Chronic laryngitis
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Transcript Chronic laryngitis
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
1.
2.
3.
4.
Non specific : No specific detectable
cause
Chronic hyperemic
Ch Hypertrophic
Atrophic
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
1.
2.
3.
Ulcers of vocal cords mouse
eaten appearance
Swelling of false VCs & Aryepiglottic
folds
X-Ray chest
Sputum for AFB
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
1.
2.
3.
Conservative
Avoid misuse of voice
Speech therapy / proper use of
voice No shouting / No whisper
? May change the profession
Surgical Microlaryngoscopy &
LASER