Dr.vijaysundaram,acute & chronic infections larynx ,12.09.16
Chronic laryngeal infections
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Transcript of Chronic laryngeal infections
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CHRONIC LARYNGITIS
By Lt Col Saeed Ullah, FCPSClassified ENT, Head and neck surgeonCMH Quetta
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Anatomy
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Calssification
Chronic specific laryngitis Chronic non specific laryngitis
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Chronic non specific laryngitis1. Chronic hyperemic2. Chronic Hypertrophic3. Atrophic laryngitis4. Pachydermia (contact granuloma /
contact ulcer
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Chronic hypreamic laryngitis Diffuse inflammatory condition
involving the whole larynx particularly true & false vocal cords
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Causes
Recurrent acute laryngitis Incompletely resolved acute laryngitis Chronic infection in the vicinity
Sinusitis, tonsillitis, bad orodental hygiene , Ch Bronchitis
Occupational factors dust & Fumes
Smoking & Alcohol Voice abuse GERD
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Clinical features
Males affected more than females Hoarseness of voice Fatigue of voice Hawking & irritation larynx Dry irritating cough
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Clinical features
Laryngoscopy Hyperemia , Vocal cords appear dull &
edges are rounded, Viscid secretions on VC / interarytnoid region
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Treatment
Eliminate The cause infection / irritating factors
Complete voice rest / Observe proper vocal hygiene
Medicated steam inhalation
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Chronic hypertrophic laryngitis Advanced stage of hyperemic laryngitis Cellular infiltrate in the submucosa Epithelium may undergo hyperplasia /
metaplasia May be generalized involvement False VC (ventricular bands)
“Dysphonia plica ventricularis” True vocal cords
Rinke’s Edema
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Causes & features
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Clinical findings
Laryngoscopy Laryngeal mucosa is thickened & dusky
red in colour Vocal cords red & swollen, Edges loose
sharp demarcation
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Treatment
Conservative Surgical
Stripping of edematous mucosa with micro-scissor
Ablation with LASER One side done at a time to prevent Web
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Chronic atrophic laryngitis Common in women Associated with Atrophic Rhinitis Laryngitis Sicca Exact cause not known
Hormonal disturbance, Dietary deficiency, Autoimmune disorder
Bacillus ozaenae secondary infection
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Clinical features
Hoarseness Dry irritating cough Dyspnoea due to crusts Laryngoscopy
Laryngeal mucosa is dry & atrophic Covered with foul smelling crusts
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Treatment
Primary condition Atrophic rhinitis
Steam inhalation 25% glucose in glycerin sprays Expectorants containing Iodides to
loosen the crusts
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Chronic specific laryngitis
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Tubercolous laryngitis
Secondary to Pulmonary tuberculosis Common in adult males Brochogenic / hematogenous route Bronchogenic route
affects posterior larynx Interarytnoid region submucosal tubercles & granuloma
Hematogenous Multiple painful ulcers in larynx & pharynx
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Clinical features
Hoarseness Painful ulcers / referred otalgia Odynophagia Laryngoscopy
Pale granulations in the interarytnoid region Ulcers of vocal cords
Mouse eaten appearance Swelling of false VCs & Aryepiglottic
folds
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Investigations
Xray chest PA view Sputum for AFB Biopsy
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Treatment
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Vocal nodules
Singer‘ nodules Common in voice misusers
Teachers, singers, preachers & Vendors Vocal trauma
submucosal hemorrhage fibrosis & hyalinization
At the junction of anterior 1/3 7 posterior 2/3 ( subject to maximum trauma )
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Clinical features
H/o misuse of voice Hoarseness Vocal fatigue Laryngoscopy
Symmetrical nodular pinkish or grey masses at junction of ant 1/3 & post 2/3 of true vocal cords
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Treatment
Conservative1. Avoid misuse of voice2. Speech therapy / proper use of
voice 1. No shouting / No whisper
3. ? May change the profession Surgical
Microlaryngoscopy & LASER
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Thanks