This document discusses laryngeal infections. It begins by introducing laryngitis as an inflammation of the larynx that can be acute or chronic. Acute laryngitis is usually self-limited while chronic lasts over 3 weeks. Causes include vocal misuse, noxious agents, and viruses or bacteria. In children, important acute laryngeal infections are epiglottitis, croup, and bacterial laryngotracheobronchitis. Chronic laryngitis can be caused by repeated acute infections or long-term irritants like smoking. Diagnosis involves examination and investigations depend on the suspected infection. Management involves treating the underlying cause, antibiotics, corticosteroids, and occasionally intubation or tracheostomy
Please find the power point on Labyrinthitis and its management. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
to differentiate b/w wheezing and stridor....lead to know to make clinical dx for asthma, croup, laryngomalacia, epiglottis...there many noisy breathing....our focus wheezing n stridor....
Please find the power point on Labyrinthitis and its management. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
to differentiate b/w wheezing and stridor....lead to know to make clinical dx for asthma, croup, laryngomalacia, epiglottis...there many noisy breathing....our focus wheezing n stridor....
Approach to Acute infective upper airway obstruction (infective stridor) in ...Jwan AlSofi
This lecture will discuss Approach to Acute infective upper airway obstruction (infective stridor) in children and paediatric age group.
Topics:-
Stridor
Stridor
croup,
Epiglottitis
laryngitis,
bacterial tracheitis
Retropharyngeal abscess
Spasmodic Croup
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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2. INTRODUCTION
• Laryngitis is one of the most common
conditions identified in the larynx.
Laryngitis, an inflammation of the larynx,
manifests in both acute and chronic forms.
• Acute laryngitis has an abrupt onset and is
usually self-limited. If a patient has
symptoms of laryngitis for more than 3
weeks, the condition is classified as
chronic laryngitis.
3. The etiology of acute laryngitis includes vocal
misuse, exposure to noxious agents, or
infectious agents leading to upper respiratory
tract infections. The infectious agents are most
often viral but sometimes bacterial.
7. Pathophysiology
1.The mucosa of the larynx becomes
congested and may become oedematous.
2.A fibrinous exudate may occur on the
surface.
3.Sometimes infection involves the
perichondrium of laryngeal cartilages
producing perichondritiis.
9. CLINICAL PRESENTATION
•Change or loss of voice;
• Difficulty in breathing/stridor;
• Sore throat and otalgia;
• Difficult or painful swallow;
• Tender larynx with/without cervical
lymphadenopathy.
11. Acute Epiglottitis
• Most frightening pediatric emergency.
• If unrecognized it can lead to death of the
child.
• 6-23 per 100,000 in chlidren.
• Haemophilus influenzae type B , is the
causative organism in most cases.
• The disease is concentrated maximally on
the epiglottis but the inflammation may
involve whole supraglottic compartment.
• Most cases seen between 1 and 6 years of
12. Clinical features
• Classical features:
– A child c/o sore throat which intensifies, with
in half and hour dysphagia reported.
– Inspiratory stridor develops and within 2 hours
child becomes critical.
– Child sits up and leans forward
– Saliva is dribbling due to absolute dysphagia
– Voice is muffled
– As time goes child becomes quiet and
respiratory distress appears to lessen.
– An an ominous sign: respiratory & cardiac
arrest imminent
15. Investigations
• Blood culture
• Throat awab culture
• WBC counts
• X ray plain lateral soft tissue neck.
• Computed tomography (CT) scans are
useful if there is a complication such as an
epiglottic abscess
16. Lateral X-ray of neck may show classical
‘thumb’ sign of swollen epiglottis
www.learningradiology.com/archives04/COW%2010
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17. Management
• It is a surgical emergency
• Admit and observe give i.v. antibiotics and
100% humidified oxygen.
• Examination of throat by tongue depressor
is particularly dangerous- sudden
respiratory obstruction may occur.
• If the clinical situation suggests that the
diagnosis is epiglottitis , there is no point
in confirming it what might turn out to be
fatal X-ray.
