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Questions and Answers
What are the common symptoms associated with nonspecific chronic laryngitis?
Common symptoms include long-standing hoarseness, throat pain, globus sensation, otalgia, excessive throat cleaning, and halitosis.
Describe the key features of the larynx observed in nonspecific chronic laryngitis.
The larynx shows a diffuse inflammatory picture with widespread irregular mucosa, varying degrees of oedema, erythema, and exudate.
What is the primary method for diagnosing tuberculosis of the larynx?
Diagnosis is made by biopsy of the laryngeal tissues.
What are the treatment options for nonspecific chronic laryngitis?
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What histological findings are associated with tuberculosis of the larynx?
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What is acute epiglottitis and which age group is more frequently affected?
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What steps should be taken in the treatment of acute epiglottitis after diagnosis?
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List two clinical signs indicative of acute epiglottitis.
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Why should pharyngeal examination be avoided in suspected acute epiglottitis?
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What is the classical radiological sign associated with acute epiglottitis?
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Identify two potential causes of chronic laryngitis.
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What are the two mechanisms of laryngeal damage during episodes of reflux disease?
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What is the mortality rate associated with untreated acute epiglottitis?
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What is the primary cause of acute laryngitis?
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Describe the typical symptoms presented in acute laryngitis.
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What is the recommended treatment for acute laryngitis?
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What triad of symptoms characterizes croup, and what causes it?
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In children with croup, what is the significance of the 'steeple sign' seen on x-ray?
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What should be monitored in a child presenting with croup during clinical examination?
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What type of medication is indicated for the treatment of croup and why?
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How does smoking affect the management of acute laryngitis?
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Study Notes
Acute Laryngitis
- Common condition with inflammation of the larynx's supraglottic and glottic structures
- Usually caused by a virus as part of an upper respiratory tract infection
- Patient presents with hoarseness and other common cold symptoms
- Examination by indirect laryngoscopy or fiberoptic examination
- Treatment is usually self-limited with resolution within two weeks
- Voice rest and avoidance of irritants like smoking are recommended
- Analgesics and anti-inflammatory medications may be helpful
- Antibiotics are usually not indicated unless bacterial laryngitis is suspected in more severe symptoms and prolonged cases.
- Erythromycin and macrolides are the antibiotics of choice
Croup
- Characterized by hoarseness, barking cough, and stridor due to inflammatory edema of the airways
- Subglottis is the narrowest part of the airway
- Mainly caused by parainfluenza virus type one
- Usually affects children between six months and three years
- Boys are more affected than girls
- Clinical presentation includes hoarseness, barking cough, and stridor, usually inspiratory early on and biphasic later
- Child usually does not appear toxic and there is no drooling
- History of preceding upper respiratory tract infection
- Examination should focus on:
- Degree of stridor
- Intercostal and subcostal recession
- Air entry
- Cyanosis and pulse oximetry
- State of consciousness
- Investigation is usually not needed, diagnosis is clinical
- Sometimes an AP view plain x-ray of the neck and chest reveals a steeple sign or pencil tip sign due to subglottic edema
- Treatment:
- Most cases are mild and self-limiting
- Oral steroids to reduce airway edema
- Reassurance and antipyretic medications
- Moderate to severe cases may require:
- Hospital admission
- Nebulized adrenaline (racemic)
- Oral corticosteroids
- Recently, heliox (mixture of helium and oxygen)
- Failure of medical treatment and worsening upper airway obstruction necessitates an alternative airway in the form of endotracheal intubation with ventilation
- Very rarely surgical airway is required
Acute Epiglottitis or Supraglottitis
- Inflammation of the supraglottic structures, mainly the epiglottis
- Caused by Haemophilus influenzae type b
- Child between 2-8 years presents with drooling, muffled voice, and inspiratory stridor with a short history of sore throat
- Child is usually toxic, febrile, and uses accessory muscles of respiration
- When acute epiglottitis is suspected, pharyngeal examination should not be attempted as this can lead to upper airway obstruction
- Diagnosis depends on clinical features and endoscopic visualization of the supraglottic area
- Should be done in the theater or intensive care unit
- Radiological examination is contraindicated before securing the airway
- The classical radiological sign is the "thumb sign"
- Treatment involves securing the airway by endotracheal intubation and mechanical ventilation
- If this fails, rigid bronchoscopy with formal tracheostomy is required
- Antibiotics for 5-7 days with third-generation cephalosporin
- Mortality is 3%
Chronic Laryngitis
- Chronic inflammation of the laryngeal structures, most commonly affecting the laryngeal mucosa
- Classification includes infectious and non-infectious
- Etiology:
- Smoking
- Voice abuse
- Reflux disease (gastroesophageal reflux and GERD laryngopharyngeal reflux)
- Mechanism of laryngeal damage during reflux disease:
- Direct effect of the refluxate on the laryngeal mucosa
- 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 include:
- Pain in the throat
- Globus sensation
- Otalgia
- Excessive throat cleaning
- Halitosis
- Examination:
- Larynx is examined by indirect laryngoscope and fiberoptic nasal endoscope
- Key features of non-specific laryngitis include a diffuse inflammatory picture with widespread irregular mucosa, varying degrees of edema, erythema, and exudate
- Treatment:
- According to the etiology
- Cessation of smoking
- Voice therapy
- Treatment of reflux disease
- Proton pump inhibitors, elevation of the head of the bed, avoidance of excessive smoking and alcohol
- If failed, Nissan fundoplication may be considered
Chronic Specific Laryngitis
- Tuberculosis of the larynx:
- Invariably occurs with the pulmonary version of the disease
- Patient complains of dysphonia, pain on speaking and swallowing, and otalgia
- Laryngeal Examination:
- Diffusely reddened and edematous larynx predominantly affecting the posterior one-third of the glottis
- There may be ulceration and the appearance can be confused with squamous cell carcinoma
- Diagnosis:
- Made by biopsy of the laryngeal tissues
- Histological examination demonstrates granulomas with caseating necrotic centers, Langhans-type giant cells, and acid-fast bacilli
- Treatment:
- Securing an airway followed by anti-tuberculous drugs
- If timely, there should be resolution of the laryngeal and pulmonary disease
- If not, the effects of chronic inflammation with stenosis and vocal cord fixation will occur
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Description
This quiz covers the definitions, causes, symptoms, and treatments of acute laryngitis and croup. It emphasizes the importance of voice rest and the role of viruses in these conditions. Assess your understanding of these common respiratory issues.
