2. CONGENITAL ABNORMALITIES OF THE LARYNX

3. Lryngomalacia (congenital laryngeal stridor) Exaggerated infantile type The epiglottis is an omega shaped. The aryepiglottic folds are approximated. The laryngeal inlet is a cruciate slit, the edges of which are sucked together by each inspiration.

4. Clinical features ‎ Inspiratory stridor at or soon after birth, croaking in character, diminished by rest, responsive to changes of posture but increased by exertion,disappears in 2nd-5th years of life. ‎Cyanosis is rare and the voice is unchanged. ‎‎ ‎Diagnosis ‎Careful history and examination. ‎Flexible fibrescopic examination, or direct laryngoscopy ‎ Treatment ‎ Reassurance Tracheostomy may rarely needs

5. Subglottic stenosis ‎ Most cases are acquired Inspiratory stridor is unaffected by posture. The voice is normal. Feeding is difficult and failure to thrive occurs in severe cases. ‎ Direct laryngoscopy and broncoscopy is required. If infant fails to thrive a tracheostomy is required. Laser treatment to vaporize the stenosis ‎

7. Subglottic haemangioma ‎ This condition is clinically indistinguishable from subglottic stenosis Laser treatment is particularly effective.

9. Laryngotracheal cleft ‎ This is the least manifestation of failure of the lateral septa of the primitive oesophagus to fuse in the midline. Minor clefts present with stridor, more severe ones with aspiration and pneumonia. ‎Diagnosis‎ by Barium swallow followed by direct laryngoscopy. Clefts below the cords cause aspiration and require open surgical repair with a preliminary tracheostomy. ‎ The mortality with aspiration is 50%.

11. Laryngeal cyst Small : hoarseness or a muffled cry. Larger : inspiratory stridor. Diagnosis may be made with a fibroptic flexible laryngoscope Direct laryngoscopy is required to evacuate and uncap a cyst. Treatment may need to be repeated.

13. Laryngeal web Almost in the anterior half of the glottis. ‎ The symptoms vary with size of the web. ‎Hoarseness is usually present. ‎Inspiratory stridor occurs in severe cases. ‎Web can be seen by direct or fibroscopic laryngoscopy.‎ ‎ No treatment, in the milder forms. Laser excision. ‎ Tracheostomy. Essential when stridor and dyspnoea are severe.

16. Vocal cord palsy Caused by damage to the recurrent laryngeal nerve in neck or chest usually from birth trauma. ‎ Inspiratory stridor and hoarse- ness in a neonate. Fibreoptic laryngoscopy is essential for diagnosis. Treatment is expectant.

17. TRAUMATIC CONDITIONS OF THE LARYNX

18. 1.Direc injuries ‎ a. Compression(closed)injuries As in blows and strangulation. ‎Pathology 1.Bruising of skin may occur 2. Surgical emphysema ‎3. Submucosal haemorrhage ‎4. Adhesions ‎5. Stenosis ‎6. Perichondritis results if infection supervenes. 7. Fracture of the laryngeal cartilages ‎

19. Clinical features ‎ ‎1. Dyspnoea may be marked. 2. Hoarseness or weakness of the voice, is common. 3.Dysphagia is a frequent symptom. 4.Haemoptysis is usually slight. 5.Pain is variable. 6.Tenderness may be elicited by palpation. ‎ 7. Crepitus is difficult to detect. 8. Submucosal haemorrhages can be seen on indirect laryngoscopy. ‎

20. Diagnosis ‎ The history and physical signs. ‎ Plain X-rays or CT scan may confirm the presence of a fracture in a cartilage.

21. Treatment ‎ The chief danger of these injuries is interference with respiration. 1.Tracheostomy may be urgently required. ‎2. Systemic antibiotics should be given prophylactically in every case. They must be continued if perichondritis threatens or supervenes. 3.Incision and drainage are needed for abscess formation. ‎

22. b. Penetrating (open) wounds ‎Usually fatal They are caused by gunshot injuries, stabs or cuts. ‎ Pathology ‎The laryngeal injuries are generally accompanied by damage to vital structures. These depend upon the direction of the injury.. 1.Oblique wounds usually involve the great vessels of the neck. ‎2. Anteroposterior wounds may cause death from involvement of the cervical spine ‎3. Transverse wounds may involve the larynx only. Survival is rare even in this type

23. Clinical features ‎Dominated by respiratory obstruction and haemorrhage. ‎ 1. Dyspnoea results from ‎Haemorrhage into the larynx and tracheobronchial tree ‎Swelling of the soft tissues of the larynx ‎Displacement of fractured cartilages ‎Mediastinal emphysema ‎ Perichondritis and/or stenosis ‎ 2. Haemorrhage may be massive and rapidly fatal.

