Diseases of the larynx

laryngeal infections

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Laryngotracheal infectionsLT COL SAEED ULLAH, MBBS, FCPSCLASSIFIED ENT, HEAD AND NECK SURGEON

laryngeal infections

3Acute laryngitis

Acute infections involving larynx Can be bacterial / viral Part of upper / lower respiratory infections Smoking / exposure to pollutants – risk factors Voice abuse / laryngeal trauma. Posterior glottis commonly involved GERDS

laryngeal infections

4Etiology

URI Neck space infections GERDS Non specific inflammation (sarcoidosis, Wegner’s granomas) Allergy Inhalation of toxic fumes

laryngeal infections

5Clinical features

Change / loss of voice Sore throat Otalgia Difficulty in swallowing / painful swallow Tender larynx Cervical adenopathy Difficulty in breathing

laryngeal infections

6Indirect laryngoscopy

laryngeal infections

7Indirect laryngoscopy

Inflammation involving mucosa of supraglottis / glottis / subglottis

Vocal cord reddish & oedematous Pooling of saliva is there is

odynophagia

laryngeal infections

8Management

Absolute voice rest Avoidance of irritants / fumes Avoidance of gargling Antibiotics reserved only for severe bacterial infections. Moraxella

catarrhalis is common. Augmented amoxicillin drug of choice

laryngeal infections

9Acute epiglottitis

Also known as supraglottitis Epiglottis is commonly affected Lingual tonsils, aryepiglottic folds and ventricular bands may also be

involved Can involve all age groups Can progress rapidly in children causing airway obstruction Hemophilus influenza is the commonest organism involved

laryngeal infections

10Acute epiglottitis

laryngeal infections

11Clinical features

Drooling Painful swallowing Voice change Inflamed epiglottis, aryepiglottic folds, arytenoids and ventricular bands Cervical adenopathy

laryngeal infections

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laryngeal infections

13Tripod’s sign

laryngeal infections

14Radiology. Thumb sign

Enlarged epiglottis “Thumb sign” Absence of deep well defined

vallecula “Vallecular sign”.

laryngeal infections

15Complications

Respiratory distress Epiglottic abscess Internal jugular vein thrombosis

laryngeal infections

16Management

If a child should be admitted Airway compromise – Tracheostomy Antibiotics – III generation cephalosporins

laryngeal infections

17Croup

Laryngotracheal bronchitis “Sore throat with hoarse breathing” Children 6 months – 3 yrs Uncommon in adults Subglottic oedema Biphasic stridor

laryngeal infections

18Etiology

Commonly viral Paramyxovirus, parainfluenza virus Types I and II have been implicated In adults herpes simplex have been implicated

laryngeal infections

19Clinical features

Cough Sore throat Malaise Mild fever Inspiratory stridor

laryngeal infections

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laryngeal infections

21X-ray chest

Narrowing seen at the level of subglottis

Steeple sign / pencil sign

laryngeal infections

22Management

Self limiting disease Patient improves within a day Completely recovers in 3-4 days Oxygenation Steroids Adrenaline nebulisation

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