Acute & chronic inflammations of larynx clinical features treatment types otorhinolraryngology ent ppt
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Acute & chronic inflammations of larynx clinical features treatment types otorhinolraryngology ent ppt
- 1. ACUTE & CHRONIC INFLAMMATIONS OF LARYNX
- 2. ACUTE LARYNGITIS • INFECTIOUS* • Following URTI • Initially viral 2’ bacterial invasion • Streptococcus pneumonia • H influenza • Hemolytic streptococco • Staphylococci • Exanthematous fevers (measles, chicken pox,whooping cough) • NON INFECTIOUS • Vocal abuse ,allergy,thermal /chemical burns (inhalation/ingestion) • Laryngeal trauma (endotracheal tube intubation)
- 3. CFs • Symptoms • Hoarseness of voice • Discomfort / pain in throat after talking • Dry irritating cough (worse at night) • General symptoms • Head cold • Rawness /dryness • Malaise • Fever (if viral infn of URT)
- 4. Laryngeal appearance • In early stage • Erythema & edema of epiglottis ,aryeppiglotic folds , arytenoids & ventricular bands • Vocal cord are white & normal (in comparison to surrounding structures) • In late stage • ↑ hyperaemia & swelling • Vocal cord red & swollen • Subglottic region is also involved • Sticky secretions b/w vocal cords & interarytenoid region
- 5. • Vocal abuse • Submucosal hemorrhages in vocal cords
- 6. Treatment • Vocal rest • Avoidance of smoking & alcohol • Steam inhalation with eucalyptus oil,pine,tr benzoin co • Cough sedative • Abx • Analgesics • Steroids following chemical; & thermal burns
- 7. Acute membranous laryngitis • Pyogenic nonspecific organisms • May begin in laynx /as an extension fron pharynx • DD laryngeal diphtheria
- 8. Acute epiglottitis/supraglottic laryngitis • Inflammation of supraglottic structures (epiglottis,aryepiglottic folds,arytenoids) • Marked edema obstrn
- 9. • Etiology • Children 2-7 yrs* • H influenza type B* • CFs • Abrupt with rapid progression • Sore throat & dysphagia in adults • Stridor & dyspnea in children • Fever (d/t septicemia)
- 10. Examination • Depress tongue with a tongue depressor • Edematous red & swollen epiglottis • Indirect laryngoscopy • Edema & congestion of supraglottic structures • Not done for fear of precipitating complete obstruction
- 11. Lateral soft tissue xray of neck THUMB SIGN
- 12. Treatment • Hospitalisation • Abx (ampicillin /3rd generation cephalosporins im/iv) • Steroids (hydrocortisone /dexamethasone im/iv ↓edema) • Adequte hydration (fluids) • Humidification & o2(mist tent & croupette) • Intubation & tracheostomy
- 13. Acute laryngo trachea bronchitis • Inflammation of Lx,trachea & bronchitis • M>F • 6 months – 3 years children * • Para influenza type 1 & 2 • 2’ bacterial invasion (gram +ve cocci)
- 14. Pathology Edema of loose areolar tissue ↓ Respiratory obstruction & stridor Thick tenacious secretions & crusts ↓ Complete occlusion
- 15. symptomatology • URTI • Hoarseness of voice • Croupy cough • Fever 39-40*C • difficulty in breathing • Inspiratory type of stridor • Supra sternal & intercostal recession
- 16. treatment • Hospitalisation • Abx ampicillin 50 mg/kg/day • Humidification • Parenteral fluids • Steroids hydrocortisone 100mg iv • Adrenaline} ↓ dyspnea • Intubation /tracheostomy
- 17. Laryngeal diphtheria • 2’ to faucial diphtheria • Children <10 yrs • Pathology • Pseudomembrane formation obstruction of lx • Exotoxin myocarditis & neurological
- 18. CFs • General • Insidious • Low grade fever (100-101*F) • Sore throat • Malaise • Laryngeal • Hoarse voice • Croupy cough • Respiratory stridor • Increasing dyspnea • Marked upper airway obstn • Greyish white membrane on tonsil palate & pharynx • adherent bleeds on removal
- 19. Buul neck due to cervical lymphadenopathy
- 20. diagnosis • Clinical • Smear & culture
- 21. treatment • Diphtheria antitoxin • Based on severity & duration • 20,000-1,00,000 u • Abx • Benzyl penicillin 5,00,000 u im qid *6days • Erythromycin • Maintenance of airway • Tracheostomy • Direct larngoscopy removal of membrane & intubation • Complete bed rest
