Chronic laryngitis

Chronic laryngitis refers to an inflammatory process that determines irreversible alterations of the laryngeal mucosa

Reactive and reparative processes of the larynx represent the main pathogenetic factor, which can persist even when the causative stimulus ends

Non specific : No specific detectable cause

1. Chronic hyperemic2. Ch Hypertrophic3. Atrophic4. Pachydermia (contact granuloma /

contact ulcer ) Specific Chronic granulomatous

lesions e.g. Tuberculosis, Syphilis, Scleroma, leprosy, fungal infections & amyloidosis

Chronic Hyperemic laryngitis Diffuse inflammatory condition

involving the whole larynx particularly true & False vocal cords

Causes Recurrent acute laryngitis /

Incompletely resolved Ac laryngitis more than 3 weeks

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 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 ? Expectorants

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 As for hyperemic chronic laryngitis

Laryngoscopy Laryngeal mucosa is thickened & dusky red in colour

Vocal cords red & swollen, Edges loose sharp demarcation

In Dysphonia plica venticularis false vocal cords swollen, may cover true VCs

Treatment

Conservative Surgical Stripping of

edematous mucosa with micro-scissor

Ablation with LASER One side done at a time to

prevent Web

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

Tuberculous 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

1. X-Ray chest2. Sputum for AFB3. Biopsy Treatment : As for pulmonary

tuberculosis

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 No shouting / No whisper

3. ? May change the profession Surgical Microlaryngoscopy &

LASER