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Acute and Chronic Laryngitis: Causes, Symptoms, and Treatment

Learn about the different types and causes of acute and chronic laryngitis, their symptoms, and treatment options. Understand how laryngitis can be related to systemic diseases and other conditions.

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Acute and Chronic Laryngitis: Causes, Symptoms, and Treatment

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  1. Cummings Chapters 63 & 64 Acute and Chronic Laryngitis Laryngeal and Tracheal Manifestations of Systemic Disease Travis Shiba 12/6/13

  2. Acute and Chronic Laryngitis • Key Points • #1 cause of acute laryngitis = viral • #1 cause of chronic laryngitis = reflux • Candidal laryngitis can occur in non immuno compromised • Even in setting of likely neoplasm, still consider infection

  3. Laryngitis • Inflammation of the larynx • Can impair swallowing, phonating and breathing

  4. Acute Laryngitis • Phonotrauma • Viral Laryngitis • Acute Bacterial Laryngitis • Acute Fungal Laryngitis

  5. Supepithelial hemorrhage from phonotrauma

  6. Supepithelial hemorrhage of R VC polyp

  7. Acute Laryngitis • Phonotrauma • Viral Laryngitis • Acute Bacterial Laryngitis • Acute Fungal Laryngitis

  8. Viral Laryngitis • Pathogens: rhinovirus, parainfluenza, RSV, adenovirus, influenza, adenovirus… • SSx: dysphonia, hoarse voice, cough • Rx: supportive care: hydration, anti-inflam, voice rest, PPI +/- steroids • Croup: laryngotracheobronchitis • Typically parainfluenza 1,3 • Steeple sign

  9. Acute Laryngitis • Phonotrauma • Viral Laryngitis • Acute Bacterial Laryngitis • Acute Fungal Laryngitis

  10. Acute Bacterial Laryngitis • Supraglottitis (epiglottitis) • Pathogens: H influenza, Strep PNA, Staph Aureus, Beta hemolytic strep • Decreased incidence with h flu B vaccine • Rx: airway control. Humid air, IV antibiotics, monitored bed, steroids

  11. Acute Bacterial Laryngitis • Diptheria • Corynebacteriumdiptheria • SSx: acetone breath, thick grey membranous and friable plaque • Rx: airway via trach, diptheria anti toxins, PCN & clinda • Whooping cough • bordetellapertusis • Vaccine protects ~ 3 yrs • Rx: erythromycin to prevent spread

  12. Acute Laryngitis • Phonotrauma • Viral Laryngitis • Acute Bacterial Laryngitis • Acute Fungal Laryngitis

  13. Acute Fungal Laryngitis • Candiasis (moniliasis) • usually seen with oral/esophageal sx or in a pt taking oral inhaled steroids • White sessile plaques on erythematous base • Rx: Fluconazole

  14. Chronic Laryngitis • Bacterial • Fungal • Mycobacterial • Non infectious

  15. Chronic Bacterial Laryngitis • Rhinoscleroma • Klebsiellarhinoscleromatosis • Path: Mikulicz Cells • Rx: fluouroquinolones/TCN • Syphillis • Secondary: painless edema • Tertiary: gummas + cartil destruction • Rx: PCN

  16. Chronic Bacterial Laryngitis • Actinomycosis • Actinomycosisisraelii • Chronic suppurativeinfxn, rarely involves layrnx • Histo: • Sulfur Granules • Rx: PCN or Clinda

  17. Chronic Laryngitis • Bacterial • Fungal • Histoplasmosis • Blastomycosis • Cryptococcus • Coccidiomycosis • Mycobacterial • Non infectious

  18. Histoplasmosis Histoplasmosis SCCA

  19. Histoplasmosis • Histoplasmacapsulatum • Mississippi River Valley • Acute/Chronic, Pulmonary/systemic • Laryngeal Lesions: anterior larynx and epiglottis • Bx: poorly defined granulomas, multinucleated giant cells and pseudoepitheliomatous hyperplasia • Grows on Sabouraouds agar • Tx: Ampho/Azoles

  20. Blastomycosis • BlastomycesDermatitides • Central america/Midwest • Airborne to lung, to larynx hematogenously • Larynx involved 2% - exophytic/ulcerative mass usually on TVC • Histo: Broad based buds • Rx: ampho/azoles

