419705783-K24-acute-chronic-laryngitis-ppt.pptx

acute and chronic laryngitis

1. ACUTE AND CHRONIC LARYNGITIS DR. APURVA JARANDIKAR ASSISTANT PROFESSOR DEPT OF ENT DPU, PIMPRI

2. ACUTE LARYNGITIS Infection Non Infetion Etiology : 1. Infection Type : - More common - Usually follows Upper Respiratory Infection - Viral Bacterial Invasions - Streptococcus Pneumoniae - H. Influenza - Streptococcus Haemolytic - Streptoccus Aureus

3. 2. Non Infections Type - Vocal abuse - Allergy - Thermal/chemical burn to larynx - Laryngeal trauma : endotracheal tube - Inhalation/ingestion Clinical Features Symptom : 1. Hoarseness aphonia 2. Pain/discomfort in the throat (after talking) 3. Dry, irritating cough (worse at night) 4. Malaise, dryness of throat ; cold; fever ( if viral infection of URI )

4. Laryngeal appearance - Erythema & edema of epiglottis, aryepiglotis, fold, arythenoid, ventricular band - Vocal cord : white & near normal Red & swollen - Sticky secretion (+) between the vocal cord & interarythenoid Therapy Vocal rest Avoidance smoking & alkohol Steam inhalation Antibiotics Analytics Obat Batuk ( cough sedative ) Steroid

5. ACUTE EPYGLOTTIS ( SUPRAGLOTTIS LARYNGITIS) Acyte inflamatory to supraglottis structures ( epiglottis, aryepiglottis fold & arythenoid ) Etiology Serious condition Children : 2- 7 years of age (can also affect adult ) The most common : H. Influenza ß Clinical features : 1. Onset of symptom : Rapid progression 2. Sore throat & dysphagia 3. Dyspnoe & stridor 4. Fever 40° C

6. Lanjutkan.... Examination Epiglottis : Red & Swollen, Better done in operation room with facilities for intubation Neck X-Ray lateral soft tissue Epiglottis swollen ( Thumb Sign ) Therapy : Hospitalisation : danger of respiratory obstruction Antibiotic ( IM/IV ) : Ampicilin, Cephalosporin Stridor : Hydrocortison / dexamethason ( IM/ IV ) Relieve Oedem Adequate hydration : Parentral fluid Humidification & O2 Intubation / tracheostomy for Respiratory obstruction

7. Tabel 56.1 Acute epiglottitis Acute laryngo-tracheo-bronchitis (or group) • Causative organism • Age • Pathology • Prodromal symptoms • Onset • Fever • Patient's look • Cough • Stridor • Odynophagia • Radiology • Treatment Haemophilus in fuenzae type B 2-7 years Suproglottic larynx Absent Sudden High Toxic Usually absent Present and may be marked PI'esent , with drooling of secretions ' Thumb sign on lateral view Humidified oxygen, third generation cephalospor'in (ceftriaxone) or amoxicillin Parainfluenza virus type I and II 3 months to 3 years Subglottic area Present Slow Low grade or no fever Non-toxic Present, (Barking seal-like) Present Usually absent Steeple sign on anteroposterior view of neck Humidified O 2 tent, steroids

8. ACUTE LARYNGO-TRACHEO BRONCHITIS Inflamatory of the larynx, trachea, bronchi Common than acute Etiology : Viral infection (moostly) 6 month – 3 years of age Laki-laki > perempuan Pathology : Loose areolan time in subglottic region oedem Respiratory obstruction & stridor Thick secretion & crusts occlude the airway

9. Symptom : URI & hoursness & croupy cough Obstruction : Fever 39 – 40°C Suprasternal Difficulty in breathing & stridor Intercostal Threatment : Hospitalization ( because of microlaring difficult in breathing ) Antibiotic : Ampicilin 50 mg/kg/day Humidification to soften the crust & thick secretion IVFD ( dehydration ) Steroid : hydrocortison 100 mg iv to relieve oedem Adrenalin via respiratory ( bronchodilator Relieve dyspnoe & evert tracheostomy ) Intubation / tracheostomy

