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ACUTE & CHRONIC 
INFLAMMATIONS OF LARYNX
ACUTE LARYNGITIS 
• INFECTIOUS* 
• Following URTI 
• Initially viral  2’ bacterial invasion 
• Streptococcus pneumonia 
•...
CFs 
• Symptoms 
• Hoarseness of voice 
• Discomfort / pain in throat after talking 
• Dry irritating cough (worse at nigh...
Laryngeal appearance 
• In early stage 
• Erythema & edema of epiglottis ,aryeppiglotic folds , arytenoids & ventricular 
...
• Vocal abuse 
• Submucosal hemorrhages in vocal cords
Treatment 
• Vocal rest 
• Avoidance of smoking & alcohol 
• Steam inhalation with eucalyptus oil,pine,tr benzoin co 
• Co...
Acute membranous laryngitis 
• Pyogenic nonspecific organisms 
• May begin in laynx /as an extension fron pharynx 
• DD la...
Acute epiglottitis/supraglottic laryngitis 
• Inflammation of supraglottic structures (epiglottis,aryepiglottic 
folds,ary...
• Etiology 
• Children 2-7 yrs* 
• H influenza type B* 
• CFs 
• Abrupt with rapid progression 
• Sore throat & dysphagia ...
Examination 
• Depress tongue with a tongue depressor 
• Edematous red & swollen epiglottis 
• Indirect laryngoscopy 
• Ed...
Lateral soft tissue xray of neck 
THUMB SIGN
Treatment 
• Hospitalisation 
• Abx (ampicillin /3rd generation cephalosporins im/iv) 
• Steroids (hydrocortisone /dexame...
Acute laryngo trachea bronchitis 
• Inflammation of Lx,trachea & bronchitis 
• M>F 
• 6 months – 3 years children * 
• Par...
Pathology 
Edema of loose areolar tissue 
↓ 
Respiratory obstruction & stridor 
Thick tenacious secretions & crusts 
↓ 
Co...
symptomatology 
• URTI 
• Hoarseness of voice 
• Croupy cough 
• Fever 39-40*C 
• difficulty in breathing 
• Inspiratory t...
treatment 
• Hospitalisation 
• Abx ampicillin 50 mg/kg/day 
• Humidification 
• Parenteral fluids 
• Steroids hydrocortis...
Laryngeal diphtheria 
• 2’ to faucial diphtheria 
• Children <10 yrs 
• Pathology 
• Pseudomembrane formation  obstructio...
CFs 
• General 
• Insidious 
• Low grade fever (100-101*F) 
• Sore throat 
• Malaise 
• Laryngeal 
• Hoarse voice 
• Croup...
Buul neck due to cervical lymphadenopathy
diagnosis 
• Clinical 
• Smear & culture
treatment 
• Diphtheria antitoxin 
• Based on severity & duration 
• 20,000-1,00,000 u 
• Abx 
• Benzyl penicillin 5,00,00...
complications 
• Air way obstructionAsphyxia & death 
• Toxic myocarditis & circulatory failure 
• Palatal paralysis nas...
Edema of larynx 
• Supra glotttic & sub glottis region *(abundant subepithelial 
connective tissue) 
• Vocal cords rare(sp...
etiology 
• Infections 
• a/c epiglottitis , laryngo trachea bronchitis, tuberculosis or syphilisnof larynx 
• Infection i...
Symptoms & signs 
• Airway obstruction 
• Inspiratory stridor 
• Indirect laryngoscopy 
• Edema of supraglottic & subglott...
• Treatment 
• Intubation/tracheostomy 
• Steroids(thermal/chemical) 
• Adrenaline (1:1000) 0.3-0.5 ml im repeated evey 15...
Chronic laryngitis 
• Chronic laryngitis with out hyperplasia (chronic hyperaemic laryngitis) 
• Chronic hypertrophic lary...
Chronic laryngitis with out hyperplasia (chronic 
hyperaemic laryngitis) 
• Diffuse & symmetrical involvement of whole of ...
