LaryngitiLaryngitiss

LaryngitiLaryngitiss

Presented Presented by:- by:-

Jay RamiJay Rami

Presented Presented by:- by:-

Jay RamiJay Rami

ANATOMY OF THE LARYNXANATOMY OF THE LARYNX

• First we will see the vocal folds First we will see the vocal folds movement during the movement during the different- different speechdifferent- different speech

LaryngitisLaryngitis• inflammation of the inflammation of the

larynx or voice box, larynx or voice box, caused by chemical or caused by chemical or mechanical irritation or mechanical irritation or bacterial infection.bacterial infection.

EtiologyEtiology

•Voice abuse or Voice abuse or misusemisuse — This means talking This means talking too much or too loudly. It can be an too much or too loudly. It can be an ongoing problem for people whose ongoing problem for people whose jobs depend on their voices, jobs depend on their voices, including singers, actors, telephone including singers, actors, telephone operators, lawyers, teachers, operators, lawyers, teachers, referees, coaches and anyone who referees, coaches and anyone who must shout over loud noise at work must shout over loud noise at work (construction workers, personnel in (construction workers, personnel in airports and train stations, factory airports and train stations, factory workers).workers).

•SmokingSmoking — Cigarette Cigarette

smoke irritates the larynx, smoke irritates the larynx, causing swelling and causing swelling and inflammation that thickens the inflammation that thickens the vocal cords. This thickening can vocal cords. This thickening can lower the pitch of the voice or lower the pitch of the voice or make it sound raspy and harsh.make it sound raspy and harsh.

• Viral infection - common cause of Viral infection - common cause of acute laryngitisacute laryngitis

• AllergiesAllergies• Larynx cancerLarynx cancer

• TumorTumor

•Drinking Drinking alcohol alcohol heavilyheavily —

Alcohol causes a chemical irritation Alcohol causes a chemical irritation of the larynx that produces changes of the larynx that produces changes similar to those seen in smokers.similar to those seen in smokers.

•Gastro esophageal Gastro esophageal reflux disease reflux disease (GERD) (GERD) — GERD is a disorder in GERD is a disorder in which acidic fluids from the stomach which acidic fluids from the stomach flow backward (reflux) into the flow backward (reflux) into the esophagus and throat, irritating the esophagus and throat, irritating the larynx. Because acid reflux usually is larynx. Because acid reflux usually is worse when lying down, the worse when lying down, the hoarseness caused by GERD often is hoarseness caused by GERD often is most noticeable in the morning right most noticeable in the morning right after awakening. after awakening. 

•Work-related Work-related exposure to irritating exposure to irritating chemicals or dustschemicals or dusts — Many industrial products are Many industrial products are suspected of causing chronic suspected of causing chronic laryngitis and other respiratory laryngitis and other respiratory problems. The U.S. Department of problems. The U.S. Department of Labor monitors many of these Labor monitors many of these products and provides safety products and provides safety guidelines for handling and exposure guidelines for handling and exposure through the Occupational Safety and through the Occupational Safety and Health Administration (OSHA).Health Administration (OSHA).

Symptoms

• The most common symptom is The most common symptom is hoarseness. hoarseness.

• A low, raspy voiceA low, raspy voice• A voice that tires easily, A voice that tires easily,

“breaks” or “cracks”“breaks” or “cracks”• The sensation of a lump in the The sensation of a lump in the

throat or a dry throat.throat or a dry throat.• Difficulty swallowingDifficulty swallowing• CoughingCoughing• Difficulty breathingDifficulty breathing

• A constant urge to clear the A constant urge to clear the throatthroat

• Heavy mucus in the throatHeavy mucus in the throat

• Chronic cough or postnasal dripChronic cough or postnasal drip

• Discomfort during swallowingDiscomfort during swallowing

DiagnosisDiagnosis

• The most common sign of The most common sign of laryngitis is hoarseness. Changes laryngitis is hoarseness. Changes in your voice can vary with the in your voice can vary with the degree of infection or irritation, degree of infection or irritation, ranging from mild hoarseness to ranging from mild hoarseness to almost total loss of your voice. almost total loss of your voice.