10. LARYNGEAL DIPHTERIA Etiology : Secondary to faucial diphteria Children < 10 years of age Due to immunisation Pathology Pseudomembrane over larynx & trachea Obstruct the airway Exotoxim Myocarditis death Clinical Features General Symptom : - Low grade fever ( 100°-101°F) - Sore throat, malaise - Tachycardi, very toxaemia, thready pulse

11. Larygeal symptomp : - Horsness - Croupy cough - Stridor inspiratory - Dyspnoe obstruction airway Greyish white membrane on : - Tonsil - Pharunx, soft palate - Removal bleeding - Larynx, trachea Cervical lymphadenophaty bull-neck Diagnosis : - Smear, culture Corynebacterium dyphtheria - Clinical feature

12. Threatment : 1. Dyphteria antitoxin : 20.000 – 100.000 unit IV 2. Antibiotic : Benzylpenicillin; Erythromicyn 3. Maintenance of airways Tracheostomy,intubation 4. Bed rest 2 – 4 weeks Complication 1. Asphyxia & death due to airway obstruction 2. Toxic myocarditis & circulatory failure 3. Palatal paralysis with nasal regurgitation 4. Laryngeal & pharyngeal paralysis

13. OEDEM LARYNX ( OEDEM GLOTTIDIS ) Involves the supraglottic & subglottic ( where laryngeal muccosa is loose ) Vocal cord oedem Rarely because subepithel connective tissue Etiology : 1. Infection : - Acute epiglottis, laryngotracheobronchitis, tuberculosis, syphilis of the larynx - Perytonsilar abses, retrofaryngeal abses & ludwig’s angina

14. 2. Trauma : Surgery of tounge, floor of mouth, laryngeal trauma, foreign body, endoscopy, intubation, thermal or caustic burn, onhalation/irritan gas/fumes 3. Neoplasma : Ca of larynx / laryngopharynx 4. Allergy 5. Radiation : Cauter of larynx 6. Sistemic diseases : Heart failure, Nephritis Symptom & Sign Airway obstruction Tracheostomy Inspiratory atridor Laryngoscopy indirect : oedem supraglottic / subglottic

15. Therapy Airway onstruction Intubation / tracheostomy Injection adrenalin ( 1 : 1000 ) 0,3 – 0,5 IM Repeated 15 minutes if necessary Useful in oedem

16. CHRONIC LARYNGITIS Chronic Hyperameic Laryngitis : Diffuse inflamatory, symetrical involving the whole larynx Vocal cord, ventricular band, inter arythenoid & epiglottis Etiology Follow incompletely resolve acute laryngitis / recurrent attack Chronic infection in paranasal sinuses teeth, tonsils Occupational factors : dust, fumes (iron ; gold ), workers in chemical industries Alcohol / smooking Persistent trauma : chronic lung disease Cough Vocal abuse trauma in larynx

17. Clinical features : Hoarness ( voice tired & aphonic ) Dryness & intermittent tickling in the throat to clear the throat repeatedly Discomfort in the throat Cough ( dry & irritating ) Laryngeal examination : hyperemia of laryngeal structure , vocal cord dull red, muccus (+) in the vocal cord & interarythenoid

18. Therapy Infection of upper & lower respiratory tract should be treated Avoidance if irritating factors Voice Rest / Speech Therapy Training Steam inhalation : to loosen secretion & give relief Expectorants : to loose viscid secretion

19. B. Chronic hyperplastic / hypertrophic laryngitis Diffuse & symetrical procces or a localised, appearing like a tumor of the larynx : vocal noduls, vocal polyp, Reinke’s oedema, contact ulcers Etiology Same as Chronic laryngitis without hyperplasia Pathology : Begin from glottic region extend to ventricular band, base glottict & subglottic mucousa Sub mucousa mucous gland Intrinsik laryngeal muscle & joints Hyperaemia, oedem sub mucousa Pseudosratified ciliated epith of the respirstory mocous Change squamous type and squamous epith of vocal cord change becaome hyperplasia & keratinisation Mucous gland hypertrophy ( at first ) later atrophy ; dryness of larynx