18. • The child is shifted to OT and
anesthetized in upright position
• Laryngoscope inserted & diagnosis
confirmed
• An appropriate size orotracheal tube
inserted
• Otherwise rigid bronchoscope used to
secure airway
• Tracheostomy / nasotracheal tube
• Culture swabs taken from epiglottis
• Nasogastric tube inserted for feeding
19. Best Clinical Practice
• Adults with suspected acute
epiglottitis should be admitted and
airway closely monitored
• Patients should be treated with I/V
second- or third-generation
cephalosporins and 100% humidified
oxygen
• Airway obstruction should be treated
early, ideally by intubation
21. Laryngotracheobronchitis
(Croup)
• As name suggests it involves larger
proportion of respiratory tract
• Area of maximum impact is sub-glottis
• An acute illness with hoarseness, a
barking cough, stridor and varying
degree of respiratory distress
• Affects young children (6 months to 3
years)
22. • In most cases causative organism is
paramyxovirus, para-infleunza virus
type I and type II
• In adults it may also occur from herpes
simplex, cytomegalovirus & influenza
virus
• Adult croup is rare, more severe &
impaired immunity should always be
considered
• The key feature is sub-glottic oedema
23. Investigations
• Direct viral antigen detection by
sampling mucus from nasopharynx
• A plain neck radiograph may show
narrowing of the subglottis (steeple
sign) and ballooning of hypopharynx
• Chest X-ray to exclude collapsed lobes
or meditational shift
27. Management
• Oxygen, steroids and nebulized
epinephrine should be administered
• Monitor airway and oxygen saturation,
consider endotracheal intubation if
necessary
• Broad spectrum antibiotics to cover
secondary infection
• No evidence to support antiviral agents
28. Best Clinical Practice
• Adult croup is rare but rapidly progressive
• Once suspected patient should be
admitted
• Larynx inspected by flexible laryngoscope
• Broad-spectrum ABx to prevent bacterial
infection
• If the airway deteriorates patient should be
intubated and ventilated
29. Bacterial
Laryngotrachealbronchitis
• May be a separate disease or be caused
by secondary bacterial infection of viral
laryngotrachealbronchitis
• Also called bacterial tracheitis since it
involves trachea predominantly
• Much more severe illness and much less
common
• More severe respiratory obstruction and
artificial airway is often needed
• Tracheostomy preferred over intubation
30. Whooping cough or Pertussis
1.an acute illness that is usually caused by
Bordetella pertussis.
It is a notifiable communicable disease that
affects all age groups and is transmitted by
coughing and sneezing.
3.Most severe in children, particularly infants.
Adults generally have a milder disease.
Clinical features
•Runny nose,
•dry cough and mild pyrexia,
• similar to a common cold
31. •The cough occurs in prolonged paroxysms
after one to two weeks and is followed by
gasping and the characteristic whoop in
children.
•The disease is generally milder in adults and
presents as protracted cough rather than the
characteristic 'whooping cough' of children.
Investigations
confirmed by serum serology and
nasopharyngeal aspirate culture and assay by
(PCR).
32. M anagement•Pertussis is usually not diagnosed until the
cough has developed.
•A 7-14-day course of erythromycin is
recommended.
•Fluoroquinolones are also likely to be
effective in adults.
The cough should be treated symptomatically
with cough suppressants.
33. Diphtheria
• Caused by Corynebacterium
diphtheriae
• Spreads by droplet infection
• Affects non-immunised children and
susceptible adults particularly elderly
• Usual site of infection is the tonsils and
fauces but it can also occur in nasal
cavities or spread to larynx
34.
35. Clinical Features
• Severe sore throat, malaise, pyrexia
• Examination of throat shows
characteristic grey membrane in
oropharynx which may spread to
larynx.
• Enlarged tender cervical lymph nodes
37. Management
• Treat with benzyl penicillin and
antitoxin
• Acute obstruction should be managed
with intubation
• Complications:
– The diffusible exotoxin has predilection
for cardiac and renal tissues
– Neurological complications soft palate
paralysis, diaphragm & EOM
38. Conditions which mimic laryngeal
infections in childhood
• Foreign bodies
• Peritonsillar abscess
• Retropharyngeal Abscess
• Infectious mononucleosis
39. Infectious mononucleosis
• A common disease often sub-clinical
or mild
• Caused by Epstein-Barr virus
• Spread is usually transfer of infected
saliva during kissing
40. Clinical Features
• Acute sore throat with large infected
tonsils
• Cervical lymphadenopathy with grossly
enlarged bilateral lymph nodes
• Fever, Malaise
• There may also be palatal petechiae,
oral ulceration, splenomegaly and
hepatomegaly
43. Investigations
• Full Blood count
• Heterophil antibody test: Heterophil antibodies are
antibodies that are stimulated by one antigen and react with an
entirely unrelated surface antigen present on cells from different
mammalian species
• Specific EBV serology
• HIV testing
44. Management
• I/V fluids
• Analgesia
• In serious infections antibiotics,
steroids and acyclovir should be
considered
• Ampicillin / amoxycillin are best
avoided for fear of inducing a
maculopapular rash
45. Complications
• Gross swelling of tonsils and adenoids
causes airway obstruction, but
inflammation and ulceration can also
extend to larynx
• The severity of laryngeal involvement
may be masked by upper airway
obstruction
• Splenic rupture
• CNS complications like encephalitis,
meningitis, CN palsies
• Immune deficiency and HIV status be
46. MYCOTIC LARYNGITIS
• Disease of both immunocompromised and
immunocompetent hosts
• May mimick leukoplakia or malignancy
– White or gray pseudomembrane on mucosa
– Mucosal erythema and edema (focal or
diffuse) surrounding white plaques
– Mucosal ulcerations
– Contact bleeding
49. Investigation
1.A chest radiograph.
