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Congenital laryngomalacia

先天性喉软化症

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Cause

 Congenital laryngeal stridor is a defect that is present at birth. During fetal development, the structures in the larynx may not fully develop.

Cause

 As a result, there is a weakness in these structures at birth, causing them to collapse during breathing. In children, congenital laryngeal stridor is the most common cause of chronic stridor. Sixty percent of infants born with congenital laryngeal stridor will have symptoms in the first week of life. Most other infants will show symptoms by 5 weeks old.

symptoms

 The major symptom of this disorder is the stridor that is heard as the infant breathes. The stridor is usually heard when the infant breathes in (inspiration), but can also be heard when the infant breathes out (expiration). Other characteristics of the stridor may include:    The stridor changes with activity. The stridor is usually less noisy when the child is laying on his/her stomach. The stridor gets worse if the infant has an upper respiratory infection.

diagnose

 a complete medical history  and physical examination  bronchoscopy of the airways - a procedure which involves a tube being passed into the airways to allow your child's physician to observe the airways during breathing.

Treatment for congenital laryngomalacia

Follow up In most cases, congenital laryngeal stridor is a harmless condition that resolves on its own, without medical intervention. The condition usually improves by the time the infant is 18 months old and has no long-term complications. In some cases, the stridor is apparent until about the age of 5. Each child's case is unique.

Surgery A small percentage develop severe respiratory problems which require medical and surgical interventions.

Acute laryngitis

急性喉炎

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 Laryngitis is an inflammation of the vocal cords causing speech to become hoarse and/or whisperlike, and often inaudible.

Cause

 Viruses -- Influenza A and B, Adenovirus, Parainfluenza, and Rhinovirus are some of the viruses that may cause this condition.

 Bacteria such as Hemophilus influenzae, beta-hemolytic streptococcus, and Moraxella catarrhalis  Inhalation of smoke, chemicals, and excessive use of voice  Acid Reflux  Allergies  Aging

symptoms

 Hoarseness  Whisperlike voice  loss of voice

Bacterial laryngitis:

 Sore throat  Fever  Painful swallowing  Cough  Hoarseness

Viral laryngitis

 General fatigue  Malaise  Low-grade fever  General body aches  Cough  Hoarseness  Sore throat  Dry throat

allergic laryngitis

 Hoarseness that is worse during and several hours after exposure to the allergen  Itchy throat  Excess phlegm or mucous in the throat  Feeling of dry throat  Cough  Itchy sensation in the throat  Sneezing

diagnose

 Throat check for pharyngitis (infection)  Neck checked for stridor (wheezing sound heard by stethoscope)

Treatment

 Avoid loud speech, such as shouting or singing  Humidifiers (cool mist better) and steam (cool to warm, not hot) can help.

 Avoid smoking, recreational drugs, and alcohol  Increase fluids  If severe, physicians will often instruct a person not to speak at all for the next few days.

 If Hemophilus influenza or Moxarella catarrhalis are suspected, antibiotics will most likely be prescribed.

 Symptoms usually resolve in fewer than seven days in most individuals.

Treatment

 If severe, physicians will often instruct a person not to speak at all for the next few days.

 If Hemophilus influenza or Moxarella catarrhalis are suspected, antibiotics will most likely be prescribed.

 Symptoms usually resolve in fewer than seven days in most individuals.

Chorinic laryngitis

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Defination

 Laryngitis is an inflammation of the larynx, the "voice box" that contains the vocal cords in the upper portion of the neck. Laryngitis occurs in two forms, acute and chronic. Acute laryngitis typically is a brief illness producing hoarseness and a sore throat. In most cases, an upper respiratory tract infection causes it. Chronic laryngitis is a more persistent disorder that produces lingering hoarseness and other voice changes. It usually is painless and has no significant sign of infection.

Cause



Cigarette smoke is chronically irritating to the laryngeal mucosa. At the extreme, it can provoke cancer.



Ethanol contains many impurities, such as mycotoxins, tannins, aldehydes, and pesticides, which may cause cancer, either by direct contact with the mucosa or through a systemic effect, or may act as an irritant.

    Gastroesophageal reflux disease Infections

The bacterium most commonly isolated in chronic infectious laryngitis is Staphylococcus aureus. Haemophilus influenzae and pneumococcal species may complicate the course of viral laryngitis. Tuberculosis, caused by infection with the tubercle bacillus Mycobacterium tuberculosis hominis, was a common disease of the larynx. Overall incidence has declined. The hematogenous route and the infected sputum from pulmonary tuberculosis are the most likely sources of infection.

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Voice abuse can be pertinent to professional singers and to occasional shouters. Lesions can range from simple edema, in the occasional abuser, to hyperplastic reactions if the stimuli persist over time.

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Allergic responses of immediate or delayed hypersensitivity types can cause chronic laryngitis. Although the authors found no data quantifying the exact number of people affected, current thought seems to indicate an increasing prevalence.

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Environmental factors, such as dust, fumes, chemicals, and toxins, can cause this condition.

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Systemic diseases, mostly autoimmune, may cause chronic laryngitis.

