CASE REPORT

ACUTE LARYNGITIS

Presentator
Moderator

: dr. Hermawan Surya D

: dr. Rio Heryanto Gunawan

Otorhinolaryngology And Head Neck Surgery Department

Medical Faculty Of Gadjah Mada University / Dr. Sardjito Hospital
Yogyakarta
2016

Acute

INTRODUCTION
Laryngitis is a general term that
describes

inflammation

regardless

of

seen

in

children aged from 1 to 5 years old,

preferring to occur in winter and spring

commonly

seasons and manifesting in hoarseness,

classified into acute and chronic types.

laryngeal stridor and cough, with an acute

Acute laryngitis is an inflammation of the

onset and a rapid progression, which is

vocal fold mucosa and larynx that lasts less

prone to trigger acute laryngeal edema and

than 3 weeks, most often caused by viral

secondary laryngeal obstruction to cause

illnesses through direct inflammation of the

asphyxia, and will endanger the life. 3

It

the

more

larynx

cause.

of

laryngitis

is

vocal cords or from irritation due to

postnasal

drainage.

Viral

laryngitis

Laryngitis is generally chronic when

is

it lasts more than 3 weeks and/or is caused

typically self-limited with a normal duration

by a mechanism that tends to have a longer

of 5 to 7 days. Patients are usually

course and require treatment. It is most

dysphonic but may also present with

commonly caused by laryngopharyngeal

odynophagia. The most common viral

reflux, but other causes include poor

pathogens in the upper respiratory tract

laryngeal hygiene (smoking, excess alcohol,

include rhinovirus, influenza A. B, C, and

or caffeine intake), some bacterial and

parainfluenza viruses. 1,2

fungal infections (e.g., blastomycosis and

A study by Bhattacharyya suggested

that annually about 1% of children in the

tuberculosis), and more obscure conditions.

1,4

United States are effected by voice or

The laryngeal edema is easy to be

swallowing problems, with laryngitis being

caused due to the narrow pediatric laryngeal

a common diagnosis in these cases. Using

cavity, abundant and tender mucosal vessels,

the 2012 National Health Interview Survey,

lymph, and glandular tissues, and loosen

the study found that an estimated 839,000

tissue

children in the United States (1.4%) reported

obstruction is caused due to the soft

a voice problem in the 12 months preceding

laryngeal cartilages. Due to the incomplete

the survey, with 53.5% of these youngsters

development of pediatric central nervous

having been given a diagnosis for it, the

system and cough reflex, and the poor

most prevalent being laryngitis (16.6%) and

protective reflex, the laryngeal and tracheal

allergies (10.4%)3

secretions are not easy to be discharged after

adherence,

while

the

glottic

stimulation, thus leading to laryngospasm

suppression, chemotherapy, diabetes and

which

individuals

can

accelerate

the

pharyngeal

who

are

locally

mucosal congestion and edema, complicated

immunocompromised because of steroid

with laryngeal obstruction. If the condition

inhaler

is

overwhelmingly candidal in etiology and

further

accelerated,

the

inspiratory

use

respond

Such

to

infections

systemic

are

dyspnea and anoxia will occur, in a severe

will

condition, asphyxia will occur, leading to

treatment. Laryngeal tubercular infection

death.4

from

Mycobacterium

antifungal

tuberculosis

is

Although rare, the physician should

classically associated with active pulmonary

begin to consider a bacterial etiology when

disease but can present as isolated laryngitis.

the supportive measures discussed above fail

Laryngeal M. tuberculosis infections follow

to decrease symptoms or if symptoms

similar

worsen after an initial plateau of symptoms.

tuberculosis and most commonly present as

Initial clinical presentation may be similar to

lesions in the posterior glottis. Less common

that of viral laryngitis, but supraglottitis and

infections of the larynx include leprosy and

epiglottitis may result. These conditions

syphilis.

require more attention care, given the

Mycobacterium lepromatosis, the causative

potential for airway demise. The causative

infectious agents of leprosy, cause dramatic

bacteria

systemic and laryngeal epithelial changes. 5

are

haemophilus

influenzae,

natural

history

to

Mycobacterial

pulmonary

leprae

and

Streptococcus species, and Staphylococcus

Almost all causes of acute laryngitis

species. Haemophilus species remain the

is a virus. Onset of infection may be

most

associated

common

but

methicillin-resistant

with

exposure

to

sudden

staphylococcus aureus infections have been

temperature changes, dietary deficiencies,

reported.3 Rarely, laryngeal inflammation

malnutrition,

results from an autoimmune condition such

Laryngitis is common in winter and easily

as

relapsing

transmitted. This is in line with immune

polychondritis, Wegener granulomatosis, or

deficiencies on the host as well as the

sarcoidosis. 5

increasing

prevalence

Laryngitis

is

rheumatoid

arthritis,

Fungal laryngitis often occurs in

immunocompromised

patients,

such

and

decreased

usually

of

immunity.