Etiology 
• Incompletely resolved a/c simple laryngitis/its recurrent attacks 
• Presence of c/c infn in paranasal sinuses...
Clinical features 
• Hoarseness 
• Easily gets tired & patient becomes aphonic by the end of the day 
• Constant hawking 
...
Laryngeal examination 
• Hyperaemia of laryngeal structures 
• Vocal cord } dull red & rounded 
• Fleks of viscid mucus in...
Treatment 
• Eliminate URTI & LRTI (sinusitis,tooth,c/c chest infection) 
• Avoidance of irritating factors (smoke,dust,al...
Chronic hypertrophic laryngitis 
• Present either as 
• Diffuse & symmetrical 
• Localised (like a tumour) 
• Dysphonia pl...
Etiology 
• Same as Chronic laryngitis with out hyperplasia
Pathology 
Hyperaemia, edema & cellular infiltration 
of submucosa 
EPITHELIAL CHANGES 
• PSEUDOSTRATIFIED SQUAMOUS TYPE ...
CFs 
• Hoarseness 
• Easily gets tired & patient becomes aphonic by the end of the day 
• Constant hawking 
• Dryness & in...
Laryngeal examination 
• On examination, changes are often diffuse and symmetrical. 
• 1. Laryngeal mucosa } dusky red and...
Treatment 
• Conservative 
• Same as for chronic laryngitis without hyperplasia. 
• Surgical 
• Stripping of vocal cords, ...
POLYPOID DEGENERATION OF VOCAL CORDS 
(REINKE'S OEDEMA) 
• b/l symmetrical swelling of the whole of membranous part of the...
Etiology 
• Chronic irritation of vocal cords 
• due to misuse of voice, 
• heavy smoking, 
• chronic sinusitis and 
• lar...
CFs 
• Hoarseness 
• Low pitched & rough voice(d/t use of false vocal cords) 
• On indirect laryngoscopy 
• Vocal cords ar...
Treatment 
• Decortication of vocal cords 
• Removal of strip of epithelium is done first on one side & 3-4 wks later on 
...
Pachydermia laryngis 
• Form of c/c hypertrophic laryngitis 
• Affecting posterior part of larynx in the region of inter a...
Etiology 
• Uncertain 
• Alcohol & smoking 
• Forceful talking 
• Gastro esophageal reflux disease (where postr part of lx...
CFs 
• hoarseness or husky voice and irritation in the throat. 
• Indirect laryngoscopy 
• heaping up of red or grey granu...
• biopsy of the lesion 
• differentiate the lesion from carcinoma and tuberculosis.
Treatment 
• Removal of granulation tissue under operating microscope 
• Control of acid reflux 
• Speech therapy
Atrophic laryngitis 
• Atrophy of laryngeal mucosa & crust formation 
• Ass with atrophic rhinitis & pharyngitis 
• Women*...
• Examination 
• Atrophic mucosa covered with foul smelling crusts 
• Expulsion of crusts excoriation & bleeding 
• treat...
Tuberculosis of larynx 
• Always 2’ to pulmonary tuberculosis 
• Hematogenous 
• Bronchogenic 
• Males in middle age grp
• Pathology 
• Posterior >anterior 
• Parts = inter arytenoid fold ,ventricular fold , vocal cords , epiglottis 
• Broncho...
• Symptoms & signs 
• Weakness of voice hoarseness of voice 
• Ulceration – pain radiating to ears 
• Dysphagia
Laryngeal examination 
• Hyperaemia of the vocal cord 
• In its whole extent 
• Or its posterior part with impairement of ...
• Diagnosis 
• X ray chest 
• Sputum examin 
• Biopsy of laryngeal lesion 
• Treatment 
• Same as pulmonary TB
Lupus of the larynx 
• Indolent tubercular infn ass with lupus of nase & pharynx 
• No pulmonary tb 
• Painless asymptomat...
Syphilis of larynx 
• Rare 
• Gumma of Tertiary stage any where in larynx 
• Smooth swelling which may ulcerate later 
• C...