 

Wegener granulomatosis. Amyloidosis.

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Relapsing polychondritis.

 Chronic laryngitis may be associated with cutaneous diseases.

The larynx and the skin share similar microcharacteristics and macrocharacteristics.

   

Neurologic causes may contribute to chronic laryngitis. Spastic dysphonia is a discrete vocal disorder characterized by strained, choked vocal attacks (laryngeal stuttering). The onset usually follows a stressful period in middle life. This condition is probably a vocal expression of psychoneurotic behavior or a CNS and/or proprioceptive disorder of the larynx. Vocal folds atrophy and lose tension with age, causing changes in phonation. Loss of thyroarytenoid ligament elasticity results in breathiness and loss of breath support because of bowed vocal folds. Muscular disorders may contribute to chronic laryngitis. Weakness of the larynx and the pharynx is present in one third of patients with myasthenia gravis.

symptoms

 Hoarseness  Sore throat  Weak or absent voice  Sensation of a lump in the throat or constant need to clear the throat  Dry cough  Fever

diagnose

 Diagnosis is based upon a combination of the clinical history and a physical exam. Some physicians might wish to do a laryngoscopy (visualization of the vocal cords).

Treatment

         If laryngitis is caused by a bacterial infection, antibiotics will be prescribed. Some palliative measures that can be taken include: Avoid public speaking during recovery Be aware that whispering puts greater strain on the vocal cords than normal speaking Inhale steam from a bowl of hot water or from a warm shower Drink warm, soothing liquids (but do not drink alcoholic beverages) Try a cool-mist humidifier; avoid air conditioning Use throat lozenges to ease the discomfort Avoid cigarettes until the symptoms have subsided

Vocal Cord Disorders

vocal nodules vocal polyps

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 Vocal cord disorders are often caused by vocal abuse or misuse, such as excessive use of the voice when singing, talking, smoking, coughing, yelling, or inhaling irritants. Some of the more common vocal cord disorders include laryngitis, vocal nodules, vocal polyps, and vocal cord paralysis.

vocal nodules

AND

vocal polyps

 Vocal nodules are benign (non-cancerous) growths on the vocal cords caused by vocal abuse. Vocal nodules are a frequent problem for professional singers. The nodules are small and callous-like and usually grow in pairs (one on each cord). The nodules usually form on areas of the vocal cords that receive the most pressure when the cords come together and vibrate (similar to the formation of a callous). Voice nodules cause the voice to be hoarse, low, and breathy.

vocal nodules

AND

vocal polyps

 A vocal polyp is a soft, benign (non-cancerous) growth, similar to a blister. A polyp usually grows alone on one vocal cord and is often caused by long-term cigarette smoking. Other causes of vocal polyps include hypothyroidism (underactive thyroid gland), gastroesophageal reflux, and continuous voice misuse. Voice polyps cause the voice to be hoarse, low, and breathy. Vocal polyps are also called Reinke's edemas or polypoid degeneration.

CAUSES

 vocal trauma (more specifically, phonotrauma in the case of vocal fold polyps and vocal fold nodules)

symptoms

 a voice change. Typical presenting symptoms include generalized and persistent hoarseness, change in voice quality, and increased effort in producing the voice. The laryngeal examination may show either unilateral or bilateral lesions.

diagnose

 Any hoarseness or change in voice that lasts longer than two weeks should be brought to the attention of your physician. (Sometimes the hoarseness may be indicative of laryngeal cancer.)  a complete medical history and physical examination  examine the vocal cords internally with a small, long-handled mirror (indirect laryngoscopy) or laryngoscopy

Treatment

 eliminating the behavior that caused the vocal cord disorder  a referral to a speech-language pathologist who has specialized training in treating voice, speech, language, or swallowing disorders that affect communication  medication  surgery to remove growths

Acute laryngitis in children

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Cause

 Laryngitis is a group of disorders in which the inflammatory process covers the mucous membrane of all or particular levels of the larynx.  These disorders have a different course in children under 4 years old than in children above 4 years old.  WHY?

specific variations of the structure of the larynx in children under 4 years old AND above 4 years old

 The larynx of a small child is located higher, and the mucous is thicker and contains a large amount of soft tissue. This soft tissue is mainly located under the mucous of the aryepiglottic folds, and especially in the subglottic region.

 The specific reactivity of the mucous membrane in small children makes them prone to infections, especially viral. Some of these infections may cause oedema of the mucus. The respiratory tract in children is relatively narrow in this region and the chondrous ring limits the size of the subglottic region. So, oedema in this region may have a dramatic course, leading even to acute respiratory distress

Cause

 viral infection   parainfluenza virus influenza virus  rubella virus and varicella-zoster virus

symptoms

 dyspnoea,  inspiratory stridor,  hoarseness  characteristic barking cough

diagnose

 general examinations  laryngological examinations  direct visualization of the larynx endoscopy, fiberoscopy and laryngoscopy

Differential diagnosis

  Foreign body of the larynx : The most general symptoms of laryngitis occur also in other disorders of the larynx which occur with dyspnoea like the foreign body of the larynx. So the precise diagnosis is a good base for planning of further treatment.