the
preceded

virus.
by

as

pharyngitis and upper respiratory tract

patients with systemic causes immune

infection. This will result in mucosal

irritation of upper respiratory tract and

haemophilus

stimulate mucus glands to produce excess

aureus,

mucus that clogs the airways. These

Diphtheria. Guidebooks use amoxicillin

conditions will induce severe coughing that

with clavulanic acid or ampicillin with

can cause irritation of the larynx and spur

sulbactam. Procaine Penicillin injection for

inflammation in the larynx.6

10 days for diphtheria germs with anti-

Diagnosis of acute laryngitis can be

established

by

anamnesis,

examination

and

Examination

with

supporting
direct

or

leukocytosis.
secretions

typically
Examination

swab and

cultures

uses

before.

4.

Tracheostomy done when occur upper

indirect

airway obstruction that fails to conservative

edema

encountered
of

serum

and

test.

Routine blood tests do not provide typical

but

diphtheria

pyogenes,

Humidification in a cool and cold 5.

especially in the upper and lower glottis.

results,

Streptococcus

staphylococcus

physical

laryngoscopy can help the diagnosis. The

vocal cords is looked red and

influenza,

throat
can be

performed to determine the cause of the

bacteria, but in children is often not found
bacteria-causing pathogens.7

treatment.7
In addition it should also be notified
to the patient to get enough rest and avoid
habits that can cause irritation in the
pharynx and larynx such as smoking or
drinking alcohol.8

CASE REPORT
A Man aged 23 years came to the

Laryngitis patient management can

poly ENT Hospital Dr. Sardjito with

be divided into two, local and systemic

complaint

therapy. Local therapy is break of speech

complained since 2 days days ago, patient

(vocal rest). Patients must be educated to

also complained sore throat, cough, little bit

limit talk and forbidden to shout. For

disphagia and dry in the throat. Since 5 days

systemic therapy can be administered: 1.

ago the patient has complained cough, runny

Symptomatic

nose and fever. Since yesterday the patient

therapy:

antipyretics,mucolytics.

analgesics,

2. Corticosteroid

complained

of

of

hoarseness.

hoarseness

Hoarseness

increasingly

therapy especially in infants and children

become heavy and accompanied by a bad

with the potential obstruction of the upper

taste in the throat. Currently cough and colds

airway. 3. Antibiotics are mainly for

improved, no shortness of breath, and fever

no longer complained by the patient. Cough

edema (+), the movement of the vocal cords

felt at times and with minimal sputum.

(+). On examination of the neck is not

Patients said that since 2 weeks ago he got

palpable enlarged lymph nodes of the neck.

inadequate rest. Long history of cough and

Patients diagnosed with acute laryngitis. In

bloody cough denied. A history of ulcers,

patients given voice rest and medical

frequent belching, and felt discomfort during

treatment

swallowing denied. Complaints to the ear

ambroxol 30mg 3x. Controls to poly in 5

denied. Denied by the patient's smoking

days. The problem in this case is the

history. Patients also denied any trauma to

diagnosis.

Paracetamol

3x

500mg

and

the neck.
The patient had no previous history
of similar complaints. The patient had no

DISCUSSION
Laryngitis

in

adults

is

often

history of asthma or allergies. History of

associated with a viral infection of the upper

tuberculosis was also denied. From the

respiratory tract. Patients present with

physical examination found the patient's

symptoms of a viral infection and dysphonia

general condition looks good, awareness

are characteristically marked by hoarseness

compos mentis, blood pressure 120/80 mm

and aphonia episodes, and decreased vocal

Hg, pulse 80 x / min, 20x frequency of

pitch. Rhinovirus is the most common

breath

37C.

causative agents. Cough and sore throat are

On examination of ENT examination auris

also commonly found in infections of the

otoskopi right and left seemed to be within

larynx. In examination found mucosal

normal limits, the tympanic membrane

erythema and edema of the vocal cords. 2

min,

temperature

mucosal

The diagnosis of acute laryngitis in

(-).

