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disorders of larynx laryngitis in adults

infection and inflammation of larynx

Health & Medicine◦
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LARYNGITIS
DEFINITION Laryngitis is the inflammation of the larynx (voice box), typically resulting in hoarseness or loss of voice due to irritation or infection. It may be acute (short-term) or chronic (long-lasting), depending on the underlying cause and duration. Related term Croup is an acute viral respiratory illness that causes inflammation of the larynx, trachea, and bronchi (laryngotracheobronchitis).
CAUSES Acute Laryngitis oViral infections (most common; e.g., rhinovirus, influenza) oBacterial infections (less common; e.g., Streptococcus pneumoniae) oOveruse or strain of vocal cords (shouting, singing) oInhalation of irritants (e.g., smoke, allergens) oGERD (Gastroesophageal reflux disease) Chronic Laryngitis oLong-term exposure to irritants (e.g., cigarette smoke, alcohol, chemicals) oRecurrent GERD oChronic sinusitis oVocal strain over a long period oInfections such as tuberculosis or syphilis oAutoimmune disorders (e.g., sarcoidosis, rheumatoid arthritis)
RISK FACTORS Upper respiratory tract infections Smoking Excessive alcohol use Professional voice use (teachers, singers) Exposure to allergens or pollutants GERD Immunocompromised state
TYPES OF LARYNGITIS Acute Laryngitis – Sudden onset, short duration, usually viral. Chronic Laryngitis – Lasts more than 3 weeks; often due to prolonged irritant exposure.
PATHOPHYSIOLOGY Irritation/Infection of Laryngeal Mucosa: Triggers inflammation. Vasodilation & Increased Permeability: Leads to edema and erythema of the vocal cords. Swelling of Vocal Cords: Causes hoarseness or voice loss due to altered vibration. Increased Mucus Production: Leads to throat clearing and cough. In Chronic Laryngitis: Persistent inflammation may lead to thickening of vocal cords, polyp formation, or dysplasia (pre-cancerous changes).
Clinical Manifestations Hoarseness or complete loss of voice (aphonia) Sore throat Dry or scratchy throat Dry, persistent cough Sensation of lump in the throat Difficulty speaking Fever (especially in infectious laryngitis) Swollen lymph nodes (in bacterial or viral infections)
DIAGNOSIS History & Physical Examination: Duration, onset, voice use, exposure to irritants, GERD symptoms Laryngoscopy:Visualizes vocal cords and larynx; detects inflammation, nodules, polyps, or tumors. Stroboscopy: Evaluates vocal cord movement. Throat Culture: To rule out bacterial/fungal infection. Imaging (CT/MRI): If mass or tumor suspected. Biopsy: In chronic cases or if malignancy is suspected.
Stroboscopy is a medical procedure used to examine the vocal cords and larynx (voice box) during speech. It uses a flashing light synchronized with the vocal cords' vibration to create a slow-motion effect, allowing doctors to assess vocal cord movement and identify potential problems. •he patient may have a numbing medication applied to the nose and throat to minimize discomfort . •A thin scope with a camera is gently inserted into the nasal passage. •The patient is asked to speak or make sounds while the scope is in place. •The strobe light is activated, and the vocal cord movement is visualized and recorded.
COMPLICATIONS Chronic hoarseness Vocal cord polyps or nodules Laryngeal stenosis Laryngeal cancer (especially in smokers or long-term irritant exposure) Aspiration pneumonia (in severe cases of vocal cord dysfunction) Permanent vocal cord damage
MANAGEMENT Medical Management Acute Laryngitis: Voice rest Hydration (oral fluids, humidified air) Analgesics/antipyretics (e.g., paracetamol, ibuprofen) Antitussives for dry cough Antibiotics (only if bacterial cause confirmed) Corticosteroids (short-term, for severe inflammation or vocal professionals)
CHRONIC LARYNGITIS: Elimination of irritants (stop smoking, avoid alcohol) Management of GERD (PPIs, dietary changes) Treatment of allergies or infections Vocal therapy (speech-language pathologist) Antifungal medications (if fungal laryngitis) Surgical excision of polyps/nodules (if present)
Nursing Management Assessment Assess voice quality (hoarseness, aphonia) History of recent URI or vocal overuse Assess for GERD symptoms Monitor for signs of infection: fever, malaise Assess hydration status Nursing Diagnoses Impaired verbal communication related to inflammation of vocal cords Risk for ineffective airway clearance related to thick secretions Acute pain related to throat irritation Deficient knowledge related to disease process and preventive strategies
Nursing Interventions Promote Voice Rest:  Encourage the patient to speak minimally and avoid whispering.  Use non-verbal communication methods. Hydration:  Encourage oral fluids.  Use humidifiers to keep air moist. Pain Management:  Administer prescribed analgesics.  Offer warm saline gargles. Infection Control:  Encourage proper hand hygiene.  Educate on completing antibiotics if prescribed. Monitor Airway:  Observe for respiratory distress or stridor.  Position patient to promote airway patency. Patient Education:  Avoid smoking, alcohol, and exposure to irritants.  Use proper vocal techniques.  Advise on dietary and lifestyle changes if GERD is present.  Educate about the importance of follow-up for chronic or recurrent symptoms.
