Transcript File

ACUTE INFLAMMATIONS
OF LARYNX
BY-KCSUDEEP,DR
Anatomy
• Clinical subdivision
– Supraglottis:
• from epiglottic tip to floor of laryngeal ventricle.
– Glottis:
• ant. commissure, TVC, post commissure
– Subglottis:
• at the inf. surface of TVC to inferior edge of cricoid
Diseases of the Larynx
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Inflammatory
Infectious
Granulomatous
Mucosal
Congenital
Neoplastic
Anatomy
ACUTE LARYNGITIS
• Acute laryngitis may be infectious or noninfectious.
AETIOLOGY
• Infectious type is more common and usually
follows upper respiratory infection.
• To begin with, it is viral in origin but soon
bacterial incasion takes place with
sretp.pneumoniee, H.infuenzae and haemolytic
streptococci or Staph. Aureus.
• Exanthematous fevers like measles, chickenpox
and whooping cough are also associated with
laryngitis.
• NON –INFECTIOUS TYPE
– It is due to vocal abuse , allergy,
thermal or chemical burns to
larynx due to inhalation or
ingestion of various substances, or
laryngeal trauma such as
endotracheal intubation.
CLINICAL FEATURES
• SYMPTOMS are usually abrupt in onset and
consists of :
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Hoarseness which may lead to complete loss of voice
Discomfort or pain in throat, particularly after talking
Dry, irritating cough which is usually worse at night .
General symptoms of head , cold rawness or dryness
of throat, malaise and fever if laryngitis has followed
viral infection of upper respiratory tract.
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Hoarseness which may lead to complete loss of voice.
Discomfort or pain in throat, particularly after talking.
Dry, irritating cough which is usually worse at night
General symptoms of head, cold, rawness or dryness of
throat, malaise and fever if laryngitis has followed viral
infection of upper respiratory tract.
• Laryngeal appearance vary with severity of disease.
• In early stages there is erythema and oedema of epiglottis,
aryepiglottic folds, arytenoids and ventricular bands, but the
vocal cords appear white and near normal and stand out in
contrast to surrounding mucosa, betraying the degree of
hoarseness patient has.
• Later, hyperaemia and swelling increase. Vocal cords also
become red and swollen. Subglottic region also gets involved.
Sticky secretions are seen between the cords and
interarytenoid region .
• In case of vocal abuse, submucosal haemorrhages may be seen
in the vocal cords.
TREATMEN
• VOCAL REST
• AVOIDANCE OF SMOKING AND
ALCOHOL
• STEAM INHALATIONS
• COUGH SEDATIVE
• ANTIBIOTICS
• ANALGESICS
• STEROIDS
• THIS CONDITION IS SIMILAR TO ACUTE
MEMBRANOUS TONSILLITIS AND IS
CAUSED BY PYOGENIC NON-SPECIFIC
ORGANISMS.
• IT MAY BEGIN IN THELARYNX OR MAY BE
AN EXTENSION FROM THE PHARYNX. IT
SHOULD BE DIFFERENTIATED FROM
LARYNGEAL DIPTHERIA.
STRIDOR
• INSPIRATORY
– SUPRAGLOTTIC OR PHARYNX
• EXPIRATORY
– LESION OF THORACIS TRACHEA,
PRI. OR SEC. BRONCHI
• BIPHASIC
– GLOTTIS, SUBGLOTTIS AND CERVIAL
TRACHEA
STRIDOR
• ACQUIRED
• CONGENITAL
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Laryngomalacia
Laryngeal web
Subglottic stenosis
Haemangioma
Vocal cord paralysis
Tongue and jaw abnormalities
– Afebrile
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Papillomatosis
Injury
Foreign body
Laryngeal oedema
Adenotonsillar hypertrophy
– Febrile
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Epiglottis
Acute laryngitis
Laryngotracheitis
Diptheria
Retropharyngeal abscess
Infectious mononucleosis
Peritonsillar abscess
Diseases associated with acute stridor
COMMON
• Acute laryngothracheitis.
• Acute laryngotracheobronchitis.
• Acute epiglottitis.
• Bacterial tracheitis.
• Foreign body.
Uncommon
• Peritonsillar abscess.
• Retropharyngeal abscess.
• Diphtheria
Viral Croup
• Common respiratory illness in young children.
• Anglo-Saxon word Kropan; cry aloud.
• Hoarse voice; dry barking cough; inspiratory
stridor; and variable amount of respiratory
distress that develops over a brief period of
time.
Croup Syndrome
• Group of diseases that varies in anatomic
involvement and etiologic agents.
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Laryngotracheitis.
Spasmodic croup.
Bacterial tracheitis.
Laryngotracheobronchitis.
Laryngotracheobronchopneumonitis.
Croup
(Acute laryngotracheo-bronchitis)
• Disease of viral origin causing subglottic & tracheal
swelling.
• The narrowed airway is responsible for the hallmark
of clinical picture.
