1. Loujain Ibrahim Alotaibi Nouf Najem Aldafeery Aliyah Mowaffag Alonizi
Laryngitis
Loujain Ibrahim Alotaibi Nouf Najem Aldafeery Aliyah Mowaffag Alonizi

2. Acute Laryngitis

4. Acute Laryngitis:
Acute laryngitis my be infectious or noninfectious.

5. Aetiology:
The infectious type is more common and usually follows upper respiratory infection. To begin with, it is viral in origin but soon bacterial invasion takes place with Streptococcus pneu-moniae, Haemophilus influenzae and haemolytic Streptococci or Staphylococcus aureus. Exanthematous fevers like measles, chickenpox and whooping cough are also associated with laryngitis.

6. Con. Aetiology:
The noninfectious type is due to vocal abuse, allergy, thermal or chemical burns to larynx due to inhalation or ingestion of various substances, or laryngeal trauma such as endotracheal intubation.

8. Clinical Features: Hoarseness. Discomfort or pain in the throat.
Dry, irritating cough which is usually worse at night.
General symptoms of head cold.

9. Diagnosis:
History.
Laryngoscopy.

10. Oedema
Sticky Mucopurulant Secretions
Hypervascularity

11. Treatment: Vocal rest. Avoidance. Steam inhalation. Cough sedative.
Antibiotics.
Analgesics.
Steroids.

12. Acute Epiglottitis:
It is an acute inflammatory condition confined to supraglottic structures, i.e. epiglottis, aryepiglottic folds and arytenoids. There is marked oedema of these structures which may obstruct the airway.

13. Aetiology:
It is a serious condition and affects children of 2–7 years of age but can also affect adults.
H. influenzae B is the most common organism responsible for this condition in children.

14. Clinical Features: Onset of symptoms is abrupt with rapid progression.
Sore throat and dysphagia are the common presenting symptoms in adults.
Dyspnoea and stridor are the common presenting symptoms in children.
Fever may go up to 40°C. It is due to septicaemia.

15. Examination:
Depressing the tongue with a tongue depressor may show red and swollen epiglottis. Indirect laryngoscopy may show oedema and congestion of supraglottic structure. This examination is avoided for fear of precipitating complete obstruction. It is better done in operation theatre where facilities for intubation are available.
Lateral soft tissue X-ray of neck may show swollen epiglottis (thumb sign).

16. Treatment:
Hospitalization. Essential because of the danger of respiratory obstruction.
Antibiotics.
Steroids. Hydrocortisone or dexamethasone is given in appropriate doses i.m. or i.v. They relieve oedema and may obviate need for tracheostomy.
Adequate hydration.
Humidification and oxygen.
Intubation or tracheostomy. It may be required for respiratory obstruction.

17. Acute Laryngo-Tracheo-Bronchitis:
It is an inflammatory condition of the larynx, trachea and bronchi.

18. Aetiology:
Viral infection (parainfluenza type I and II) affecting children between 6 months and 3 years of age.
Secondary bacterial infection by Gram-positive cocci soon supervenes.

19. 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.

20. Clinical Features:
Starts as upper respiratory infection with hoarseness and croupy cough.
There is fever of 39–40°C.
Difficulty in breathing and inspiratory type of stridor.

21. Treatment:
Hospitalization is often essential because of the increasing difficulty in breathing.
Antibiotics.
Humidification helps to soften crusts and tenacious secretions which block tracheobronchial tree.
Adequate hydration.
Steroids, e.g. hydrocortisone 100 mg i.v. may be useful to relieve oedema.
Adrenaline may relieve dyspnoea and avert tracheostomy.
Intubation/tracheostomy is done, should respiratory obstruction increase.

22. Reinke’s Oedema:
It is bilateral symmetrical swelling of the whole of membranous part of the vocal cords. This is due to oedema of the subepthelial space (reinke’s space )of the vocal cords.
Most often seen in middle aged men and women.
Chronic sinusitis and laryngopharyngeal reflex are the probable aetiological factors.
It can also occur in myxoedema.

