This document discusses laryngeal disorders including their anatomy, physiology, common disorders, and treatment. It provides details on: 1. The anatomy of the laryngeal framework, muscles, innervation, and blood supply. 2. Common laryngeal disorders such as acute laryngitis, croup, epiglottitis, vocal nodules, polyps, and granulomas. It describes their causes, symptoms, signs, and treatments. 3. Other disorders like laryngeal carcinoma, trauma, and laryngopharyngeal reflux and how they present and are managed.

1. Laryngeal disordersLaryngeal disorders
DR MAHIPALDR MAHIPAL

2. Laryngeal disordersLaryngeal disorders
BY/DR KBY/DR K
SUBHASH.,DRSUBHASH.,DR
SRIDHAR,DRSRIDHAR,DR
SREEKANTH AND ALLSREEKANTH AND ALL
ENT SURGEONS OFENT SURGEONS OF

4. Pretest T or FPretest T or F
1. Reurrent laryngeal nerve1. Reurrent laryngeal nerve pure motor fiberpure motor fiber
larynxlarynx
3. Acute laryngitis3. Acute laryngitis
4.4. epiglottitis laryngospasmepiglottitis laryngospasm
5. Thumb5. Thumb’’s signs sign croupcroup
6. Vocal nodule6. Vocal nodule unilateral massunilateral mass
7. Vocal granuloma7. Vocal granuloma intubationintubation
8. Laryngeal trauma8. Laryngeal trauma intubationintubation
9. Most common symptom9. Most common symptom ของของ true vocal carcinomatrue vocal carcinoma
neck node enlargementneck node enlargement

5. Laryngeal disordersLaryngeal disorders
ผศผศ..นพนพ..ยงยุทธ วศินวงศ์ยงยุทธ วศินวงศ์
ภาควิชาจักษุ โสต นาสิกภาควิชาจักษุ โสต นาสิก
ลาริงซ์วิทยาลาริงซ์วิทยา
คณะแพทยศาสตร์คณะแพทยศาสตร์

6. Laryngeal disordersLaryngeal disorders
ObjectivesObjectives
1.1. AnatomyAnatomy
2.2. PhysiologyPhysiology
3.3. Common disordersCommon disorders
4.4. TreatmentTreatment

7. 1. Anatomy1. Anatomy
FrameworkFramework
Muscles – intrinsicMuscles – intrinsic
- extrinsic- extrinsic
InnervationInnervation
VesselsVessels

8. FrameworkFramework

11. MusclesMuscles
IntrinsicIntrinsic – adductors ;– adductors ; thyroarytenoid (truethyroarytenoid (true
vocal cord:TVC),vocal cord:TVC),
cricoarytenoid,cricoarytenoid, interarytenoidinterarytenoid
- abductor ;- abductor ; post cricoarytenoidpost cricoarytenoid
ExtrinsicExtrinsic -- cricothyroidcricothyroid

14. InnervationInnervation
Inferior RLNInferior RLN
motor - all muscles except..motor - all muscles except..
sensory- below TVCsensory- below TVC
Superior RLNSuperior RLN
motor – cricothyroid musclemotor – cricothyroid muscle
sensory – above TVCsensory – above TVC

15. Blood supplyBlood supply
ArterialArterial
sup. laryngeal arterysup. laryngeal artery
inf. Laryngeal arteryinf. Laryngeal artery
VenousVenous
sup. & inf. Thyroid veinssup. & inf. Thyroid veins

16. PhysiologyPhysiology
1.1. Airway protectionAirway protection
2.2. SwallowingSwallowing
3.3. Voice productionVoice production
4.4. Air passageAir passage

