Chronic-Laryngitis--Lectures：慢性喉炎讲座课件.ppt

1、Prepared by Dr.Hiwa AsadIs a chronic inflammation of the mucosa of the larynx.Follows repeated acute attacks but usually it arise insidiously due to:lFaulty use of voice.lInfection of teeth,tonsil,sinus,and lower respiratory tract infection.lExcessive alcohol consumption or smoking.lDust or irritant

2、 fumes.Chronic nonspecific laryngitis:1.Chronic simple laryngitis.2.Hyper keratosis of larynx(chronic keratosis or leukoplakia).3.Pachydermia laryngis.4.Contact granuloma.5.Atrophic laryngitis.Chronic specific laryngitis:lTuberculous laryngitislSyphilitic laryngitis.lLeprosy of the larynx.lScleroma

3、of the larynx.lWegeners(malignant)granuloma of the larynx.lMycosis of the larynx.lPathology:Hyperaemia of vocal cord.Edema.Myositis occurs in the intrinsic muscles.Excessive secretion due to hyper activity of the mucous gland.Hyperaemic and edematous stage often passes to a hypertrophic one and rare

4、ly to an atrophic one.lClinical Features:-Hoarseness(intermittent then persistent).-Cough(slightly dry).-Sore throat(very common).Chronic laryngitis:there is hyperemia of mucus membrane.Odema of the margins of the vocal cord(Rienkes edema)lLaryngeal appearanceThree types:1.Hyperaemic.2.Hypertrophic.

5、3.Edematous.In all types the larynx is always affected bilaterally&symmetrically.Treatment:lVocal restlElimination of irritating factors such as dust and smoking.lSystemic antibiotics.lCarbocisteine(a mucolytic)when secretion are thick.lStripping of the vocal cords is performed endoscopically in per

6、sistent cases.lDefinition:A localized form of epithelial hyperplasia characterized by leukoplakic raised patches on the vocal cord.lPathology:There is hyperplastic change in the epithelium,together with extension of the papillae into the cornium;and basement membrane remains intact.lClinical feature

7、s:lHoarseness(gradual onset).lExamination:there is a white raised patch on one or both vocal cords the anterior and middle thirds are usually involved.Mobility of cords is not impaired.lTreatment:-Infection in the mouth,throat and nose treated.-Stripping of the cords can sometimes be done through a

8、direct laryngoscope but recurrence is usualConstant supervision is essential to detect early malignant change demanding radical removal or radiotherapy.-Biopsy is mandatory in suspicious cases and may require repetition.Leukoplakia of vocal cordlDefinition:A form of chronic hypertrophic laryngitis a

9、ffecting the epithelium and subepithelium of the posterior part of the larynx.lEtiology:-A rare condition more common in men.-The cause usually unknown but aggravating factors includes excessive alcohol and tobacco.lPathology:Hypertrophy occur both in the epithelium and subepithelial connective tiss

10、ue.An inflammatory reaction may be seen.Neoplastic changes does not occur.lClinical features:1.Hoarseness2.Sore throat3.Granular or papilliferous appearance which occur in the posterior sites and is bilateral and symmetricallTreatment:Similar to that for simple chronic laryngitis.surgical removal an

11、d diathermy of the masses give little relief and are inadvisable.lUnilateral.lSituated medially or superiorly on the vocal process of the arytenoid cartilage.lConfused with contact ulcer.lThe granuloma has a typical polypoid appearance which is a local reaction to trauma.lGranulation tissue can deve

12、lop if the perichondrium is damaged either vocal trauma or through trauma from an endotracheal tube.lSlight hoarseness,with history of previous surgery or usage of excessive voice.lTreated by simple removal by microlaryngoscopy but local recurrence are common.Contact granulomalUncommon.usually assoc

13、iated with atrophic rhinitis and pharyngitis.lAggravating factors:dusty atmosphere,industry fumes and chronic infection of the paranasal sinuses.lHoarseness and sore throat both of which are improved temporarily by hawking and coughing up the crust.lSometimes dyspnea.lOn examination:the mucosa will

14、be dry and atrophic,crusts different sizes lie over the mucosa which may be excoriated when they are removed.lTreatment:1.Treatment of infection any where2.Change of atmospheric conditions3.Removal of crust will give some local relief.This is aided by:lInhalation of menthollCarbocisteine by mouth.lH

15、ormones(results are uncertain)lLaryngeal spray e.g.Benadryl,or 0.5%solutions of sodium bicarbonate.Acute miliary tuberculosis of larynx:lthe laryngeal lesion are accompanied by lesion in the pharynx.lTubercles appear on the swollen mucosa of the epiglottis and arytenoids,these break down and form gr

16、eyish ulcer.lSevere pain is usually present.lTreatment is that of general infection.Chronic tuberculosis of the larynx(laryngeal phthisis):lEtiologyIt is almost always secondary to the pulmonary lesion.It may be:lSputogenic.lOr hematogeniclOr carried by lymph stream.lPathology:with sputogenic type o

17、f infection the tubercle bacillus can infect the intact laryngeal mucosa,the submucosal layer become infected and small round cell infiltration occur.One or more surface nodules soon appear which caseate and leads to ulceration and later on there will be formation of granulation tissue and cellular

18、swellings which is called pseudo-edema.Clinical features:lWeakness of voice with periods of aphonia.lHoarsenesslCough is a prominent symptom.lPain on swallowing if the laryngeal inlet is involved.lReferred otalgia is common.lDyspnea rare.lLocalized tenderness is rare unless perichondritis is present

19、.Laryngoscopic appearance:1.Slight impairment of adduction.2.Marked injection of one vocal cord may involve the whole of the cord or the posterior part of it.3.Ulceration of the edge of the cord(mouse-nibbled)4.Granulation in the interarytenoid region or on the vocal process of the arytenoid cartila

20、ge.5.Edema of the mucosa of the ventricle.6.Pseudo-edema of the epiglottis and arytenoids(turban larynx)of a pale sausage-like appearance,with occasional small bluish superficial ulcers.7.Vocal cord paralysis may occur from apical pulmonary disease,this affect the right side more commonly than the l

21、eft.:lDiagnosis:1.CXR must always be taken when there are persistant laryngeal symptoms to exclude TB of the lungs.2.Sputum will usually contain tubercle bacilli.3.Biopsy when any doubt exist.The lesions most often confused with TB laryngitis are Carcinoma,ulcerative type of syphilis,lupus,pachyderm

22、ia and chronic simple laryngitis.lTreatment:is that of primary lung TB.Lupus of the larynx:lRare and secondary to diseases in the nose and pharynx.lYoung females are more commonly affected.lThe epiglottis is involved first,then the aryepiglottic fold.The vocal cords may be involved much later.lReddi

23、sh granulation tissue are seen on a pale mucosa,area of ulceration and scarring coexist.lAsymptomatic and discovered on routine examination of the larynx.There may be dyspnea and hoarseness which are late symptoms.lPrognosis is good.lTreatment:1.Antituberculous chemotherapy.2.Calciferol(vit.D2)150,000 i.u daily for 3-6 months,2 pints of milk per day should be taken with calciferol.3.Tracheostomy in cases with marked stenosis.