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1. ACUTE & CHRONIC
INFLAMMATIONS OF LARYNX

2. ACUTE LARYNGITIS
• INFECTIOUS*
• Following URTI
• Initially viral  2’ bacterial invasion
• Streptococcus pneumonia
• H influenza
• Hemolytic streptococco
• Staphylococci
• Exanthematous fevers (measles, chicken pox,whooping cough)
• NON INFECTIOUS
• Vocal abuse ,allergy,thermal /chemical burns (inhalation/ingestion)
• Laryngeal trauma (endotracheal tube intubation)

3. CFs
• Symptoms
• Hoarseness of voice
• Discomfort / pain in throat after talking
• Dry irritating cough (worse at night)
• General symptoms
• Head cold
• Rawness /dryness
• Malaise
• Fever (if viral infn of URT)

4. Laryngeal appearance
• In early stage
• Erythema & edema of epiglottis ,aryeppiglotic folds , arytenoids & ventricular
bands
• Vocal cord are white & normal (in comparison to surrounding structures)
• In late stage
• ↑ hyperaemia & swelling
• Vocal cord red & swollen
• Subglottic region is also involved
• Sticky secretions b/w vocal cords & interarytenoid region

5. • Vocal abuse
• Submucosal hemorrhages in vocal cords

6. Treatment
• Vocal rest
• Avoidance of smoking & alcohol
• Steam inhalation with eucalyptus oil,pine,tr benzoin co
• Cough sedative
• Abx
• Analgesics
• Steroids following chemical; & thermal burns

7. Acute membranous laryngitis
• Pyogenic nonspecific organisms
• May begin in laynx /as an extension fron pharynx
• DD laryngeal diphtheria

8. Acute epiglottitis/supraglottic laryngitis
• Inflammation of supraglottic structures (epiglottis,aryepiglottic
folds,arytenoids)
• Marked edema obstrn

9. • Etiology
• Children 2-7 yrs*
• H influenza type B*
• CFs
• Abrupt with rapid progression
• Sore throat & dysphagia in adults
• Stridor & dyspnea in children
• Fever (d/t septicemia)

10. Examination
• Depress tongue with a tongue depressor
• Edematous red & swollen epiglottis
• Indirect laryngoscopy
• Edema & congestion of supraglottic structures
• Not done for fear of precipitating complete obstruction

11. Lateral soft tissue xray of neck
THUMB SIGN

12. Treatment
• Hospitalisation
• Abx (ampicillin /3rd generation cephalosporins im/iv)
• Steroids (hydrocortisone /dexamethasone im/iv ↓edema)
• Adequte hydration (fluids)
• Humidification & o2(mist tent & croupette)
• Intubation & tracheostomy

13. Acute laryngo trachea bronchitis
• Inflammation of Lx,trachea & bronchitis
• M>F
• 6 months – 3 years children *
• Para influenza type 1 & 2
• 2’ bacterial invasion (gram +ve cocci)

14. Pathology
Edema of loose areolar tissue
↓
Respiratory obstruction & stridor
Thick tenacious secretions & crusts
↓
Complete occlusion

15. symptomatology
• URTI
• Hoarseness of voice
• Croupy cough
• Fever 39-40*C
• difficulty in breathing
• Inspiratory type of stridor
• Supra sternal & intercostal recession

16. treatment
• Hospitalisation
• Abx ampicillin 50 mg/kg/day
• Humidification
• Parenteral fluids
• Steroids hydrocortisone 100mg iv
• Adrenaline} ↓ dyspnea
• Intubation /tracheostomy

17. Laryngeal diphtheria
• 2’ to faucial diphtheria
• Children <10 yrs
• Pathology
• Pseudomembrane formation  obstruction of lx
• Exotoxin myocarditis & neurological

18. CFs
• General
• Insidious
• Low grade fever (100-101*F)
• Sore throat
• Malaise
• Laryngeal
• Hoarse voice
• Croupy cough
• Respiratory stridor
• Increasing dyspnea
• Marked upper airway obstn
• Greyish white membrane on tonsil palate & pharynx
• adherent bleeds on removal

19. Buul neck due to cervical lymphadenopathy

20. diagnosis
• Clinical
• Smear & culture

21. treatment
• Diphtheria antitoxin
• Based on severity & duration
• 20,000-1,00,000 u
• Abx
• Benzyl penicillin 5,00,000 u im qid *6days
• Erythromycin
• Maintenance of airway
• Tracheostomy
• Direct larngoscopy removal of membrane & intubation
• Complete bed rest

22. complications
• Air way obstructionAsphyxia & death
• Toxic myocarditis & circulatory failure
• Palatal paralysis nasal regurgitation
• Laryngeal & pharyngeal paralysis

