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Chronic laryngitis

Chronic laryngitis. Chronic laryngitis refers to an inflammatory process that determines irreversible alterations of the laryngeal mucosa Reactive and reparative processes of the larynx represent the main pathogenetic factor, which can persist even when the causative stimulus ends.

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Chronic laryngitis

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  1. Chronic laryngitis • Chronic laryngitis refers to an inflammatory process that determines irreversible alterations of the laryngeal mucosa • Reactive and reparative processes of the larynx represent the main pathogenetic factor, which can persist even when the causative stimulus ends

  2. Non specific : No specific detectable cause • Chronic hyperemic • Ch Hypertrophic • Atrophic • Pachydermia (contact granuloma / contact ulcer ) • Specific  Chronic granulomatous lesions e.g. Tuberculosis, Syphilis, Scleroma, leprosy, fungal infections & amyloidosis

  3. Chronic Hyperemic laryngitis • Diffuse inflammatory condition involving the whole larynx particularly true & False vocal cords

  4. Causes • Recurrent acute laryngitis / Incompletely resolved Ac laryngitis more than 3 weeks • Chronic infection in the vicinity sinusitis, tonsillitis, bad orodental hygiene , Ch Bronchitis • Occupational factors  dust & Fumes • Smoking & Alcohol • Voice abuse • GERD

  5. Clinical Features • Males affected more than females • Hoarseness of voice • Fatigue of voice • Hawking & irritation larynx • Dry irritating cough • Laryngoscopy Hyperemia , Vocal cords appear dull & edges are rounded, Viscid secretions on VC / interarytnoid region

  6. Treatment • Eliminate The cause  infection / irritating factors • Complete voice rest / Observe proper vocal hygiene • Medicated steam inhalation • ? Expectorants

  7. Chronic hypertrophic laryngitis • Advanced stage of hyperemic laryngitis • Cellular infiltrate in the submucosa • Epithelium may undergo hyperplasia / metaplasia • May be generalized involvement • False VC (ventricular bands)  “Dysphonia plica ventricularis” • True vocal cords  Rinke’s Edema

  8. Causes  As for hyperemic chronic laryngitis • Laryngoscopy  Laryngeal mucosa is thickened & dusky red in colour • Vocal cords red & swollen, Edges loose sharp demarcation • In Dysphonia plica venticularis false vocal cords swollen, may cover true VCs

  9. Treatment • Conservative • Surgical  Stripping of edematous mucosa with micro-scissor • Ablation with LASER • One side done at a time to prevent Web

  10. Atrophic laryngitis • Common in women • Associated with Atrophic Rhinitis • Laryngitis Sicca • Exact cause not known  Hormonal disturbance, Dietary deficiency, Autoimmune disorder • Bacillus ozaenae secondary infection

  11. Clinical features • Hoarseness • Dry irritating cough • Dyspnoea due to crusts • Laryngoscopy  Laryngeal mucosa is dry & atrophic • Covered with foul smelling crusts

  12. Treatment • Primary condition  Atrophic rhinitis • Steam inhalation • 25% glucose in glycerin sprays • Expectorants containing Iodides to loosen the crusts

  13. Tuberculous laryngitis • Secondary to Pulmonary tuberculosis • Common in adult males • Brochogenic / hematogenous route • Bronchogenic route affects posterior larynx --- Interarytnoid region, submucosal tubercles & granuloma • Hematogenous  Multiple painful ulcers in larynx & pharynx

  14. Clinical features • Hoarseness • Painful ulcers / referred otalgia • Odynophagia • Laryngoscopy  Pale granulations in the interarytnoid region

  15. Ulcers of vocal cords  mouse eaten appearance • Swelling of false VCs & Aryepiglottic folds • X-Ray chest • Sputum for AFB • Biopsy • Treatment : As for pulmonary tuberculosis

  16. Vocal Nodules • Singer‘ nodules • Common in voice misusers  Teachers, singers, preachers & Vendors • Vocal trauma  submucosal hemorrhage  fibrosis & hyalinization • At the junction of anterior 1/3 7 posterior 2/3 ( subject to maximum trauma )

  17. Clinical features • H/o misuse of voice • Hoarseness • Vocal fatigue • Laryngoscopy  Symmetrical nodular pinkish or grey masses at junction of ant 1/3 & post 2/3 of true vocal cords

  18. treatment • Conservative • Avoid misuse of voice • Speech therapy / proper use of voice  No shouting / No whisper • ? May change the profession • Surgical  Microlaryngoscopy & LASER

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