CHRONIC LARYNGITIS

Prepaired By: Dr.Zabihullah “Rasooly

The Laynx:

• Synunym:Voice box.• Definition:Larynx is a

portion of the respirato -ry tract that causes

phonation.• Length:Two(2)• Shape:Tube –shape.

Sructures:

• Cartilages:Paired and Unpaired: -Unpaired:Thyroid,Cricoid and Epiglottis. -Paired:Arytenoid,Corniculate and Cuneiform.• Laryngeal Joints: Cricoarytenoid joint and

Cricothyroid joint.• Laryngeal Membranes:Extrinsic &Intrinsic M.• Laryngeal ligament:Extrinsic & Intrinsic Lig.• Laryngeal Muscles: Extrinsic & Intrinsic Ms.

Cartilages:

• Thyroid crtilage: - Fibroelastic. - two alae(lamina). - ossification(25-65). - Adam’s apple.

• Cricoid cartilage: - Hyaline . - It is ring form. - Its laminae is post. - Its arch is ant.

Cartilages:

Cartilages:

• Epiglottis Cartilage: - Shape:Leaf like. - Anteroupper of larynx. - Fibroelastic cartilage.• Arytenoid Cartilages: - Pyramidal shape. - Elastic cartilage

Cartilages:

• Corniculate Cartilages: - Conical shape. - Hyaline cartilage.• Coneiform Cartilages: - Club shape. - Hyaline cartilage

Laryngeal Joints:

• Cricoarytenoid Joint: - Synovial. - Movement:o Rotatory.o Gliding .• Cricothyroid Joint: - Synovial.o Rotatory.

Laryngeal Membranes:

• Extrinsic membranes: - Thyrohyoid Menmbrane. - Cricothyroid membrane - Cricotracheal membran• Intrinsic Membrane: - Crico vocal membrane. - Quadriangular memb.

Muscles of the larynx:

• Intrinsic Muscles:o Acting on vocal cord: - Adductors:1. Lateral cricoarytenoid.2. Interarytenoid.3. Thyroarytenoid. - Abductors:4. Post.Cricoarytenoid. - Tensor:5. Cricothyroid.6. Vocalis(Int.Part of TA).

Muscles of the larynx:o Acting on laryngeal inlet - Openers of laryngeal inl1. Thyroepiglottic Ms. - Closers of laryngeal inl:2. Interarytenoid Ms.• Extrinsic Muscles:o Depressors Of laryngeal inlet or Infrahyoid Ms:1. Sterno-thyroid.2. Sterno-hyoid.3. Thyro-hyoid.4. Omo-hyoid.

Muscles of the larynx:o Elevators of Laryngeal inlet or Suprahyoid Ms: - Primary:1. Stylopharyngeus.2. Salpingopharyngeus.3. Palatopharyngeus.4. Thyrohyoid. - Secondary:5. Mylohyoid(main).6. Stylohyoid.7. Genohyoid.8. Digastric.

Cavity of the larynx:

• Supraglottis: - Ventrical:fals vocal cord - Ventricular band. - Vestibule.• Glottis.• Subglottis.

Blood Suply of the larynx:

• Laryngeal Bronches of superior thyroid artery.

• Laryngeal Bronches of Inferior thyroid artery.

• Cricothyroid Bronches of Inf. Thyroid artery.

Nerve Suply of The Larynx:

• Vagus Nerve:o Sup. Laryngeal Nerve:1. Internal Br. (sensory).2. External Br. Motor.o Recurrent(Inferior)

Laryngeal Nerve:1. Anterolatral(Motor)Br.2. Poteromedial(sensory)

Bronch.

Lymphatic Drainage of the Larynx:

• Supra Glottic:1. Pre epiglottic Nodes.2. Upper Deep Cervical Nodes.• Sub Glottic:1. Pre Laryngeal & Pre Tracheal Nodes.2. Lower Deep Cervical Nodes.

Physiology of Larynx:

1. Protection of lower airway.2. Phonation.3. Respiration.4. Fixation of the chest.

Chronic Phryngitis:

• Chronic Laryngitis without Hyperplasia (Chroic Hyperaemic Laryngitis)

• Chronic Hypertrophic Laryngitis (Syn.Chronic Hyperplastic Laryngitis) OR Infectious or Allergic Chronic Laryngitis.

Pathophysiology:

• An inflammatory process that determines irreversible altrerations of the larynx mucosa.

• Damage of the ciliated epithelium.• Impaires the moving of the mucos out.• Mucos stasis on the post.wall or around vocal cords.• Reactive cough.• Laryngospasm.• Hyperkeratosis, Dyskeratosis, Parakeratosis,

Acanthosis and cellular atypia.

