• General Objectives:

– The study aims to help the students be critically

aware of the disease to help those who are
affected by it, to help each of the family members
to inform of this diseases. This study aims to gain
knowledge facts about laryngitis and once
knowledge is required, we shall disseminate this
knowledge to the common people to help
increase awareness of the disease.
• Specific Objectives
– At the end of 3 hours case presentation our group will be able to:
1.Identify its causes, predisposing and precipitating factor.
2.Explain the pathophysiology of laryngitis.
3.Provide a clear interpretation of its functions.
4.Provide a brief and understandable description of the related structures.
5.Provide a plan care with specific, measurable, attainable, realistic and time
bounded nursing care plan for the client.
6.Attain a comprehensive drug study on the medications prescribed to the client.
7.Provide client with the appropriate health teachings with regards to disease
process, self-care therapies and diet, and medication regimen.
8.Present a well validated patient assessment.
• Prognosis of Laryngitis:
– It is a minor ailment and clears up on its own
within a few days or weeks.
– Prognosis for laryngitis is excellent. Recovery is
complete, and usually occurs within a week’s time.
– Laryngitis caused by a virus or vocal strain usually
will disappear in a few days to a week. If the
laryngitis is caused by a bacterial infection, the
outlook depends on the type of bacterial involved.
 INTRODUCTION
• What is laryngitis?
• The larynx is the voice box that allows us to speak, shout, whisper, and
sing. The larynx consists of a cartilage skeleton that houses the vocal cords,
which are covered by a mucus lining. Muscles inside the larynx adjust the
position, shape, and tension of the vocal cords, allowing us to make
different sounds. Any change in the air flow (which is generated by the
lungs) across the vocal cords will affect the voice and the quality of the
sound.
• The larynx is located at the junction of the mouth and trachea and has a
flap-like covering called the epiglottis, whose job it is to prevent food and
saliva from entering the larynx during swallowing.
• Laryngitis (larynx + itis = inflammation) is an inflammation of the voice box,
causing a hoarse or gravelly-sounding voice or even an inability to speak.
• What causes laryngitis?
• Laryngitis is an inflammation of the vocal cords. Most
commonly, acute laryngitis is caused by an infection
that inflames the vocal cords.
• In infants and young children, the classic signs and
symptoms of an inflamed larynx include: croup, a
hoarse barky cough, and fever.
• Similarly, in adults, a viral upper respiratory tract
infection may be associated with:runny nose,
dry cough, and a loss of voice.
• Rarely, since most people are immunized and
protected against this infection, diphtheria
may cause laryngitis-like symptoms.Laryngitis
may also be caused by voice overuse with
excess talking, singing, or shouting.Chronic
laryngitis, often described as lasting for more
than three weeks, may be caused by
prolonged alcohol use, smoking, and
excess coughing
THE LARYNX PART I: OVERVIEW AND CARTILAGES

