This document discusses various acute inflammations of the larynx including acute laryngitis, acute epiglottitis, acute laryngotracheobronchitis, laryngeal diphtheria, and edema of the larynx. It describes the etiology, clinical features, investigations, and treatment for each condition. Viruses and bacteria are common causes and may result in hoarseness, pain, difficulty swallowing, and airway obstruction in severe cases. Treatment involves antibiotics, steroids, humidified oxygen, intubation or tracheostomy if needed.

1. ACUTE INFLAMMATIONS OF
LARYNX
PRESENTED BY – SUNITI SINGH
129

2. ACUTE INFLAMMATIONS OF LARYNX
• Acute laryngitis
• Acute epiglottitis
• Acute laryngotracheobronchitis
• Laryngeal diptheria
• Oedema of larynx

3. ACUTE LARYNGITIS
• Laryngitis refers to inflammation of the larynx
and can present in both acute and chronic form.
• Acute Laryngitis is a mild and self-limiting
condition lasting for < 3 weeks. The acute form
of laryngitis is more common among both.
• It can be infectious or non infectious.

4. ETIOLOGY
• Infectious type : it usually follow upper
respiratory infection . It is viral in origin but soon
bacterial invasion takes place.
• Viral agents -Rhinovirus, Parainfluenza virus,
Respiratory Syncytial virus, coronavirus,
adenovirus, influenza virus.
• Bacterial agents- Streptococcus pneumoniae ,
H.influenzae, and Moraxella catarrhalis .

5. ETIOLOGY
• Exanthematous fevers like measles,
chickenpox and whooping cough are also
associated with acute laryngitis.
• Non-infectious : vocal abuse, allergy,
gastroesophageal reflux disease,
environmental pollution, smoking and thermal
or chemical burns of the larynx.

6. CLINICAL FEATURES
SYMPTOMS
• Hoarseness which may lead to complete loss
of voice (aphonia).
• Discomfort and pain in the throat.
• Dysphagia, odynophagia
• Dry irritating cough which worsens at night.
• General symptoms - dryness of throat, malaise,
and fever

7. SIGNS
• Later vocal cords also turn
red and edematous. The
subglottic region may also
get involved.
• In case of vocal abuse,
submucosal hemorrhage
may also be seen in vocal
cord
• In the early stages there is erythema and edema
of the epiglottis, aryepiglottic folds, arytenoids,
and ventricular bands, but vocal cords, in contrast,
are normal and white.

8. TREATMENT
• Voice rest: This is the single most important
factor.
• Steam Inhalation: it is soothing and loosen viscid
secretion.
• Avoidance of smoking and alcohol.
• Cough sedative
• Antibiotics
• Analgesics
• Dietary modification: dietary restriction is
recommended for patients with gastroesophageal
reflux disease

9. ACUTE EPIGLOTTITIS
• It is an acute inflammatory
condition confined to
supraglottic structures.
• It is the most frightening
pediatric emergency
• There is marked edema of
these structures which may
obstruct the airway.
• It affects children of 2-7
years of age but can also
affect adult.

10. ETIOLOGY
• In children, Haemophilus influenzae type B is
the most common cause.
• However, this has decreased since the
widespread use of immunization. Other
agents such as Streptococcus pyogenes, S.
pneumoniae, and S. aureus have also been
implicated.

11. CLINICAL FEATURES
• Onset - is abrupt with rapid progression.
• Sore throat and dysphagia are common
presenting symptom in adults.
• Dyspnoea and stridor are common presenting
features in children .They are rapidly progressive
and may prove fatal .
• Examination : It is avoided for fear of
precipitating complete obstruction. But can be
done in operation theatre
red and swollen epiglottis
Edema and congestion of supraglottic structures.