Leprosy of larynx 
• Rare 
• Leprosy of skin & nose 
• Diffuse nodular infiltration of epiglottis, aryepiglottic folds & 
...
Scleroma of larynx 
• c/c inflammatory condition by klebsiella rhinoscleromatis 
• Nasal involvement +/- 
• smooth red swe...
• LARYNGEAL MYCOSIS 
• Fungal infections such as candidiasis, histoplasmosis and 
blastomycosis may rarely affect the lary...
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Acute & chronic inflammations of larynx clinical features treatment types otorhinolraryngology ent ppt

based on dhingrambbs curricula ent infectious non infectious leprosy scleroma leprosy syphilis tuberculosis diagnosis treatment Pachydermia laryngis reinkes edema diagrams etiology hypertrophic based on dhingra....mbbs,,, curricula, ent, infectious,, non infectious, leprosy, scleroma ,leprosy, syphilis, tuberculosis ,diagnosis ,treatment ,Pachydermia, laryngis, reinkes edema .,diagrams ,etiology, hypertrophic..........................diagnosis treatment ...............................................................................................................................

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Acute & chronic inflammations of larynx clinical features treatment types otorhinolraryngology ent ppt

  1. 1. ACUTE & CHRONIC INFLAMMATIONS OF LARYNX
  2. 2. ACUTE LARYNGITIS • INFECTIOUS* • Following URTI • Initially viral  2’ bacterial invasion • Streptococcus pneumonia • H influenza • Hemolytic streptococco • Staphylococci • Exanthematous fevers (measles, chicken pox,whooping cough) • NON INFECTIOUS • Vocal abuse ,allergy,thermal /chemical burns (inhalation/ingestion) • Laryngeal trauma (endotracheal tube intubation)
  3. 3. CFs • Symptoms • Hoarseness of voice • Discomfort / pain in throat after talking • Dry irritating cough (worse at night) • General symptoms • Head cold • Rawness /dryness • Malaise • Fever (if viral infn of URT)
  4. 4. Laryngeal appearance • In early stage • Erythema & edema of epiglottis ,aryeppiglotic folds , arytenoids & ventricular bands • Vocal cord are white & normal (in comparison to surrounding structures) • In late stage • ↑ hyperaemia & swelling • Vocal cord red & swollen • Subglottic region is also involved • Sticky secretions b/w vocal cords & interarytenoid region
  5. 5. • Vocal abuse • Submucosal hemorrhages in vocal cords
  6. 6. Treatment • Vocal rest • Avoidance of smoking & alcohol • Steam inhalation with eucalyptus oil,pine,tr benzoin co • Cough sedative • Abx • Analgesics • Steroids following chemical; & thermal burns
  7. 7. Acute membranous laryngitis • Pyogenic nonspecific organisms • May begin in laynx /as an extension fron pharynx • DD laryngeal diphtheria
  8. 8. Acute epiglottitis/supraglottic laryngitis • Inflammation of supraglottic structures (epiglottis,aryepiglottic folds,arytenoids) • Marked edema obstrn
  9. 9. • Etiology • Children 2-7 yrs* • H influenza type B* • CFs • Abrupt with rapid progression • Sore throat & dysphagia in adults • Stridor & dyspnea in children • Fever (d/t septicemia)
  10. 10. Examination • Depress tongue with a tongue depressor • Edematous red & swollen epiglottis • Indirect laryngoscopy • Edema & congestion of supraglottic structures • Not done for fear of precipitating complete obstruction
  11. 11. Lateral soft tissue xray of neck THUMB SIGN
  12. 12. Treatment • Hospitalisation • Abx (ampicillin /3rd generation cephalosporins im/iv) • Steroids (hydrocortisone /dexamethasone im/iv ↓edema) • Adequte hydration (fluids) • Humidification & o2(mist tent & croupette) • Intubation & tracheostomy
