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4 laryngeal disorders

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  • 1. Laryngeal Disorders Aiyun jiang
  • 2. Laryngeal Disorders
    • *Acute epiglottitis
    • Acute laryngitis
    • *Acute laryngitis in children
    • Chronic laryngitis, vocal polyp, vocal nodules
    • Paralysis of vocal fold
    • Laryngeal papilloma
    • Laryngeal carcinoma
  • 3. .
    • Acute epiglottitis
  • 4. Case study
    • Male, 42, businessman ,
    • Comlain : severe sore throat with a low fever for 10
    • hours.
    • History: 10 hours ago the patient felt a slight pain in his
    • larynx, and the pain became severe rapidly that
    • he daren’t swallow. He has a slight fever and fells
    • fatigue. 2 hours ago he felt it difficult to breath in.
    • Examination: stridor, retraction of supraclavicular and
      • intercostal spaces , inspiratory d yspnea; Cyanos ;the epiglottis becomes hyperemia and swelling ”,and looks like a ball
      • Question: (1)what’s the diagnosis?
      • (2) How to treat the patient?
  • 5. Acute epiglottitis
    • Acute epilgottitis is a most dangerous condition . It is characterized by the abrupt onset of rapidly progressive respiratory obstruction due to a swollen, cherry-red epiglottis. Complete airway obstruction may occur in a few hours and cause death.
    • Definition:
      • it is a localized inflammation of the supraglottic larynx ,usually involve the mucous membranes of epiglottis.
  • 6. Etiology
      • Infection usually Haemophilus nfluenzae
      • allergic
      • others: trauma( physical or chemical), etc.
  • 7. pathology
    • severe swelling of the epiglotic mucosa +/- phlegmon
    • 3 pathologic types:
    • acute catarrh epiglottitis
      • Only involve mucosa, diffuse hyperemia and swelling . The epiglottis becomes thicker than normal ones.
    • acute edema epiglottitis
      • usually for allergy; epiglottis becomes “ball-like”, and obstruct the laryngeal inlet for severity , causing laryngeal obstruction
    • acute anabrotic epiglottitis
      • Inflammation is severe in this condition.The underlayer of the mucosa and the glands are involved. may cause laryngeal obstruction
  • 8. Clinical manifestation
    • general symptoms ( fever, fatigue, anorexia, etc. )
    • Local symptoms:
      • Rapid onset of a severe sore throat (worse on swallowing, ) the pain is so severe that the patient can’t swallow normally. Oral secretions increase and usually manifested as drooling.
      • Unclear speech: This kind of change is different from hoarseness caused by VC diseases. It sounds just like there is Sth in the patient’s mouth.
      • Dyspnea: stridor, retraction of supraclavicular and
      • intercostal spaces, difficult in inspiratory stage
      • ( Dyspnea in asthma occurs in exspiratory stage)
      • Cyanosis or even death
    • for child,
      • usually severe and develop rapidly,
      • maybe life threatening
  • 9. Physical examination
    • indirect or direct laryngoscopy :
      • the epiglottis becomes hyperemia and swelling ;
      • maybe “ball-shape” or anabrotic ;
      • L aryn geal obstruction
    • For child, laryngoscopy shouldn’t be admitted
    • lateral neck radiography --cherry-shaped epiglotti c swelling ( Thumb’s sign )
    Induce laryngospasm
  • 10. laryngoscopy Normal epiglottis Acute epiglottis : Hyperemia and swelling
  • 11. X-ray - “Thumb’s sign”
  • 12. Diagnosis and Differential D iagnosis
    • Diagnosis:
    • indirect laryngoscopy important!!!!!!!!!!!!
    • according to typical history and clinical manifestation, a diagnosis of AE can be confirmed. Remember , if the patient has an abrupt onset of severe sore throat, Don’t simply make a diagnosis of acute tonsillitis or acute pharyngitis. Indirect laryngoscope must be performed to observe the epiglottis. Misdiagnosis of AE may delay proper and prom treatment and may cause death!!
    • Differential diagnosis
      • foreign body in the larynx
      • laryngeal tuberculosis
      • laryngeal edema
  • 13. Treatment
    • Once the diagnosis of AE is confirmed ,the patient must be hospitalized as an emergency measure because laryngeal obstruction may occur rapidly.
    • 1 C losed monitoring
    • 2 Antiinflammatory
      • broad spectrum antibiotic
      • +/- systematic steriod
    • 3 Local treatment:
      • Inhalation of ster io d
      • discission if necessary to maintain the airway unobstructed
      • tracheostomy if necessary
      • restlessness, stridor, cyanosis,and retraction of supraclavicular and intercostal spaces are indications of immediate tracheostomy
  • 14. Case study
    • Male, 42, businessman ,
    • Comlain : severe sore throat with a low fever for 10
    • hours.
