ACUTE and CHRONIC INFLAMMATION of LARYNX

By T.ANANTH

ACUTE LARYNGITIS
*

They are of two types namely

INFECTIOUS NON-INFECTIOUS

ACUTE LARYNGITIS AETIOLOGY

INFECTIOUS
Usually follows upper respiratory tract infections. Viral in origin. Bacterial invasion follows. Exanthematous fevers.

NON-INFECTIOUS
Vocal abuse. Allergy. Thermal or chemical burns to larynx. Laryngial trauma as in endotracheal intubation.

CLINICAL FEATURES

Hoarsness to loss ofvoice

Discomfert or pain in throat

Dry,irritating cough

Gen sym of head,cold,rawness of throat

Malaise and fever

LARYNGEAL APPEARENCES
EARLY Erythema and eodema of epiglottis adenoids aryepiglottic fold. Vocal cord appear white and normal in contrast to its surrounding mucosa. LATE Hyperimia and swelling increases. Vocal cord becomes swollen and red. Sticky secretions are seen between cord and interaryteniod region.

TREATMENT
 Vocal rest.  Avoidance of smoking and alcohol.  Steam inhalation with oil of eucalyptus or pine or Tr.Benzoin.  Cough sedatives.  Antibiotics .  Analgesics.  Steriods.

EPIGLOTTITIS (supraglottic laryngitis)

Inflammation of supraglottic structures. AETIOLOGY Chidren of 2 to 7 age. Mostly H.influenzaB infection. CLINICAL FEATURES  Sore throat ,dysphagia in adults.  Dyspnoea ,stridor in children.  Fever upto 40 due to septicemia.

EXAMINATION
Tongue depressor = red swollen epiglottis. IDL = oedema congestion of supraglottic strucs. X RAY Lateral soft tissue x-ray Thumbs sign

TREATMENT
- admit, closed monitoring - broad spectrum penicillin - hydration, humidification - steriod - prepare for intubation

Croup (acute laryngotracheobronchitis)

- Severe respiratory infection - 6 months-2 yrs. Pathogen - parainfluenza*influenza, adenovirus - follow by bacterial esp. H. influenza
Symptoms - early URI symptoms - 2-3 days - barking cough, stridor - exhausted, lying down

Croup (acute laryngotracheobronchitis)

Diagnosis - symptoms & signs - flexible scope - x-ray norrowing of subglottis Pencil s sign

Pencils sign

Normal

Croup (acute laryngotracheobronchitis)

Treatment - early detection - observe, admit - humidification, hydration, O2 - antibiotic (penicillin) severe - steroid - intubation

CHRONIC LARYNGITIS
It is of two types namely Chronic laryngitis without hyperplasia (chronic hyperaemic laryngitis) Chronic hypertrophic laryngitis (chronic hyperplastic laryngitis)

Chronic laryngitis without hyperplasia

Diffuse inflammation of whole larynx. AETIOLOGY  Follow acute laryngitis.  Chronic infection of paranasal sinuses.  Occupation in dusty areas.  Smoking and alcohol.  Vocal abuse.

CLINICAL FEATURES
Hoarsness patient becmes aphonic at end of the day. Constant hawking-tickly sensation and repeated clearing. Cough dry and irritating. LARYNGEAL EXAMINATION Hyperaemia of laryngeal structures. Vocal cord appear dull red and rounded. Viscid mucus seen in cords and interaryteniod.

TREATMENT
Elimination of infection of respiratory tract Avoidance of irritating substance Voice rest and speech therapy Steam inhalation expectorants

Chronic hypertrophic laryngitis (chronic hyperplastic laryngitis)

Diffuse or localised inflammation of larynx. Localised variety are Dysphonia plica ventricularis Vocal nodules Vocal polyp Reinke s oedema Contact ulcer

Pathology
Starts from glottic region Mucosa,sub mucosa,mucous gland and even intrinsic muscles are involved. Sub mucosa=hyperaemia,oedema,cellular infiltration Res mucosa=psuedostrtified ciliated to squamus Vocalcord=squamus to hyperplasia,keratinisation Mucous gland=hypertrophy then to atropy leading to diminished secretion and dryness of larynx.

Examination
Laryngeal mucosa=dusky red and thickened Vocal cord=red and swoolen sharp edges becmes rounded in later stages become irregular and bulky. Mobility of cords get impaired. Treatment  Conservative  Surgical=stripping of vocal cords removing hyperplastic and oedematous mucosa, one cord is operated at a time.

Polypoid degeneration of vocalcord (REINKE S OEDEMA)

Bilater swelling of whole membranous of cords comman in middle age. Oedema of subepithelial sace of cords Chronic irritation of vocal cord Hoarsness of voice IDL=cords look as fusiform swellingwith pale translucent look.ventricular bands appear hyperemic and hypertrophic.

.REINKE S OEDEMA

Treatment Decortication of cords one at a time Voice rest , speech therapy

PACHYDERMA LARYNGITIS
Posterior part of larynx Hoarsness and husky voice and irritation of throat IDL=heaping up red and grey granulation sometimes with ulcer so this desease also called contact ulcer. Bilateral and symmetrical. Does nt undergo malignant. Men with alcohol and smoking Excessive forceful talking and GERD TREATMENT Removal of granulation tissue

ATROPHIC LARYNGITIS (LARYNGITIS SICCA)

Atrophy of laryngial mucosa+crust formation Hoarsness=improves oncoughing and removal of crest Examination=atropy of mucosa +foul smelling crust,on removal shows bleeding TREATMENT Elimination of causative factor Humidification Nasal spray

TUBERCULOSIS OF LARYNX
Secondary to pulmonary tuberculosis Affects posterior larynx more than anterior Weakness of voice,hoarsness,ulceration of larynx,dysphagia Pseudoedema of epiglottis=turban epiglottis SYPHILIS OF LARYNX Rare ,only gumma of tertiary stage is seen Laryngial stenosis is a frequent complication

SCLEROMA OF LARYNX
Klebsiella rhinoscleromatis Swelling in subglottis region Hoarsness, wheezing,dyspnoea Streptomycin or tetracycline+steriods