control is difficult under these conditions, and it is recommended to drive once symptoms have subsided.
Infectious dental, parotitis and submaxillitis:
- These conditions interfere with driving in their acute stage.
- Surgical procedures prevent driving until the physician reports that driving may be allowed based on a good clinical course.
- Costen’s syndrome: driving may be limited in symptomatic periods, and the physician should warn patients that they cannot drive if they feel dizzy.
- Driving is not allowed when dyspnoea exists.
- A physician report stating that the condition has completely resolved is required to permit driving.
- Acute traumatic laryngitis and Laryngitis due to fume aspiration: driving is not recommended during the acute episode, and cannot be authorised until the problem is completely resolved.
- Laryngeal tumours and radiation therapy: patients should be warned of this possibility, and must consult their physician and refrain from driving when any symptom occurs.
- Laryngeal or cough-induced: the physician will give advice to prevent these conditions, that may have tragic consequences if they occur while driving..
- Submucosal vocal chord: driving should be avoided until complete resolution of the episode, due to the risk of recurrence.