  13. 13. Acute laryngo trachea bronchitis • Inflammation of Lx,trachea & bronchitis • M>F • 6 months – 3 years children * • Para influenza type 1 & 2 • 2’ bacterial invasion (gram +ve cocci)
  14. 14. Pathology Edema of loose areolar tissue ↓ Respiratory obstruction & stridor Thick tenacious secretions & crusts ↓ Complete occlusion
  15. 15. symptomatology • URTI • Hoarseness of voice • Croupy cough • Fever 39-40*C • difficulty in breathing • Inspiratory type of stridor • Supra sternal & intercostal recession
  16. 16. treatment • Hospitalisation • Abx ampicillin 50 mg/kg/day • Humidification • Parenteral fluids • Steroids hydrocortisone 100mg iv • Adrenaline} ↓ dyspnea • Intubation /tracheostomy
  17. 17. Laryngeal diphtheria • 2’ to faucial diphtheria • Children <10 yrs • Pathology • Pseudomembrane formation  obstruction of lx • Exotoxin myocarditis & neurological
  18. 18. CFs • General • Insidious • Low grade fever (100-101*F) • Sore throat • Malaise • Laryngeal • Hoarse voice • Croupy cough • Respiratory stridor • Increasing dyspnea • Marked upper airway obstn • Greyish white membrane on tonsil palate & pharynx • adherent bleeds on removal
  19. 19. Buul neck due to cervical lymphadenopathy
  20. 20. diagnosis • Clinical • Smear & culture
  21. 21. treatment • Diphtheria antitoxin • Based on severity & duration • 20,000-1,00,000 u • Abx • Benzyl penicillin 5,00,000 u im qid *6days • Erythromycin • Maintenance of airway • Tracheostomy • Direct larngoscopy removal of membrane & intubation • Complete bed rest
  22. 22. complications • Air way obstructionAsphyxia & death • Toxic myocarditis & circulatory failure • Palatal paralysis nasal regurgitation • Laryngeal & pharyngeal paralysis
  23. 23. Edema of larynx • Supra glotttic & sub glottis region *(abundant subepithelial connective tissue) • Vocal cords rare(sparse connective tissue)
  24. 24. etiology • Infections • a/c epiglottitis , laryngo trachea bronchitis, tuberculosis or syphilisnof larynx • Infection in neighbourhood } • Peritonsillar abscess,retropharyngeal abscess,ludwings angina • Trauma : • Surgery of tongue , laryngeal trauma,fb,endoscopy , inhalation ,irritant gases, thermal , chemical burns, intubation • Neoplasm • Ca of lx, laryngopharynx often ass with deep ulceration • Allergy • Angioneurotic edema,anaphylaxis • Radiation • Systemic diseases
  25. 25. Symptoms & signs • Airway obstruction • Inspiratory stridor • Indirect laryngoscopy • Edema of supraglottic & subglottic region
  26. 26. • Treatment • Intubation/tracheostomy • Steroids(thermal/chemical) • Adrenaline (1:1000) 0.3-0.5 ml im repeated evey 15 minute (allergic)
  27. 27. Chronic laryngitis • Chronic laryngitis with out hyperplasia (chronic hyperaemic laryngitis) • Chronic hypertrophic laryngitis
  28. 28. Chronic laryngitis with out hyperplasia (chronic hyperaemic laryngitis) • Diffuse & symmetrical involvement of whole of larynx • (true cords ,ventricular bands , inter arytenoid region , root of epiglottis)
  29. 29. Etiology • Incompletely resolved a/c simple laryngitis/its recurrent attacks • Presence of c/c infn in paranasal sinuses , teeth & tonsil & chest • Occupational } dust & fumes • Smoking & alcohol • Vocal abuse • Persistent trauma of cough as in c/c lung disease
  30. 30. Clinical features • Hoarseness • Easily gets tired & patient becomes aphonic by the end of the day • Constant hawking • Dryness & intermittent tickling } repeated clearing • Discomfort in throat • Dry & irritating cough
  31. 31. Laryngeal examination • Hyperaemia of laryngeal structures • Vocal cord } dull red & rounded • Fleks of viscid mucus in interarytenoid in the vocal cords