  21. Cryptococcus Cryptococcus neoformans Bird droppings H&N Sx: meningitis (SNHL), membranous Npharyngitis; larynx (only TVC) Dx: india ink stain showing capsules Tx: ampho/azoles

  22. Coccidiomycosis • CoccidioidesImmitis • “valley fever” Southwest US and North Mexico • H&N: lesions (nodules/erosions) of skin, mucous membranes, epiglottis, trachea, salivary glands • Histo: “Sac with bugs” • Rx: ampho/azole

  23. Chronic Laryngitis • Bacterial • Fungal • Mycobacterial • Non infectious

  24. Mycobacterial Laryngitis • Tubercolosis • Direct from lungs or via blood • Dx: PPD/Quant/AFB • Tx: INH/Rifampin/voice rest • Leprosy (Hansen’s) • AFB and granulomas • Ulcerative supraglottis • Dx: foamy leprous cells • Rx: dapsone & CS

  25. Chronic Laryngitis • Bacterial • Fungal • Mycobacterial • Non infectious

  26. Non Infectious Laryngitis Smoking Pollution Vocal Abuse Rhinosinusitis Laryngopharyngeal Reflux

  27. LPR • Etiologies: acid/bile/pepsin • RF: obsity, EtOH, hiatial hernia, preg, scleroderma, feeding tube • SSx: Hoarse (am>pm), globus, dysphagia • Dx: trial of PPI/NP scope • Barium swallow • 24 hour dual pH probe • esophagoscopy

  28. LPR • Rx: • Behavioral: smoking cessation, elevate HOB, avoid late meals, overeating, avoid tight close/loose weight • Decrease caffiene, EtOH, mints, chocolate, • Avoid ASA, nitrates, CCB • Medications • PPI (usually 2x dose for LPR versus GERD) • H2 blockers • Surgery • Fundoplication

  29. Laryngeal and Tracheal Manifestations of Systemic Disease • Key Points • Symptoms: hoarseness, cough, stridor, airway compromise • Mimic laryngeal carcinoma

  30. Wegener’s Granulomatosis Relapsing Polychondritis Sarcoidosis Rheumatoid Arthritis Pemphigus/pemphigoid Amyloidosis

  31. Wegener’s Granulomatosis • Idiopathic necrotizing granulomatousvasculitis • Types: • Limited (no renal) • Systemic (pulm and renal) • Laryngeal SSx: subglottic mass, dyspnea, biphasic stridor • Rx: Steroids + cyclophosphamide then MTX/Azathiaprine

  32. Wegener’s Granulomatosis

  33. Replapsing Polychondritis • Idiopathic inflammation of cartilage • Laryngeal SSx: 14% present with laryngeal sx; 50% eventually have laryngeal sx • Radiology: non erosive arthopathy • Histo: non specific inflammation • Rx: steroids, dapsone, azathiaprine, cyclophosphamide, cyclosporine

  34. Sarcoidosis • Systemic granulomatosis • Laryngeal SSx (1-5%): suprglotticsubmucosal mass (“turbin like thickening”) • Dx: biopsy, incr ACE, hypercalcemia, hypergammaglobulinemia • Histo: noncaseatinggranulomas • Rx: endoscopic removal of mass if symptomatic • Systemic v injected steroids

  35. Sarcoidosis

  36. Rheumatoid Arthritis • Autoimmune • 25% Laryngeal involvement • Acute: tender/erythematous larynx • Chronic: cricoarytenoidankylosis, submucosal nodules • Increased RF, ESR; decreased C’ • Rx: steroids and antireflux

  37. Pemphigus/Pemphigoid • Autoimmune • Pemphigusvulgaris: anti desmosometonofilament • Intracellular bridges disrupted->intraepithelial blisters • BullousPemphigoid: anti basement membrane • Subepidermal blistering • Laryngeal SSx: can occur on the mucosa if other oral lesions. Usually does not extend to SG • Rx: corticosteroids

  38. Pemphigus/Pemphigoid

  39. Amyloidosis • Abnormal deposition of fibrillar protein and polysaccharide complexes • Laryngeal SSx: anterior subglottic mass • Dx: biopsy (congo red) • Rx: endoscopic removal

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