2. CHRONIC LARYNGITIS
Prepaired By: Dr.Zabihullah “Rasooly

3. The Laynx:
• Synunym:Voice box.
• Definition:Larynx is a
portion of the respirato
-ry tract that causes
phonation.
• Length:Two(2)
• Shape:Tube –shape.

4. Sructures:
• Cartilages:Paired and Unpaired:
-Unpaired:Thyroid,Cricoid and Epiglottis.
-Paired:Arytenoid,Corniculate and Cuneiform.
• Laryngeal Joints: Cricoarytenoid joint and
Cricothyroid joint.
• Laryngeal Membranes:Extrinsic &Intrinsic M.
• Laryngeal ligament:Extrinsic & Intrinsic Lig.
• Laryngeal Muscles: Extrinsic & Intrinsic Ms.

5. Cartilages:
• Thyroid crtilage:
- Fibroelastic.
- two alae(lamina).
- ossification(25-65).
- Adam’s apple.
• Cricoid cartilage:
- Hyaline .
- It is ring form.
- Its laminae is post.
- Its arch is ant.
Cartilages:

6. Cartilages:
• Epiglottis Cartilage:
- Shape:Leaf like.
- Anteroupper of larynx.
- Fibroelastic cartilage.
• Arytenoid Cartilages:
- Pyramidal shape.
- Elastic cartilage

7. Cartilages:
• Corniculate Cartilages:
- Conical shape.
- Hyaline cartilage.
• Coneiform Cartilages:
- Club shape.
- Hyaline cartilage

8. Laryngeal Joints:
• Cricoarytenoid Joint:
- Synovial.
- Movement:
o Rotatory.
o Gliding .
• Cricothyroid Joint:
- Synovial.
o Rotatory.

9. Laryngeal Membranes:
• Extrinsic membranes:
- Thyrohyoid Menmbrane.
- Cricothyroid membrane
- Cricotracheal membran
• Intrinsic Membrane:
- Crico vocal membrane.
- Quadriangular memb.

10. Muscles of the larynx:
• Intrinsic Muscles:
o Acting on vocal cord:
- Adductors:
1. Lateral cricoarytenoid.
2. Interarytenoid.
3. Thyroarytenoid.
- Abductors:
1. Post.Cricoarytenoid.
- Tensor:
1. Cricothyroid.
2. Vocalis(Int.Part of TA).

11. Muscles of the larynx:
o Acting on laryngeal inlet
- Openers of laryngeal inl
1. Thyroepiglottic Ms.
- Closers of laryngeal inl:
1. Interarytenoid Ms.
• Extrinsic Muscles:
o Depressors Of laryngeal
inlet or Infrahyoid Ms:
1. Sterno-thyroid.
2. Sterno-hyoid.
3. Thyro-hyoid.
4. Omo-hyoid.

12. Muscles of the larynx:
o Elevators of Laryngeal
inlet or Suprahyoid Ms:
- Primary:
1. Stylopharyngeus.
2. Salpingopharyngeus.
3. Palatopharyngeus.
4. Thyrohyoid.
- Secondary:
1. Mylohyoid(main).
2. Stylohyoid.
3. Genohyoid.
4. Digastric.

13. Cavity of the larynx:
• Supraglottis:
- Ventrical:fals vocal cord
- Ventricular band.
- Vestibule.
• Glottis.
• Subglottis.

14. Blood Suply of the larynx:
• Laryngeal Bronches of
superior thyroid artery.
• Laryngeal Bronches of
Inferior thyroid artery.
• Cricothyroid Bronches
of Inf. Thyroid artery.

15. Nerve Suply of The Larynx:
• Vagus Nerve:
o Sup. Laryngeal Nerve:
1. Internal Br. (sensory).
2. External Br. Motor.
o Recurrent(Inferior)
Laryngeal Nerve:
1. Anterolatral(Motor)Br.
2. Poteromedial(sensory)
Bronch.

16. Lymphatic Drainage of the Larynx:
• Supra Glottic:
1. Pre epiglottic Nodes.
2. Upper Deep Cervical Nodes.
• Sub Glottic:
1. Pre Laryngeal & Pre Tracheal Nodes.
2. Lower Deep Cervical Nodes.

17. Physiology of Larynx:
1. Protection of lower airway.
2. Phonation.
3. Respiration.
4. Fixation of the chest.

18. Chronic Phryngitis:
• Chronic Laryngitis without Hyperplasia
(Chroic Hyperaemic Laryngitis)
• Chronic Hypertrophic Laryngitis
(Syn.Chronic Hyperplastic Laryngitis)
OR
Infectious or Allergic Chronic Laryngitis.

19. Pathophysiology:
• An inflammatory process that determines
irreversible altrerations of the larynx mucosa.
• Damage of the ciliated epithelium.
• Impaires the moving of the mucos out.
• Mucos stasis on the post.wall or around vocal
cords.
• Reactive cough.
• Laryngospasm.
• Hyperkeratosis, Dyskeratosis, Parakeratosis,
Acanthosis and cellular atypia.

