acute and chronic laryngitis

1. DR. APURVA JARANDIKAR
ASSISTANT PROFESSOR
DEPT OF ENT
DPU, PIMPRI

2. ACUTE LARYNGITIS
1. Infection
2. Non Infetion
Etiology :
1. Infection Type :
- More common
- Usually follows Upper Respiratory Infection
- Viral Bacterial Invasions
- Streptococcus Pneumoniae
- H. Influenza
- Streptococcus Haemolytic
- Streptoccus Aureus

3. 2. Non Infections Type
- Vocal abuse
- Allergy
- Thermal/chemical burn to larynx
- Laryngeal trauma : endotracheal tube
- Inhalation/ingestion
Clinical Features
• Symptom : 1. Hoarseness aphonia
2. Pain/discomfort in the throat (after talking)
3. Dry, irritating cough (worse at night)
4. Malaise, dryness of throat ; cold; fever ( if
viral infection of URI )

4.  Laryngeal appearance
- Erythema & edema of epiglottis, aryepiglotis, fold, arythenoid,
ventricular band
- Vocal cord : white & near normal Red & swollen
- Sticky secretion (+) between the vocal cord & interarythenoid
Therapy
1. Vocal rest
2. Avoidance smoking & alkohol
3. Steam inhalation
4. Antibiotics
5. Analytics
6. Obat Batuk ( cough sedative )
7. Steroid

5. ACUTE EPYGLOTTIS
( SUPRAGLOTTIS LARYNGITIS)
Acyte inflamatory to supraglottis structures ( epiglottis,
aryepiglottis fold & arythenoid )
Etiology
- Serious condition
- Children : 2- 7 years of age (can also affect adult )
- The most common : H. Influenza ß
Clinical features :
1. Onset of symptom : Rapid progression
2. Sore throat & dysphagia
3. Dyspnoe & stridor
4. Fever 40° C

6. Lanjutkan....
Examination
1. Epiglottis : Red & Swollen, Better done in operation room
with facilities for intubation
2. Neck X-Ray lateral soft tissue Epiglottis swollen
( Thumb Sign )
Therapy :
1. Hospitalisation : danger of respiratory obstruction
2. Antibiotic ( IM/IV ) : Ampicilin, Cephalosporin
3. Stridor : Hydrocortison / dexamethason ( IM/ IV ) Relieve
Oedem
4. Adequate hydration : Parentral fluid
5. Humidification & O2
6. Intubation / tracheostomy for Respiratory obstruction

7. Tabel 56.1
Acute epiglottitis Acute laryngo-tracheo-
bronchitis (or group)
• Causative organism
• Age
• Pathology
• Prodromal symptoms
• Onset
• Fever
• Patient's look
• Cough
• Stridor
• Odynophagia
• Radiology
• Treatment
Haemophilus in fuenzae
type B
2-7 years
Suproglottic larynx
Absent
Sudden
High
Toxic
Usually absent
Present and may be
marked
PI'esent, with drooling of
secretions
' Thumb sign on lateral
view
Humidified oxygen, third
generation
cephalospor'in
(ceftriaxone) or
amoxicillin
Parainfluenza virus type I
and II
3 months to 3 years
Subglottic area
Present
Slow
Low grade or no fever
Non-toxic
Present, (Barking seal-
like)
Present
Usually absent
Steeple sign on
anteroposterior view of
neck
Humidified O 2 tent,
steroids

8. ACUTE LARYNGO-TRACHEO BRONCHITIS
 Inflamatory of the larynx, trachea, bronchi
 Common than acute
Etiology :
- Viral infection (moostly)
- 6 month – 3 years of age
- Laki-laki > perempuan
Pathology :
- Loose areolan time in subglottic region oedem
Respiratory obstruction & stridor
- Thick secretion & crusts occlude the airway

9. Symptom :
- URI & hoursness & croupy cough Obstruction :
- Fever 39 – 40°C Suprasternal
- Difficulty in breathing & stridor Intercostal
Threatment :
1. Hospitalization ( because of microlaring difficult in
breathing )
2. Antibiotic : Ampicilin 50 mg/kg/day
3. Humidification to soften the crust & thick
secretion
4. IVFD ( dehydration )
5. Steroid : hydrocortison 100 mg iv to relieve oedem
6. Adrenalin via respiratory ( bronchodilator
Relieve dyspnoe & evert tracheostomy )
7. Intubation / tracheostomy