17. ProtectionProtection
inspirationinspiration
phonationphonation

18. 1. Inflammation - Acute & chronic laryngitis, croup,
epiglottitis, ulcer,
2. Tumor - benign, nodule, polyp, granuloma
- malignancy
3. Trauma - penetrating injury
- blunt injury
- iatrogenic
4. Congenital - cord paralysis, Laryngeal web,
subglottic stenosis
5. Miscellaneous - laryngopharyngeal reflux (LPR)
disease
Laryngeal disordersLaryngeal disorders

19. Common laryngeal disordersCommon laryngeal disorders
1. Acute laryngitis1. Acute laryngitis
2. Croup2. Croup
3. Epiglottitis3. Epiglottitis
4. Vocal nodule4. Vocal nodule
5. Vocal polyp5. Vocal polyp
6. Vocal granuloma6. Vocal granuloma
7. Laryngeal carcinoma7. Laryngeal carcinoma
8. Laryngeal trauma8. Laryngeal trauma
9. Laryngopharyngeal reflux (LPR)9. Laryngopharyngeal reflux (LPR)

20. Acute laryngitisAcute laryngitis
Pathogen - adenovirus, influenzaPathogen - adenovirus, influenza
Morexella catarrharisMorexella catarrharis
Hemophilus influenzaHemophilus influenza
Streptococcus pneumoniaeStreptococcus pneumoniae
Symptoms - hoarseness
cough, +/- fever, malaise
Sign - TVC swelling

22. Acute laryngitisAcute laryngitis
TreatmentTreatment - voice rest- voice rest
- mucolytic, anticold- mucolytic, anticold
+/- antibiotic+/- antibiotic
Symptoms > 2 week,
recurrent
DDx - chronic laryngitis

23. CroupCroup (acute laryngotracheobronchitis)(acute laryngotracheobronchitis)
- Severe respiratory infection- Severe respiratory infection
-- 6 months-2 yrs.
Pathogen - parainfluenza*influenza, adenovirus
- follow by bacterial esp. H. influenza
Symptoms - early URI symptoms
- 2-3 days
- barking cough, stridor
- exhausted, lying down

24. CroupCroup (acute laryngotracheobronchitis)(acute laryngotracheobronchitis)
Diagnosis - symptoms & signs
- flexible scope
- x-ray
norrowing of subglottis
“Pencil’s sign”

25. Pencil’s
sign
NormalNormal

26. CroupCroup (acute laryngotracheobronchitis)(acute laryngotracheobronchitis)
Treatment - early detection
- observe, admit
- humidification, hydration, O2
- antibiotic (penicillin)
severe - steroid
-- intubation

27. EpiglottitisEpiglottitis
- infection of supraglottis >> epiglottis- infection of supraglottis >> epiglottis
-- 2-10 yr., adult
Pathogen - H. influenza type B
Symptoms - early URI symptoms
- children > change very fast 6-12 hr.
- high fever, pain in throat
- นั่ง โน้มตัวมาข้างหน้า*

28. EpiglottitisEpiglottitis
Signs- epiglottis > swelling, inflam
- ** laryngospasm เมื่อกดลิ้น
- fiberoptic
X-ray - “Thumb’s sign”

29. EpiglottitisEpiglottitis
Treatment - admit, closed monitoring
- broad spectrum penicillin
- hydration, humidification
- +/- steriod
- prepare for intubation

30. Vocal cord noduleVocal cord nodule
- vocal abuse, over-used
- children, adult
- fibrous formation
Symptoms - hoarseness
Sign - nodule TVC> bilateral
> anterior 1/3

31. NoduleNodule
Treatment - voice rest
- speech therapy
- failed, recurrent > surgery

32. Vocal polypVocal polyp
- vocal abuse- vocal abuse
-- Reinke edema > capsule surrounding (polyp)
Symptoms - hoarseness > 2 wk
Sign - ant 1/3 TVC, unilateral
Treatment - surgery
- follow by speech therapy

