Inflammation of the Larynx Laryngitis

Heartburn and Acid Reflux Cure Program

How To Cure GERD Naturally

Get Instant Access

Whether acute or chronic, laryngitis presents with hoarseness and generalized hyperemia of the laryngeal mucous membrane. Acute laryngitis commonly follows an upper respiratory tract infection, or is traumatic following vocal abuse. Voice rest is the most effective treatment.

Chronic laryngitis may be associated with infection in the upper or lower respiratory tract, but is commonly "irritative" due to occupation and environment, vocal abuse, or tobacco. The unusual laryngitis of myxoedema must not be forgotten.

Normal Laryngoscope View
Fig. 4.69 Normal vocal cords. These are ivory-colored and smooth with few vessels on the surface. This is the view obtained through a laryngoscope at direct microlaryngoscopy.

Fig. 4.70 A fiberoptic endoscopic view of a normal larynx (see Fig. 1.62).

Fig. 4.71 A laryngeal web. Congenital abnormalities of the larynx are uncommon. Webbing of varying degrees of severity is one of the commoner developmental abnormalities, and presents as hoarseness. Similar webbing may follow inadvertent trauma at endoscopic surgery to both vocal cords near the anterior commissure. A mucosal web is treated with surgical division. Most webs, however, are deep and fibrous and need an indwelling "keel" after division to avoid recurrence.

rlfl r 1

Fig. 4.72 Laryngeal nodules (arrows). A specific and localized type of chronic laryngitis, often seen in professional voice users, is laryngeal nodules (singer's nodules). Initially an edema is seen on the vocal cord between the anterior one-third and posterior two-thirds of the cord. Removal of the nodules may be necessary, but attention to the underlying voice production by a speech therapist is the most important aspect of treatment. These nodules are not an uncommon cause of hoarseness in children, particularly of large families involved in competitive shouting ("screamers" nodules'). Vocal cord nodules are also seen in those who overuse or misuse their voices.

Vocal Cord Papilloma
Fig. 4.73 Vocal cord nodule seen through a fiberoptic endoscope. A solitary vocal cord nodule at the characteristic site is not uncommon, although they are usually bilateral and fairly symmetrical.
Laryngeal Papillomatosis

Fig. 4.74 Vocal cord nodule with hematoma. A

vocal cord nodule with hematoma formation following vocal abuse.

Fig. 4.74 Vocal cord nodule with hematoma. A

vocal cord nodule with hematoma formation following vocal abuse.

Fig. 4.75 Juvenile laryngeal papilloma.

Recurrent respiratory papillomatosis must be excluded in a hoarse infant or child, for if the hoarseness is ignored, stridor will develop as papillomas accumulate in the laryngeal airway. Nevertheless, vocal cord nodules ("screamers' nodes") are the commonest cause of hoarseness in children.

In juvenile papillomas, multiple wart-like excrescences develop, usually before the age of five, mostly on or around the vocal cords. Recurrence follows removal, but fortunately eventual spontaneous regression is usual. The cause is now established as the human papilloma virus (types 6 and 11), which produces the disease in children who have an HLA-linked T-cell deficit.

Management consists of regular microlaryngoscopy with removal of papillomas using the CO2 laser or laryngeal microdebrider. The aim is not to achieve radical removal of all the papillomas, but just to maintain a safe airway and as good a voice as possible while awaiting spontaneous resolution, avoiding damage to the underlying laryngeal tissues which might produce scarring and stenosis. In severe cases a tracheostomy may be necessary, but should be avoided if at all possible as papillomas tend to develop around the tracheal stoma and "seed" further down the tracheobronchial tree. In very severe cases adjuvant chemotherapy with interferon may be used.

Severe Laryngomalacia

Fig. 4.76 Laryngomalacia. This is the commonest cause of stridor in infants. The epiglottis is curled ("omega-shaped") and tightly tethered to the aryepiglottic folds, which are tall and floppy, resulting in supraglottic collapse on inspiration.

Diagnosis can usually be established from the history and confirmed by awake flexible fiberoptic laryngoscopy.

Most cases are mild, no treatment is necessary, and the stridor gradually fades, resolving completely by about age 2. However, 10% of cases are severe with failure to thrive (and often associated gastroesophageal reflux). In these patients an endoscopic aryepiglottoplasty may be required to release the epiglottis and reduce the aryepiglottic folds.

Fig. 4.76 Laryngomalacia. This is the commonest cause of stridor in infants. The epiglottis is curled ("omega-shaped") and tightly tethered to the aryepiglottic folds, which are tall and floppy, resulting in supraglottic collapse on inspiration.