20. EpidemiologY:
• Mortality:Related to main disease which
associated with.
• Race.
• Sex: (2:1)
• Age.

21. Signs and Symptoms:
• Derive from anatomic functional alterations of
the larynx they are as follow:
1. Hoarse voice and dysphonia.
2. Chronic cough (at night).
3. Stridor due fo bronchospasm.
4. Dysphagi and Otalgia.

22. Examination:
• Personal History:
1- Time of onset of symptoms.
2- General state of health.
3- Occupatioal history.
4-Vocal abuse.
5- Heart burn,Regurgitation,Dysphagia,Cough…
6- Presence of asthma.
7-Prescription or over-the counter medication.
A- Local drying or mucosal injury.
B- I nhaled Steroid use or Immunosuppressant.

23. Personal history:
8-Medications(CCB,BB,Nitrates,progestrone).
9- Inhalation treatment(thermal inhale).
10-Surgical history(intubation).
11-Neck trauma history.
12-Ingestion of caustic substance.
13-Travel history(parasitic infection).

24. Examination:
• Family History:
1. Autoimmune diseases.
2. Invironmental pollutants.
3. Infectious disease(TB...).
• Social history:
1. Cigarette smoking,recreational drugs,alcohol.
2. Eating habits(chocolate,caffeine).
3. Practices that may pose a risk of infectious
diseas (HIV,AIDS,Syphilis).

25. Causes:
• GERD.
• Infections:
1. Commonly staph aureus,H.Ifluenza…
2. TB.
3. Leprosy.
4. Syphilis.
5. Rinoscleroma.
6. Actinomycosis.
7. Viruses.
8. Fungal Infection.

26. Causes:
• Voice abuse.
• Allergic responses.
• Invironmental Factors.
• Inhelation of sulfur,Mustard,Alkyline warfare
agent.
• Systemic Disease:
1. Wegener granulomatosis.
2. Amyloidosis.
3. Relapsing polychondritis.

27. Causes:
• Cutaneous Diseases:
1. Similar mic and mac characteristic in skin and
larynx.
2. Pemphigus,SJS,SLE,Epidermolysis bullosa.
• Neorogic .
• Spastic dysphonia.
• Vocal folds atrophy.
• Muscular disorders.
• Pellagra.

28. Differential Dianosis:
• Chondronecrosis of the Larynx.
• Cntact Granulomas.
• Glottic Stenosis.
• Iatrogenic Vocal Fold Scar.
• Subcglottic Stenosis in adults.
• Sulcus Vocalis.
• Vascular Lesions of the Vocal Fold.
• Vocal Fold Cysts.

29. Workup:
• Laboratory studies.
• Imaging studies.
• Other tests.
• Procedures.
• Histological findings.
o Lab studies:
1. CBC and DLC.
2. Swab of laryngeal mucosa.
3. Serologic markers for autoimmun D.
4. Study for TB and Syphilis.

30. Workup:
o Imaging studies:
1. Lateral plain neck radiography.
2. Chest Radiography.
3. CT scan.
4. MRI.
5. Barium swallow study, double contrst.
6. Videostrobe.

31. Workup:
o Other tests:Skin tests if allergies are suspected
o Direct exam of the larynx with flexible
fiberoptic nasopharyngoscope:
1. Direct laryngoscopy.
2. Bronchoscopy and Esophagoscoy.
3. Stroboscopic exam.
4. Endoscopic removal of polyp and lysis of
adhesions.

32. Workup:
o Histologic Finding:
1. Infiltrative disorders.
2. Chronic nonsoecific inflammation.
3. Chronic granolomatous diseases.
4. Proliferative processes.

33. Treatment and management:
• Rest.
• Medical care.
• Surgical Care.
• Diet.
• Activity.
• Consultations.

34. Medical care:
• Infection(CBL): Antimicrobial therapy.
• GERD:(H2 receptor antagonests,PPI,Prokinetics.
• Decongestants.
• Aalgesics.
• Steroids.
• Expectorants.
• Supportive measures:
o Hydration.
o Steam inhelation.
o Avoiddance of pollutants or irritative/toxic substance.
o Avoidance of invironmental and occupational sensitizers:
-Limitation of exposure.
- Avoidance of cigarette smoking.

35. Surgical care:
• Reduction of stenosis.
• Exophytic mass removal by surgical means.
• Laser Vaporization.
• Laparoscopic antireflux surgery.

36. Consultation:
• Allergists:
• Gastroenterologists.
• Pulmonologists.
• Speech therapists.

37. DieT:
• Avoid: Fat, alcohol,Caffeine.
• Avoid allergen food.

38. Activity:
• Avoid: Habits or activities that cause acid
reflux.

39. Complications:
• Spread of Infection.
• Laryngeal stenosis.
• Transformation info cancer.

40. Prevention:
• Hands washing.
• Avoid cantac whith who have flu or cold.
• Avoid excessive use of voice.
• Avoid working in pullotant area.
• Avoid smoking.

41. Prognosis:
• Relates to causative process.

42. References:
• PL Dhingra.
• Medscape.
• AAO