URTI

1. LARYNGITIS
MR. ROY

2. ANATOMYOF THE LARYNX

4. LARYNGITIS
Inflammation and swelling of the mucous
membrane lining the larynx or voice box, which
is located in the upper part of the respiratory
tract; caused by chemical or mechanical
irritation or bacterial infection called as
laryngitis.

5. RISK FACTORS
 Having a respiratory infection such as a cold, flu,
bronchitis, sinusitis, pneumonia.
 Exposure to irritants such as cigarette smoke, stomach
acid (reflux /heart burn).
 Exposure to irritants distributed by air conditioning
systems such as mold, pollen and pollutants, workplace
chemicals /dust.
 Extremely cold weather.
 Excess alcohol consumption.

6. ETIOLOGY

7.  This means talking too much or too loudly.
 It can be an ongoing problem for people whose jobs
depend on their voices, including singers, actors,
telephone operators, lawyers, teachers, referees,
coaches and anyone who must shout over loud noise at
work (construction workers, personnel in airports and
train stations, factory workers).
1) VOICE ABUSE OR MISUSE

9. 2) SMOKING
Cigarette smoke irritates the larynx, causing swelling
and inflammation that thickens the vocal cords. This
thickening can lower the pitch of the voice or make it
sound raspy and harsh.
Viral infection - common cause of acute laryngitis
Allergies
Larynx cancer
Tumour

10. 3) ALCOHOL CONSUMPTION :
Alcohol causes a chemical irritation of the
larynx that produces changes similar to
those seen in smokers.

11. 3) GASTRO ESOPHAGEAL REFLUX
DISEASE:
 GERD is a disorder in which acidic fluids from the
stomach flow backward (reflux) into the oesophagus and
throat, irritating the larynx.
 Because acid reflux usually is worse when lying down,
the hoarseness caused by GERD often is most noticeable
in the morning right after awakening.

12. 4) WORK RELATED EXPOSURE TO
IRRITATING CHEMICALS OR DUSTS :
 Many industrial products are suspected of causing chronic
laryngitis and other respiratory problems.
 The U.S. Department of Labour monitors many of these
products and provides safety guidelines for handling and
exposure through the Occupational Safety and Health
Administration (OSHA).

13. TYPES OF LARYNGITIS
Laryngitis is categorized as :
1. Acute laryngitis.
2. Chronic laryngitis

14. ACUTE
LARYNGITIS

15. DEFINITION
 It is the acute inflammation of larynx which lasts less
than a few days and leads to oedema of laryngeal
mucosa and underlying structures.
 Most cases of acute laryngitis are temporary and
improve after the underlying cause gets better.

16. ETIOLOGY
 Frequently caused by “Rhinovirus”
 Other causative organism:
– Para influenza virus.
– respiratory syncytial virus
– Adenovirus
– Measles and mumps
– Bacterial infection such as diphtheria – this is rare.

17. vocal misuse, vocal strain caused by yelling or
overusing of the voice.
exposure to noxious
Viral infections such as those that cause a cold.
Frank aphonia

18. CHRONIC LARYNGITIS

19. • Laryngitis that lasts more than 3 weeks is known as
chronic laryngitis.
• Chronic laryngitis is a more persistent disorder that
produces lingering hoarseness and other voice
changes.
• It usually is painless and has no significant sign of
infection.
DEFINITION

20. • Vocal misuse
• Exposure to noxious agents
• Infectious agents leading to upper respiratory tract
infections. The infectious agents are most often viral
but sometimes bacterial.
• Inhaled irritants such as chemical fumes, allergens or
smoking.
• Acid reflux, also gastro esophageal reflux disease
(GERD)
ETIOLOGY

21.  Chronic sinusitis, bronchitis.
 Excessive alcohol use.
 Habitual overuse of the voice such as with singers or
cheerleaders.
 Smoking.
# Less common cause of chronic laryngitis include:
 Infections such as tuberculosis, Syphilis or a fungal
infection.
 Infections with certain parasites.
 Cancer.
 Vocal cord paralysis, which can result from injury,
stroke or a lung tumor or other conditions.

22. PATHOPHYSIOLOGY

24. SYMPTOMS

25. The most common symptom is -
• Hoarseness.
• A low, raspy voice, voice loss.
• Tickling sensation and rawness in throat.
• A voice that tires easily, “breaks” or “cracks”
• The sensation of a lump in the throat or a dry throat, sore throat
• Difficulty swallowing
• Cold or flu like symptoms.
• Fever
• Swollen lymph nodes in the neck.

