Inflammatory Disorders Of Larynx

Binaya BhandariRoll no. 4BDS,1st Batch,KUSMS ,Nepal

ClassificationAcute infections;- Acute simple laryngitis

- Acute epiglottitis- Viral LTB - Bacterial LTB

- Spasmodic croup

Chronic infections;-Chronic laryngitis

-Tuberculosis-Scleroma

-Candidiasis-Sarcoidosis

Laryngeal edemaLaryngo-Pharyngeal

Reflux Disease (LPRD)

Inflammatory Disorders Of Larynx

Acute LaryngitisDefinition; It is the acute inflammation of larynx leading

to oedema of laryngeal mucosa and underlying structures.

AetiologyInfectious; Viral – Influenza, Parainfluenza, Rhino virus Bacterial – H.influenzae, Strept. Pneumoniae, H.

Streptococci

Non Infectious; Inhaled fumes Allergy Polluted atmospheric conditions Vocal abuse Iatrogenic trauma

Inhaled Fumes Polluted atmospheric conditions

Vocal abuse Trauma

PathologyThe mucosa of the larynx becomes congested

and may become oedematous.A fibrinous exudate may occur on the

surface.Sometimes infection involves the

perichondrium of laryngeal cartilages producing perichondritiis.

Clinical FeaturesHoarseness which may lead to complete loss

of voiceDiscomfort or pain in throat, particularly

after talkingDry, irritating cough which is usually worse

at nightGeneral symptoms including headache, cold,

dryness of throat, malaise and fever if laryngitis has followed viral infection of upper respiratory tract.

Clinical DiagnosisSigns of acute URTI.Dry thick sticky secretions.Dusky red and swollen vocal cords.Diffuse congestion of laryngeal mucosa.

Differential DiagnosisAcute epiglottitisAcute laryngo tracheo bronchitis.Laryngeal perichondritisLaryngeal oedemaLaryngeal diphtheriaReinke’s oedema

TreatmentSupportive;

Voice rest.Steam inhalation.Cough suppressants.Avoid smoking and cold.Fluid intake.

Definitive; Antibiotics Steroids Analgesics

Chronic LaryngitisDefinition; It is a diffuse inflammatory condition

symmetrically involving the whole larynx, i.e. true cords, ventricular bands, interarytenoid region and root of epiglottis.

AetiologyIt may follow incompletely resolved acute simple

laryngitis or its recurrent attackPresence of Ch. Infections PNS, teeth, tonsils and

chest.Occupational factors – exposure to dust and fumes

such as in miners, strokers, gold, iron smiths and workers in chemical industries

Smoking and alcoholPersistent trauma of cough as in chronic lung

diseaseVocal abuse

Clinical FeaturesHoarseness. This is the commonest

complaint. Voice become easily tired and patient becomes aphonic by end of the day

Constant hawking. There is dryness and intermittent tickling in the throat and patient is compelled to clear the throat repeatedly

Discomfort in the throatCough. It is dry and irritating

Clinical DiagnosisDiagnosis is based upon a combination of the

clinical history and a physical exam. Some physicians might wish to do a laryngoscopy (visualization of the vocal cords).

Hyperemia of laryngeal structuresVocal cords appear dull red or roundedFlecks of viscid mucus are seen on the vocal

cords and interarytenoid region

Differential DiagnosisReinkes oedemaVocal nodulesVocal cord polypContact ulcerHyperkeratosis and leukoplakiaAtrophic laryngitisLaryngeal lupusTuberculous laryngitis

TreatmentEliminate URTI/LRTIAvoidance of irritating factorsVoice rest and speech therapySteam inhalationsExpectorantsAntibiotics

ReferencesDiseases of Ear, Nose and Throat – P L Dhingra ,

3rd editionAtlas of Acute and Chronic Laryngitiswww.healthline.comwww.patient.co.uk/health/www.myoclinic.orgwww.emedicine.medscape.comThank you

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