Congenital defect of the larynx: When the symptoms of laryngitis occur at under 6 months of age or are prolonged or recurrent, a congenital defect of the larynx should be suspected, i.e. laryngeal web or haemangioma of the larynx. In these cases direct examination of the larynx is an urgent necessity, because the treatment of these disorders varies.

       

Treatment

Hospitalise systemic anti-inflammatory drugs, humidification and cooling the air in the room. hydrocortisone in high dose (10 mg per kg b. w.), preferably i.v., may be necessary. Intubation:Only intubation is a good method which protects the child from asphyxiation.

Formerly, tracheotomy was performed, but now it is not often performed in this disease. Antibiotics are administrated in those patients in whom bacterial complications develop. It should be underlined that the antibiotics given for uncomplicated laryngitis in small children do not bring improvement, so should be avoided.

In patients older than 4 years of age etiologic factors may be different e.g. allergy. In these cases administration of anti-histaminic drugs and calcium may be suitable.

Acute epiglottitis

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Definition

 A very rapidly progressive infection causing inflammation of the epiglottis (the flap that covers the trachea) and tissues around the epiglottis that may lead to abrupt blockage of the upper airway and death.

Cause



Infection:

H influenzae Haemophilus parainfluenzae

Streptococcus pneumoniae, and group A streptococci. Less common infectious bacteria (eg, Staphylococcus aureus, mycobacteria, Bacteroides melaninogenicus,

Enterobacter cloacae, Escherichia coli, Fusobacterium necrophorum, Klebsiella pneumoniae,

Neisseria meningitidis, Pasteurella multocida), herpes simplex virus (HSV), other viruses, infectious mononucleosis, Candida (in immunocompromised patients), and Aspergillus (in immunocompromised patients).



Noninfectious factors: thermal causes crack cocaine smoking marijuana smoking throat burns affecting the epiglottis of bottle-fed infants) caustic insults (eg, automatic dishwasher soap ingestion) foreign body ingestion head and neck chemotherapy. Before widespread Hib vaccination, H influenzae caused almost all pediatric cases. Allergy

symptoms

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Sore throat (95%)

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Odynophagia/dysphagia (95%)

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Muffled voice (54%)

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Usually, no prodromal symptoms occur in children. Adults may have preceding upper respiratory infection (URI) symptoms.

General symptoms

             

Fever Drooling/inability to handle secretions Cervical adenopathy Stridor - A late finding indicating advanced airway obstruction Muffled voice (54%) Tripod position - Sitting up on hands with the tongue out and the head forward Hypoxia Respiratory distress Severe pain on gentle palpation over the larynx Mild cough Fever Irritability Tachycardia Toxic appearance of patient

diagnose

 

Differential Diagnoses

Peritonsillar Abscess Retropharyngeal Abscess Toxicity, Caustic Ingestions  

Other Problems to Be Considered

Airway obstruction Foreign body aspiration Bacterial laryngotracheobronchitis Laryngotracheobronchopneumonitis Retropharyngeal abscess Peritonsillar abscess Laryngitis Laryngeal diphtheria Caustic ingestions Acute angioedema Sepsis

Treatment

 Antibiotics  Antivirus  hydrocortisone  adequate airway nasotracheal intubation intubation tracheostomy Skilled nursing care.

Papilloma of larynx

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Cause

 Most common benign tumor of the larynx and occurs in patients of all age.  The causative agent is thought to be HPV.

 Papillomas usually regress during puberty.

Cause

 Usually involving the true vocal cords but may affect supraglottic and subglottic regions.

 May also involve the trachea and bronchus.

Cause

 Papillomas in juveniles is more often multiple and recurs more frequently than in adults.

 Papillomas in adults are usually single but may undergo malignant change ( HPV 16 ， 18 ).

symptoms

 Subg lottic carcinoma ：  There are no definitive symptoms in the early stage.  Dyspnea and lymph nodes metastasis is the late symptoms

diagnose Physical examination

 Laryngoscopic examination can find a mass on one or both vocal cords  fixation of the vocal cords is common  mass in the neck

Differential diagnosis

 Tuberculosis of the larynx

：

chest X-ray film  Papilloma of the larynx  Syphilis of the larynx

Treatment

Tracheotomy

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 Tracheotomy is a surgical procedure in which an opening is made in the anterior wall of the trachea to establish an airway.

 Tracheotomy is often temporary and reversible if the patient is able to breathe through an unobstructed upper airway

Anatomy

 2 nd -4 th ring of trachea

Indication

：

⒈

Laryngeal obstruction

⒉

Secretion obstructed in lower respiratory tract (coma)

⒊

Before some major head & neck surgery

Complications

 Hemorrhage  Subcutaneous emphysema  Pneumothorax  Difficulty of decannulation  Laryngeal or tracheal stenosis

ricothyrotomy

 Employed in first-aid cases.

 Making an opening in the membrane between the cricoid cartilage and thyroid cartilage and insert a cannula.  After the situation becomes stable, ordinary tracheotomy should be performed.