10. LARYNGEAL DIPHTERIA
Etiology :
1. Secondary to faucial diphteria
2. Children < 10 years of age
3. Due to immunisation
Pathology
1. Pseudomembrane over larynx & trachea Obstruct the airway
2. Exotoxim Myocarditis death
Clinical Features
- General Symptom : - Low grade fever ( 100°-101°F)
- Sore throat, malaise
- Tachycardi, very toxaemia, thready
pulse

11. - Larygeal symptomp : - Horsness
- Croupy cough
- Stridor inspiratory
- Dyspnoe obstruction airway
 Greyish white membrane on :
- - Tonsil
- Pharunx, soft palate
- Removal bleeding
- Larynx, trachea
 Cervical lymphadenophaty bull-neck
Diagnosis : - Smear, culture Corynebacterium
dyphtheria
- Clinical feature

12. • Threatment :
1. Dyphteria antitoxin : 20.000 – 100.000 unit IV
2. Antibiotic : Benzylpenicillin; Erythromicyn
3. Maintenance of airways Tracheostomy,intubation
4. Bed rest 2 – 4 weeks
• Complication
1. Asphyxia & death due to airway obstruction
2. Toxic myocarditis & circulatory failure
3. Palatal paralysis with nasal regurgitation
4. Laryngeal & pharyngeal paralysis

13. OEDEM LARYNX
( OEDEM GLOTTIDIS )
 Involves the supraglottic & subglottic ( where laryngeal
muccosa is loose )
 Vocal cord oedem Rarely because subepithel
connective tissue
Etiology :
1. Infection : - Acute epiglottis, laryngotracheobronchitis,
tuberculosis, syphilis of the larynx
- Perytonsilar abses, retrofaryngeal abses &
ludwig’s angina

14. 2. Trauma : Surgery of tounge, floor of mouth, laryngeal
trauma, foreign body, endoscopy, intubation,
thermal or caustic burn, onhalation/irritan
gas/fumes
3. Neoplasma : Ca of larynx / laryngopharynx
4. Allergy
5. Radiation : Cauter of larynx
6. Sistemic diseases : Heart failure, Nephritis
Symptom & Sign
1. Airway obstruction Tracheostomy
2. Inspiratory atridor
3. Laryngoscopy indirect : oedem supraglottic / subglottic

15. Therapy
- Airway onstruction Intubation /
tracheostomy
- Injection adrenalin ( 1 : 1000 ) 0,3 – 0,5 IM Repeated
15 minutes if necessary Useful in oedem

16. CHRONIC LARYNGITIS
A. Chronic Hyperameic Laryngitis :
Diffuse inflamatory, symetrical involving the whole
larynx Vocal cord, ventricular band, inter
arythenoid & epiglottis
Etiology
1. Follow incompletely resolve acute laryngitis / recurrent
attack
2. Chronic infection in paranasal sinuses teeth, tonsils
3. Occupational factors : dust, fumes (iron ; gold ), workers
in chemical industries
4. Alcohol / smooking
5. Persistent trauma : chronic lung disease Cough
6. Vocal abuse trauma in larynx

17.  Clinical features :
1. Hoarness ( voice tired & aphonic )
2. Dryness & intermittent tickling in the throat to clear
the throat repeatedly
3. Discomfort in the throat
4. Cough ( dry & irritating )
Laryngeal examination : hyperemia of laryngeal structure
, vocal cord dull red, muccus (+) in the vocal cord &
interarythenoid

18. Therapy
- Infection of upper & lower respiratory tract
should be treated
- Avoidance if irritating factors
- Voice Rest / Speech Therapy Training
- Steam inhalation : to loosen secretion & give relief
- Expectorants : to loose viscid secretion

19. B. Chronic hyperplastic / hypertrophic laryngitis
Diffuse & symetrical procces or a localised, appearing like a tumor
of the larynx : vocal noduls, vocal polyp, Reinke’s oedema,
contact ulcers
Etiology
- Same as Chronic laryngitis without hyperplasia
Pathology :
- Begin from glottic region extend to ventricular band, base
glottict & subglottic mucousa Sub mucousa
mucous gland Intrinsik laryngeal muscle & joints
- Hyperaemia, oedem sub mucousa
- Pseudosratified ciliated epith of the respirstory mocous
Change squamous type and squamous epith of vocal cord
change becaome hyperplasia & keratinisation
- Mucous gland hypertrophy ( at first ) later atrophy ;
dryness of larynx