13. INVESTIGATIONS
• Blood culture
• Throat swab culture
• WBC count
• X ray plain lateral soft tissue
neck– may show Thumb sign
( swollen epiglottis)

14. TREATMENT
• Hospitalisation
• Antibiotics : i.v. antibiotic ( amoxicillin or 3rd
generation cephalosporin-ceftriaxone )
• Humidification and oxygen
• Steroids : relieve edema.
• Adequate hydration
• Intubation or Tracheostomy :may be required
for respiratory obstruction.

15. Acute laryngo-tracheo-bronchitis
• It is an inflammatory condition of the larynx , trachea
and bronchi .
• Mostly affect children between 6 months and 3 years
of age.
ETIOLOGY
• Parainfluenza virus
SYMPTOMS
• Hoarseness of voice and croupy cough( barking cough)
• Stridor and varying degree of respiratory distress.
• Fever( low grade )

16. INVESTIGATION
• Nasal washings for serology.
• X ray neck (AP View)- It may show a
characteristic narrowing of the trachea in 50%
of cases, known as the steeple sign.

17. TREATMENT
• Hospitalisation : is often essential because of
increasing difficulty in breathing.
• Humidified oxygen
• Steroids: to relieve edema
• Nebulized epinephrine: may relieve dyspnea
• Antiobiotics : for secondary infections (
ampicillin 50mg/kg/day in divided doses)
• Intubation / tracheostomy : if the obstruction
increase despite the above mentioned
measures.

18. Laryngeal diptheria
• It is an acute toxin mediated disease caused by
corynebacterium diptheriae.
• Mostly it affects children below 10 years of age.
PATHOLOGY
• Formation of tough pseudomembrane over the
larynx and trachea which may completely
obstruct the airway.
• Exotoxin liberated by bacteria leading to
myocarditis and various neurological
complications.

19. CLINICAL FEATURES
GENERAL SYMPTOMS : low grade fever
• sore throat
• malaise
• patient is very toxaemic with tachycardia and
thready pulse.
Laryngeal symptoms : hoarse voice
• croupy cough
• inspiratory stridor
• increasing dyspnea

20. • Membrane : greyish white membrane is seen on
tonsil , pharynx and soft palate .it is adherent and
removal leave bleeding spot . It can spread to
larynx
• Cervical lymphadenopathy : bull neck may be
seen .

21. DIAGNOSIS
• Always clinical but confirmed by smear and
culture of corynebacterium diptheriae.
TREATMENT
• Diptheria antitoxin :20,000-100,000 units i.v.
route as saline infusion after a test dose .
• Antibiotic : benzylpenicillin ( 500,000 units i.m.
every 6h for 6 days) , erythromycin
• Intubation or tracheostomy
• Complete bed rest

22. COMPLICATIONS
• Asphyxia and death
• Toxic myocarditis and ciculatory failure
• Palatal paralysis with nasal regurgitation
• Laryngeal and pharyngeal paralysis.

23. OEDEMA OF LARYNX
• It involves the supraglottic and subglottic region.
ETIOLOGY
1. INFECTIONS
 Acute epiglottitis
 Laryngotracheobronchitis
 Tuberculosis or syphilis of larynx
 Peritonsilar abscess, retropharyngeal abscess
 Ludwig’s angina
2. Trauma –surgery of tongue, floor of mouth laryngeal
trauma, foreign body endoscopy , intubation
3. Neoplasms
4. Allergy
5. Radiation
6. Systemic disease : nephritis , heart failure or myxoedema

24. CLINICAL FEATURES
• Airway obstruction
• Inspiratory stridor
• Edema of supraglottic and subglottic region
TREATMENT
• Intubation or tracheostomy
• Adrenaline (in cases of allergy)
• Steroids ( epiglottitis,laryngotracheobronchitis)

27. PERTUSSIS
• Pertussis or whooping cough is a highly infectious,
vaccine preventable disease.
• It is caused by a Gram negative bacteria Bordetella
pertussis .
• symptoms - severe cough, inspiratory whoop, and
post-tussive vomiting. However, these symptoms
may be mild in adolescent or adult patients
• Treatment : supplemental oxygen , antibiotics(
erythromycin, azithromycin )