Diseases of the larynx

Acute laryngitis

Inflammation of the mucous membrane

Acute (catarrhal) laryngitis

Ethiology: viruses
Mucous membrane: hyperemic and swollen
changed voice, cough, fever
usually without dyspnoe

(laryngitis acuta)
bacterial complication of viral infection of larngeal mucous membrane
Hoarseness, laryngeal pain, cough, expectorating purulent discharge
By laryngoscopy: redd mucous membrane, thick mucus covered by discharge, subglottic swelling
antibiotics, mucolytics, inhalations

Acute subglottic laryngitis

oedema of subepithelial connective tissue of subglottic
children 6-month – 6-year old, season (autumn/winter)
ethiology: virus (Parainfluenza type 1, 2 i 3, Influenza A i B), allergy, GERD
symptoms: (at night) – dry cough, dyspnoea with stridor, voice is clear
general condition: pretty good

TREATMENT:
Steroids in inhalation
Cold air, Humidification of air
Hydratation
In serious cases steroids i.m or i.v.
Optionally: mucolytics, expectorants, antiallergic drugs,antibiotics,

Acute epiglottitis

  • inflammatory inflitration of mucosa of epiglottis and/or aryepiglottic folds
    small children (2 – 8 y.o), but also adults
  • etiology: bacterial , mainly Haemophilus influenzae Type B H. parainfluenza, Strep. pneumoniae, Moraxella catarrhalis, Staph. aureus
  • symptoms: 4 x D” = Drooling, Dysphagia, Dyspnoea, Dysphonia
    bad condition: patient is anxious, has fever, may quickly develop sepsis and 
r-c insufficiency
  • treatment: i.v. antibiotics max. doses, steroids, painkillers, mucolytics, oxygen, intubation (1 – 2 days) [elective], incision when abscess present

inflammation of submucous tissue

limited

Laryngeal abscess:
older children and adults
bacterial (streptococcal)
infiltration, purulent content below the mucosa, mainly glossal surface of epiglottis, aryepiglottic fold
symptoms: fever, painful swallowing, dyspnea, otalgy, swelling and
 red epiglottis /aryepiglottic fold
treatment: abscess drainage, antibiotics i.v.
complications: laryngeal or neck phlegmon, mediastinitis, pneumonia, sepsis

diffuse

laryngeal phlegmon:
adults, frequently older
etiology: bacterial (streptococcal)
diffuse purulent infiltration below the mucous membrane surface 
of the larynx
symptoms: bad condition, fever, chills, painful neck, unclear outlines of the larynx, severe dyspnea, painful swallowing, drooling, otalgy, hoarseness, aphonia; Inflammatory swelling of the mucosa, thick and immobilized epiglottis
treatment: tracheotomy, antibiotics, multiple incisions of the mucosa
complications: neck phlegmon, mediastinitis, pneumonia, sepsis,

Chronic laryngitis

simple

  • Thickening of epithelium, hyperaemia, hypersecretion of thick mucus
  • Hoarseness (morning), voice weakening (evening), hawking
  • Laryngoscopy: hyperaemic, thick vocal cords, between vocal cords secretion
  • Elimination of predisposing irritating factors, mucolytics, inhalations

hypertrophic

  • Continuation of chronic simple laryngitis
  • Advanced stages are precancerous laesions
  • Thickening of epithelium with keratosis
  • Globus feeling in the throat, hawking, change of voice (hoarseness and aphonia)
  • Laryngoscopy: hypertrophic, thick vocal cords covered with thick secretion, edge of cords sometimes with polyps. Ventricule folds thick with focal keratosis
  • Elimination of irritating factors, laryngeal microsurgery, mucolytics, NSAIDs
  • Follow-up

atrophic

  • Atrophy of mucous membrane and its glands
  • Associated with Sjoegren syndrom, hormonal disorders, after irradiation
  • Feeling of dryness, itching in the throat and larynx, cough, hawk, change of voice
  • Vocal cords thin, greyish, weak
  • Treatment is symptomatic: mucolytics, intralaryngeal drops, voice therapy