• The cricoid ring in the upper trachea which is
subglottic, has a narrow diameter which renders
children vulnerable to inflammation.
Viral Croup
( Acute laryngotracheobronchitis)
• Etiology:
Respiratory viruses e.g. parainfluenza viruses 1,2,and
3, RSV, Influenza viruses A & B.
• Clinical picture:
Age 6mths- 3 years, M>F, Fall & winter.
Gradual onset of low grade fever,URTI, barking
cough, inspiratory stridor & respiratory distress.
Hoarseness & aphonia may occur.
Croup, diagnosis & treatment
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Clinically
Lateral neck X-ray ( steeple sign).
Fluid intake
Cool mist/ hot steamy bathroom.
Aerosolized adrenaline.
Steroids( controversial)
Endotracheal intubation.
Helium-Oxygen Mixture.
Antibiotics
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Acute epiglottitis,
etiology
Bacterial infection of the
supraglottic structures(
epiglottis, aryepiglottic folds &
arytenoids soft tissues) causing
rapid airway obstruction.
• Haemophilus Influenza type B in
prevaccination era.
• Bacteria associated with
epiglottitis in the Hib vaccine era
include: HiA, Str. Pn, Staph
aureus, ß-hemolytic
streptococci Gps A,B,C,and F
Acute epiglottitis, clinical picture
 Age usually 2- 7 years.
 Sudden onset.
 High fever.
 Apprehensive, sitting
forward, drooling saliva,
hyperextended neck &
protruded chin.
 Stridor, dysphagia.
Acute epiglottitis, diagnosis
 Direct visualization.
 X-RAY; shows THUMB sign on
Lat view
 Blood cultures.
 Latex agglutination of serum
or urine.
Acute epiglottitis, treatment
 Hospitalization
 Treatment is a medical emergency.
 Ventilatory support, intubation.
 Steroids for e.g. hydrocortisone 100mg i.v. may be
useful to relieve oedema.
 IV antibiotics, 2nd or 3rd generation cephalosporin's or
chloramphenicol till cultures & sensitivity are known.
Croup Vs Epiglottitis
Characteristics of Laryngotracheitis and Epiglottitis
Feature
Age
Onset
Cough
Posture
Drooling
Radiograph
Laryngotracheitis
<3 years
Gradual (days)
Barky
Supine
No
Steeple sign, narrowed subglottis
Cause
Treatment
Viral
Supportive (croup tent)
Epiglottitis
>3 years
Acute (hours)
Normal
Sitting
Yes
Thumb sign, enlarged
epiglottis,dilated hypopharynx
Bacterial
Airway management (intubation or
tracheotomy), antibiotics
Diffuse tonsillar &
pharyngeal
Erythema seen
here as a non
Specific finding
that can be
produced
By a variety of
pathogens
Intense erythema
seen in association
With acute tonsillar
enlargement
& palatal petichiae
is highly suggestive
Of Gp A betastreptococcal
Infection, though
other pathogens
Can produce these
findings.
Exudative tonsillitis
Seen with either Group A
Beta hemolytic streptococcal
Or EB virus infection.
Peritonsillar abscess
Photograph taken in the OR
Shows an intensely inflamed
Soft palatal mass that obscures
The tonsil & bulges forward &
Toward the midline deviating
The uvula .
Retropharyngeal
abscess
This young child presented
With high fever, drooling,
Opisthotonous posture.
Pharyngeal examination in
The OR reveals an intensely
Erythematous unilateral
Swelling of the posterior
Pharyngeal wall.
Retropharyngeal abscess, a lateral neck XR shows prominent
Prevertebral swelling displacing the trachea forward.
Croup
This radiograph shows a long area of narrowing extending below the
Normally narrowed area at the level of the vocal cords.
Croup
Direct visualization revealed subglottic narrowing that was so severe
Only tracheostomy would enable establishment of an adequate airway.
Epiglottitis
A 3 year old seen a few hours after
Onset of symptoms.
She was anxious but with no positional
Preference or drooling.
Epiglottitis
This 5 year old holds his
neck
Extended, head forward, is
mouth
Breathing, drooling, and
shows
Signs of tiring.
Epiglottitis
This 2-year old was in
Severe distress and was
Too exhausted to hold
His head up.
IN the OR the epiglottis
Appears intensely red &
Swollen.
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Questions
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A 12 yr old boy with 4 days of sore throat comes to
your office. Afebrile with rhinorrhea, cough, and one
day diarrhea associated with his sore throat. Throat
is mildly erythematous a with normal appearing
tonsils. The best course of action is:
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4.
Swab the throat and give 10 days AB.
Swab his throat and wait for results.
Symptomatic Rx.
AB without testing for gp A strept.
Question 2
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A 3 yr old fussy boy , febrile with proffuse
rhinorrhea. Shallow ulcers are noted on the soft
palate and vesicles are noted on one palm and
both soles of the feet. The etiology of this
infection is
1.
2.
3.
4.
Gp A strept
Acranobacterium hemolyticum
Coronavirus.
Coxackie virus