Laryngitis
SS block-ENT
Dr Abdulsalam Mohammad
ENT-surgen
Academic year 2022-2023
Acute laryngitis
● Is a common condition in which there is
inflammation of the supraglottic and glottic structures
of the larynx
Acute laryngitis
● Commonly caused by virus as a part of upper
respiratory tract infection .
● Patient presented usually with hoarseness and other
symptoms of common cold.
● Examination by indirect laryngoscopy or fiberoptic
examination
Fiberoptic laryngoscope indirect laryngoscope
Endoscopic view of the larynx
Erythema of the vocal
cords with streaks of
mucus
Treatment
Acute laryngitis is self limited disease with resolution
within two weeks.
● Voice rest.
● Avoidance of irritant like smoking.
● Analgesics and or anti-inflammatory.
● Antibiotics usually not indicated unless bacterial
laryngitis is suspected in more sever symptoms and in
prolonged cases.
● Erythromycin and macrolides are the antibiotics of
choice.
Croup
(viral laryngotacheobronchitis)
Croup
● Is a clinical condition characterized by triad of
symptoms of hoaresness,barking cough and stridor
due to inflammatory edema of the airways.
● Subglottis is
the narrowest
Part of airway
Croup
● It is mainly caused by parainfluenza virus type One .
● Usually affect children between six months to three
years mainly in winter months.
● Boys are more affected than girls .
Clinical presentation
● The child presented with hoarseness ,barking cough
and stridor which is inspiratory in early stage and
biphasic in late stage ??.
● Child usually not appear toxic and no drooling
● History of preceded upper respiratory tract infection .
On examination
Concentrate on :
● Degree of stridor
● Intercostal and subcostal recession
● Air entry
● Cyanosis + pulse oximetry
● State of consciousness
Investigation
● Usually not needed
,diagnosis is clinical
● Sometimes AP view
plain x -ray of the neck
and chest reveal steeple
sign or pencil tip sign
due to Subglottic edema
Treatment
● Most cases of croup are mild and self limiting
● Oral steroid to reduce the airway edema.
● Reassurance
In moderate and sever cases
● 1-Admission to hospital
● 2- Nebulized adrenaline (racemic)
● 3- oral corticosteroid
● 4- recently heliox (mixture of helium and oxygen )
Failure of medical treatment and worsening upper
airway obstruction necessitate
an alternative airway in form of endotracheal intubation
with ventilation
Very rarely …..Surgical airway
????
Acute epiglottitis or supraglottitis
● Is an inflammation of the supraglottic structures
mainly the epiglottis
● Caused by Haemophilus influenzae type b
Clinical presentation
● Child between 2 to 8 year presented with drooling
,muffled voice ,and inspiratory stridor with short
history of sore throat .
● On examination
● Is toxic ,febrile with use of accessory muscles of
respiration.
● When acute epiglottis is suspected pharyngeal
examination should not be attempted as this can lead
to upper airway obstruction
● Diagnosis depend on clinical features and endoscopic
visualization of the supraglottic area (should b done
either in the theater or intensive care unit )
● Radiological examination is contraindicated before
securing the airway
● The classical radiological sign is thumb sign
Treatment
● After the diagnosis is confirmed securing the airway
by endotracheal intubation and mechanical
ventilation.
● If this failed rigid bronchoscope with formal
tracheostomy.
● Antibiotics for 5- 7 days by third generation
cephalosporin.
● Mortality is 3%
Chronic laryngitis
● Chronic laryngitis is chronic inflammation of the
laryngeal structures, most commonly affecting the
laryngeal mucosa
● Classification
● Infectious and noninfectious
Aetiology
1- smoking
2- voice abuse
3- reflux disease (gastroesophageal reflux and
laryngopharyngeal reflux )
Mechanism of laryngeal damage during reflux disease:
Direct effect of the refluxate on laryngeal mucosa.
Second by excessive throat cleaning and cough caused
by vagal stimulation from the esophagus.
Nonspecific chronic laryngitis
● Is a common condition characterized by long standing
hoarseness
Other associated symptoms
● Pain in the throat
● Globus sensation
● Otalgia
● Excessive throat cleaning and
● Halitosis
On examination
● The larynx is examine by
indirect laryngoscope
● Fiberoptic nasal endoscope
● The key features of non-
specific laryngitis are
● diffuse inflammatory
picture with widespread
irregular mucosa, varying
degrees of oedema,
erythema, exudate,
Treatment
● According to the aetiology
● Cessation of smoking
● Voice therapy
● Treatment of reflux disease
Treatment of reflux disease
● Proton pump inhibitors
● Elevation of the head of the bed
● Avoidance of excessive smoking and alcohol
● If failed Nissan fundoplication
Chronic specific laryngitis
Tuberculosis of the larynx
● Invariably tuberculosis (TB) occurs with the
pulmonary version of the disease
● with the patient complaining of dysphonia, pain on
speaking and swallowing and otalgia .
Laryngeal examination
● There is a diffusely reddened and edematous larynx
predominantly affecting the posterior one-third of the
glottis . There may be also be ulceration and the
appearances can be confused with squamous cell
carcinoma.
Tuberculosis of the larynx
● Diagnosis is made by biopsy of the
● laryngeal tissues. Histological examination
demonstrates granulomas with caseating necrotic
centers, Langhans-type giant cells and acid-fast bacilli
Treatment
is to secure an airway followed by anti-tuberculous
drugs. If timely, there should be resolution of the
laryngeal and pulmonary disease and if not there will
be the effects of chronic inflammation with stenosis
and vocal cord fixation
Thank you