33. ReinkeReinke’’s edemas edema
Vocal polypVocal polyp
Both polyp, noduleBoth polyp, nodule

34. Vocal granulomaVocal granuloma
inflammation > ulcer > granulomainflammation > ulcer > granuloma
etiology - intubation
- gastroesophageal reflux
- partial laryngectomy
Symptoms - hoarseness 2-3 wk after extubation

35. Vocal granulomaVocal granuloma
Sign - arytenoid, unilateral
Treatment - surgery
- follow by speech therapy
- Rx acid reflux

36. CarcinomaCarcinoma
Chronic irritationChronic irritation - smoking, alcohol,
pollution, acid reflux
Pathology - epithelial hyperplasia >
dysplasia >
carcinoma insitu >
carcinoma

37. CarcinomaCarcinoma
Symptoms > 2-3 weeks
- glottis > hoarseness
- supraglottis > dysphagia
- subglottis > airway problems
others - referred otalgia, chronic cough,
hemoptysis, lymphadenopathy,
wt. loss

38. CarcinomaCarcinoma
DiagnosisDiagnosis - biopsy ; indirect or direct- biopsy ; indirect or direct
laryngoscopylaryngoscopy
- extension ; CT, MRI- extension ; CT, MRI
- metastasis ; CXR, LFT- metastasis ; CXR, LFT
TreatmentTreatment - depends on staging TNM- depends on staging TNM
- early > surgery or RT alone- early > surgery or RT alone
- stage 3, 4 > combined- stage 3, 4 > combined
surgery, RT, ChemoRxsurgery, RT, ChemoRx

39. Laryngeal traumaLaryngeal trauma
Most common -Car accidentMost common -Car accident
OthersOthers - athlete, penetrating, gun-short- athlete, penetrating, gun-short
woundwound
S&SS&S >> location, severity>> location, severity
- stridor, bleeding, emphysema,- stridor, bleeding, emphysema,
hemoptysis, dysphagia, crepitationhemoptysis, dysphagia, crepitation
- severe case > coma- severe case > coma

40. Laryngeal traumaLaryngeal trauma
ชนิด การรักษา
Minor
- มีhematoma,emphysema, - explore ,แผล removetureignbody
tearofcartilage - วางdrain
- reconstructionofframework
+ intubation
Major
- multiplecartilagefracture - needintubationortracheostomy
- laryngotrachealsubluxation - exploration&reconstruction
+intraluminalstent

41. Laryngopharyngeal reflux (LPR)Laryngopharyngeal reflux (LPR)

42. Laryngopharyngeal reflux (LPR)Laryngopharyngeal reflux (LPR)
Stomach acid > reflux to esophagus + othersStomach acid > reflux to esophagus + others
= gastroesophageal reflux (GER)= gastroesophageal reflux (GER)
reflux up to larynx = LPRreflux up to larynx = LPR
EtiologyEtiology - relax sphincter, acid production- relax sphincter, acid production
food ;food ; chocolate, spicy, cola, alcohol,chocolate, spicy, cola, alcohol,
drugs ;drugs ; theophylintheophylin
llife-styleife-style ;; eat late at nighteat late at night

43. Laryngopharyngeal reflux (LPR)Laryngopharyngeal reflux (LPR)
SymptomsSymptoms - feel lump in the throat,- feel lump in the throat,
chronic cough,chronic cough,
regurgitation, heartburnregurgitation, heartburn
SignsSigns -- arytenoid edema, TVC swelingarytenoid edema, TVC sweling
granuloma, ulcergranuloma, ulcer
>>> carcinoma>>> carcinoma

44. Laryngopharyngeal reflux (LPR)Laryngopharyngeal reflux (LPR)
TreatmentTreatment - Lifestyle modification- Lifestyle modification
diet, stress, avoid eatingdiet, stress, avoid eating
before bedtimebefore bedtime
- medication- medication
protonpump inhibitor,protonpump inhibitor,
H2 antagonist, antacidH2 antagonist, antacid
+ prokinetic+ prokinetic
- surgery- surgery