23. Edema of larynx
• Supra glotttic & sub glottis region *(abundant subepithelial
connective tissue)
• Vocal cords rare(sparse connective tissue)

24. etiology
• Infections
• a/c epiglottitis , laryngo trachea bronchitis, tuberculosis or syphilisnof larynx
• Infection in neighbourhood }
• Peritonsillar abscess,retropharyngeal abscess,ludwings angina
• Trauma :
• Surgery of tongue , laryngeal trauma,fb,endoscopy , inhalation ,irritant gases,
thermal , chemical burns, intubation
• Neoplasm
• Ca of lx, laryngopharynx often ass with deep ulceration
• Allergy
• Angioneurotic edema,anaphylaxis
• Radiation
• Systemic diseases

25. Symptoms & signs
• Airway obstruction
• Inspiratory stridor
• Indirect laryngoscopy
• Edema of supraglottic & subglottic region

26. • Treatment
• Intubation/tracheostomy
• Steroids(thermal/chemical)
• Adrenaline (1:1000) 0.3-0.5 ml im repeated evey 15 minute (allergic)

27. Chronic laryngitis
• Chronic laryngitis with out hyperplasia (chronic hyperaemic laryngitis)
• Chronic hypertrophic laryngitis

28. Chronic laryngitis with out hyperplasia (chronic
hyperaemic laryngitis)
• Diffuse & symmetrical involvement of whole of larynx
• (true cords ,ventricular bands , inter arytenoid region , root of
epiglottis)

29. Etiology
• Incompletely resolved a/c simple laryngitis/its recurrent attacks
• Presence of c/c infn in paranasal sinuses , teeth & tonsil & chest
• Occupational } dust & fumes
• Smoking & alcohol
• Vocal abuse
• Persistent trauma of cough as in c/c lung disease

30. Clinical features
• Hoarseness
• Easily gets tired & patient becomes aphonic by the end of the day
• Constant hawking
• Dryness & intermittent tickling } repeated clearing
• Discomfort in throat
• Dry & irritating cough

31. Laryngeal examination
• Hyperaemia of laryngeal structures
• Vocal cord } dull red & rounded
• Fleks of viscid mucus in interarytenoid in the vocal cords

32. Treatment
• Eliminate URTI & LRTI (sinusitis,tooth,c/c chest infection)
• Avoidance of irritating factors (smoke,dust,alcohol)
• Voice rest & speech therapy
• Steam inhalation
• Expectorant

33. Chronic hypertrophic laryngitis
• Present either as
• Diffuse & symmetrical
• Localised (like a tumour)
• Dysphonia plica ventricularis
• Vocal nodules
• Vocal polyp
• Reinkes edema
• Contact ulcer

34. Etiology
• Same as Chronic laryngitis with out hyperplasia

35. Pathology
Hyperaemia, edema & cellular infiltration
of submucosa
EPITHELIAL CHANGES
• PSEUDOSTRATIFIED SQUAMOUS TYPE
• SQUAMOUS EPITHELIM OF VOCAL
CORDS
• HYPERTROPHY & KERATINISATION
HYPERTROPHY OF MUCUS GLANDS
ATROPHY LATER (diminished secretion &
dryness
Starts in glottic region
Ventricular bands
Base of epiglottis
Even subglottis

36. CFs
• Hoarseness
• Easily gets tired & patient becomes aphonic by the end of the day
• Constant hawking
• Dryness & intermittent tickling } repeated clearing
• Discomfort in throat
• Dry & irritating cough

37. Laryngeal examination
• On examination, changes are often diffuse and symmetrical.
• 1. Laryngeal mucosa } dusky red and thickened.
• 2. Vocal cords } red and swollen. Their edges lose sharp demarcation
and appear rounded. In late stages, cords become bulky and
irregular giving nodular appearance.
• 3. Ventricular bands } red and swollen
• 4.
• oedema and infiltration,
• later due to muscular atrophy
• arthritis of the cricoarytenoid joint.
Mobility of cords gets impaired

38. Treatment
• Conservative
• Same as for chronic laryngitis without hyperplasia.
• Surgical
• Stripping of vocal cords, removing the hyperplastic and oedematous mucosa,
may be done in selected cases.
• Damage to underlying vocal ligament should be carefully avoided. One cord is
operated at a time.

39. POLYPOID DEGENERATION OF VOCAL CORDS
(REINKE'S OEDEMA)
• b/l symmetrical swelling of the whole of membranous part of the
vocal cords,
• in middle-aged men and women.
• due to oedema of the subepithelial space (Reinke's space) of the
vocal cords.