- 22. complications • Air way obstructionAsphyxia & death • Toxic myocarditis & circulatory failure • Palatal paralysis nasal regurgitation • Laryngeal & pharyngeal paralysis
- 23. Edema of larynx • Supra glotttic & sub glottis region *(abundant subepithelial connective tissue) • Vocal cords rare(sparse connective tissue)
- 24. etiology • Infections • a/c epiglottitis , laryngo trachea bronchitis, tuberculosis or syphilisnof larynx • Infection in neighbourhood } • Peritonsillar abscess,retropharyngeal abscess,ludwings angina • Trauma : • Surgery of tongue , laryngeal trauma,fb,endoscopy , inhalation ,irritant gases, thermal , chemical burns, intubation • Neoplasm • Ca of lx, laryngopharynx often ass with deep ulceration • Allergy • Angioneurotic edema,anaphylaxis • Radiation • Systemic diseases
- 25. Symptoms & signs • Airway obstruction • Inspiratory stridor • Indirect laryngoscopy • Edema of supraglottic & subglottic region
- 26. • Treatment • Intubation/tracheostomy • Steroids(thermal/chemical) • Adrenaline (1:1000) 0.3-0.5 ml im repeated evey 15 minute (allergic)
- 27. Chronic laryngitis • Chronic laryngitis with out hyperplasia (chronic hyperaemic laryngitis) • Chronic hypertrophic laryngitis
- 28. Chronic laryngitis with out hyperplasia (chronic hyperaemic laryngitis) • Diffuse & symmetrical involvement of whole of larynx • (true cords ,ventricular bands , inter arytenoid region , root of epiglottis)
- 29. Etiology • Incompletely resolved a/c simple laryngitis/its recurrent attacks • Presence of c/c infn in paranasal sinuses , teeth & tonsil & chest • Occupational } dust & fumes • Smoking & alcohol • Vocal abuse • Persistent trauma of cough as in c/c lung disease
- 30. Clinical features • Hoarseness • Easily gets tired & patient becomes aphonic by the end of the day • Constant hawking • Dryness & intermittent tickling } repeated clearing • Discomfort in throat • Dry & irritating cough
- 31. Laryngeal examination • Hyperaemia of laryngeal structures • Vocal cord } dull red & rounded • Fleks of viscid mucus in interarytenoid in the vocal cords
- 32. Treatment • Eliminate URTI & LRTI (sinusitis,tooth,c/c chest infection) • Avoidance of irritating factors (smoke,dust,alcohol) • Voice rest & speech therapy • Steam inhalation • Expectorant
- 33. Chronic hypertrophic laryngitis • Present either as • Diffuse & symmetrical • Localised (like a tumour) • Dysphonia plica ventricularis • Vocal nodules • Vocal polyp • Reinkes edema • Contact ulcer
- 34. Etiology • Same as Chronic laryngitis with out hyperplasia
- 35. Pathology Hyperaemia, edema & cellular infiltration of submucosa EPITHELIAL CHANGES • PSEUDOSTRATIFIED SQUAMOUS TYPE • SQUAMOUS EPITHELIM OF VOCAL CORDS • HYPERTROPHY & KERATINISATION HYPERTROPHY OF MUCUS GLANDS ATROPHY LATER (diminished secretion & dryness Starts in glottic region Ventricular bands Base of epiglottis Even subglottis
- 36. CFs • Hoarseness • Easily gets tired & patient becomes aphonic by the end of the day • Constant hawking • Dryness & intermittent tickling } repeated clearing • Discomfort in throat • Dry & irritating cough
- 37. Laryngeal examination • On examination, changes are often diffuse and symmetrical. • 1. Laryngeal mucosa } dusky red and thickened. • 2. Vocal cords } red and swollen. Their edges lose sharp demarcation and appear rounded. In late stages, cords become bulky and irregular giving nodular appearance. • 3. Ventricular bands } red and swollen • 4. • oedema and infiltration, • later due to muscular atrophy • arthritis of the cricoarytenoid joint. Mobility of cords gets impaired
- 38. Treatment • Conservative • Same as for chronic laryngitis without hyperplasia. • Surgical • Stripping of vocal cords, removing the hyperplastic and oedematous mucosa, may be done in selected cases. • Damage to underlying vocal ligament should be carefully avoided. One cord is operated at a time.
- 39. POLYPOID DEGENERATION OF VOCAL CORDS (REINKE'S OEDEMA) • b/l symmetrical swelling of the whole of membranous part of the vocal cords, • in middle-aged men and women. • due to oedema of the subepithelial space (Reinke's space) of the vocal cords.
