1. Laryngeal Diseases
Dr.
Sa’ad Y. Sulaiman

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

3. 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

4. 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

5. 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.

6. Cause of Hoarseness
Congenital
Paralysis
Inflammation
Neoplastic

7. 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.

8. 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
Treatment is by endoscopic removal.

9. 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?!

10. 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.

11. 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.

12. 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 ).
Squamous cell Carcinoma (SCCA) is the most common laryngeal Ca (>90%).
Sex: Male: female = 6:1.
Age: middle-aged and elderly.

13. 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%).

14. 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 %
Subglottic %
Distant: Lung, Liver, Brain and Bone

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

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

18. 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

25. 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.

26. 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).

27. 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.