2.Direct laryngoscopy and biopsy may be
necessary to confirm a diagnosis of fungal
laryngitis.
3.Tissue samples should be sent for special
fungal stains, such as methenamine silver
and periodic acid-schiff, to identify the
fungal hyphae.
50. Treatment of fungal
laryngitis
1. Fluconazole x 3wks
2. Nystatin swish and swallow (100,000
units/ml, 10ml tid).
3. Prevention spacers for inhaled
steroids oral rinse, gargle with water
after use.
51. Chronic Laryngitis
Is a chronic inflammation of the mucosa of
the larynx
Definition
Grade I Mild erythema, stasis of secretions, string
sign, piling u p of i nter-arytenoid mucosa
Grade II Diffuse oedema a nd mucosal thickening,
but with little erythema
Grade III Diffuse erythema, with granular friable
mucosa or Ulceration
Grade IV Discrete granuloma(s) with or without
oedema and erythema
52. Etiology
• Follows repeated acute attacks but
usually it arise insidiously due to :
• Faulty use of voice.
• Infection of teeth, tonsil, sinus, and
lower respiratory tract infection.
• Excessive alcohol consumption or
smoking.
• Dust or irritant fumes.
53. Clinical classification:
Chronic nonspecific laryngitis
1. Chronic simple laryngitis.
2. Hyper keratosis of larynx
(chronic keratosis or
leukoplakia).
3. Pachydermia laryngis.
4. Contact granuloma.
5. Atrophic laryngitis.
Chronic specific laryngitis
• Tuberculous laryngitis
• Syphilitic laryngitis.
• Leprosy of the larynx.
• Scleroma of the larynx.
• Wegener’s (malignant)
granuloma of the larynx.
• Mycosis of the larynx.
54. Simple chronic laryngitis
Pathology:
•Hyperaemia of vocal cord.
•Edema.
•Myositis occurs in the intrinsic muscles.
•Excessive secretion due to hyper activity of
the mucous gland.
•Hyperaemic and edematous stage often
passes to a hypertrophic one and rarely to an
atrophic one.
Clinical Features:
-Hoarseness (intermittent then persistent).
-Cough (slightly dry).
-Sore throat (very common).
55. Chronic laryngitis: there is hyperemia of mucus membrane.
Odema of the margins of the vocal cord(Rienkes edema
56. Laryngeal appearance
Three types:
1. Hyperaemic.
2. Hypertrophic.
3. Edematous.
In all types the larynx is always
affected bilaterally &
symmetrically.
57. Treatment:
•Vocal rest
•Elimination of irritating factors such as dust
and smoking.
•Systemic antibiotics.
•Carbocisteine ( a mucolytic ) when
secretion are thick.
•Stripping of the vocal cords is performed
endoscopically in persistent cases.
58. REINKE'S OEDEMA
1. Polypoid corditis
2. Proliferation of superficial lamina propria
chronic irritant exposure
Smoke, LPR, occupational exposures
3.Water-balloon outpouching from
membranous VF
4. characterized by oedema of the vocal
cords.
60. •Surgery
1. Airway compromise
2. Preserve some superficial lamina
propria and overlying epithelium
to preserve mucosal wave
•Stage for bilateral disease to prevent
anterior web
•Remove irritants and treat LPR
Treatment
61. Vocal cord polyp
•Polypoidal lesion of cords
•More in male
•localised vascular engorgement
and microhaemorrhage followed by
oedema.
•Gelatinous,fibrous,talengiectatic
63. Effect of polyps on mucosal
waveAsymmetric mass produces more
chaotic vibrations and aperiodic
mucosal waves
Larger polyps cause decreased wave
amplitude
Excessive air egress during phonation
Fatigue
Frequent voice breaks
decreased vocal power
64. Treatment
•Conservative for small polyps
•Microsurgery mainstay of therapy
•Hemorrhagic polyps
Pulsed-dye lasers absorbed by hemoglobin
(585 nm) Lasers more effective for smaller
polyps.
65. Tuberculous laryngitis
•Almost always to secondary to
pulmonary TB
•Infected sputum
•Younger age group
•Tubercle formation is characteristic
•Infilteration stage followed by
proliferative stage
•Posterior part of larynx involved
66. The typical site and appearance of tuberculous
lesion involving the posterior commissure in
secondary-acquired tuberculous laryngitis.
67. To improve vocal hygiene
• Drinking lot of fluids - Drink 7-9 glasses of water
per day; also good are herbal tea and chicken
soup.
• maintaining good general health - Exercise
regularly.
• Avoiding smoking - They are bad for the heart,
lungs and vocal tract.
• Eating a balanced diet - Include vegetables, fruits
and whole grain foods.
• Avoid dry, artificial interior climates.
• Do not eat late at night - may have problems
when stomach acid backs up on the vocal cords.
• Use a humidifier to assist with hydration.