This document summarizes different types of chronic laryngitis, including chronic nonspecific laryngitis (hyperemic, hypertrophic, atrophic), chronic specific laryngitis (tuberculosis), and vocal nodules. Chronic hyperemic laryngitis involves diffuse inflammation of the larynx caused by recurrent acute laryngitis or chronic infection/irritation. Chronic hypertrophic laryngitis is an advanced stage with cellular infiltration and possible vocal cord swelling/thickening. Chronic atrophic laryngitis most affects women and causes a dry, irritated cough from a dry, atrophic larynx covered in crusts. Tuberculous laryngitis stems from pulmonary TB and causes ulcers and granulomas

3. CHRONIC LARYNGITIS
By
Lt Col Saeed Ullah, FCPS
Classified ENT, Head and neck surgeon
CMH Quetta

7. Anatomy

9. Calssification
 Chronic specific laryngitis
 Chronic non specific laryngitis

10. Chronic non specific
laryngitis
1. Chronic hyperemic
2. Chronic Hypertrophic
3. Atrophic laryngitis
4. Pachydermia (contact granuloma / contact
ulcer

11. Chronic hypreamic laryngitis
 Diffuse inflammatory condition involving the
whole larynx particularly true & false vocal
cords

12. Causes
 Recurrent acute laryngitis
 Incompletely resolved acute laryngitis
 Chronic infection in the vicinity
 Sinusitis, tonsillitis, bad orodental hygiene ,
 Ch Bronchitis
 Occupational factors
 dust & Fumes
 Smoking & Alcohol
 Voice abuse
 GERD

13. Clinical features
 Males affected more than females
 Hoarseness of voice
 Fatigue of voice
 Hawking & irritation larynx
 Dry irritating cough

14. Clinical features
 Laryngoscopy
 Hyperemia ,Vocal cords appear dull & edges are
rounded,Viscid secretions onVC / interarytnoid
region

17. Treatment
 EliminateThe cause
 infection / irritating factors
 Complete voice rest / Observe proper vocal
hygiene
 Medicated steam inhalation

19. Chronic hypertrophic
laryngitis
 Advanced stage of hyperemic laryngitis
 Cellular infiltrate in the submucosa
 Epithelium may undergo hyperplasia /
metaplasia
 May be generalized involvement
 FalseVC (ventricular bands)
 “Dysphonia plica ventricularis”
 True vocal cords
 Rinke’s Edema

20. Causes & features

21. Clinical findings
 Laryngoscopy
 Laryngeal mucosa is thickened & dusky red in
colour
 Vocal cords red & swollen, Edges loose sharp
demarcation

23. Treatment
 Conservative
 Surgical
 Stripping of edematous mucosa with micro-
scissor
 Ablation with LASER
 One side done at a time to preventWeb

24. Chronic atrophic laryngitis
 Common in women
 Associated with Atrophic Rhinitis
 Laryngitis Sicca
 Exact cause not known
 Hormonal disturbance, Dietary deficiency,
Autoimmune disorder
 Bacillus ozaenae secondary infection

25. Clinical features
 Hoarseness
 Dry irritating cough
 Dyspnoea due to crusts
 Laryngoscopy
 Laryngeal mucosa is dry & atrophic
 Covered with foul smelling crusts

28. Treatment
 Primary condition
 Atrophic rhinitis
 Steam inhalation
 25% glucose in glycerin sprays
 Expectorants containing Iodides to loosen the
crusts

30. Chronic specific laryngitis

31. Tubercolous laryngitis
 Secondary to Pulmonary tuberculosis
 Common in adult males
 Brochogenic / hematogenous route
 Bronchogenic route
 affects posterior larynx
 Interarytnoid region
 submucosal tubercles & granuloma
 Hematogenous
 Multiple painful ulcers in larynx & pharynx

32. Clinical features
 Hoarseness
 Painful ulcers / referred otalgia
 Odynophagia
 Laryngoscopy
 Pale granulations in the interarytnoid region
 Ulcers of vocal cords
 Mouse eaten appearance
 Swelling of falseVCs & Aryepiglottic folds

34. Investigations
 Xray chest PA view
 Sputum for AFB
 Biopsy

35. Treatment

37. Vocal nodules
 Singer‘ nodules
 Common in voice misusers
 Teachers, singers, preachers &Vendors
 Vocal trauma
 submucosal hemorrhage
 fibrosis & hyalinization
 At the junction of anterior 1/3 7 posterior 2/3 (
subject to maximum trauma )

38. Clinical features
 H/o misuse of voice
 Hoarseness
 Vocal fatigue
 Laryngoscopy
 Symmetrical nodular pinkish or grey masses at
junction of ant 1/3 & post 2/3 of true vocal cords

41. Treatment
 Conservative
1. Avoid misuse of voice
2. Speech therapy / proper use of voice
1. No shouting / No whisper
3. ? May change the profession
 Surgical
 Microlaryngoscopy & LASER

42. Thanks