  32. 32. Treatment • Eliminate URTI & LRTI (sinusitis,tooth,c/c chest infection) • Avoidance of irritating factors (smoke,dust,alcohol) • Voice rest & speech therapy • Steam inhalation • Expectorant
  33. 33. Chronic hypertrophic laryngitis • Present either as • Diffuse & symmetrical • Localised (like a tumour) • Dysphonia plica ventricularis • Vocal nodules • Vocal polyp • Reinkes edema • Contact ulcer
  34. 34. Etiology • Same as Chronic laryngitis with out hyperplasia
  35. 35. Pathology Hyperaemia, edema & cellular infiltration of submucosa EPITHELIAL CHANGES • PSEUDOSTRATIFIED SQUAMOUS TYPE • SQUAMOUS EPITHELIM OF VOCAL CORDS • HYPERTROPHY & KERATINISATION HYPERTROPHY OF MUCUS GLANDS ATROPHY LATER (diminished secretion & dryness Starts in glottic region Ventricular bands Base of epiglottis Even subglottis
  36. 36. CFs • Hoarseness • Easily gets tired & patient becomes aphonic by the end of the day • Constant hawking • Dryness & intermittent tickling } repeated clearing • Discomfort in throat • Dry & irritating cough
  37. 37. Laryngeal examination • On examination, changes are often diffuse and symmetrical. • 1. Laryngeal mucosa } dusky red and thickened. • 2. Vocal cords } red and swollen. Their edges lose sharp demarcation and appear rounded. In late stages, cords become bulky and irregular giving nodular appearance. • 3. Ventricular bands } red and swollen • 4. • oedema and infiltration, • later due to muscular atrophy • arthritis of the cricoarytenoid joint. Mobility of cords gets impaired
  38. 38. Treatment • Conservative • Same as for chronic laryngitis without hyperplasia. • Surgical • Stripping of vocal cords, removing the hyperplastic and oedematous mucosa, may be done in selected cases. • Damage to underlying vocal ligament should be carefully avoided. One cord is operated at a time.
  39. 39. POLYPOID DEGENERATION OF VOCAL CORDS (REINKE'S OEDEMA) • b/l symmetrical swelling of the whole of membranous part of the vocal cords, • in middle-aged men and women. • due to oedema of the subepithelial space (Reinke's space) of the vocal cords.
  40. 40. Etiology • Chronic irritation of vocal cords • due to misuse of voice, • heavy smoking, • chronic sinusitis and • laryngopharyngeal reflex • myxoedema
  41. 41. CFs • Hoarseness • Low pitched & rough voice(d/t use of false vocal cords) • On indirect laryngoscopy • Vocal cords are fusiform pale translucent look • Ventricular folds hyperaemic & hypertrophic and hides true vocal cords
  42. 42. Treatment • Decortication of vocal cords • Removal of strip of epithelium is done first on one side & 3-4 wks later on other side • Voice rest • Speech therapy for proper voice production
  43. 43. Pachydermia laryngis • Form of c/c hypertrophic laryngitis • Affecting posterior part of larynx in the region of inter arytenoid & posterior part of vocal cords
  44. 44. Etiology • Uncertain • Alcohol & smoking • Forceful talking • Gastro esophageal reflux disease (where postr part of lx is constantly washed with acid juices)
  45. 45. CFs • hoarseness or husky voice and irritation in the throat. • Indirect laryngoscopy • heaping up of red or grey granulation tissue in the interarytenoid region and posterior thirds of vocal cords; the latter sometimes showing ulceration due to constant hammering of vocal processes as in talking, forming what is called the 'contact ulcer'. • bilateral & symmetrical. • It does not undergo malignant change.
  46. 46. • biopsy of the lesion • differentiate the lesion from carcinoma and tuberculosis.
