2. ACUTE LARYNGITIS (SIMPLE)
ā¢ AETIOLOGY: Secondary to inflammation of
nose, throat, paranasal sinuses
ā¢ Air born infection by adenovirus, influenzaļ
leads to secondary bacterial infection by
damaging mucosa
ā¢ Most common organisms are moraxella
catarrhalis, streptococcus pneumoniae,
haemophilus influenzae
ā¢ Unfavorable climate, physical, psychological
strain are predisposing factors
3. ACUTE LARYNGITIS (SIMPLE)-
PATHOLOGY
ā¢ Mucosal inflammationļ extravasation of
fluid
ā¢ Infiltration of neutrophils/ lymphocytes/
plasma cells
ā¢ Muscles, joints, perichondrium affected
ā¢ Epithelial exfoliation, necrosis occurs
ā¢ In some instance fibrosis results with
mucosal loss leading to chronic laryngitis
4. ACUTE LARYNGITIS (SIMPLE)-
SYMPTOMS
ā¢ Hoarseness of voice
ā¢ Discomfort
ā¢ Pain
ā¢ Instant paroxysmal cough
ā¢ General cold
ā¢ Dryness of throat
ā¢ Malaise
ā¢ fever
5. ACUTE LARYNGITIS (SIMPLE)-
SIGNS
ā¢ Erythema and edema of epiglottis, aryepiglottic
folds, arytenoids and ventricular bands
ā¢ Vocal cords appear normal in early stages
ā¢ In later stages congestion and swelling increases,
vocal cords become red and swollen
ā¢ Sticky secretions are seen between cords and
interarytenoid region
ā¢ Submucosal hemorrhages may be seen in the
vocal cords
8. ACUTE FIBRINOUS
LARYNGITIS
ā¢ Laryngotrachoebronchitis involving the
entire respiratory system
ā¢ Age: 6 months-7 years
ā¢ Super infections following influenza by
hemolytic streptococcus
9. ACUTE FIBRINOUS
LARYNGITIS- PATHOLOGY
ā¢ Affects entire respiratory tract
ā¢ The loose areolar tissue in the subglottic
region swells up and causes respiratory
obstruction and stridor
ā¢ This coupled with thick tenacious
secretions and crusts may completely
occlude the airway
10. ACUTE FIBRINOUS
LARYNGITIS- SIGNS AND
SYMPTOMS
ā¢ Hoarseness
ā¢ Croupy cough
ā¢ 39- 40 degree temperature
ā¢ Common cold
ā¢ Difficulty to breath
ā¢ Inspiratory stridor
ā¢ Increased muscular energy consumption
ā¢ Increased CO2 retention leads to metabolic
respiratory acidosis, paralysis of respiratory
regulation centers
ā¢ CYNOSIS may be present
12. ACUTE FIBRINOUS
LARYNGITIS- TREATMENT
ā¢ Hospitalization: isolated room
ā¢ Treatment with moist air
ā¢ Antibiotics-Broad spectrum penicillinsļ amoxicillin
50mg/kg
ā¢ Mucolytics: oral or aerosol
ā¢ Nasogastric feeding
ā¢ Hydration
ā¢ Steroids ?