LARYNGEAL OBSTRUCTION Laryngeal obstruction refers to a partial or complete blockage of the airway at the level of the larynx, which can result in impaired airflow to the lungs. It is a medical emergency that can cause life-threatening respiratory distress if not managed promptly.
CAUSES Laryngeal obstruction can be caused by a variety of conditions, broadly categorized as: 🔹 Congenital Causes - Laryngeal web, laryngomalacia (Laryngomalacia is a congenital anomaly in which a baby's larynx cartilage is soft and floppy, causing noisy breathing (stridor) due to the upper larynx collapsing inward during inhalation), subglottic stenosis, vocal cord paralysis 🔹 Acquired Causes a. Infectious – Epiglottitis, laryngotracheobronchitis (croup), diphtheria, abscesses (e.g., retropharyngeal) b. Traumatic- Direct trauma to the neck, inhalation burns, post-extubation edema, foreign body aspiration c. Neoplastic - Laryngeal tumors (benign or malignant), vocal cord papillomas d. Allergic/Inflammatory – Anaphylaxis, angioedema, severe allergic laryngitis e. Neurological - Bilateral vocal cord paralysis
RISK FACTORS Recent upper respiratory infection History of allergies or anaphylaxis Trauma or recent surgery involving the neck or airway Inhalation of toxic fumes or hot gases Foreign body aspiration (especially in children) Smoking and alcohol (for laryngeal cancers) Vocal abuse or misuse
PATHOPHYSIOLOGY Triggering event (infection, trauma, allergen) causes inflammation, edema, or structural change in the larynx. Airway narrows due to:  Swelling of the vocal cords or surrounding structures.  Physical obstruction (foreign body, tumor). Increased airway resistance leads to:  Stridor (high-pitched sound during inspiration).  Hypoxia due to decreased oxygenation.  Respiratory distress or failure if untreated. In complete obstruction, no air can pass → asphyxia → cardiac arrest.
CLINICAL MANIFESTATIONS Symptoms vary based on severity: Early Signs (Partial Obstruction) Inspiratory stridor Hoarseness Cough Difficulty breathing Anxiety or agitation Use of accessory muscles Progressive Signs Retractions (intercostal, suprasternal) Cyanosis Drooling (especially in epiglottitis) Dysphagia Tachypnea and tachycardia Late Signs (Complete Obstruction) - Silent chest (no air entry), Severe hypoxia, Loss of consciousness, Respiratory arrest
Diagnosis History and Physical Examination - Sudden onset vs gradual progression, associated symptoms (fever, trauma, allergy), stridor and breathing pattern •Laryngoscopy: Direct visualization of laryngeal structures. •Chest X-ray/Neck X-ray: To identify foreign body, soft tissue swelling. •CT scan: For tumors, deep infections. •Pulse oximetry: Assess oxygen saturation. •ABG (Arterial Blood Gas): To evaluate respiratory failure. •Allergy testing: If anaphylaxis is suspected. ⚠️In cases of suspected epiglottitis, throat examination or laryngoscopy should be performed in a controlled environment (e.g., OT), as it can trigger sudden airway closure.
MANAGEMENT Emergency Management Ensure airway patency is the top priority. Basic Interventions Positioning (sitting upright) Oxygen therapy (humidified O via mask) ₂ Suctioning if secretions are present Advanced Interventions Epinephrine nebulization (in croup or anaphylaxis) Corticosteroids (e.g., dexamethasone) to reduce edema Antihistamines (e.g., diphenhydramine) in allergic causes Intramuscular epinephrine in anaphylaxis Antibiotics for bacterial infections (e.g., epiglottitis) Foreign body removal via laryngoscopy or bronchoscopy Endotracheal intubation or tracheostomy in severe cases
Complications Acute respiratory failure Hypoxic brain injury Cardiac arrest Pulmonary edema (negative pressure pulmonary edema) Aspiration pneumonia Long-term vocal cord damage or laryngeal stenosis
NURSING MANAGEMENT Assessment Monitor respiratory rate, effort, and oxygen saturation Observe for signs of cyanosis, stridor, or restlessness Evaluate for history of allergies, trauma, or infection Assess voice quality (hoarseness, muffled voice) Nursing Diagnoses Ineffective airway clearance related to obstruction Impaired gas exchange related to airway compromise Anxiety related to breathing difficulty Risk for aspiration related to swelling or foreign body
INTERVENTIONS Maintain Airway and Breathing  Position patient in high Fowler’s  Administer humidified oxygen  Prepare for intubation or emergency tracheostomy Monitor Vital Signs  Frequent respiratory and cardiovascular monitoring  Continuous pulse oximetry and ABG if indicated Medications  Administer prescribed corticosteroids, epinephrine, antibiotics, and antihistamines as needed  Monitor for adverse reactions Emergency Preparedness  Keep emergency airway equipment at bedside  Collaborate with the medical team (ENT, anesthesia) Education  Instruct on allergen avoidance (for allergic causes)  Importance of early treatment for infections  Safe eating practices in children to prevent aspiration Psychological Support  Reassure patient and family  Provide calm and clear communication to reduce anxiety