40. Etiology
• Chronic irritation of vocal cords
• due to misuse of voice,
• heavy smoking,
• chronic sinusitis and
• laryngopharyngeal reflex
• myxoedema

41. CFs
• Hoarseness
• Low pitched & rough voice(d/t use of false vocal cords)
• On indirect laryngoscopy
• Vocal cords are fusiform pale translucent look
• Ventricular folds hyperaemic & hypertrophic and hides
true vocal cords

42. Treatment
• Decortication of vocal cords
• Removal of strip of epithelium is done first on one side & 3-4 wks later on
other side
• Voice rest
• Speech therapy for proper voice production

43. Pachydermia laryngis
• Form of c/c hypertrophic laryngitis
• Affecting posterior part of larynx in the region of inter arytenoid &
posterior part of vocal cords

44. Etiology
• Uncertain
• Alcohol & smoking
• Forceful talking
• Gastro esophageal reflux disease (where postr part of lx is constantly washed
with acid juices)

45. CFs
• hoarseness or husky voice and irritation in the throat.
• Indirect laryngoscopy
• heaping up of red or grey granulation tissue in the interarytenoid region and
posterior thirds of vocal cords; the latter sometimes showing ulceration due
to constant hammering of vocal processes as in talking, forming what is called
the 'contact ulcer'.
• bilateral & symmetrical.
• It does not undergo malignant change.

46. • biopsy of the lesion
• differentiate the lesion from carcinoma and tuberculosis.

47. Treatment
• Removal of granulation tissue under operating microscope
• Control of acid reflux
• Speech therapy

48. Atrophic laryngitis
• Atrophy of laryngeal mucosa & crust formation
• Ass with atrophic rhinitis & pharyngitis
• Women*
• CFs
• Hoarseness of voice improving on coughing & removal of crusts
• Dry irritating cough
• Dyspnea(obstructing crusts)

49. • Examination
• Atrophic mucosa covered with foul smelling crusts
• Expulsion of crusts excoriation & bleeding
• treat,ment
• Elimination of causative factor & humidification
• Laryngeal sprays with glucose in glycerine /pine oil } loosen the crusts
• Trt ass nasal & pharyngeal conditions
• Expectorants to loosen the crusts

50. Tuberculosis of larynx
• Always 2’ to pulmonary tuberculosis
• Hematogenous
• Bronchogenic
• Males in middle age grp

51. • Pathology
• Posterior >anterior
• Parts = inter arytenoid fold ,ventricular fold , vocal cords , epiglottis
• Bronchogenic spread
From bronchi (Tubercle bacilli carried by sputum)
↓
Penetrate intact laryngeal mucosa (particularly inter arytenoid region)
↓
Formn of submucosal tubercles
↓
Ulceration & caseation
• Laryngeal mucosa } red & swollen ( pseudo edema due to cellular infiltration)
• Perichondritis & cartilage necrosis

52. • Symptoms & signs
• Weakness of voice hoarseness of voice
• Ulceration – pain radiating to ears
• Dysphagia

53. Laryngeal examination
• Hyperaemia of the vocal cord
• In its whole extent
• Or its posterior part with impairement of adduction (first sign)
• Mamillated swelling in interarytenoid region
• Ulceration of larynx } mouse nibbled appearance
• Superficial ragged ulceration in arytenoid & interarytenoid region
• Granulation tissue in interarytenoid /vocal process of arytenoid
• Pseudoedema of epiglottis (turban epiglottis)
• Swelling of ventricular bands & aryepiglottic folds
• Marked pallor of surrounding mucosa

54. • Diagnosis
• X ray chest
• Sputum examin
• Biopsy of laryngeal lesion
• Treatment
• Same as pulmonary TB

55. Lupus of the larynx
• Indolent tubercular infn ass with lupus of nase & pharynx
• No pulmonary tb
• Painless asymptomatic
• Posterior >anterior
• Epiglottis  aryepiepiglottic folds v entricular bands
• Trt anitubercular drugs

56. Syphilis of larynx
• Rare
• Gumma of Tertiary stage any where in larynx
• Smooth swelling which may ulcerate later
• Complication  laryngeal stenosis

57. Leprosy of larynx
• Rare
• Leprosy of skin & nose
• Diffuse nodular infiltration of epiglottis, aryepiglottic folds &
arytenoids
• Dx : biopsy
• Complication : laryngeal stenosis
• Deformity of laryngeal inlet

58. Scleroma of larynx
• c/c inflammatory condition by klebsiella rhinoscleromatis
• Nasal involvement +/-
• smooth red swelling in the subglottic region.
• Hoarseness of voice,
• wheezing and
• dyspnoea .
• Dx biopsy.
• Treatment streptomycin or tetracycline + steroids to prevent fibrosis.
Subglottic stenosis is a frequent complication requiring subsequent
reconstructive surgery.

59. • LARYNGEAL MYCOSIS
• Fungal infections such as candidiasis, histoplasmosis and
blastomycosis may rarely affect the larynx. Diagnosis is usually made
on biopsy and
• on finding a similar lesion in other parts of the body.