• The Larynx serves a number of purposes. Though it may

seem designed specifically for our speaking and singing,
the larynx has evolved to allow us this control. It has
other purposes too, ones that are essential to life. These
purposes are called "biological", while speaking and
singing are called "non-biological", as it is quite possible
to survive without speech or singing. Witness those
individuals who have had to have their larynges ( La - rin -
jeeze,the plural of larynx) removed due to cancer and who
talk through a process much like burping. Perhaps not
very aesthetically pleasing, but possible.
• Biological Function:
• to act as a valve to prevent air from escaping the lungs,
e.g. weightlifting
• to prevent foreign substances from entering the lungs,
trachea and glottis, e.g. while swallowing, the epiglottis
covers the opening to the larynx.
• to forcefully expell foreign substances which threaten
the trachea, e.g. coughing
• Non-Biological Function:
• the production of sound
 Medical Management
• Medical Care
• Vaughan states that patients know that laryngitis treatment requires only time
and the common-sense avoidance of vocal excess and other irritants. The
following measures can help lessen the intensity of the laryngitis while waiting for
the condition to resolve:
• Inhaling humidified air promotes moisture of the upper airway, helping to clear
secretions and exudate.
• Complete voice rest is suggested, although this recommendation is nearly
impossible to follow. If the patient must speak, soft sighing phonation is best.
Avoidance of whispering is best, as whispering promotes hyperfunctioning of the
larynx.
• Prevailing data do not support the use of antihistamines and corticosteroids. If a
patient uses these medications, he or she may have the false impression that the
laryngitis is resolving and may continue to use his or her voice, leading to further
insult. The drying effect of these medicines may also be deleterious.
• A patient who smokes must cease smoking in order to promote timely resolution of the acute
laryngitis. If the patient's laryngitis is from an infectious etiology, continued smoking delays
prompt resolution of the disease process.
• The most common etiology for acute laryngitis is an infectious source, usually a viral upper
respiratory tract infection. In 1985, Schalen observed that, at the time of the acute laryngitic
episode, many patients were carriers of bacterial infectious agents, the most common of
which were Branhamella catarrhalis and Haemophilus influenzae.6 These patients
experienced more severe dysphonia than patients with negative culture results.
• Despite the high isolation rate of organisms from the nasopharynx, a double-blind, placebo-
controlled study of patients with acute laryngitis revealed that administration of penicillin V
was not advantageous in the treatment of acute laryngitis. 6 The study found that penicillin V
administration did not decrease bacterial counts or alleviate symptoms. Schalen concluded
that antibiotic treatment for otherwise healthy patients with acute laryngitis is currently
unsupported; however, for high-risk patients and patients with severe symptoms, antibiotics
may be considered. Others advocate the use of narrow-spectrum antibiotics only in the
presence of an identifiable Gram stain and culture.2
• An excellent review from the Cochrane Database Systemic Review found no benefit in
using antibiotics to treat acute laryngitis. They recommended that antibiotics should not
be prescribed as a first-line treatment for acute laryngitis. 7
• The treatment for gastroesophageal reflux disease (GERD)–related laryngitic conditions
includes dietary and lifestyle modifications as well as antireflux medications. Antacid
medications that suppress acid production, such as H2-receptor and proton pump
blocking agents, are highly effective against gastroesophageal reflux. Of the various
classes of medicines available to treat GERD, the proton pump inhibitors are the most
effective.8 Patients on prolonged antireflux therapy or with a history of long-standing
GERD should be evaluated by a gastroenterologist to ensure that serious sequelae of
GERD, such as Barrett esophagitis, have not manifested or do not develop.
• Note that optimal timing of proton pump inhibitor intake increases its efficacy. For
patients who require twice-a-day dosing, suggested dosing times that are 15-30 minutes
before breakfast and dinner.9 Katz cautions that treatment durations may be longer for
patients with reflux laryngitis than for patients with other extraesophageal
manifestations of GERD (eg, asthma, cough, noncardiac chest pain).
• Diet
• Dietary restrictions are recommended for patients with GERD. These include avoidance of
caffeine, fatty foods, chocolate, peppermint, and late meals (ie, <3 h before retiring). 9 The
patient should maintain hydration and fluid intake at a stress level to support requirements
during the illness. The patient should drink at least 6-8 glasses (8 oz each) of water per day.
• Activity
• Although not always possible, patients who use their voices professionally should attempt
complete vocal rest. If the patient must communicate, soft sighing use of the voice causes the
least vocal trauma. Patients suspected of having GERD should avoid lying down after meals
and should elevate the heads of their beds.
• A physician is often consulted to decide if a professional voice user should cancel or perform
an engagement. A contraindication to performance is the presence of vocal fold hemorrhage
or exudative laryngitis.2 If the patient has mild laryngitis, the physician's decision whether to
allow the patient to perform becomes difficult. Vaughan's guiding principle is to do no harm
because tomorrow is important, also. If the professional performer wants the show to
proceed, he or she should adapt the show and vocal efforts during the performance to
minimize vocal abuse.
• Medication
• The goals of pharmacotherapy are to reduce morbidity and prevent
complications.
• Proton pump inhibitors
• These agents inhibit gastric acid secretion by inhibition of the
H+/K+/ATP-ase enzyme system in the gastric parietal cells. These agents
are used in cases of severe esophagitis.
•  
• Omeprazole (Prilosec)
• Specifically suppress gastric acid secretion by potent inhibition of the
H+/K+ ATPase enzyme system at secretory surface of gastric parietal cell.
This blocks the final step in gastric acid production. Effect is dose related
and inhibits both basal and meal stimulated acid secretion.
 Surgical Management
• Normal Larynx
•
  
