Acute & Chronic Laryngitis Abeer alotaibi Arwa almutairi Alaa alharbi

Acute Laryngitis Non-infectious Type: Infectious Type: -Vocal abuse and allergy. -Chemical burns to larynx : inhalation or ingestion of various substances. -Laryngeal trauma : Endotracheal intubation. - More common, Follows URTI - Viral in origin, but bacterial invasion takes place : Streptococcus pneumoniae , Haemophilus influenzae and Staphylococcus aureus. - Association: Exanthematous fever and whooping cough

Treatment Symptoms 1. Vocal rest: This is the most important single factor. 2. Avoidance of smoking and alcohol. 3. Steam inhalations: soothing and loosen viscid secretions. 4. Cough sedative. 5. Antibiotics: When there is secondary infection with fever or purulent expectoration. 6. Analgesics. 7. Steroids: Useful in laryngitis following thermal or chemical burns. 1- Hoarseness may lead to complete loss of voice. 2- Discomfort or pain in throat: after talking. 3- Dry and irritating cough: worse at night. 4- General sym. of head cold and rawness. 5- Fever if it has followed viral infection of URTI

(Syn. Supraglottic laryngitis) Acute Epiglottitis (Syn. Supraglottic laryngitis)

- Acute inflammatory condition to supraglottic structures : 1) Epiglottis. 2) Aryepiglottic folds. 3) Arytenoids. -What will happen to these structures? Marked oedema that may obstruct the airway. Aetiology: -Affect children of 2-7 years of age but can also affect adult. -The most common organism responsible for this condition in children is : H. Influenzae B

Treatment Examination Symptoms 1. Hospitalization. 2. Antibiotics. Ampicillin or third generation cephalosporin 3. Steroids.. 4. Adequate hydration.. 5. Humidification and oxygen. 6. Intubation or tracheostomy. 1. Red and swollen epiglottis. Indirect laryngoscopy may show oedema and congestion of supraglottic structure. It is better done in operation theatre where facilities for intubation are available. 2. Lateral soft tissue X-ray of neck show swollen epiglottis (Thumb sign) 1. Onset of symptoms is abrupt with rapid progression. 2. The common presenting symptoms in adults : Sore throat and dysphagia. 3. The common presenting symptoms in children: Dyspnoea and stridor. 4. Fever may go up to 40°C. It is due to septicaemia. Patient’s condition may rapidly deteriorate.

Acute Laryngo-Tracheo-Brnochitis

Aetiology: Pathology: -It is an inflammatory condition of the larynx, trachea and bronchi; more common than acute epiglottitis. Aetiology: -Mostly: it is viral infection (parainfluenza type I and II) -Affecting children between 6 months and 3 years of age. -Male children are more often affected. -Secondary bacterial infection by: Gram-positive cocci. Pathology: The loose areolar tissue in the subglottic region swells up and causes respiratory obstruction and stridor. This, coupled with thick tenacious secretions and crusts, may completely occlude the airway.

Treatment Symptoms 1. Hospitalization. 2. Antibiotics like ampicillin effective against secondary infections due to Gram-positive cocci and H. influenzae. 3. Humidification. 4. Parenteral fluids. 5. Steroids,. 6. Adrenaline: bronchodilator and may relieve dyspnoea and avert tracheostomy. 7. Intubation/tracheostomy -Starts as upper respiratory infection with hoarseness and croupy cough. -Fever of 39–40°C. -Difficulty in breathing and inspiratory type of stridor. Respiratory difficulty may gradually increase with signs of upper airway obstruction, i.e. suprasternal and intercostal recession.

Laryngeal Diphtheria

Aetiology: Pathology: -Mostly: it is secondary to faucial diphtheria -Affecting: children below 10 years of age. Pathology: 1. Formation of a tough pseudomembrane over the larynx and trachea completely obstruct the airway. 2. Exotoxin liberated by bacteria myocarditis and various neurological complications. Diagnosis is always clinical but confirmed by smear and culture of : Corynebacterium diphtheriae

Treatment Symptoms Complications 1. Diphtheria antitoxin. 2. Antibacterials: Benzylpenicillin. 3. Maintenance of airway:Tracheostomy, Direct laryngoscopy, removal of diphtheritic membrane. 1. Asphyxia and death due to airway obstruction. 2. Toxic myocarditis and circulatory failure. 3. Palatal paralysis with nasal regurgitation. 4. Laryngeal and pharyngeal paralysis • General symptoms. low-grade fever, sore throat and malaise. • Laryngeal symptoms: Hoarse voice, croupy cough, inspiratory stridor, increasing dyspnoea with marked upper airway obstruction. • Membrane: Greyish white membrane on: tonsil, pharynx , soft palate, larynx and trachea. It is adherent and its removal leaves a bleeding surface. • Cervical lymphadenopathy: “bull-neck” Complications

Oedema of Larynx

-It involves the supraglottic and subglottic region where laryngeal mucosa is loose. AETIOLOGY 1. Infections: (a) Acute epiglottitis, laryngo-tracheo-bronchitis, tuberculosis or syphilis of larynx. (b) Infection in neighborhood: peritonsillar abscess, retropharyngeal abscess and Ludwig’s angina. 2. Allergy: Angioneurotic oedema or anaphylaxis. 3. Radiation: For cancer of larynx or pharynx. 4.Trauma: Surgery of tongue, floor of mouth, laryngeal trauma, foreign body, endoscopy especially in children, intubation, thermal or caustic burns or inhalation or irritant gases or fumes. 5. Neoplasms: Cancer of larynx or laryngopharynx often associated with deep ulceration. 6. Systemic diseases: Nephritis, heart failure or myxoedema

Treatment Symptoms - If there is airway obstruction: intubation of larynx or tracheostomy. -An injection of adrenaline is useful in allergic or angioneurotic oedema. -Steroids are useful in epiglottitis,laryngo-tracheo-bronchitis or oedema due to traumatic allergic or postradiation causes 1. Airway obstruction. 2. Inspiratory stridor. 3. Indirect laryngoscopy: It shows oedema of supraglottic or subglottic region. -Children may require direct laryngoscopy.

