Chronic laryngeal infections
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Transcript of Chronic laryngeal infections
CHRONIC LARYNGITIS
By Lt Col Saeed Ullah, FCPSClassified ENT, Head and neck surgeonCMH Quetta
Anatomy
Calssification
Chronic specific laryngitis Chronic non specific laryngitis
Chronic non specific laryngitis1. Chronic hyperemic2. Chronic Hypertrophic3. Atrophic laryngitis4. Pachydermia (contact granuloma /
contact ulcer
Chronic hypreamic laryngitis Diffuse inflammatory condition
involving the whole larynx particularly true & false vocal cords
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
Clinical features
Males affected more than females Hoarseness of voice Fatigue of voice Hawking & irritation larynx Dry irritating cough
Clinical features
Laryngoscopy Hyperemia , Vocal cords appear dull &
edges are rounded, Viscid secretions on VC / interarytnoid region
Treatment
Eliminate The cause infection / irritating factors
Complete voice rest / Observe proper vocal hygiene
Medicated steam inhalation
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
Causes & features
Clinical findings
Laryngoscopy Laryngeal mucosa is thickened & dusky
red in colour Vocal cords red & swollen, Edges loose
sharp demarcation
Treatment
Conservative Surgical
Stripping of edematous mucosa with micro-scissor
Ablation with LASER One side done at a time to prevent Web
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
Clinical features
Hoarseness Dry irritating cough Dyspnoea due to crusts Laryngoscopy
Laryngeal mucosa is dry & atrophic Covered with foul smelling crusts
Treatment
Primary condition Atrophic rhinitis
Steam inhalation 25% glucose in glycerin sprays Expectorants containing Iodides to
loosen the crusts
Chronic specific laryngitis
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
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
Investigations
Xray chest PA view Sputum for AFB Biopsy
Treatment
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 )
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
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
Thanks