  47. 47. Treatment • Removal of granulation tissue under operating microscope • Control of acid reflux • Speech therapy
  48. 48. Atrophic laryngitis • Atrophy of laryngeal mucosa & crust formation • Ass with atrophic rhinitis & pharyngitis • Women* • CFs • Hoarseness of voice improving on coughing & removal of crusts • Dry irritating cough • Dyspnea(obstructing crusts)
  49. 49. • Examination • Atrophic mucosa covered with foul smelling crusts • Expulsion of crusts excoriation & bleeding • treat,ment • Elimination of causative factor & humidification • Laryngeal sprays with glucose in glycerine /pine oil } loosen the crusts • Trt ass nasal & pharyngeal conditions • Expectorants to loosen the crusts
  50. 50. Tuberculosis of larynx • Always 2’ to pulmonary tuberculosis • Hematogenous • Bronchogenic • Males in middle age grp
  51. 51. • Pathology • Posterior >anterior • Parts = inter arytenoid fold ,ventricular fold , vocal cords , epiglottis • Bronchogenic spread From bronchi (Tubercle bacilli carried by sputum) ↓ Penetrate intact laryngeal mucosa (particularly inter arytenoid region) ↓ Formn of submucosal tubercles ↓ Ulceration & caseation • Laryngeal mucosa } red & swollen ( pseudo edema due to cellular infiltration) • Perichondritis & cartilage necrosis
  52. 52. • Symptoms & signs • Weakness of voice hoarseness of voice • Ulceration – pain radiating to ears • Dysphagia
  53. 53. Laryngeal examination • Hyperaemia of the vocal cord • In its whole extent • Or its posterior part with impairement of adduction (first sign) • Mamillated swelling in interarytenoid region • Ulceration of larynx } mouse nibbled appearance • Superficial ragged ulceration in arytenoid & interarytenoid region • Granulation tissue in interarytenoid /vocal process of arytenoid • Pseudoedema of epiglottis (turban epiglottis) • Swelling of ventricular bands & aryepiglottic folds • Marked pallor of surrounding mucosa
  54. 54. • Diagnosis • X ray chest • Sputum examin • Biopsy of laryngeal lesion • Treatment • Same as pulmonary TB
  55. 55. Lupus of the larynx • Indolent tubercular infn ass with lupus of nase & pharynx • No pulmonary tb • Painless asymptomatic • Posterior >anterior • Epiglottis  aryepiepiglottic folds v entricular bands • Trt anitubercular drugs
  56. 56. Syphilis of larynx • Rare • Gumma of Tertiary stage any where in larynx • Smooth swelling which may ulcerate later • Complication  laryngeal stenosis
  57. 57. Leprosy of larynx • Rare • Leprosy of skin & nose • Diffuse nodular infiltration of epiglottis, aryepiglottic folds & arytenoids • Dx : biopsy • Complication : laryngeal stenosis • Deformity of laryngeal inlet
  58. 58. Scleroma of larynx • c/c inflammatory condition by klebsiella rhinoscleromatis • Nasal involvement +/- • smooth red swelling in the subglottic region. • Hoarseness of voice, • wheezing and • dyspnoea . • Dx biopsy. • Treatment streptomycin or tetracycline + steroids to prevent fibrosis. Subglottic stenosis is a frequent complication requiring subsequent reconstructive surgery.
  59. 59. • LARYNGEAL MYCOSIS • Fungal infections such as candidiasis, histoplasmosis and blastomycosis may rarely affect the larynx. Diagnosis is usually made on biopsy and • on finding a similar lesion in other parts of the body.

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based on dhingrambbs curricula ent infectious non infectious leprosy scleroma leprosy syphilis tuberculosis diagnosis treatment Pachydermia laryngis reinkes edema diagrams etiology hypertrophic based on dhingra....mbbs,,, curricula, ent, infectious,, non infectious, leprosy, scleroma ,leprosy, syphilis, tuberculosis ,diagnosis ,treatment ,Pachydermia, laryngis, reinkes edema .,diagrams ,etiology, hypertrophic..........................diagnosis treatment ...............................................................................................................................

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