DISEASES OF THE LARYNX

Prepared by Dr. Muaid I. Aziz Otolaryngologisthead & neck surgeon M.B.Ch.B F.I.C.M.S

Inflammatory . Benign laryngeal lesions. Malignant laryngeal lesions. Vocal cord paralysis Stridor Tracheostomy Laryngeal trauma

Inflammatory diseases of the larynx

Acute laryngitis Its an acute inflammation of the larynx of V. or B. origin. Sx 2ndry to airway size. Acute simple lary. = laryngo-tracheo-bronchitis (ALTB) = epiglotitis

Acute simple lary.

Commonly occurs as a sequel to URTI of rhino virus origin . Sx; fever , malaise voice change Pain , aggravates on swallowing or speech Cough SN; Hyperaemic & edematous vc R/ Voice rest , AB , analgesics, hydration , steam inhalation , steroids, cough suppressants & expectorants .

Acute laryngo-tracheo-bronchitis(ALTB) (croup)

More sever condition affecting L.T.B, usually of viral origin Parainfluenza 1,2 & influenza A <5y Boys > girls More in winter but overall the year

fever Barky cough Stridor may occur after 24-48 hrs

Respiratory distress sn + bilateral coarse crepitations X-ray neck AP steeple sn R; admission , Humidified O2 , hydration , AB , steroids , intubation or tracheostomy (agitation , cynosis , lethargy, PR 140 , RR 80.)

Plain radiograph AP view

Croup Narrowing of subglottis (Steeple sign)

Acute epiglotitis

Acute inflammation of the Epig. Common in children H. Influenza B (others like s.p ,staph aureus) SX; Fever , Sore throat , odynophagia Voice change Breathing problem later on SN; drooling child Tripod sign All exam . Should be done with extreme gentleness SUNRISE Sign (tongue depressor) IDL avoided FLS X-ray ; thumb print sign R; same of the croup.

Plain radiograph
of upper airway (Lateral film)

Normal anatomy

T: tonsill E: epiglottis AE: ary ep.folds A: arytenoid VC: vocal cords V: ventricle

Plain radiograph of upper airway Lateral film

Acute epiglottitis
(open arrow) Epiglottis (short arrow) Aryep. Folds (long arrow) Ventricle (h) Hyoid bone

Acute epiglottitis (Thumb print sign)

Chronic laryngitis

Chronic specific laryng. = non = = Its chronic inflam. of the larynx predominantly involving v.c , may follow repeated attacks of acute laryngitis. Causes : smoking alcohol dust & chemicals exposure URT allergy reflux oesophagitis vocal abuse chronic URT inf. (sinusitis)

marked by long standing hoarseness dry irritative cough sensation of cleaning of the throat Examination Congested, hyperemic vc (ch.simple hyperemic laryng.CSHL). Thickening of the lary. Epith. (ch. Hyperplastic laryng.CHL) R; 1ry cause Voice rest Speech therapy Microlaryngeal surgery stripping of the cords Ruling out GERD - PPI

Inflammatory Diseases

Candidiasis (as leukoplakia of vocal cords)in immunocompromized pt Tuberculosis(+/_ pul.TB) , as granular pathology ( biopsy , culture , cxr ) Sarcoidosis Syphilis

Epig. Is commonest site

S diff. from TB & fungal inf.

Benign laryngeal lesions.

Nodules Polyp Polypoid

corditis (Reinkes edema)

Cyst
Granuloma

Papillomatosis

V.C Nodules (Singers , teachers , screamers nodules)

Small , greyish white, benign, firm swellings, occuring along the free margin of the TVC as a result of vocal trauma. Ant.1/3 junction w post. 2/3 Usually bilateral. Women more affected Hoarseness R; complete voice rest MLS speech therapy

Its a polypoidal mass forms along the memb. part of the vc Size , Shape & tissue composition are variable - Sessile or pedunculated - Vascular , Fibrotic , or mixoid Commonest site is the ant. commissure or 3 mm post. to ant. Comm. on subglottic surface of the vc. Overlying epith. Is usually normal Size:small:0-3 mm medium:3-6 mm large: < 6 mm R; MLS voice rest speech therapy

Polyp

expiration

inspiration

Polypoid corditis (Reinkes edema)

Difficult to diff. it from a polyp histolog. & morphologically. Diffuse nature, sausage shaped swelling v.c . On manipulation during microlaryngoscopy, feel Boggy & the swelling can be rolled beneath the instruments .

granuloma

1. 2.

3.

Majority arise in arytenoid region Ususally exophytic with narrow base Seen in pt. with GER & with endotracheal intubaton R/:voice therapy & antireflux therapy Surg.resection : Conserv.management has failed Concern of malg.dis. airway compromise

papillomatosis

Result from epithelial proliferation usually induced by human papilloma virus (HPV) 6,11,16 of papova class May involve entire aerodigestive tract, most commonly effects the larynx 2 general forms: juvenile onset and adult onset

Recurrent Respiratory Papillomas (RRP)

Most common benign neoplasm of the larynx in children and adults 2nd most common cause of hoarseness in children In children diagnosis occurs between 2-3 years of age, 75% are diagnosed before 5

Recurrent Respiratory Papillomas (RRP)

Juvenile

Adult onset
more lifetime sexual partners higher frequency of oral sex

vaginal delivery low socioeconomic status

Factors contributing to RRP

Child immune status Time in birth canal Viral load in birth canal

Local trauma

Signs and Symptoms

Begins as an inspiratory stridor or mild hoarseness, progressing to worsening airway obstruction

Cough, pneumonias, and dysphagia

Often misdiagnosed as asthma, croup, allergies, vocal nodules, or bronchitis

Surgical Therapy

excision with phonomicrosurgical instruments Laser: CO2 Laryngeal microdebrider shaver Tracheostomy

Adjuvant Medical Therapy

Interferon alpha Photodynamic Therapy Acyclovir Cidofovir Methotrexate

Interferon Alpha
5 megaunits/m2/IM QD x 28 days, then 3x per week for 5 months, followed by observation for 6 months.