EpidemiologY:

• Mortality:Related to main disease which associated with.

• Race.• Sex: (2:1)• Age.

Signs and Symptoms:

• Derive from anatomic functional alterations of the larynx they are as follow:

1. Hoarse voice and dysphonia.2. Chronic cough (at night).3. Stridor due fo bronchospasm.4. Dysphagi and Otalgia.

Examination:

• Personal History:1- Time of onset of symptoms.2- General state of health.3- Occupatioal history.4-Vocal abuse.5- Heart burn,Regurgitation,Dysphagia,Cough…6- Presence of asthma.7-Prescription or over-the counter medication. A- Local drying or mucosal injury. B- I nhaled Steroid use or Immunosuppressant.

Personal history:

8-Medications(CCB,BB,Nitrates,progestrone).9- Inhalation treatment(thermal inhale).10-Surgical history(intubation).11-Neck trauma history.12-Ingestion of caustic substance.13-Travel history(parasitic infection).

Examination:

• Family History:1. Autoimmune diseases.2. Invironmental pollutants.3. Infectious disease(TB...).• Social history:1. Cigarette smoking,recreational drugs,alcohol.2. Eating habits(chocolate,caffeine).3. Practices that may pose a risk of infectious diseas

(HIV,AIDS,Syphilis).

Causes:

• GERD.• Infections:1. Commonly staph aureus,H.Ifluenza…2. TB.3. Leprosy.4. Syphilis.5. Rinoscleroma.6. Actinomycosis.7. Viruses.8. Fungal Infection.

Causes:

• Voice abuse.• Allergic responses.• Invironmental Factors.• Inhelation of sulfur,Mustard,Alkyline warfare

agent.• Systemic Disease:1. Wegener granulomatosis.2. Amyloidosis.3. Relapsing polychondritis.

Causes:

• Cutaneous Diseases:1. Similar mic and mac characteristic in skin and

larynx.2. Pemphigus,SJS,SLE,Epidermolysis bullosa.• Neorogic .• Spastic dysphonia.• Vocal folds atrophy.• Muscular disorders.• Pellagra.

Differential Dianosis:

• Chondronecrosis of the Larynx.• Cntact Granulomas.• Glottic Stenosis.• Iatrogenic Vocal Fold Scar.• Subcglottic Stenosis in adults.• Sulcus Vocalis.• Vascular Lesions of the Vocal Fold.• Vocal Fold Cysts.

Workup:

• Laboratory studies.• Imaging studies.• Other tests.• Procedures.• Histological findings.o Lab studies:1. CBC and DLC.2. Swab of laryngeal mucosa.3. Serologic markers for autoimmun D.4. Study for TB and Syphilis.

Workup:

o Imaging studies:1. Lateral plain neck radiography.2. Chest Radiography.3. CT scan.4. MRI.5. Barium swallow study, double contrst.6. Videostrobe.

Workup:

o Other tests:Skin tests if allergies are suspectedo Direct exam of the larynx with flexible

fiberoptic nasopharyngoscope:1. Direct laryngoscopy.2. Bronchoscopy and Esophagoscoy.3. Stroboscopic exam.4. Endoscopic removal of polyp and lysis of

adhesions.

Workup:

o Histologic Finding:1. Infiltrative disorders.2. Chronic nonsoecific inflammation.3. Chronic granolomatous diseases.4. Proliferative processes.

Treatment and management:

• Rest.• Medical care.• Surgical Care.• Diet.• Activity.• Consultations.

Medical care:• Infection(CBL): Antimicrobial therapy.• GERD:(H2 receptor antagonests,PPI,Prokinetics.• Decongestants.• Aalgesics.• Steroids.• Expectorants.• Supportive measures:o Hydration.o Steam inhelation.o Avoiddance of pollutants or irritative/toxic substance.o Avoidance of invironmental and occupational sensitizers: -Limitation of exposure. - Avoidance of cigarette smoking.

Surgical care:

• Reduction of stenosis.• Exophytic mass removal by surgical means.• Laser Vaporization.• Laparoscopic antireflux surgery.

Consultation:

• Allergists:• Gastroenterologists.• Pulmonologists.• Speech therapists.

DieT:

• Avoid: Fat, alcohol,Caffeine.• Avoid allergen food.

Activity:

• Avoid: Habits or activities that cause acid reflux.

Complications:

• Spread of Infection.• Laryngeal stenosis.• Transformation info cancer.

Prevention:

• Hands washing.• Avoid cantac whith who have flu or cold.• Avoid excessive use of voice.• Avoid working in pullotant area.• Avoid smoking.

Prognosis:

• Relates to causative process.

References:

• PL Dhingra.• Medscape.• AAO