Chronic Laryngitis

A- CHRONIC LARYNGITIS WITHOUT HYPERPLASIA (CHRONIC HYPERAEMIC LARYNGITIS) - It is a diffuse inflammatory condition symmetrically involving the whole larynx.

Treatment symptoms Aetiology 1-Eliminate infection of upper or lower respiratory tract. 2. Avoidance of irritating factors. 3-Voice rest and speech therapy. 1. Hoarseness: This is the commonest complaint. Voice becomes easily tired and patient becomes aphonic by the end of the day. 2. Constant hawking. 3. Discomfort in the throat. 4. Cough. 1.It may follow incompletely resolved acute simple laryngitis or its recurrent attacks. 2.Presence of chronic infection in paranasal sinuses, teeth and tonsils and the chest are important contributory causes. 3.Occupational factors 4. Smoking and alcohol. 5. Persistent trauma of cough as in chronic lung diseases. 6. Vocal abuse. Constant hawking: There is dryness and intermittent tickling in the throat and patient is compelled to clear the throat repeatedly.

B-CHRONIC HYPERTROPHIC LARYNGITIS (SYN B-CHRONIC HYPERTROPHIC LARYNGITIS (SYN. CHRONIC HYPERPLASTIC LARYNGITIS) -It may be either a diffuse and symmetrical process or a localized one, the latter appearing like a tumor of the larynx. Pathology: Pathological changes start in the glottic region and later may extend to ventricular bands, base of epiglottis and even subglottis. Mucosa, submucosa, mucous glands and in later stages intrinsic laryngeal muscles and joints may be affected. - Mostly affects males (8:1) in the age group of 30–50 years.

Treatment Symptoms 1. Conservative: Same as for chronic laryngitis without hyperplasia. 2. Surgical. 1. Laryngeal mucosa, in general, is dusky red and thickened. 2. Vocal cords appear red and swollen. 3. Ventricular bands appear red and swollen. 4-Mobility of cords gets impaired due to oedema and infiltration

Polypoid Degeneration Of Vocal Cords (Reinke’s Oedema)

It is bilateral symmetrical swelling of the whole of membranous part of the vocal cords. Most often seen in middle-aged men and women. This is due to oedema of the subepithelial space (Reinke’s space) of the vocal cords. Symptoms: 1-Hoarseness. 2-vocal cords appear as fusiform swellings with pale translucent look. Ventricular bands may appear hyperaemic and hypertrophic. The oedema cause in vocal cords due to misuse of voice, heavy smoking, chronic sinusitis and laryngopharyngeal reflex are the probable aetiological factors. It can also occur in myxoedema

TREATMENT: Decortication of the vocal cords ( surgical) Voice rest. 3. Speech therapy

Tuberculosis Of Larynx

Etiology: - It is almost always secondary to pulmonary tuberculosis, - Affecting : Males in middle age group. -Tubercle bacilli reach the larynx by bronchogenic or haematogenous routes. Pathology: Disease affects posterior part of larynx more than anterior. Parts affected are: 1- interarytenoid fold. 2- ventricular bands. 3- vocal cords. 4-epiglottis. -Tubercle bacilli, carried by sputum from the bronchi,settle and penetrate the intact laryngeal mucosa particularly in the interarytenoid region (bronchogenic spread). -This leads to formation of submucosal tubercles which may later caseate and ulcerate. -Laryngeal mucosa appears red and swollen due to cellular infiltration (pseudoedem)

Examination Symptoms : - The earliest symptom: Weakness of voice, followed by hoarseness. - Ulceration in the larynx severe pain radiate to the ears. -Swallowing is painful with marked dysphagia in later stages. Examination 1. Hyperaemia of the vocal cord in its whole extent or confined to posterior part with impairment of adduction is the first sign. 2. Swelling in the interarytenoid region mamillated appearance. 3. Ulceration of vocal cord mouse-nibbled appearance. 4. Superficial ragged ulceration on the arytenoids and interarytenoid region. 5. Granulation tissue in interarytenoid region or vocal process of arytenoid. 6. Pseudoedema of the epiglottis “turban epiglottis.” 7. Swelling of ventricular bands and aryepiglottic folds. 8. Marked pallor of surrounding mucosa.

Treatment Diagnosis -The same as for pulmonary tuberculosis ( Anti T.B e.g. Rifampin). -Voice rest is important. -Biopsy of laryngeal lesion is essential to exclude carcinoma and differentiate it from other condition. -In addition : X-ray chest and sputum examination

Syphilis Of The Larynx -It is a rare condition now. -Only gumma of tertiary stage is sometimes seen. -It may occur in any part of the larynx and present as a smooth swelling which may later ulcerate. -Diagnosis is only on biopsy and serological tests. -Laryngeal stenosis is a frequent complication.

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