Acute laryngitis

1

Acute Laryngitis

Author: Arvils Neško RSU MFIII

Supervisor: Dr. Dins Sumerags

07.03.2016. Rīga

2

Inflammatory process in the mucosa of the vocal cords and larynx

Abrupt onset, lasts less than 3 weeks, self limitedTypical symptoms are

»Hoarse voice

»Sensation of tickling, rawness in throat

»Dry cough

»Mild fever

Definition and Presentation

3

Etiopathogenesis

Caused by»Viral infections

»Traumatic (excessive shouting, inhalation of toxic fumes, direct injury)

»Bacterial infections

Edema and hyperemia of damaged laryngeal structures

4

Loss of function»Phonation

»External breathing

Etiopathogenesis

5

Diagnosis of laryngitis is based on symptomsDirect laryngoscopy if symptoms > 3 wk

Diagnostics

6

Differential Diagnosis of Importance

Reflux laryngopharyngitis Infectious/allergic chronic laryngitis Spasmodic disphonia

7

Therapy

Voice rest Steam inhalations Smoking cessation Cough suppressants (Dextrometorphanum) Corticosteroids should not be prescribed on regular

basis

8

When Acute Laryngitis Must Be Taken Seriously

9

Pediatric Epiglottitis

Medical emergency Etiology

»H. Infulenzae B and non-type B

»Sometimes Str. pneumoniae et pyogenes, S. Aureus

2 - 4 y/o Rapid onset (2-6 h) Fever, sore throat, stridor

10


Diagnosis is based on clinical findings Indirect laryngoscopy is not recommended Lateral soft tissue X-rays with «thumb sign»

11

Thumb Sign

12


Airway maintenance»General anesthesia

»Oral/nasotracheal intubation

»Direct laryngoscopy

- Cherry red and swollen epiglottis, false vocal cords, arytenoid folds

- Subglottic region normal or minimally involved

»Culture sample

Empiric antibiotic therapy»Ampicillin/sulbactam

»2nd or 3rd generation cephalosporines

13

Case Report

Ashley M. Cerqueira et Al., «A case of acute epiglottitis caused by Haemophilus influenzae type a in an

adult», JMM Case Reports (2014)

14

Case report

65 y/o woman Presents w/:

»Sore throat

»Mild fever and chills

»General malaise

Previous history significant w/:»Obesity

»DM type II, hyperlipidemia and proteinuria

»Osteoarthritis

15

Case Report

Prescribed Tamiflu (oseltamivir) Returned on the following day w/:

»Progressive dysphagia and dyspnea

»Severe sore throat and drooling

»Increased neck swelling

Sent to emergency department

16

Case Report

Physical examination»Temperature of 35.6°C

»HR, RR, BP and blood oxygen saturation N

»Cervical lymphadenopathy with tenderness on palpation

Instrumental data»Chest X-ray revealed clear lungs, normal pleura and a

normal-sized heart

»Neck X-ray showed prominence of the epiglottis and upper tracheal narrowing, confirming epiglottitis

17

Lateral Neck X-Ray

18

Therapy

i/v dexamethasone 10 mg i/v ceftriaxone 1 g and vancomycin 1 g

19

Results

Three days after admission, the patient showed an improvement in breathing and swallowing, and was able to speak

Discharged home and oral Kephlex (Cephalexine) was prescribed

Culture sample revealed H. influenzae type A

20

Resources

Basic Otorhinolaryngology A Step-by –Step- Learning Guide.

» Authors: R.Probst, G.Grevers, H.Iro

» Publisher: Themie 2006

Ballenger`s otolaryngology: head and Neck Surgery (16th Edition)

» Authors: Snow, James B. Wackym, P.Ashley

» Publisher: PMPH USA, Ltd, original publication 2003

Cummings otolaryngology–head & neck surgery (6th edition)

» [edited by]: Paul W. Flint, Bruce H. Haughey, Valerie Lund, John K. Niparko, K. Thomas Robbins, J. Regan Thomas, Marci M. Lesperance

» Publisher: Saunders, 2015

21

Some More Resources

http://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/laryngeal-disorders/laryngitis

http://emedicine.medscape.com/article/864671-overview

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498669/






22

Thank You!

Health & Medicine

Acute laryngitis