Acute laryngitis

2015./2016.akad.gada LOR pulciņa 9.sēdes prezentācija "Acute laryngitis". Autors Arvils Neško (RSU MF III students).

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Acute Laryngitis
Author: Arvils Neško RSU MFIII
Supervisor: Dr. Dins Sumerags
07.03.2016. Rīga

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Inflammatory process in the mucosa of the vocal
cords and larynx
Abrupt onset, lasts less than 3 weeks, self limited
Typical symptoms are
»Hoarse voice
»Sensation of tickling, rawness in throat
»Dry cough
»Mild fever
Definition and Presentation

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Etiopathogenesis
Caused by
»Viral infections
»Traumatic (excessive shouting, inhalation of toxic fumes,
direct injury)
»Bacterial infections
Edema and hyperemia of damaged laryngeal
structures

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Loss of function
»Phonation
»External breathing
Etiopathogenesis

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Diagnosis of laryngitis is based on symptoms
Direct laryngoscopy if symptoms > 3 wk
Diagnostics

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Differential Diagnosis of Importance
Reflux laryngopharyngitis
Infectious/allergic chronic laryngitis
Spasmodic disphonia

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Therapy
Voice rest
Steam inhalations
Smoking cessation
Cough suppressants (Dextrometorphanum)
Corticosteroids should not be prescribed on regular
basis

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When Acute Laryngitis Must Be
Taken Seriously

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Pediatric Epiglottitis
Medical emergency
Etiology
»H. Infulenzae B and non-type B
»Sometimes Str. pneumoniae et pyogenes, S. Aureus
2 - 4 y/o
Rapid onset (2-6 h)
Fever, sore throat, stridor

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Pediatric Epiglottitis
Diagnosis is based on clinical findings
Indirect laryngoscopy is not recommended
Lateral soft tissue X-rays with «thumb sign»

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Thumb Sign

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Pediatric Epiglottitis
Airway maintenance
»General anesthesia
»Oral/nasotracheal intubation
»Direct laryngoscopy
-Cherry red and swollen epiglottis, false vocal cords, arytenoid folds
-Subglottic region normal or minimally involved
»Culture sample
Empiric antibiotic therapy
»Ampicillin/sulbactam
»2nd or 3rd generation cephalosporines

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Case Report
Ashley M. Cerqueira et Al.,
«A case of acute epiglottitis caused by Haemophilus influenzae type a in an
adult»,
JMM Case Reports (2014)

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Case report
65 y/o woman
Presents w/:
»Sore throat
»Mild fever and chills
»General malaise
Previous history significant w/:
»Obesity
»DM type II, hyperlipidemia and proteinuria
»Osteoarthritis

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Case Report
Prescribed Tamiflu (oseltamivir)
Returned on the following day w/:
»Progressive dysphagia and dyspnea
»Severe sore throat and drooling
»Increased neck swelling
 Sent to emergency department

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Case Report
Physical examination
»Temperature of 35.6°C
»HR, RR, BP and blood oxygen saturation N
»Cervical lymphadenopathy with tenderness on palpation
Instrumental data
»Chest X-ray revealed clear lungs, normal pleura and a
normal-sized heart
»Neck X-ray showed prominence of the epiglottis and upper
tracheal narrowing, confirming epiglottitis

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Lateral Neck X-Ray

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Therapy
i/v dexamethasone 10 mg
i/v ceftriaxone 1 g and vancomycin 1 g

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Results
Three days after admission, the patient showed an
improvement in breathing and swallowing, and was
able to speak
Discharged home and oral Kephlex (Cephalexine)
was prescribed
Culture sample revealed H. influenzae type A

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Resources
Basic Otorhinolaryngology A Step-by –Step- Learning Guide.
»Authors: R.Probst, G.Grevers, H.Iro
»Publisher: Themie 2006
Ballenger`s otolaryngology: head and Neck Surgery (16th Edition)
»Authors: Snow, James B. Wackym, P.Ashley
»Publisher: PMPH USA, Ltd, original publication 2003
Cummings otolaryngology–head & neck surgery (6th edition)
»[edited by]: Paul W. Flint, Bruce H. Haughey, Valerie Lund, John K. Niparko,
K. Thomas Robbins, J. Regan Thomas, Marci M. Lesperance
»Publisher: Saunders, 2015

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Some More Resources
http://www.merckmanuals.com/professional/ear,-nose,-
and-throat-disorders/laryngeal-disorders/laryngitis
http://
emedicine.medscape.com/article/864671-overview
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC349866
9/

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Thank You!