    • History: 10 hours ago the patient felt a slight pain in his
    • larynx, and the pain became severe rapidly that
    • he daren’t swallow. He has a slight fever and fells
    • fatigue. 2 hours ago he felt it difficult to breath in.
    • Examination: stridor, retraction of supraclavicular and
      • intercostal spaces , inspiratory d yspnea; Cyanos ; the epiglottis becomes hyperemia and swelling ”,and looks like a ball
      • Question: (1)what’s the diagnosis? (AE)
      • (2) How to treat?( hospitalized, tracheostomy ,
      • antibiotic, systematic steriod , inhalation of
      • steriod)
  • 15. Acute laryngitis
  • 16. Case sdudy
    • Female, 35, nurse
    • Complain: hoarseness for 3 days,aphonia for 2 hours.
    • History: 3 days ago the patient caught a “cold”
    • and became hoarse. She had nonproductive
    • cough and a tickling sensation in her larynx.
    • Two hours ago she shouted very loudly to
    • her naughty son and then lost her vioce
    • ( aphonia ).
    • Physical examination: vocal fold s are congestive and swelling with stringy mucus between the cords
    • Question: (1)what’s the diagnosis?
      • (2) How to treat the patient?
  • 17. definition
    • acute catarrhal inflammation of the laryngeal mucosa
      • usually a mild, self-limited inflammatory condition
      • often a manifestion of a more diffuse upper respiratory infection
      • More common in winter months
  • 18. etiology
    • Infection
      • the most common cause
      • almost always a virus upper respiratory infection, such as: influenza, common cold
    • Bacterial invasion may be secondary .
    • Predisposed to by:
      • vocal over-use.
      • smoking.
      • drinking of spirit.
      • irritant gas inhalation
  • 19. Clinical manifestation
    • Symptoms
      • H oarseness aphonia in severe case
      • cough, +/-fever
      • Throat pain, tenderness of the larynx
      • symptoms of a common cold for some case s
    • Signs
      • red ness and dry of the larynx,
      • vocal fold swelling with stringy mucus between the cords
  • 20. Acute laryngitis
  • 21. diagnosis
    • according to :
      • the history
      • hoarseness
      • redness and edema of the mucosa of the vocal cord s .
    • Throat culture
      • rarely used,
      • only for prolong cases or in the face of a possible epidemic.
      • Differential diagnosis: hysteria
  • 22. treatment
    • 1 Total voice rest
      • supreme i mportant
      • e ven whisper should be avoided.
    • 2 local treatment: Inhalations with steam
    • (steriod)
    • 3 Anti inflammation
      • antibiotics + steroid
  • 23. Case sdudy
    • Female, 35, nurse
    • Complain: hoarseness for 3 days,aphonia for 2 hours.
    • History: 3 days ago the patient caught a “cold”
    • and became hoarse. She had nonproductive
    • cough and a tickling sensation in her larynx.
    • Two hours ago she shouted very loudly to
    • her naughty son and then lost her vioce
    • ( aphonia ).
    • Physical examination: vocal fold s are congestive and swelling with stringy mucus between the cords
    • Question: (1)what’s the diagnosis? (AL)
      • (2) How to treat?( voice rest , antibiotics + steroid , Inhalations with steam )
  • 24. .
    • Acute laryngitis in children
  • 25. Case study
    • Boy, 2, hoarseness, fever 16 hours.
    • History: The boy had a fever and hoarseness
    • for16 hours. His mother give him some
    • Chinese to take, but his condition wasn’t
    • improved. 2 hours ago it became even
    • worse. The patient had a barking and
    • dyspnea.
    • Physical examination: stridor, cyanosis, retraction of supraclavicular and intercostal spaces
    • Question: (1)what’s the diagnosis?
    • (2) How to treat the patient?
  • 26. Acute laryngitis in children
      • Dyspnea usually happen , for:
    • Anatomic factors
      • narrow laryngeal cavity
      • soft cartilage
      • pultaceous connect tissue
      • richly supplied with lymphatic vessels
    • Low cough reflex ability
      • difficulty in eliminate the secretion
    • the immature nerve system
      • Laryngospasm happens easily
    • the immature immune system
      • Severe inflammation
  • 27. Clinical manifestation
    • Symptoms:
      • hoarseness;
      • barking cough
      • inspiratory dyspnea
      • s ymptoms of upper respiratory infection: fever, fatigue, et al
    • Signs:
      • laryngeal stridor
      • retraction of supraclavicular and intercostal spaces
  • 28. Acute laryngitis in children Acute laryngitis
  • 29. diagnosis
    • Differential diagnosis
      • foreign body in larynx;
      • upper respiratory infection or bronchitis;
      • Laryngeal spasm;
      • laryngeal diphtheria
    hoarseness barking cough laryngeal stridor dyspnea children consider the diagnosis confirm the diagnosis
  • 30. treatment
    • Should be treated as soon as possible!!!!
