Acute inflammations of larynx Dr Sheetal Rai Assistant

Acute inflammations of larynx Dr. Sheetal Rai Assistant Professor Department of ENT Yenepoya Medical College

ACUTE LARYNGITIS • INFECTIOUS* • Following URTI • Initially viral 2’ bacterial invasion • Streptococcus pneumonia • H influenza • Hemolytic streptococci • Staphylococci • Exanthematous fevers • NON INFECTIOUS • Vocal abuse , allergy, thermal /chemical burns (inhalation/ingestion) • Laryngeal trauma (endotracheal tube intubation)

C/F • Symptoms • Hoarseness of voice • Discomfort /pain in throat after talking • Dry irritating cough • General symptoms

Normal larynx

ACUTE LARYNGITIS (SIMPLE)

• Submucosal haemorrhage in vocal cords

Treatment • Vocal rest • Avoidance of smoking & alcohol • Steam inhalation • Cough suppressants • Antibiotics • Analgesics • Steroids following chemical & thermal burns

Acute membranous laryngitis • Pyogenic nonspecific organisms • May begin in larynx /as an extension from pharynx • DD - laryngeal diphtheria

Acute epiglottitis/supraglottic laryngitis • Inflammation of supraglottic structures • Marked edema obstruction of the airway

• Etiology • Children 2 -7 yrs* • H influenza type B* • C/F • Abrupt with rapid progression • Sore throat & dysphagia in adults • Stridor in children • Fever (d/t septicemia)

Examination

Lateral soft tissue X ray of neck THUMB SIGN

Treatment • Hospitalization • Antibiotics (ampicillin /3 rd generation cephalosporins) • Steroids (hydrocortisone /dexamethasone im/iv) • Adequate hydration • Humidification • Intubation or tracheostomy

Acute laryngo tracheo bronchitis or croup • Inflammation of Larynx, trachea & bronchi • M>F • 6 months – 3 years children * • Para influenza type 1 & 2 • 2’ bacterial invasion (gram +ve cocci)

Pathology Edema of loose areolar tissue in subglottis ↓ Respiratory obstruction & stridor Thick tenacious secretions & crusts ↓ Complete occlusion

symptomatology • Hoarseness of voice • Croupy cough • Fever 39 -40*C • Inspiratory type of stridor • Supra sternal & intercostal recession

treatment • Hospitalization • Abx ampicillin 50 mg/kg/day • Humidification • Parenteral fluids • Steroids - Hydrocortisone 100 mg iv • Adrenaline - dyspnea • Intubation /tracheostomy

Organism Age Area affected Onset Fever Patients look Cough Stridor Odynophagia Radiology Treatment Acute epiglottitis H. Influenza type B 2 -7 years Supraglottis Croup Parainfluenza I & II 3 months to 3 years Subglottis Abrupt High Toxic Absent Present (marked) Present Slow Low grade Non toxic Present Absent Thumb sign Abx, oxygen Steeple sign Oxygen, steroids

Laryngeal diphtheria • 2’ to faucial diphtheria • Children <10 yrs • Pathology • Pseudomembrane formation obstruction of larynx • Exotoxin myocarditis & neuropathy

C/F • General symptoms • Laryngeal • Hoarse voice • Croupy cough • Respiratory stridor • Increasing dyspnea • Marked upper airway obstn • Greyish white membrane

Bull neck appearance due to cervical lymphadenopathy

Treatment • Diphtheria antitoxin • 20, 000 -1, 000 u • Antibiotics • Benzyl penicillin 5, 000 u im qid *6 days • Erythromycin • Maintenance of airway • Tracheostomy • Direct larngoscopy removal of membrane & intubation • Complete bed rest

complications • Air way obstruction Asphyxia & death • Toxic myocarditis & circulatory failure • Palatal paralysis nasal regurgitation • Laryngeal & pharyngeal paralysis

Edema of larynx • Supra glotttic & sub glottic region *(abundant subepithelial connective tissue) • Vocal cords rare(sparse connective tissue)

Etiology • Infections • Trauma • Neoplasm • Allergy • Radiation • Systemic diseases

Symptoms & signs • Airway obstruction • Inspiratory stridor • Indirect laryngoscopy • Edema of supraglottic & subglottic region

• Treatment • Intubation/tracheostomy • Steroids(thermal/chemical) • Adrenaline (1: 1000) 0. 3 -0. 5 ml im repeated evey 15 minute (allergic)

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