CHRONIC LARYNGITIS

By Lt Col Saeed Ullah, FCPSClassified ENT, Head and neck surgeonCMH Quetta

Anatomy

Calssification

Chronic specific laryngitis Chronic non specific laryngitis

Chronic non specific laryngitis1. Chronic hyperemic2. Chronic Hypertrophic3. Atrophic laryngitis4. Pachydermia (contact granuloma /

contact ulcer

Chronic hypreamic laryngitis Diffuse inflammatory condition

involving the whole larynx particularly true & false vocal cords

Causes

Recurrent acute laryngitis Incompletely resolved acute laryngitis 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

Clinical features

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

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 & features

Clinical findings

Laryngoscopy Laryngeal mucosa is thickened & dusky

red in colour Vocal cords red & swollen, Edges loose

sharp demarcation

Treatment

Conservative Surgical

Stripping of edematous mucosa with micro-scissor

Ablation with LASER One side done at a time to prevent Web

Chronic 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

Chronic specific laryngitis

Tubercolous 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

Investigations

Xray chest PA view Sputum for AFB Biopsy

Treatment

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 1. No shouting / No whisper

3. ? May change the profession Surgical

Microlaryngoscopy & LASER

Thanks