Laryngitis PDF 2022-2023

Laryngitis Laryngitis SS block-ENT Dr Abdulsalam Mohammad ENT-surgen Academic year 2022-2023 at gave 8 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...

Laryngitis Laryngitis SS block-ENT Dr Abdulsalam Mohammad ENT-surgen Academic year 2022-2023 at gave 8 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. Hoarseness SYMPHIL add Examination by indirect laryngoscopy or fiberoptic examination to Fiberoptic laryngoscope indirect laryngoscope Endoscopic view of the larynx Erythema of the vocal cords with streaks of mucus 0 Treatment Acute laryngitis is self limited disease with resolution within two weeks. Voice rest. Avoidance of irritant like smoking. Analgesics and or anti-inflammatory. y 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.  viral Croup (viral laryngotacheobronchitis) 006 around ie Laryngotuniff I hinn 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 negation fever Croup Pavalnfluenza typel 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. arises Clinical presentation The child presented with hoarseness ,barking cough 0 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 0 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 antipyretic fermi In moderate and sever cases 1-Admission to hospital 2- Nebulized adrenaline (racemic) 2 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. prodling Muffled voice Insp stridor sore throat  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 Fuffled 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 GERD 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 i 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, O 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 000 speaking and swallowing and otalgia. 0 Laryngeal examination There is a diffusely reddened and edematous larynx predominantly affecting the posteriorE one-third of the glottis. There may be also be ulceration and the appearances can be confused with squamous cell carcinoma. we Tuberculosis of the larynx  0 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