• This is an example of a normal larynx. The true vocal folds are pearly white, they meet in
the midline on phonation, and the surrounding structures are light pink. As you view the
following examples of diseases of the larynx, you can compare them to this example.
• Nodules
•
  
• Nodules are calluses on the vocal folds that occur with improper voice use or overuse.
They are most common in children and females.They prevent the vocal folds from meeting
in the midline and thus produce an hourglass deformity on closure resulting in a raspy,
breathy voice. Most time,s these will respond to appropriate speech therapy. Occasionally
(20% of the time), these may persist after intensive speech therapy and will require
meticulous microlaryngeal surgery
 Anatomy
• Polyps
•
  
• Polyps are benign lesions of the larynx, occurring mostly in adult males, that are usually
located on the phonating margin (edge) of the vocal folds and prevent the vocal folds from
meeting in the midline. Polyps can interfere with voice production and may produce a
hoarse, breathy voice that tires easily. These may respond to conservative medical therapy
and intensive speech therapy. If the lesion fails to respond, meticulous microsurgery may
be indicated. One of the cofactors in the cause of these lesions may be laryngeal reflux
disease.
• Laryngitis sicca
•
  
• Laryngitis sicca is caused by inadequate hydration of the vocal folds. Thick, sticky mucus
prevents the folds from vibrating in a fluid, uniform manner.
• Vocal fold hemorrhage  
•
  