20. Clinical Feature Man : women = 8:1 at 30 – 50 years of age Hoarness ; clear the throat ; dry cough ; tired of voice ; discomfort in the throat Examination 1.Laryngeal mocosa ; dusky red & thickened 2. Vocal cord : red & swallen. In late stage become bulky & irregular giving modullar appearance 3. Ventricular band : Red & swallen 4. Mobility of cord inpaired due to oedem & infiltration, later muscular atrophy or arthrities of crichoarythenoid joint. Therapy Conservative Surgical One cord is operated at a time ; removing the hyperplastic

21. PHACYDERMIA LARYNGITIS A chronic hyperplatis laryngitis affecting : - Posterior part of interarythenoid - Posterior part of vocal cord Clinically : - Hoarness / husky voice - Irritation in the throat Indirect laryngoscopy - Red/grey granulation tissue in the interarythenoid region & posterrior third of vocal cord - Sometimes ulceration / contact ulcer - Bilateral / symetrical Diagnosis : Biopsy to differentiate form carsinoma & tubercullosis

22. Etiology : - Uncertain - >> man – alcohol & smoking - Forcefull talking & gastro – esophageal reflux Therapy : - Removal granulation tissue Repetition - Control acid reflux - Speech therapy

23. ATROPHIC LARYNGITIS ( Laryngitis Sicca ) Atrophy laryngeal mucosa & crust formation Often in women & associated with atrophic rhinitis & pharyngitis Symptomp : Hoarnes, Coughing, Removal crusts, dry irritation cough, sometimes dyspnoe ( due to obstructive crusts ) Examinatoon : - Atrophic mucosa - Foul smelling crusts - Crusts expelled Mucosa excoriation & bleeding

24. TUBERCULOSIS OF LARYNX Therapy : - Elimination the causative factor - Humidification - Loosen the crusts ( expectorant ) Etiology : - Secondary to pulmonary tuberculosis - Man middle age group - Bronchogenic / haemotogenic

25. Pathology : - Affect posterior part larynx >> anterior 1. Interarythenoid fold 2. Ventricular band 3. Vocal cord 4. Epiglottis - Bronchus + sputum ( BTA (+)) penetrate the laryngeal mucosa in the interarythenoid region ( bronchogenic spread ) Tubercle the mucosal ulcerate - Laryngeal mucosa : Red & swallen - Stadium perychondritis & cartilage necrosis Not common Symptoms & sign : - Depend on the stage of tuberculosis - Weakness of the voice (earliest symptom ) Hoarseness - Ulcer in the larynx - severe pain to the ear - Painfull in swallowing dyspepsia

26. Laryngeal examination : 1. Whole vocal cord hypereami or posterior part impairment of adduction 2. Swelling in inter arythenoid region 3. Vocal cord : ulceration (+) mouse bite / nibbled 4. Ulceration (+) in arythenoid & interarythenoid region 5. Granulation tissue in interarythenoid region 6. Turban epiglottis 7. Swelling of ventricular band & aryepiglottic fold 8. Marked pattor of surrounding mucosa Diagnosis - X – ray chest - Sputum examination - Biopsy laryngeal lesion

27. Therapy : - Voice rest ( important ) - Anti tuberculosis drugs SYPHILIS OF THE LARYNX Rare condition Tertiary stage : gumma (+) Any part of the larynx : smooth swelling ulcer Diagnosis 1. Biopsy 2. Serological test

28. Complication : Laryngeal stenosis LEPROSY OF THE LARYNX Biopsy, Deformity of laryngeal inlet Stenosis Complication : Laryngeal stenosis SCLEROMA OF THE LARYNX Biopsi Klebsiella Rhinoscleromatis Complication : Laryngeal stenosis

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