ACUTE INFLAMMATIONS OF LARYNX - PowerPoint Presentation

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ACUTE INFLAMMATIONSOF LARYNX

BY-KCSUDEEP,DR

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Anatomy

Clinical subdivision

Supraglottis

: from epiglottic tip to floor of laryngeal ventricle.Glottis: ant. commissure, TVC, post commissureSubglottis: at the inf. surface of TVC to inferior edge of cricoid

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Diseases of the LarynxInflammatory

Infectious

Granulomatous

MucosalCongenitalNeoplastic

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Anatomy

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ACUTE LARYNGITIS

Acute laryngitis may be infectious or non- infectious.

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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.

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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.

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CLINICAL FEATURES

SYMPTOMS are usually abrupt in onset and consists of :

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.

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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.

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TREATMEN

VOCAL REST

AVOIDANCE OF SMOKING AND ALCOHOL

STEAM INHALATIONSCOUGH SEDATIVE ANTIBIOTICS ANALGESICSSTEROIDS

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ACUTE MEMBRANOUS LARYNGITIS

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.

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STRIDOR

INSPIRATORY

SUPRAGLOTTIC OR PHARYNX

EXPIRATORYLESION OF THORACIS TRACHEA, PRI. OR SEC. BRONCHIBIPHASICGLOTTIS, SUBGLOTTIS AND CERVIAL TRACHEA

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STRIDOR

CONGENITAL

Laryngomalacia

Laryngeal webSubglottic stenosisHaemangiomaVocal cord paralysisTongue and jaw abnormalitiesACQUIREDAfebrilePapillomatosis InjuryForeign bodyLaryngeal

oedema

Adenotonsillar

hypertrophy

Febrile

Epiglottis

Acute laryngitis

Laryngotracheitis

Diptheria

Retropharyngeal abscess

Infectious mononucleosis

Peritonsillar

abscess

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Diseases associated with acute stridor

COMMON

Acute

laryngothracheitis.Acute laryngotracheobronchitis.Acute epiglottitis.Bacterial tracheitis.Foreign body. UncommonPeritonsillar

abscess.

Retropharyngeal abscess.

Diphtheria

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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.

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Croup Syndrome

Group of diseases that varies in anatomic involvement and etiologic agents.

Laryngotracheitis.

Spasmodic croup.Bacterial tracheitis.Laryngotracheobronchitis.Laryngotracheobronchopneumonitis.

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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.

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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.

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Croup, diagnosis & treatment

Clinically

Lateral neck X-ray ( steeple sign).

Fluid intakeCool 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

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Acute epiglottitis

,

clinical picture

Age usually 2- 7 years.Sudden onset.High fever.

Apprehensive, sitting forward, drooling saliva,

hyperextended

neck & protruded chin.

Stridor

,

dysphagia

.

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Acute epiglottitis,

diagnosis

Direct visualization.

X-RAY; shows THUMB sign on Lat viewBlood cultures.

Latex agglutination of serum or urine.

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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, 2

nd

or 3

rd

generation cephalosporin's or

chloramphenicol

till cultures & sensitivity are known.

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Croup Vs Epiglottitis

Characteristics of Laryngotracheitis and Epiglottitis

Feature Laryngotracheitis EpiglottitisAge <3 years >3 yearsOnset Gradual (days) Acute (hours)Cough Barky NormalPosture Supine SittingDrooling No Yes

Radiograph Steeple sign, narrowed subglottis Thumb sign, enlarged

epiglottis,dilated hypopharynx

Cause Viral Bacterial

Treatment Supportive (croup tent) Airway management (intubation or

tracheotomy), antibiotics

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Diffuse tonsillar &

pharyngeal

Erythema seen here as a non

Specific finding that can be produced By a variety of pathogens

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Intense erythema seen in

association

With acute tonsillar enlargement

& palatal petichiae is highly suggestive Of Gp A beta-streptococcalInfection, though other pathogens Can produce these findings.

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Exudative tonsillitis

Seen with either Group A

Beta hemolytic streptococcal

Or EB virus infection.

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Peritonsillar

abscess

Photograph taken in the OR

Shows an intensely inflamedSoft palatal mass that obscuresThe tonsil & bulges forward &Toward the midline deviating The uvula .

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Retropharyngeal

abscess

This young child presented

With high fever, drooling,Opisthotonous posture.Pharyngeal examination in The OR reveals an intenselyErythematous unilateral Swelling of the posterior Pharyngeal wall.

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Retropharyngeal abscess

, a lateral neck XR shows prominent

Prevertebral swelling displacing the trachea forward.

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Croup

This radiograph shows a long area of narrowing extending below the

Normally narrowed area at the level of the vocal cords.

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Croup

Direct visualization revealed subglottic narrowing that was so severe

Only tracheostomy would enable establishment of an adequate airway.

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Epiglottitis

A 3 year old seen a few hours after

Onset of symptoms.

She was anxious but with no positionalPreference or drooling.

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Epiglottitis

This 5 year old holds his neck

Extended, head forward, is mouth

Breathing, drooling, and shows Signs of tiring.

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Epiglottitis

This 2-year old was in

Severe distress and was

Too exhausted to hold His head up.IN the OR the epiglottisAppears intensely red & Swollen.

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?

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Questions

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:Swab the throat and give 10 days AB.Swab his throat and wait for results.Symptomatic Rx.AB without testing for

gp

A

strept

.

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Question 2

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 isGp A streptAcranobacterium hemolyticumCoronavirus.

Coxackie

virus