Laryngeal Diseases Dr. Sa’ad Y. Sulaiman

Objectives: Investigations of laryngeal disease Symptoms of laryngeal disease Hoarseness and its causes

Investigations of laryngeal diseases History General examination Examination of the larynx * Laryngeal mirror(indirect larygoscopy) * Flexible laryngoscope Laboratory & Radiological exam. Direct laryngoscopy &Hypopharyngoscopy * Diagnostic * Therapeutic

Symptoms of Laryngeal Disease   Symptoms of Laryngeal Disease Hoarseness Stridor: Inspiratory Larynx Expiratory Below the larynx Mixed Laryngeal+bronchial(Laryngotracheobronchitis) Cough Expectoration Pain(local and referred) Dysphagia

Hoarseness For production of normal voice, vocal cords should: Be able to approximate properly with each other. Have proper size and stiffiness. Have the ability to vibrate regularly in response to air column.

Cause of Hoarseness Congenital Paralysis Inflammation Neoplastic

Singer's nodule (Screamer nodule) Bilateral ,small, grayish-white nodules at the junction of the anterior 1/3 with the posterior 2/3 of vocal cords ( max. vibration) due to voice abuse Trauma oedema&haemorrhage in submucosal space hyalinization and fibrosis Treatment: Small nodule; speech therapy. Large nodule; endoscopic removal.

Vocal cord polyp The most common laryngeal mass. Aetiology is not well understood but it may be due to: * * Vocal abuse * Allergy * Smoking. Mostly, it affects men in the age of 30-50. Treatment is by endoscopic removal.

Acute laryngitis Usually occurs as part of a generalized URTI. Viral Bacterial In young children respiratory obstruction. Duration: 4-5 days. C/O malaise, hoarseness & pain on speaking. O/E redness and swelling of the laryngeal mucosa. Treatment: symptomatic; Voice rest, steam inhalation & avoidance of irritant Analgesics. Antibiotics?!

Chronic laryngitis Non-specific laryngitis: Causes: URTI: e.g. chronic sinusitis, nasal polyps LRTI: e.g. chronic bronchitis Others: smoking, drinking and GERD. Specific laryngitis: TB, Syphilis.

Laryngeal tumors Benign Tumors Papilloma most common benign neoplasms of the larynx (84% of benign tumors). In children it is multiple and recurrent In adult it is single but it is a premalignant disease. Treatment is endoscopic removal. Chondroma and haemangioma rarely affect the larynx.

Carcinoma of the larynx Malignant tumors Carcinoma of the larynx The larynx is the most common site for CA in the upper aerodigestive tract (5 per 100 000). Squamous cell Carcinoma (SCCA) is the most common laryngeal Ca (>90%). Sex: Male: female = 6:1. Age: middle-aged and elderly.

Previous radiation to neck for benign lesions. Aetiology: Tobacco Alcohol Previous radiation to neck for benign lesions. Occupational exposure to asbestos, mustard gas and other chemical or petroleum product. Site of origin: Glottic SCCA: most common (60%) > supraglottic SCCA (30%) > subglottis SCCA (<10%).

Spread of malignancy Local Involves other divisions of the larynx Spread beyond the larynx to involve tongue, trachea, pyriform sinus, oesophagus, thyroid etc. Regional: To the cervical lymph nodes 18% Supraglottis – 39% Glottis - 05% Subglottic - 13% Distant: Lung, Liver, Brain and Bone

Clinical features- Symptoms Progressive and unremitting dysphonia or hoarseness Dyspnoea Stridor Pain / Referred pain Dysphagia Cough and irritation Neck swelling Haemoptysis, Anorexia, Cachexia.

Clinical Features- Signs EXAMINATION OF LAYNX External examination + Mobility I.D.L. Examination of the neck Examination of ear, nose and throat Systemic examination.

Small tumors with no cervical lymph nodes Treatment: Radiotherapy: Small tumors with no cervical lymph nodes Has the advantage of preserving voice Total laryngectomy +/- radical neck dissection +post op. radiotherapy Large tumors with cervical LAP Palliative treatment: For advanced tumors

Paralysis of the vocal cords The cricothyroid muscle has an adductor effect on the vocal cords, and thus a lesion which spares the superior laryngeal nerve will leave the cord lying nearer the midline than one which paralyses both the recurrent and superior laryngeal nerves. The recurrent laryngeal nerve is the motor nerve to all the laryngeal muscles except the cricothyroid muscles which is supplied by the external branch of the superior laryngeal nerve.

Types of paralysis: Incomplete: the abductor group is paralyzed; position of vocal cords is near the midline e.g. thyroid surgery. Complete: both abductor and adductor muscles are paralyzed: position of vocal cords is half way (cadaveric position).

The chance is twice for the left recurrent nerve to be paralyzed than the right. Bronchogenic carcinoma is an important cause of left recurrent paralysis and should always be excluded by X-ray chest, bronchoscopy and biopsy.