24. Treatment ‎Must be immediate. 1.Clamping and ligature of divided vessels. 2.Intubation through the open wound may prevent asphyxia. 3.Tracheostomy should be performed as soon as facilities permit. ‎4. Removal of foreign bodies with excision of devitalized tissues and suturing of the mucosa. 5.Systemic antibiotics. 6.Fluids intravenously or by nasogastric tube. No food must be given by mouth for at least 24 hours

25. 2. Burns and scalds ‎ Aetiology ‎ ‎Inhalation of irritant fumes or gases. ‎Swallowing of corrosive fluids. ‎Inhalation of steam. ‎Pathology ‎Oedema of the laryngeal inlet and vestibule is the usual ‎finding ‎

26. Clinical features ‎Dyspnoea is the presenting symptom. Pain and dysphagia are usual. ‎Treatment ‎Usually conservative. ‎1.Rest to bed, strict rest of the voice, and sedative drugs. 2.Steroids intravenous or intramuscular injection. 3.Antibiotics to prevent secondary infection. 4.Analgesic drugs. ‎5.Tracheostomy or laryngotomy must be performed if the airway is compromised.

27. 3.Radiotherapy reactions ‎ Severe local reactions in the larynx may follow radical irradiation ‎Dyspnoea ‎Discomfort on swallowing may result ‎Pain results from perichondritis or cartilage necrosis ‎

28. Treatment ‎ Preventive or curative. 1.Elimination of oral sepsis 2.Tracheostomy is rarely necessary 3.Systemic antibiotics if pericho- ndritis is present or threatening. ‎4.Analgesic preparation ‎5.Laryngectomy in severe intractable cases where necrosis is present.

29. 4.Inhaled foreign bodies ‎ rare, but sharp foreign bodies, such as pins or glass, may be impacted in the larynx. Large foreign bodies, such as boluses of food, are almost immediately fatal when impacted in the larynx. ‎Clinical features ‎Smaller foreign bodies may be compatible with life. ‎Dyspnoea & ‎Cough ‎ ‎Hoarseness or aphonia may appear due to oedema. Perichondritis and stenosis follow when the foreign body is retained or causes severe trauma. ‎Treatment ‎A 'bear hug' (Heimlich's manoeuvre) from behind with hands clasped just below the xiphisternum may expel the object. ‎Removal by direct laryngoscopy as soon as possible. ‎Tracheostomy or laryngotomy may be necessary in an emergency ‎Systemic antibiotics should be given to prevent bronchopulmonary infection.

30. 5.Intubation injuries ‎Aetiology ‎ 1.Rough intubation 2.Prolonged intubation 3.Too large a tube. ‎Pathology ‎Superficial abrasions. ‎Granulomatous formation esp. the vocal processes of the ‎arytenoid cartilages. F/M:(4:1). Subglottic oedema. In children, rarely in adults. ‎Clinical features ‎ Hoarseness ‎ Dyspnoea, Sometimes. ‎‎Treatment ‎ Voice rest may suffice. ‎Endoscopic removal of granulomlas. ‎ Tracheostomy for dyspnoea.

32. 6.Acute submucosal haemorrhages on the vocal cords (acute haemorrhagic laryngitis) ‎Aetiology ‎The haemorrhages after coughing, shouting, weight- lifting and injuries to the larynx. ‎Clinical features ‎Hoarseness occurs suddenly after a vocal strain. Pain may occur. The haemorrhages may be single or multiple and the remainder of the cords may be injected. Rarely the whole of one cord is involved. The haemorrhages may organize into the granulomatous or fibrous nodules. ‎‎Treatment ‎Vocal rest. The most important part of the treatment.

34. 7.Singer's nodes ; vocal nodules ‎Voice abusers; ‎singers (especially sopranos and tenors), actors, teachers, mothers of young children and persons talking to the deaf,more common in women and in singers who sing above their natural range. ‎Pathology ‎Localized hyperkeratosis. The site is constant, at the junction of the anterior third and posterior two-thirds of the free edge of one or both vocal cords. The nodules never become neoplastic. ‎Clinical features ‎Increasing hoarseness. suddenly or slowly and insidiously ‎Vocal fatigue. ‎Nodules are more commonly bilateral and symmetrical, vary in size from pinhead to that of a grape-pip. Treatment ‎Vocal rest ‎ Removal by direct laryngoscopy ‎ Speech therapy helps to re-educate voice production

36. 8.Contact 'ulcer' ‎Aetiology ‎An uncommon, almost in male adults esp. singers and street vendors and results from the hammering of one vocal process of the arytenoid cartilage against the other. ‎ Coughing is always detrimental. ‎‎Clinical features ‎ Discomfort in the throat ;slight or severe. ‎ Huskiness; slight or severe ` Vocal fatigue. ‎ Referred otalgia may occur. ‎‘Kiss ulcer' is the common finding on indirect laryngoscopy. the granuloma of one side fitting into the 'ulcer' crater of the other. ‎Treatment ‎Vocal rest for 2 or 3 weeks may be necessary. ‎Steroids have proved successful Removal of thickened epithelium by microlaryngoscopy. ‎