26. • A constant urge to clear the throat
• Heavy mucus in the throat
• Chronic cough or postnasal drip
• Dysphagia.
• Coughing
• Difficulty in breathing : Children face the added risk of encountering
breathing difficulty, because the opening of a child’s larynx is narrow
to begin with, and inflammation restricts the air passages even
further.
• Feeling of fullness in the throat or neck.

27. DIAGNOSIS

28.  Diagnosis is based upon a combination of the
complete history and physical exam.
 If symptoms are severe, particularly in children,
the doctor may order an X-ray of the neck and
chest.
 Sometimes in children rarely in adults, the doctor
may order blood work such as complete blood
count (CBC)
 These techniques are sometimes used to help
diagnose laryngitis.

29. LARYNGOSCOPY:
 Doctorcan visually examine vocal cords in a procedure called
laryngoscopy, by using a light and a tiny mirror to look into
the back of your throat.
 Or doctor may use fiber-optic laryngoscopy.
 This involves inserting a thin, flexible tube (endoscope) with a
tiny camera and light through nose or mouth and into the
back of throat.
 Then doctor can watch the motion of vocal cords as the person
speak.

30. BIOPSY
 If doctor sees a suspicious area, doctor may do a
biopsy- taking a sample of tissue for
examination under a microscope.

31. TREATMENT

32. Sometimes laryngitis may be more serious. Several symptoms
should cause the symptoms to see a doctor:
 High fever with a sore throat.
 Coughing up yellow or green phlegm
 Coughing up blood.
 Unable to take liquids
 A history of breathing problems.
 Symptoms that last for 2-3 weeks despite resting the voice.
 Child are different than adults because they are more likely to
become infected with certain microbes.

33.  If a child just has a hoarse voice with or without other
symptoms of a virus such as low grade fever less than 100.5˚
F, runny nose, muscle aches, cough or nasal congestion then
the treatment is the same as for an adult.
 If the child has a fever, a sore throat, won’t eat or think or has
a decreased number of wet diapers (indicating less than
adequate drinking), however should take the child to see a
doctor.

34. • Voice rest.
• Steam inhalation.
• Avoid smoking and cold.
• Fluid intake.
• voice rehabilitation
• Humidification
• Increase intake of fluids.
• Reduction of high impact stress to the vocal cords
caused by loud, frequent and high pitched voicing is
recommended
SUPPORTIVE THERAPY

35. MEDICAL MANAGEMENT
 Anti-fungal or antibiotics – for bacterial or fungal infection.
 Short course of steroids eg. Prednisone, prednisolone or
dexamethasone may be used to decrease the inflammation
and shorten the course of symptoms.
 H2 blocker such as Zantac or Prilosec for a period of 4-6
weeks in case of gastroesophageal reflux.
 Analgesic- eg Acetaminophen, ibuprofen
 Cough suppressants.

36. NURSING MANAGEMNET
1. To prevent dryness or irritation to the vocal cords.
 Do not smoke and avoid passive smoking- Smoke dries throat
and irritates vocal cords.
 Drink plenty of water- Fluid help keep the mucus in the throat
thin and easy to clear.
 Advice patient to avoid cleaning the throat- This does more
harm than good, because it causes an abnormal vibration of the
vocal cords and can increase swelling and causes the throat to
secrete more mucus and feel more irritated.
 Avoid upper respiratory infections. Make sure annual flu shot
as per the recommendation of the doctor.
 Wash hands more often and avoid contact with people who have
upper respiratory infections such as colds.

37. 2) The following steps may relieve the symptoms of
laryngitis and reduce strain on voice.
 Use a humidifier: Keep the air throughout the moist
home. Try a cool mist humidifier. Avoid air conditioning.
 Drink plenty of fluids to prevent dehydration.
 Avoid alcohol and caffeine.
 Give your voice a break.
 Rest the voice when and as much as possible.
 Inhale steam or breath moist air.
 Breath in steam from a bowl of hot water or a hot
shower.

39. PREVENTION
 Wash hands before touching face.
 Hemophilus influenza vaccine for children to
prevent the possibility of life threatening bacterial
infection.
 Prevention of overuse of voice.

40. HO ME REMEDIES FOR
LARYNGITIS
 Avoid shouting
 Do not whisper
 Breathe through the nose
 Steam inhalation
 Using a humidifier
 Drink lots of water
 Drink lemon and honey mixture
 Moisten throat
 Say no to decongestant
 Avoid throat cleaning
 Avoid smoking.