• If you have chronic hoarseness, If you have chronic hoarseness, your doctor may want to listen to your doctor may want to listen to your voice and to examine your your voice and to examine your vocal cords, and he or she may vocal cords, and he or she may refer you to an ear, nose and refer you to an ear, nose and throat specialist.throat specialist.

• These techniques sometimes are These techniques sometimes are used to help diagnose laryngitis:used to help diagnose laryngitis:

•LaryngoscopeLaryngoscope:-Your :-Your

doctor can visually examine your doctor can visually examine your vocal cords in a procedure called vocal cords in a procedure called laryngoscope, by using a light and a laryngoscope, by using a light and a tiny mirror to look into the back of tiny mirror to look into the back of your throat. Or your doctor may use your throat. Or your doctor may use fiber-optic laryngoscope. fiber-optic laryngoscope.

• This involves inserting a thin, flexible This involves inserting a thin, flexible tube tube (endoscope) (endoscope) with a tiny camera with a tiny camera and light through your nose or mouth and light through your nose or mouth and into the back of your throat. and into the back of your throat.

• Then your doctor can watch the Then your doctor can watch the motion of your vocal cords as motion of your vocal cords as you speak.you speak.

•BiopsyBiopsy:- If your doctor :- If your doctor sees a suspicious area, he or she sees a suspicious area, he or she may do a biopsy — taking a may do a biopsy — taking a sample of tissue for examination sample of tissue for examination under a microscope.under a microscope.

Types Types

Acute Acute laryngitislaryngitis

DEFINITIONDEFINITIONo It is the acute inflammation ofIt is the acute inflammation of

larynx leading to oedema of larynx leading to oedema of laryngeallaryngeal

mucosa and underlying structures.mucosa and underlying structures.

o Acute laryngitis is an inflammationAcute laryngitis is an inflammation

of the vocal fold mucosa and larynxof the vocal fold mucosa and larynx

that lasts less than 3 weeks.that lasts less than 3 weeks. 

ACUTE VIRAL ACUTE VIRAL LARYNGITISLARYNGITIS

• Frequently caused by “Rhinovirus”Frequently caused by “Rhinovirus”• Other causes:Other causes:

– ParainfluenzaParainfluenza– respiratory syncytial virusrespiratory syncytial virus– AdenovirusAdenovirus

Symptoms Symptoms

• Hoarseness or change in voice.Hoarseness or change in voice.• Husky, high pitched voice.Husky, high pitched voice.• Discomfort in throat, pain.Discomfort in throat, pain.• Body aches. Body aches. • Dysphagia, Dysphonea..Dysphagia, Dysphonea..• Dry irritating paroxysmal cough.Dry irritating paroxysmal cough.• Fever, Malaise.Fever, Malaise.

ETIOLOGYETIOLOGY

• vocal misusevocal misuse

• exposure to noxiousexposure to noxious

• infectious agents leading infectious agents leading to upper respiratory tract to upper respiratory tract infections The infectious agents infections The infectious agents are most often viral but are most often viral but sometimes bacterial.sometimes bacterial.

•   • Frank aphoniaFrank aphonia

Treatment Treatment

• Inhaling humidified air promotes Inhaling humidified air promotes moisture of the upper airway, moisture of the upper airway, helping to clear secretions and helping to clear secretions and exudate.exudate.

• Complete voice rest is Complete voice rest is suggested, although this suggested, although this recommendation is nearly recommendation is nearly impossible to follow. impossible to follow.

• If the patient must speak, soft If the patient must speak, soft sighing phonation is best. sighing phonation is best. Avoidance of whispering is best, Avoidance of whispering is best, as whispering promotes hyper as whispering promotes hyper functioning of the larynx.functioning of the larynx.