Vocal fold polyp

Reinke edema

  • hypertrophy of the anterior 2/3 of the vocal folds, bilateral
  • Mainly female patients
  • Voice abuse, tobacco smoking, GERD, hypothyreosis
  • Voice disorders, hoarseness, rarely dyspnea
  • Microsurgery (decortication), voice rehabilitation

Singers nodules

  • Mainly children and women
  • symmetric, located 
in the anterior 1/3 of the both 
vocal folds
  • Result of the voice abuse and microtrauma
  • functional vocal insufficiency of the larynx
  • New nodules – conservative treatment
  • Hard nodules – microsurgery of the larynx

GERD

  • Inflammatory – oedematous laesions of mucuos membrane of posterior part of the larynx
  • present features: ulcers, granulomas, submucous exudation laesions
  • Voice disorders, coughing, hawking, feeling of „globus” in the throat
  • Gastroenterological diagnositcs and treatment
  • Microsurgery, voice therapy

Congenital malformations

  • Congenital laryngeal malacia (50 – 75%)
  • Congenital subglottic stenosis
  • Vocal folds paresis
    Laryngeal web (diaphragm)
    Laryngeal cysts (laryngocoele i mucocoele)
    Subglottic haemangioma
    Atresia of the larynx (atresio laryngis)

Symptoms

  • stridor
  • dyspnoea with varying degree of severity
    weak, silent cry and scream of the baby
  • choking during feeding
  • changed voice, hoarseness

laryngomalacia

  • the most common congenital malformation (50-75%)
  • 2 x more frequent in males
  • the flaccid parts of supraglottis collapse into the larynx during inspiration causing stridor
    it increases during cry, feeding, lying on the back
  • etiology unclear
    (some abnormalities in calcium metabolism, disorders of neuro-muscular coordination, gastro-esophageal reflux)
  • it usually subsides by the age of 2

Laryngeal tumors

  • Epithelial origin
    benign: papilloma, adenoma
    malignant: carcinoma
  • mesenchymal
    benign: fibroma, lipoma, angioma, myoma, chondroma, osteoma, neurogenic tumors
    malignant: sarcoma, lymphoma, malignant melanoma

Papilloma

  • Juvenile type
    Hoarseness, dyspnea
    multiple, HPV infection, easily transmitted to the other sites like trachea, bronchi,
    frequent recurrence → terapeutic problems
    treatment – surgical excision microlaryngoscopy, CO2 laser, interferon.
  • Adult type
    The most frequent benign tumor of the larynx
    M > F
    Hoarseness
    Etiology – cigarette smoke, trauma
    Recurrence rarely
    Malignant transformation is observed – each papilloma should be removed as potentially malignant
    Treatment - surgery

Laryngeal sarcoma is very rare
Endoscopy- usually looks like polyp
The most frequent fibrosarcoma – 5% of laryngeal sarcoma, at any age, M=F, mostly on the vocal cord or in the supraglottic area
tendency to local recurrence

Chondroma/Chondrosarcoma –
endoscopy: bulge with normal mucosa
frequent in older males, 75% cases from dorsal part of cricoid cartilage, well differentiated- 3x more frequent
local recurrence

Malignant melanoma: very rare as a primary, frequent as a metastase
Usually males, > 50 y.o.
Supraglottic area location, non-pigmentous polyp or tumor
Prognosis very poor

Metastatic laryngeal tumors

Very rare
Blood and lymphatic vessels
30% of the metastates to the larynx – malignant melanoma

  • 17% renal carcinoma
  • 10% bronchial carcinoma
  • 10% breast cancer
  • 6% prostate cancer
  • 2% digestive tract cancer
  • sarcomas – extremely rare
    Prognosis is usually very poor

Matar