      • Sufficient antibiotic, + systemic steroid for severe cases
      • Inhalations with steam (steroid + adrenaline)
      • Management of laryngeal obstruction:
      • stridor, cyanosis,and retraction of supraclavicular and intercostal spaces are indications of immediate tracheostomy
    • Supporting therapy
      • sedation,
      • be sure of water-electrolyte balance
  • 31. Case study
    • Boy, 2, hoarseness, fever 16 hours.
    • History: The boy had a fever and hoarseness
    • for16 hours. His mother give him some
    • Chinese to take, but his condition wasn’t
    • improved. 2 hours ago it became even
    • worse. The patient had a barking and
    • dyspnea.
    • Physical examination: stridor, cyanosis, retraction of supraclavicular and intercostal spaces
    • Question: (1)What’s the diagnosis? (AL in children)
    • (2) How to treat ? hospitalized, C losed monitoring
    • antibiotic, systematic steriod , inhalation of
      • steriod)
  • 32. Chronic laryngitis
    • non-specificity chronic inflammation
    • of the larynx
  • 33. etiology
    • Every factor that can affect the vocal folds (physical, chemical, infection)
      • Excessive vocal use
      • Vocal misuse, Habitual shouting
      • Long-term inhalation of irritative gas( smoking, et al)
      • Chronic airway infection( bronchitis, sinusitis)
      • Acute laryngitis procrastinating
  • 34. high risk group
    • Occupation required frequent vocal use
    • Irritable character
    • Pollution envirenment
    • chronic u pper respiratory inflammation
  • 35. Clinical manifestation
    • Symptoms:
      • Hoarseness
      • Vocal fatigues easilly
      • Discomfort and a tendency to clear the throat constantly
      • Cough (with white sputum)
    • Signs: three kinds of laryngeal changes
      • Chronic simple laryngitis
      • Chronic hypertrophy laryngitis
      • Chronic atrophy laryngitis
  • 36.
  • 37.  
  • 38. diagnosis
    • NEVER MAKE A DIAGNOSIS OF CHRONIC LARYGITIS UNTIL OTHER LESIONS CAUSING HOARSENESS HAVE BEEN CAREFULLy EXCLUDED!!!!!!!!!!!!!!!
    • Differential diagnosis:
      • laryngeal tuberculosis and syphilis;
      • laryngeal carcinoma;
      • vocal cord paresis;
      • hysteria
  • 39. treatment
    • Removal of the cause ,
      • voice rested, correct vocal use,etc
    • Steam inhalation
    • Chinese medicine
  • 40. Vocal fold nodules
    • Etiology:
      • excessive or improper vocal use.
    • Clinical manifestation:
      • Symptoms:
        • hoarseness
      • Signs:
        • small smooth nodule of the anterior 1/3 of the free edge of each cord,
        • usually bilateral ,
        • symmetric
  • 41.
    • edema types:
      • vocal rest
      • speech therapy
      • medicine
    • Fibrosis types
      • surgery
    • CAUTION: no surgery for children
    Treatment Vocal fold nodules
  • 42. surgery for v ocal fold nodules
  • 43. Vocal polyp
    • Etiology  
      • vocal abuse ;
      • improper vocal use
    • Clinical manifestation:
      • symptoms
        • – hoarseness(persistent)
      • signs
        • smooth neoplasm at anterior 1/3 VC,
        • unilateral
  • 44. Vocal polyp
  • 45.
    • Differential diagnosis  
      • laryngeal fibroma ,
      • neurofibroma ;
      • papilloma;
      • carcinoma
    • Treatment  
      • surgery :
        • indirect laryngoscope;
        • fiber lary n goscope;
        • Selfretaining laryngoscope
      • follow by speech therapy
    Vocal polyp
  • 46.  
  • 47. diseases of laryngeal motor nerve ( laryngeal paralysis)
      • disturbance of the motor n. ( superior laryngeal n. and recurrent laryngeal n.) of laryngeal muscle that cause the TVC motion disorder.
    • etiology
      • centric disorder
      • peripheral disorder
        • trauma; tumor; inflammation; intoxication;
    • left﹥rignt
  • 48. Clinical manifestation
    • voiced function disorder
    • 4 types:
      • Incomplete recurrent laryngeal n. paralysis
      • Complete recurrent laryngeal n. paralysis
      • Superior laryngeal n. paralysis
      • Mix laryngeal n. paralysis
  • 49. .
