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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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