20.  Clinical Feature
- Man : women = 8:1 at 30 – 50 years of age
- Hoarness ; clear the throat ; dry cough ; tired of voice ; discomfort
in the throat
 Examination
1.Laryngeal mocosa ; dusky red & thickened
2. Vocal cord : red & swallen. In late stage become bulky & irregular
giving modullar appearance
3. Ventricular band : Red & swallen
4. Mobility of cord inpaired due to oedem & infiltration, later
muscular atrophy or arthrities of crichoarythenoid joint.
Therapy
- Conservative
- Surgical One cord is operated at a time ; removing the
hyperplastic

21. PHACYDERMIA LARYNGITIS
 A chronic hyperplatis laryngitis affecting :
- Posterior part of interarythenoid
- Posterior part of vocal cord
• Clinically :
- Hoarness / husky voice
- Irritation in the throat
• Indirect laryngoscopy
- Red/grey granulation tissue in the interarythenoid region &
posterrior third of vocal cord
- Sometimes ulceration / contact ulcer
- Bilateral / symetrical
• Diagnosis :
Biopsy to differentiate form carsinoma & tubercullosis

22.  Etiology :
- Uncertain
- >> man – alcohol & smoking
- Forcefull talking & gastro – esophageal reflux
• Therapy :
- Removal granulation tissue Repetition
- Control acid reflux
- Speech therapy

23. ATROPHIC LARYNGITIS ( Laryngitis Sicca )
• Atrophy laryngeal mucosa & crust formation
• Often in women & associated with atrophic rhinitis &
pharyngitis
• Symptomp :
Hoarnes, Coughing, Removal crusts, dry irritation cough,
sometimes dyspnoe ( due to obstructive crusts )
 Examinatoon :
- Atrophic mucosa
- Foul smelling crusts
- Crusts expelled Mucosa excoriation & bleeding

24. TUBERCULOSIS OF LARYNX
• Therapy :
- Elimination the causative factor
- Humidification
- Loosen the crusts ( expectorant )
• Etiology :
- Secondary to pulmonary tuberculosis
- Man middle age group
- Bronchogenic / haemotogenic

25. Pathology :
- Affect posterior part larynx >> anterior
1. Interarythenoid fold
2. Ventricular band
3. Vocal cord
4. Epiglottis
- Bronchus + sputum ( BTA (+)) penetrate the laryngeal
mucosa in the interarythenoid region ( bronchogenic spread )
Tubercle the mucosal ulcerate
- Laryngeal mucosa : Red & swallen
- Stadium perychondritis & cartilage necrosis Not common
Symptoms & sign :
- Depend on the stage of tuberculosis
- Weakness of the voice (earliest symptom ) Hoarseness
- Ulcer in the larynx - severe pain to the ear
- Painfull in swallowing
dyspepsia

26.  Laryngeal examination :
1. Whole vocal cord hypereami or posterior part impairment of
adduction
2. Swelling in inter arythenoid region
3. Vocal cord : ulceration (+) mouse bite / nibbled
4. Ulceration (+) in arythenoid & interarythenoid region
5. Granulation tissue in interarythenoid region
6. Turban epiglottis
7. Swelling of ventricular band & aryepiglottic fold
8. Marked pattor of surrounding mucosa
• Diagnosis
- X – ray chest
- Sputum examination
- Biopsy laryngeal lesion

27.  Therapy :
- Voice rest ( important )
- Anti tuberculosis drugs
SYPHILIS OF THE LARYNX
• Rare condition
• Tertiary stage : gumma (+)
• Any part of the larynx : smooth swelling ulcer
Diagnosis
1. Biopsy
2. Serological test

28.  Complication :
Laryngeal stenosis
LEPROSY OF THE LARYNX
Biopsy, Deformity of laryngeal inlet Stenosis
Complication : Laryngeal stenosis
SCLEROMA OF THE LARYNX
Biopsi Klebsiella Rhinoscleromatis
Complication : Laryngeal stenosis

29.  THANK YOU!