• Prevailing data do not support Prevailing data do not support the use of antihistamines and the use of antihistamines and corticosteroidscorticosteroids

Chronic Chronic laryngitislaryngitis

Definition Definition • Chronic laryngitis is a more Chronic laryngitis is a more

persistent disorder that persistent disorder that produces lingering hoarseness produces lingering hoarseness and other voice changes. It and other voice changes. It usually is painless and has no usually is painless and has no significant sign of infection.significant sign of infection.

ETIOLOGYETIOLOGY

• Vocal misuseVocal misuse

• Exposure to noxious agentsExposure to noxious agents

• Infectious agents leading Infectious agents leading to upper respiratory tract to upper respiratory tract infections. The infectious agents infections. The infectious agents are most often viral but are most often viral but sometimes bacterial.sometimes bacterial.

INFECTIOUS:INFECTIOUS: ViralViral BacterialBacterial

NON INFECTIOUSNON INFECTIOUS Inhaled fumesInhaled fumes AllergyAllergy

Polluted atmospheric Polluted atmospheric

conditionsconditions Vocal abuseVocal abuse Iatrogenic traumaIatrogenic trauma

Differential Differential DiagnosisDiagnosis

• Acute epiglottitisAcute epiglottitis

• Acute laryngotracheo bronchitis.Acute laryngotracheo bronchitis.

• Laryngeal perichondritisLaryngeal perichondritis

• Laryngeal oedemaLaryngeal oedema

• Laryngeal diphtheriaLaryngeal diphtheria• Reinke’s oedemaReinke’s oedema

PAEDIATRIC PAEDIATRIC CONCERNSCONCERNS

• Lacks firm cartilaginous skeleton.Lacks firm cartilaginous skeleton.

• Flabby , easily collapses.Flabby , easily collapses.

• Glottis aperture , relatively Glottis aperture , relatively smaller.smaller.

• Mucosa swells up rapidly in Mucosa swells up rapidly in response to slightest trauma or response to slightest trauma or infection.infection.

• Stridor is the most noticeable Stridor is the most noticeable presentation.presentation.

TREATMENTTREATMENT

SUPPORTIVESUPPORTIVE• Voice rest.Voice rest.• Steam inhalation.Steam inhalation.• Cough suppressants.Cough suppressants.• Avoid smoking and cold.Avoid smoking and cold.• Fluid intake.Fluid intake.• Consider short course of Consider short course of

corticosteroidscorticosteroids• voice rehabilitationvoice rehabilitation• HumidificationHumidification

DEFINITIVEDEFINITIVE

• ANTIBIOTICSANTIBIOTICS• STEROIDSSTEROIDS• ANALGESICSANALGESICS

•Treatment Treatment 4 hoarse 4 hoarse voicevoice

Voice TherapyVoice Therapy

• Voice therapy is an approach to Voice therapy is an approach to treating voice disorders that treating voice disorders that involves vocal and physical involves vocal and physical exercises coupled with exercises coupled with behavioral changes. behavioral changes.

• The purpose of voice therapy is The purpose of voice therapy is to help attain the best possible to help attain the best possible voice and the most relief from voice and the most relief from the vocal symptoms that are the vocal symptoms that are bothering the patientbothering the patient

Duration of Duration of voice voice

therapytherapy

The length of each individual voice The length of each individual voice therapy session usually ranges from therapy session usually ranges from ½ to 1 hour.½ to 1 hour.

The sessions are weekly. The sessions are weekly.

However, for some types of voice However, for some types of voice disorders, two or more sessions per disorders, two or more sessions per week are best for the first few week are best for the first few weeks, tapering down as the therapy weeks, tapering down as the therapy progresses. progresses.

The duration of the entire voice The duration of the entire voice therapy program is highly therapy program is highly individual.individual.

The program can be as short as The program can be as short as just a few sessions, or as long just a few sessions, or as long as 12 weeks or more.as 12 weeks or more.

The voice The voice quality in quality in laryngitislaryngitis

ThankThankyouyou