- 40. Etiology • Chronic irritation of vocal cords • due to misuse of voice, • heavy smoking, • chronic sinusitis and • laryngopharyngeal reflex • myxoedema
- 41. CFs • Hoarseness • Low pitched & rough voice(d/t use of false vocal cords) • On indirect laryngoscopy • Vocal cords are fusiform pale translucent look • Ventricular folds hyperaemic & hypertrophic and hides true vocal cords
- 42. Treatment • Decortication of vocal cords • Removal of strip of epithelium is done first on one side & 3-4 wks later on other side • Voice rest • Speech therapy for proper voice production
- 43. Pachydermia laryngis • Form of c/c hypertrophic laryngitis • Affecting posterior part of larynx in the region of inter arytenoid & posterior part of vocal cords
- 44. Etiology • Uncertain • Alcohol & smoking • Forceful talking • Gastro esophageal reflux disease (where postr part of lx is constantly washed with acid juices)
- 45. CFs • hoarseness or husky voice and irritation in the throat. • Indirect laryngoscopy • heaping up of red or grey granulation tissue in the interarytenoid region and posterior thirds of vocal cords; the latter sometimes showing ulceration due to constant hammering of vocal processes as in talking, forming what is called the 'contact ulcer'. • bilateral & symmetrical. • It does not undergo malignant change.
- 46. • biopsy of the lesion • differentiate the lesion from carcinoma and tuberculosis.
- 47. Treatment • Removal of granulation tissue under operating microscope • Control of acid reflux • Speech therapy
- 48. Atrophic laryngitis • Atrophy of laryngeal mucosa & crust formation • Ass with atrophic rhinitis & pharyngitis • Women* • CFs • Hoarseness of voice improving on coughing & removal of crusts • Dry irritating cough • Dyspnea(obstructing crusts)
- 49. • Examination • Atrophic mucosa covered with foul smelling crusts • Expulsion of crusts excoriation & bleeding • treat,ment • Elimination of causative factor & humidification • Laryngeal sprays with glucose in glycerine /pine oil } loosen the crusts • Trt ass nasal & pharyngeal conditions • Expectorants to loosen the crusts
- 50. Tuberculosis of larynx • Always 2’ to pulmonary tuberculosis • Hematogenous • Bronchogenic • Males in middle age grp
- 51. • Pathology • Posterior >anterior • Parts = inter arytenoid fold ,ventricular fold , vocal cords , epiglottis • Bronchogenic spread From bronchi (Tubercle bacilli carried by sputum) ↓ Penetrate intact laryngeal mucosa (particularly inter arytenoid region) ↓ Formn of submucosal tubercles ↓ Ulceration & caseation • Laryngeal mucosa } red & swollen ( pseudo edema due to cellular infiltration) • Perichondritis & cartilage necrosis
- 52. • Symptoms & signs • Weakness of voice hoarseness of voice • Ulceration – pain radiating to ears • Dysphagia
- 53. Laryngeal examination • Hyperaemia of the vocal cord • In its whole extent • Or its posterior part with impairement of adduction (first sign) • Mamillated swelling in interarytenoid region • Ulceration of larynx } mouse nibbled appearance • Superficial ragged ulceration in arytenoid & interarytenoid region • Granulation tissue in interarytenoid /vocal process of arytenoid • Pseudoedema of epiglottis (turban epiglottis) • Swelling of ventricular bands & aryepiglottic folds • Marked pallor of surrounding mucosa
- 54. • Diagnosis • X ray chest • Sputum examin • Biopsy of laryngeal lesion • Treatment • Same as pulmonary TB
- 55. Lupus of the larynx • Indolent tubercular infn ass with lupus of nase & pharynx • No pulmonary tb • Painless asymptomatic • Posterior >anterior • Epiglottis aryepiepiglottic folds v entricular bands • Trt anitubercular drugs
- 56. Syphilis of larynx • Rare • Gumma of Tertiary stage any where in larynx • Smooth swelling which may ulcerate later • Complication laryngeal stenosis
- 57. Leprosy of larynx • Rare • Leprosy of skin & nose • Diffuse nodular infiltration of epiglottis, aryepiglottic folds & arytenoids • Dx : biopsy • Complication : laryngeal stenosis • Deformity of laryngeal inlet
- 58. Scleroma of larynx • c/c inflammatory condition by klebsiella rhinoscleromatis • Nasal involvement +/- • smooth red swelling in the subglottic region. • Hoarseness of voice, • wheezing and • dyspnoea . • Dx biopsy. • Treatment streptomycin or tetracycline + steroids to prevent fibrosis. Subglottic stenosis is a frequent complication requiring subsequent reconstructive surgery.
- 59. • LARYNGEAL MYCOSIS • Fungal infections such as candidiasis, histoplasmosis and blastomycosis may rarely affect the larynx. Diagnosis is usually made on biopsy and • on finding a similar lesion in other parts of the body.