Infections Of Larynx

Question 1

Functions of larynx

Answer 1

Protection of airways
Swallowing
Respiration
Phonation

Question 2

What is stridor?

Answer 2

High pitched noise that is produced as a result of turbulence of air when it passes down through narrowed airways

Stridor is produced when there’s obstruction in the larynx upto secondary bronchi

Question 3

What are the types of stridor ?

Answer 3

Inspiratory
Expiratory
Biphasic

Question 4

Types of stridor

Answer 4

Inspiratory
Expiratory
Biphasic

Question 5

What causes Inspiratory stridor ?

Answer 5

Supraglottic and glottic conditions

Question 6

What causes expiratory stridor?

Answer 6

Obstruction of intrathoracic trachea upto secondary bronchi

This is because during inspiration there will be decreased intrathoracic pressure that causes the airway to expand well allowing air to flow in . But during expiration the pressure in the intrathoracic cavity builds up and causes narrowing of airways causing expiratory stridor

Question 7

What causes biphasic stridor ?

Answer 7

Subglottis conditions

Here there is cricoid cartilage that is a complete ring and obstruction at this level while not be altered by the external pressure and stridor is present both during inspiration and expiration

Also seen in cervical trachea and in some glottic conditions

Question 8

What is stretor?

Answer 8

Low pitched noise that is produced as a result of obstruction above the level of larynx ( nose , nasopharynx ,oropharynx )

Question 9

What is wheeze ?

Answer 9

Noise that is produced as a result of obstruction beyond secondary bronchi

Question 10

If stridor changes with positions then where is the pathology?

Answer 10

At the level of supraglottis ( at the level of inlet )

Stridor increase in supine position and decrease in prone position/bending forward

Question 11

Speech in glottic conditions

Answer 11

Will be changed
It will be hoarseness , Dysphonia , aphonia

Speech will be mostly normal in supraglottic conditions but can be sometimes muffled

Question 12

Dysphagia is seen when which part is affected ?

Answer 12

Dysphagia / odynophagia / drooling occurs when there’s inflammation of epiglottis , arytenoids(inlet is affected)

Drooling of saliva is seen in infants (mostly) as it is very painful even to swallow the saliva

Question 13

Acute Epiglottitis is also known as

Answer 13

Acute supraglottic laryngitis

Question 14

What is acute Epiglottitis / supraglottic laryngitis ?

Answer 14

Acute inflammatory condition confined to supraglottic structures ,I.e,epiglottis , Aryepiglottic folds , arytenoids

Question 15

Causative organism of supraglottic laryngitis / acute Epiglottitis

Answer 15

Earlier - H.Influenza type B

Now-a-days - Streptococcus

Question 16

Age group affected in acute Epiglottitis / supra glottic laryngitis

Answer 16

2-7 years - most common

Adults sometimes can also be affected

Question 17

Clinical features of supra-glottic laryngitis / acute Epiglottitis

Answer 17

Sore throat

Dysphagia / odynophagia / drooling of saliva - in adults

Dyspnoea and stridor (Inspiratory) - due to edema of the involved structures that will obstruct the airways - in children

Fever - due to septicaemia

Voice may be normal / muffled

Stridor will be more in supine position and less in prone / bending forward position /tripod position

Overall the child will have a toxic / sick appearance

Question 18

Investigations for acute Epiglottitis / supra glottic laryngitis

Answer 18

Indirect laryngoscope is contraindicated as it will precipitate laryngospasm and causes complete obstruction

Preffered investigation - x ray of lateral soft tissue neck

Question 19

X ray findings in acute Epiglottitis / supra epiglottis laryngitis

Answer 19

Thumb sign - swollen epiglottis

Question 20

When is endoscopy / IDL is done ?

Answer 20

For children it is done in ot under intubation

For adults it can done in op as there’s is not much edema when compared to children - edema is not so much as submucous tissue is so tight in adults

Question 21

Management of acute Epiglottitis / acute supraglottic laryngitis

Answer 21

Hospitalisation - as there is risk / danger of airway obstruction

Secure the airway - either by intubation / tracheostomy (if intubation is not possible)

I.V antibiotic - to reduce infection = ampicillin / third generation cephalosporins are used

Steroids - to reduce edema = hydrocortisone / dexamethasone

Adrenaline nebulisation - to improve breathing as it Causes vasoconstriction and bronchodilation

Hydration - since they will be dehydrated

Question 22

What is the other name for croup ?

Answer 22

Acute laryngo - tracheo - bronchitis

Question 23

Croup is caused by

Answer 23

It is an viral infection (parainfluenza types 1 and 2 )

Secondary infection by gram positive cocci

Affects child between 6 months - 3 years of age

Question 24

Symptoms of croup

Answer 24

Starts as URTI with hoarseness of voice and croupy / barking / seal like cough

Fever

Initially the stridor is Inspiratory later it becomes biphasic ; doesn’t change with position

Difficulty in respiration will gradually increase

There will be no Dysphagia , odynophagia , drooling of saliva

Question 25

X ray sign of croup

Answer 25

Steeple sign / pencil tip sign.

Question 26

Difference between croup and acute Epiglottitis

Answer 26

In croup - the patient will have running nose , malaise , general symptoms ; will have a gradual onset

In acute Epiglottitis - the onset will be acute and will be localised

Question 27

Management of croup

Answer 27

Hospitalisation - due to respiratory obstruction / breathing difficulty

Do laryngoscope after anaesthesia and take swab for to identify if there’s any secondary infection and intubate

Antibiotics if there’s secondary infection - ampicillin

Steroids - to relieve edema

Adrenaline nebulisation - to improve breathing as it causes vasoconstriction and dilation of bronchi

Hydration

Humidification - to soften crusts and tenacious secretions in tracheobronchial tree

Heliox - helium : oxygen (70:30) = make the air flow to become more laminar

Question 28

Tb larynx findings

Answer 28

Pseudoedema of epiglottis - turban epiglottis

Mouse nibbled vocal cords

Mamillated arytenoids

Here , TB IS PAINFUL