    • .
    • .
    Mix left laryngeal n. paralysis
  • 50. treatment
    • Etiological treatment
    • Symptomatic treatment:
      • local injection,
      • surgery( neuro-muscular-pedical grafting, neuroanastomosis, medial or lateral cordopexy, partial cricoidectomy)
    • Voice training
    • Tracheotomy (bilateral incomplete recurrent laryngeal n. paralysis)
  • 51. CASE bilateral incomplete recurrent n. paralysis male, 41yrs bilateral incomplete recurrent n. paralysis for laryngeal trauma,with laryngeal obstruction Tracheotomy Satisfied vioce Endotracheal anethesia Arytenoidectomy Successfully extubate
  • 52. .
    • .
    • .
    incomplete bilateral recurrent laryngeal n. paralysis
  • 53. . Neoplasms of the larynx
  • 54. . Benign : amyloid tumor papilloma angioma fibroma
  • 55. Laryngeal papilloma
    • Cause: HPV-6 , HPV-11 infection
    • Pathology:
      • epithelioma,
      • no basic membrane infiltrated
    • Clinical manifestation:
      • Progressive hoarseness, inspiratory dyspnea
      • (1)Adults: unifocal, may recurrent , cancerate
      • (2)Children:
        • multifocal, any position of the larynx, may in trachea
        • Fast grow, easily recurrent, seldom cancerate
  • 56. treatment
    • surgery
      • mostly via edoscopy, often need more than once
      • Laryngofissure for some adults
    • Antivirus
    • Immunotherapy
      • Transfer factor
      • interferon
  • 57. Laryngeal papilloma of children
  • 58. Laryngeal papilloma of adult
  • 59. 谢谢~~
  • 60. Carcinoma of larynx
  • 61. Carcinoma of larynx
    • Etiology
      • Smoking,alcohol abuse
      • Virus infection
      • Enviroment factors
      • Sexual hormone
    • Pathology
      • 93~99% squamous cell carcinoma
    • Classification of tumor sides:
      • supraglottic carcinoma
      • Glottic carcinoma
      • Subglottic carcinoma
      • Transglottic carcinoma
    classification
  • 62. Clinical manifestation
    • Supraglottic carcinoma
      • Maybe no symptoms for early stage
      • Layngalgia, bloody sputum for some cases
    • Glottic carcinoma
      • Hoarseness       at early stage
      • Apnea
    • Subglottic carcinoma
      • No symptoms for early stage
      • Difficult to detect
    • Trans-glottic carcinoma
      • No symptoms for early stage
      • Hoarseness following
    Missed diagnosis
  • 63. Carcinoma of larynx
  • 64. route of metastasis(1)
    • 1 、 direct metastasis
    • Barrier for restricting metastasis
      • Tendon of anterior commissure
      • The space between supraglottic and infraglottic area
      • Vocal process of arytenoid cartilage
      • Pyriform sinus
      • Thyroid cartilage
  • 65. route of metastasis(1)
    • Supraglottic carcinoma
      • Anteriad preepiglottic space,   extrinsic muscles
      • Astern layngopharynx
      • Downward vocal folds
    • glottic carcinoma
      • Anteriad preepiglottic space,   contralateral vocal
      • thyroid cartilage
      • upward vestibule, ventricle
      • Downward infraglottic area
    • Subglottic carcinoma
      • Upward vocal folds
      • Downward trachea
      • Anteriad thyroid
      • Astern esophagus
    direct metastasis
  • 66. route of metastasis(2)
    • Lymphatic metastasis
      • Supraglottic carcinoma: easy
      • Glottic carcinoma: seldom
      • Subglottic carcinoma:
    • Hematogenous metastasis
      • For some advaned stage cases
  • 67. Carcinoma of larynx
    • diagnosis
    hoarseness Laryngoscopy Laryngeal mass biopsy
    • Differential diagnosis:
    • laryngeal tuberculosis
    • Laryngeal syphilis
    • Laryngeal papilloma
  • 68. treatment
    • Surgery
    • Radiotherapy
    • Others
      • Chemotherapy
      • Hyperthermia
      • Photoradiative Therapy
      • Immune modulation
  • 69. surgery
    • Via laryngendoscope or microscope for early stage
    • Partial laryngectomy
      • Acording to the location and the bound of the tumor
      • The principle is: 1 、 to remove the tumor completely
      • 2 、 function reservation
    • Total Laryngectomy
    • Neck dissection
    treatment
  • 70. radiotherapy
    • Radical radiotherapy
      • Carcinoma in situ or T1
    • Combine with surgery
      • Before or after the surgery
    • Radiotherapy alone as palliation
    treatment
  • 71. 谢谢~~

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