• Vocal fold hemorrhage is a very rare occurrence that usually is caused by
aggressive or improper use of vocal folds (e.g. cheerleading). It is a result
of rupture of a blood vessel on the true vocal fold, with bleeding into the
tissues of the fold.
• Cancer
•  
•   
• This is an example of a very early cancer of the vocal folds. If these
lesions are detected early, they can be treated with either radiation or
surgery, with a cure rate approaching 96%.
• Impaired Vocal Fold Mobility, a condition where
one or both of the vocal folds do not move
appropriately, can be due to paralysis, paresis,
scarring, or inflammation of the crico-arytenoid
joint.
•  
•   
• Vocal fold paralysis or paresis results from a
lesion of the neural or muscular mechanism.
• Unilateral vocal fold paralysis can be caused by a variety
of diseases or disorders that prevent movement in one
vocal fold. When one weakened vocal fold does not
move well enough to meet the other fold in the midline
during speech, air leaks out too quickly. This causes the
voice to sound breathy and weak, making it necessary for
the speaker to take more frequent breaths during
speech. After a full day of talking, someone with a weak
vocal fold can feel exhausted due to the frequent
breathing, and can experience choking and coughing on
food or liquids.
• Bilateral vocal fold paralysis: When both vocal folds
have movement problems, the situation can be
much more serious. With both vocal folds paralyzed
in the midline position, the person has difficulty
breathing and a tracheotomy may be necessary to
establish an airway. If both folds are paralyzed near
the midline, although the voice may be good the
airway may be compromised. If both folds are
paralyzed far apart, there may be no voice.
• Vocal fold bowing, can result from neural, muscular, traumatic,
congenital, or functional causes, with or without vocal fold
atrophy, and can result in vocal weakness.
•  
•   
• Presbylaryngis is a condition that is caused by thinning of the
vocal fold muscle and tissues with aging. The vocal folds have
less bulk than a normal larynx and therefore do not meet in the
midline. As a result, the patient has a hoarse, weak, or breathy
voice. This condition can be corrected by injection of fat or
other material into both vocal folds to achieve better closure.
• Laryngeal Dystonia (Spasmodic Dysphonia)
• Laryngeal dystonia, or spasmodic dysphonia
(SD) is a voice disorder caused by involuntary
movements of one or more muscles of the
larynx. There are two major types of
spasmodic dysphonia: adductor and abductor,
although most are a mixture of both types.
• Adductor SD, with spasms causing sporadic vocal fold closures, are identified by a strained, strangled
voice.
•  
•  
•  
•  
• Listen
•  
•  
• Audio
•  
•  
•  
• Audio
•  
•  
• Abductor SD, with spasms causing sporadic vocal fold closures, produces a voice with interruptions of air
• PATHOPHYSIOLOGY
•  
•  
• PREDISPOSING FACTORS
•  
• Exposure to dust, chemical, smoke, other
pollutants
• Exposure to sudden temperature changes
• Dietary deficiencies
• Malnutrition or immune suppression
•  
• Viral infection Bacterial infection
•  
•  
•  
•
Hoarseness or Aphomia / Complete loss of voice
Strep throat
• Severe dry cough
• Sore throat that worsens in the evening hours
• IDEAL NURSING CARE
Ideal nursing care include resting the voice, avoiding smoking,
resting and inhaling cool steam or anaerosol. If the laryngitis is
part of more extensive respiratory infection due to a bacterial
organism or if it is severe, appropriate anti bacterial therapy is
instituted.
For chronic laryngitis, the treatment includes resting the voice
eliminating any primary respi-tract infection, eliminating smoking
and avoiding second-hand smoke. Topical corticosteroids such as
beclomentnasome dipropinate (vanceril) inhalation, may also be
used. These preparations have no systemic or long-lasting effects
in may reduce local inflammatory reaction.
• What is the Definition of Laryngitis?
•
Laryngitis is an inflammation of the mucous
membrane lining the larynx (voice box), which is
located in the upper part of the respiratory tract.
• It causes hoarseness, and possibly a temporary
loss of speech.
• Causes of Laryngitis
•
Laryngitis may result from prolonged straining of the voice. It also may occur as an isolated local
infection of the larynx as part of another, more serious underlying disorder, such as pneumonia or 
tuberculosis. In most cases, however, it is a minor ailment and clears up on its own within a few days
or weeks.
• Acute laryngitis may result from excessive strain on the vocal cords, as occurs with activities such as
yelling, cheering, singing, or public speaking.
• Postnasal drip, allergies, or inhalation of smoke fumes, or caustic chemicals can irritate the larynx and
cause inflammation.
• Chronic laryngitis may be caused by excessive alcohol consumption, smoking, or constant exposure to
dust or chemical irritants like paint remover.
• Chronic upper respiratory tract disorders such assinusitis, bronchitis, nasal polyps, and allergies can
cause chronic laryngitis.
• Repeated episodes of acute laryngitis may eventually lead to chronic laryngitis.
• Gastroesophageal reflux (heartburn) may ulcerate the larynx.
• Symptoms of Laryngitis
•
The major symptoms of laryngitis are:
• Hoarseness
• Sore throat
• Weak or absent voice
• Sensation of a lump in the throat or constant need to
clear the throat
• Dry cough
• Fever
• Diagnosis of Laryngitis
•
Diagnosis is based upon a combination of the
clinical history and a physical exam. Some
physicians might wish to do a laryngoscopy
(visualization of the vocal cords).
• Treatment for Laryngitis
•
If laryngitis is caused by a bacterial infection, antibiotics will be prescribed.
• Some palliative measures that can be taken include:
• Avoid public speaking during recovery
• Be aware that whispering puts greater strain on the vocal cords than normal
speaking
• Inhale steam from a bowl of hot water or from a warm shower
• Drink warm, soothing liquids (but do not drink alcoholic beverages)
• Try a cool-mist humidifier; avoid air conditioning
• Use nonprescription pain relievers and throat lozenges to ease the discomfort
• Avoid cigarettes until the symptoms have subsided
• Above all, make sure that the underlying cause of chronic laryngitis has been
diagnosed and treated.
• What Questions to ask Your Doctor About Laryngitis?
•
What is the cause of the laryngitis?Is there an underlying
medical problem?
• Is there an infection present?
• Is it caused by an upper respiratory problem?
• Are antibiotics needed?
• Can you identify a possible source of irritation of the larynx?
• How can the symptoms be relieved?