Posterior

this patient based on history, the hoarseness

of

mucosal

and sore throat patients feel during 2 days

hyperemia (-), secret (-). Examination of the

where the previous 5 days the patient

oropharynx

(-),

complained of cough, cold and fever, as well

granulation in the wall of the pharynx (-),

as the acquisition of a history of excessive

T1-T1. Indirect laryngoscopy examination

voice use. From the patient's physical

of the vocal cords, arytenoid, and fold

examination,

ariepiglotika, looked hyperemia (+) and

indirect laryngoscope vocal cords, arytenoid,

intact.

Anterior

hyperemia
rhinoscopy

(-),

rhinoscopy:
secret

examination

mucosa

hyperemia

examination

obtained

an

and fold ariepiglotika looked hyperemia and

epithelial lesions of the mucosa surfaces,

oedem.2

which may be focal or diffuse. Because of

The disease is self-limiting and

treated with humidification, resting the
voice,

hydration,

smoking

decline in immune responses both locally

and systemically. 3

cessation,

M. tuberculosis infections follow

antitussive and expectorant. Antibiotics are

similar

indicated only when there is a sekunder

tuberculosis and most commonly present as

infection.2 In this patients is given medical

lesions

treatment

laryngeal infections present with similar

of

symptomatic

form

of

natural

in

history

the

posterior

pulmonary

glottis.While

Paracetamol 3 x 500mg, ambroxol 3x30 mg,

symptoms

and it is recommended to voice rest.

(cough,hemoptysis,

Paracetamol is used because of its side

loss, fever, night sweats),patients may also

effects are lower than other NSAIDs and

present with laryngopharyngeal symptoms

corticosteroids for the treatment laryngitis.11

such

as

as

to

pulmonary

infections

unintentional

dysphonia,

weight

dysphagia,

and

The problem in this patients is

odynophagia. Physical examination can

diagnosis. How to distinguish whether the

demonstrate exophytic masses that mimic

cause of acute laryngitis from viral, bacterial

malignancy.

or other causes. For bacterial cause initial

demonstrates caseating granulomas that are

clinical presentation may be similar to that

pathognomonic

of viral laryngitis, but supraglottitis and

infection.3

epiglottitis may result. Most common

supraglottic

area.

Diagnosis

to

M.

examination

tuberculosis

Syphilis is caused by treponema

on

pallidum infection. The primary stage

endoscopic examination of the larynx.

generally presents to the otolaryngologist as

Radiologic

imaging

to

a painless oropharyngeal chancre. During

supplement

endoscopic

and

the secondary stage, patients can present

findings can include the classic "thumb-

with laryngeal manifestations, including

may be

relies

Pathologic

used

evaluation,

print" sign of supraglottic inflammation.

For fungal cause patients will present

leukoplakia, exophytic mass( es ), and very

rarely,

decreased

vocal

Diagnosis

dysphagia

Physical

(venereal disease research laboratory or

examination demonstrates white plaque-like

rapid plasma regain) and/or dark-field

dysphonia.

serologic

mobility.

with laryngopharyngeal symptoms, such as

and

involves

fold

studies

microscopy to visualize the pathopneumonic

2nd control after 6 days of therapy the

spirochetes sampled from suspect mucosal

patient begins to feel an improvement in his

lesions. The mainstay of treatment is

voice. However, the patient is recommended

penicillin.

to minimize talk and when the complaint

Reinke's oedema is a swelling of

was being worse came back quickly to the

vocal cords that mostly occurs bilaterally. It

doctor

is

On

prevented. If patients with acute laryngitis

examination a transparent, sometimes a pink

do not improve within 3 weeks, there should

swelling is seen along the length and on the

be an evaluation to find the cause of the

upper side of the vocal cord. The oedema

chronic laryngitis.

chronic

benign

condition.

so

the

complications

can

be

grows and changes the biomechanics of the

larynx, the functional impairment of the

RESUME

phonation appears, vocal cords do not

It has been reported male patients, aged 23

vibrate appropriately and the voice becomes

years, with a diagnosis of acute laryngitis. In

low-pitched and hoarse.12

these patients had been given medical

According to Bailey (2014) during

treatment paracetamol 3 x 500mg, ambroxol

the period of acute laryngitis vocal cords

3x30 mg, and educated to minimalize talk

swell and the use of excessive voice can

(voice rest). Patient control 3 days after

cause vocal cord injury; Therefore, reducing

therapy and came with the condition has not

the use of voice-or-break speech is very

improved, because patient didnt rest his

important. In this case the first control (three

voice. After re-educated and treatment was

days after treatment) the patient's complaints

continued,

do not improve because the patient did not

symptoms were improved when control in

rest his voice. After patients are given

6th

education and agreeing to rest his voice, the

patient's

day

voice

after

and

other

therapy.

Reference

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