Disorders of the larynx Flashcards
What are the causes of acute laryngitis?
Infection (w/ URTI, fever, malaise)
- Commonly viral
- Bacterial 🡪 Strep. pneumoniae, H. influenzae, M. catarrhalis
- Fungal (predisposed by DM & use of steroid inhalers)
Vocal strain
Irritant substances 🡪 cigarette smoke, fumes
What are the signs and symptoms of acute laryngitis?
Symptoms
- Hoarse voice
- Aphonia (loss of voice)
- Pain on speaking or swallowing
O/E
- Inflamed larynx 🡪 swelling & erythema of vocal cords, arytenoids, false cords, epiglottis
- Movements of cords restricted (symmetrical; no paralysis)
What is the treatment of acute laryngitis?
Supportive 🡪 voice rest, simple analgesia, anti-cough
Voice rest is crucial
- Forced vocalization of an inflamed larynx can cause haemorrhage into vocal fold and fibrous reaction, leading to permanent vocal disorders
- Speak minimally in a quiet conversation voice (no whispering)
What is the cause of epiglottitis/ supraglottitis?
Haemophilus influenzae (type B), spread from retropharyngeal abscess
What are the clinical features of epiglottitis/ supraglottitis?
- Starts w/ routine URTI
- Fever, sore throat
- Suggestive features (3Ds) 🡪 dysphagia, drooling, distress, voice change (hot potato), change in child’s cry, child sitting up & using accessory muscles of respiration
- CThe patient will look unwell and is classically seen, in late stages on the disease, sitting in the tripod position (to allow gravity to assist in keeping the airway open)
- Respiratory distress (inspiratory retractions, cyanosis) and inspiratory stridor
- Toxic appearance
- Can rapidly progress to total airway obstruction within hours of onset
How is epiglottitis/ supraglottitis managed?
Do not lie patient down (may obstruct airway)
No intra-oral examination (can cause respiratory arrest and laryngospasm)
Transfer to OT, examine larynx to make diagnosis w/ ENT surgeon and anaesthetist
Secure airway by endotracheal tube
Give IV antibiotics + ventilator support + IV steroids (to reduce inflammation) + IV hydration (if poor oral intake)
what causes croup/ laryngotracheobronchitis?
viral (e.g. parainfluenza, RSV, adenovirus), H. influenzae
Diffuse inflammation of the airways
Tends to have longer course than epiglottitis; serious & life-threatening
what are the clinical features of croup/ laryngotracheobronchitis?
- Croup is a self-limiting illness, becoming worse within 48 hours and then gradually improving.
- It is typically preceded by an upper respiratory infection, before developing into dyspnoea and a characteristic barking cough, with potential fever. Symptoms are usually worse at night.
- Rise in temperature and stridor
- Generalized deterioration, child becomes toxic
how is croup/ laryngotracheobronchitis managed ?
IV antibiotics, nebulized adrenaline
Airway obstruction
- Always be mindful and monitor for this possibility
- Period of ventilation might be necessary 🡪 requires ETT, temporary tracheostomy
What causes chronic laryngitis?
- Chronic laryngeal inflammation is often multi-factorial, may be triggered by URTI
- Common causes 🡪 cigarette smoke, vocal abuse, chronic bronchitis, sinusitis (w/ postnasal drip), environmental pollutants, acid reflux (LPR), alcohol fumes
- Rarer causes (require vocal cord biopsy) 🡪 TB, syphilis, leprosy, scleroma, fungal infections
what are the symptoms and signs of chronic laryngitis?
Symptoms 🡪 hoarse voice
Signs 🡪 erythematous, thickened, oedematous vocal cords
what are the complications of chronic laryngitis?
Reinke’s oedema (permanent accumulation in submucosal lamina propria or Reinke’s space, due to poor lymph drainage)
Dysplasia or carcinoma in situ (due to chronic inflammation)
Invasive cancer
how is chronic laryngitis managed?
Speech therapy, removal of causative factors
Monitoring for development of cancer
For Reinke’s oedema 🡪 incision of mucosa, sucking out of oedematous fluid