Diagnosis can usually be established from the history and confirmed by awake flexible fiberoptic laryngoscopy.

Most cases are mild, no treatment is necessary, and the stridor gradually fades, resolving completely by about age 2. However, 10% of cases are severe with failure to thrive (and often associated gastroesophageal reflux). In these patients an endoscopic aryepiglottoplasty may be required to release the epiglottis and reduce the aryepiglottic folds.

Vocal Cord Polyps
Fig. 4.77 Pedunculated vocal cord polyp. A large pedunculated polyp may form on the vocal cord and be missed on examination for it moves above and below the cord on expiration and inspiration. A large polyp (a) is less apparent (b) when it is below the cord on inspiration.

< ■

*

t

il

11

* 1™

/ *

Fig. 4.78 Intubation granulomas of the larynx. These result from trauma by the anesthetic tube to the mucosa overlying the vocal process of the arytenoid; they are, therefore, posterior. With the skill that anesthetists have achieved for endotracheal intubation, trauma to this region is uncommon. Granulomas at this site also develop after prolonged vocal abuse has caused a chronic laryngitis in which the epithelium over the vocal process becomes ulcerated ("contact ulcers"). Removal at the pedicle is necessary.

Fig. 4.79 Granulomas of the larynx excision. Here the pedicle of the intubation granuloma is being held with forceps. Recurrence frequently follows excision, but laser beam techniques appear to lessen the likelihood. Relatively large lesions can occupy the posterior half of the larynx with minimal voice change. Anteriorly in the larynx, however, small lesions cause conspicuous voice change.

Fig. 4.80 Polyp at the anterior commissure. This site is not always easy to see on indirect laryngoscopy for it may be partly obscured by the tubercle of the epiglottis. The laryngoscope is placed against the tubercle, displacing it forwards and a clear view is obtained.

A small lesion near or at the anterior commissure of the larynx may produce conspicuous hoarseness. However, a larger lesion posteriorally in the larynx may not produce such a conspicuous voice change.

Indirect Laryngoscope

Fig. 4.81 Hemangiomas

(arrow). These are uncommon vocal cord lesions and if small may cause no hoarseness or bleeding, and be a chance finding on examination. Laser surgery promises to be the effective treatment for larger hemangiomas.

These hemangiomas may be associated with similar lesions in the head and neck in children (Figs 3.4a,b).

Fig. 4.81 Hemangiomas

(arrow). These are uncommon vocal cord lesions and if small may cause no hoarseness or bleeding, and be a chance finding on examination. Laser surgery promises to be the effective treatment for larger hemangiomas.

These hemangiomas may be associated with similar lesions in the head and neck in children (Figs 3.4a,b).

Acute Laryngitis
Fig. 4.82 Acute laryngitis showing slight hyperemia and edema of both vocal cords seen with the fiberoptic endoscope.
Vocal Cord Inflammation

Fig. 4.83a, b Chronic laryngitis. With this condition, hyperemia of the mucous membrane may be associated with other changes in the larynx. Edema of the margin of the vocal cords is common (Reinke's edema), so that the free margin is polypoid and a large sessile polyp may form. The edema, although affecting both cords, may be more marked on one side (b).

Fig. 4.83a, b Chronic laryngitis. With this condition, hyperemia of the mucous membrane may be associated with other changes in the larynx. Edema of the margin of the vocal cords is common (Reinke's edema), so that the free margin is polypoid and a large sessile polyp may form. The edema, although affecting both cords, may be more marked on one side (b).

Fig. 4.84 Hypertrophy of the ventricular bands. Hypertrophy of the ventricular bands is another finding in chronic laryngitis and they may meet in the mid-line on phonation, producing a characteristic hoarseness. Reinke's edema is also present. Microlaryn-goscopy and surgical excision of the edematous margins is effective with dissection or the laser beam. Excision to the anterior commissure is made on one cord only to avoid webbing.

Mucus LaryngitisCyst Larynx
Fig. 4.85 Prolaps of the ventricular mucous membrane. This may also occur in chronic laryngitis and presents as a supraglottic swelling. A supraglottic cyst or carcinoma must be excluded.

Fig. 4.86 Long-standing chronic laryngitis. The mucous membrane may become extremely hypertrophic with white patches (leukoplakia). Histologically, the white patches represent areas of keratosis which may precede malignant change and be reported as carcinoma in situ. This patient had smoked over 60 cigarettes a day for 50 years.

Was this article helpful?

0 0
Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

Get My Free Ebook


Post a comment