ā¢ Intubation / tracheostomy
ā¢ Ventilator support may be required
13. SUBGLOTTIC LARYNGITIS
(PSEUDOCROUP)
ā¢ Common in young children- 3 years of age
ā¢ Caused by influenza virus
ā¢ Signs and symptoms: subglottic edema (+)
croup, stridor, no fever
ā¢ Treatment : voice rest, steroids, tracheostomy
may be needed
14. ACUTE EPIGLOTTITIS
(SUPRAGLOTTITIS)
ā¢ Etiology :
1. Common in children between 2-7 years
2. Incidence 1:17000
3. In adult 1:100000
4. Caused by h. influenza type B
16. ACUTE EPIGLOTTITIS-
CLINICAL FEATURES
ā¢ Onset : abrupt / rapid progressive
ā¢ Sore throat
ā¢ Dysphagia in adults
ā¢ Dyspnoea and stridor in children
ā¢ Tripod sign
ā¢ Drooling of saliva
ā¢ Fever 40 degree Celsius
17. ACUTE EPIGLOTTITIS-
CLINICAL FEATURES
ā¢ Epiglottis appears like a rounded swollen
mass
ā¢ Tongue depression and indirect
laryngoscopy may cause fatal laryngeal
spasm so it is avoided
ā¢ Lateral soft tissue x ray shows swollen
epiglottis (thumb sign)
20. Simple Subglottic Laryngotracheo epiglottitis
laryngitis laryngitis bronchitis
Age Any 1-4 yrs 1-8 yrs 3-6 yrs
Onset gradual rapid gradual Rapid
Etiology virus Viral ? bacterial bacterial
temperature <39 <38 <38 >39
Voice hoarse harsh hoarse Normal
Posture Indifferen restless lying Sitting
t
treatment supportive supportive Antibiotics/int Antibiotics/int
ubation ubation
monitoring no no yes yes
21. OEDEMA OF THE LARYNX
ā¢ Oedema of mucosa can accompany any
inflammatory reaction therefore not a
specific disease but rather a sign
ā¢ Solitary reaction to different types of
stimuli like exogenous or unknown /
trauma, infection, tobacco, radiation
22. OEDEMA OF THE LARYNX-
ETIOLOGY
ā¢ Infection: acute epiglottitis, croup, tuberculosis,
syphilis
ā¢ From neighboring structures: quinsy, retro and
parapharyngeal abscess, Ludwig's angina
ā¢ Trauma: tongue, larynx, floor of mouth burns
(physical, chemical), Foreign bodies, post
endoscopy
ā¢ Neoplasms: larynx, tongue, pharynx
ā¢ Allergy
ā¢ Angioneurotic oedema
ā¢ Radiation
ā¢ Systemic diseases: nephritis, cardiac failure,
myxedema
23. REINKEāS OEDEMA
ā¢ Named after German anatomist
ā¢ Reinkeās space bound between superior
and inferior arcuate lines which is filled
with loose areolar tissue
24. REINKEāS OEDEMA
Etiology
ā¢ Precisely not known
ā¢ Allergy, infection, local irritants like
tobacco
ā¢ Common in men age 30-60 yrs
Clinical features
ā¢ On IDL examination : vocal cord red
swollen, slightly translucent, mucosa
shows polypoidal changes
ā¢ Hoarseness stridor cough present
26. REINKEāS OEDEMA-
TREATMENT
ā¢ Rehabilitation
ā¢ Microlaryngeal stripping: mucosa on both
sides incised sagittally not up to anterior
commissure
ā¢ Voice rest and speech therapy
27. ANGIONEUROTIC OEDEMA
ā¢ May be allergic, non allergic OR
hereditary and non hereditary
ā¢ Recurrent attacks of local swelling in
various parts of the body: face, larynx,
limbs, buttocks
ā¢ Death occurs because of the edema of the
larynx
ā¢ Colic, nausea, vomiting
28. ANGIONEUROTIC OEDEMA
ā¢ Allergic: food, medicines, inhaled
allergens (ACE inhibitors used in
treatment of essential hypertension)
ā¢ Hereditary Angioneurotic edema:
described by Sir William Osler (1888)
ļ Serum deficiency of C1 esterase inhibitor
protein thus inhibiting compliment
activation, kinin formation and fibrinolysis
ļ Triad of symptoms: abdominal pain,
peripheral non pitting oedema, laryngeal
oedema
29. ANGIONEUROTIC OEDEMA-
TREATMENT
ā¢ 36000 units of C1 INH
ā¢ Recurrent attacks : use fibrinolytic
inhibitors like epsilon amino caprioc acid,
tranexamic acid or methyl testosterone
derivative ( danazol)ļ these drugs
stimulate C1 INH production
32. CHRONIC LARYNGITIS
ā¢ Diffuse inflammatory condition symmetrically
involving whole larynx
ā¢ Aetiology
1. Incomplete resolution of acute laryngitis and its
recurrent attacks
2. Chronic infection in paranasal sinuses, teeth,
tonsils and chest
3. Occupational factorsļ miners, gold/ironsmiths,
chemical industries
4. Smoking, alcohol
5. Chronic lung disease
6. Vocal abuse
33. CHRONIC LARYNGITIS-
CLINICAL FEATURES
ā¢ Hoarseness of voiceļ easily tired becoming
aphonic
ā¢ Constant hawking, dryness, compelled to clear
throat
ā¢ Discomfort in throat
ā¢ Dry irritating cough
Signs
ā¢ Hyperemia of vocal cords : dull, red and round
ā¢ Viscid mucosa in vocal cord and interarytenoid
region