23. Clinical Features: Hoarsness is the common symptom.
On direct laryngoscopy, vocal cords appear as fusiform swellings with pale translucent look . Ventricular bands may appear hyperaemic and hypertophic.

24. Treatment : Decortication of the vocal cords. Voice rest.
Speech therapy for proper voice production.

25. Vocal Fold Nodule:
They appear symmetrically on free edge of vocal cord , at the junction of anterior one-third and posterior two-thirds . as this area of maximum vibration of the cord and thus subject to maximum trauma.
Pathologically , trauma to the vocal cord in the form of vocal abuse or misue cause of oedema and haemorrahge in submucosal space.”

26. Clinical Features: Hoarseness. Vocal fatigue.
Pain in the neck on prolonged phonation.

27. Treatment:
Conservative : in early stages , by educating the patient proper use of voice.
Surgery is required for large nodules or nodules of long standing in adult.

28. Chronic Laryngitis

29. A. Chronic Laryngitis Without Hyperplasia (Chronic Hyperemia Laryngitis):
It is a diffuse inflammatory condition symmetrically involving the whole larynx, i.e. true cords, ventricular bands, interarytenoid region and root of epiglottis.

30. Aetiology:
It may follow incompletely resolved acute simple laryngitis or its recurrent attacks.
chronic infection in paranasal sinuses, teeth and tonsils and the chest.
Occupational factors.
Smoking and alcohol.
Persistent trauma of cough as in chronic lung diseases.
Vocal abuse.

31. Clinical Features:
Hoarseness: Is the commonest complaint. Voice becomes easily tired and patient becomes aphonic by the end of the day.
Constant hawking: There is dryness and intermittent tickling  in the throat and patient is compelled to clear the throat repeatedly.
Discomfort in the throat.
Dry & Irritating cough.

32. Laryngeal Examination:
On laryngeal examination. There is
Hyperaemia of vocal cords: dull, red and round.
viscid mucus in the vocal cords and interarytenoid region.

33. Treatment: Eliminate infection of upper and lower respiratory tract.
Avoidance of irritating factors. E.g. smoking, alcohol or polluted environment, dust and fumes.
Voice rest and speech therapy. Voice rest has to be prolonged for weeks or months.
Steam inhalation. They help to loosen secretions and give relief.

34. 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. Localized variety presents as dysphonia plica ventricularis, vocal nodules, vocal polyp, Reinke's oedema and contact ulcer.    

35. Aetiology:
Same as discussed under chronic laryngitis without hyperplasia.

36. Pathology:
Pathological changes start in the glottic region and later may extend to vintricular bands, base of epiglottis and even subglottis. Mucosa, submucosa, mucous glands and in later stages intrinsic laryngeal muscles and joints may be affected.
Initially, there is hyperaemia , oedema and cellular infiltration in the submucosa. The pseudostratified ciliated epithelium of respiratory mucosa changes to squamous type, and squamous epithelium of the vocal cords to hyperplasia and keratinization. The mucous glands suffer hypertrophy at first but later undergo atrophy with diminished secretion and dryness of larynx.

37. Clinical Features:
This disease mostly affects males (8:1) in the age group of years.
Hoarseness, constant desire to clear the throat, dry cough, tiredness of voice and discomfort in throat when the voice has been used for an extended period of time are the common presenting symptoms.

38. Examination:
On examination, changes are often diffuse and symmetrical.
Laryngeal mucosa, in general, is dusky red and thickened.
Vocal cords appear red and swollen. Their edges lose sharp demarcation and appear rounded. In late stages, coeds become bulky and irregular giving nodular appearance. 
Ventricular bands appear red and swollen and may be mistaken for prolapse or eversion of the ventricle. 
Mobility of cords gets impaired due to oedema and infiltration, and later due to muscular atrophy or arthritis of the cricoarytenoid joint. 

39. Treatment:
Conservative. Same as for chronic laryngitis without hyperplasia.
Surgical. Stripping of vocal cords, removing the hyperplastic and oedematous mucosa.

40. References: o

41. Thank you