CHRONIC LARYNGITIS

 NON SPECIFIC LARYNGITIS

 SPECIFIC LARYNGITIS

pgmedicalworld.com
• CHRONIC LARYNGITIS IS CHRONIC
INFLAMMATION OF LARYNGEAL STRUCTURES
MOST COMMONLY OF LARYNGEAL MUCOSA
• IT IS MAINLY OF TWO TYPES

1. SPECIFIC
2. NON SPECIFIC

pgmedicalworld.com
 FOUR POINT GRADATION OF CHRONIC
LARYNGITIS
1. GRADE I - MILD ERYTHEMA,STASIS OF
SECRETIONS, STRING SIGN, PILING UP OF INTER
ARYTENOID MUCOSA
2. GRADE II – DIFFUSE EDEMA AND MUCOSAL
THICKENING BUT WITH LITTLE ERYTHEMA
3. GRADE III – DIFFUSE ERYTHEMA, WITH
GRANULAR FRIABLE MUCOSA OR ULCERATION
4. GRADE IV DISCRETE GRANULOMAS WITH OR
WITHOUT EDEMA AND ERYTHEMA

pgmedicalworld.com
 NON SPECIFIC LARYNGITIS
 IT IS COMMON CONDITION WITH WIDE SPECTRUM
OF SIGN SYMPTOMS AND SEVERITY
 PATIENTS PRESENT WITH DYSPHONIA AND
SYMPTOMS SUCH AS THROAT DISCOMFORT,
HALITOSIS OR OTALGIA
 COMMON ETIOLOGICAL FACTORS ARE

1. SMOKING
2. VOICE ABUSE
3. GASTRO OESOPHAGAL REFLUX
DISEASE

pgmedicalworld.com
pgmedicalworld.com
 TYPES
1. CHRONIC LARYNGITIS WITHOUT
HYPERPLASIA
2. CHRONIC HYPERTROPHIC LARYNGITIS
3. PACHYDERMIA LARYNGIS
4. ATROPHIC LARYNGITIS
5. LARYNGEAL HYPERKERATOSIS

pgmedicalworld.com
 CHRONIC LARYNGITIS WITHOUT
HYPERPLASIA
 IT SYMMETRICALLY INVOLVES WHOLE LARYNX
 ETIOLOGY-

1. UNRESOLVED ACUTE SIMPLE LARYNGITIS

2. PRESENCE OF CHRONIC INFECTION IN PNS ,
TEETH AND TONSILS
3. OCCUPATIONAL FACTORS( DUST, FUMES)
4. SMOKING
5. ALCOHOL

pgmedicalworld.com
 CLINICAL FEATURES

 HOARSENESS –VOICE EASILY TIRES PATIENT

BECOMES APHONIC
 CONSTANT HAWKING – DRYNESS AND
INTERMITTENT TICKLING IN THROAT
 DISCOMFORT IN THROAT
 COUGH – DRY AND IRRITATING
 ON LARYNGEAL EXAMINATION – HYPERAMIA OF
LARYNGEAL STRUCTURES, VOCAL CORDS
APPEAR DULL, RED AND ROUND. FLECKS OF
MUCUS SEEN IN INTER ARYTENOID REGION

pgmedicalworld.com
 TREATMENT

 ELIMINATE INFECTION OF UPPER AND LOWER

RESPIRATORY TRACT- SINUS, TONSIL. TEETH,
CHRONIC CHEST INFECTION IS TREATED
 AVOIDANCE OF IRRITANT FACTORS
 VOICE REST AND SPEECH THERAPY
 STEAM INHALATION – THEY HELP TO LOOSEN
SECRETIONS AND GIVE RELIEF
 EXPECTORANTS-THEY HELP TO RELIEVE VISCID
SECRETIONS AND GIVE RELIEF FROM HAWKING

pgmedicalworld.com
CHRONIC HYPERTROPHIC LARYNGITIS

 IT MAY BE EITHER DIFFUSE AND SYMMETRICAL OR

LOCALISED
 LOCALISED VARIETIES PRESENT AS

• VOCAL NODULES
• POLYPUS
• CONTACT ULCER
• REINKE’S EDEMA

pgmedicalworld.com
 CHRONIC DIFFUSE HYPERTROPHIC
LARYNGITIS
 ETIOLOGY IS SIMILAR TO THAT OF LARYNGITIS
WITHOUT HYPERPLASIA
 PATHOLOGICAL CHANGES START IN GLOTTIC
REGION AND MAY EXTEND TO BANDS,BASE OF
EPIGLOTTIS ,SUBGLOTTIS AND SUB MUCOSAL
GLANDS
 HYPERAEMIA,EDEMA AND CELLULAR
INFILTRATION IN SUB MUCOSA SEEN INITIALLY
 THERE WILL BE CHANGE OF RESPIRATORY
EPITHELIUM TO HYPERPLASTIC SQUAMOUS TYPE
AND LATER KERATINISATION OCCUR
 MUCOUS GLANDS INITIALLY HYPERTROPHY BUT
LATER UNDERGOES ATROPHY
pgmedicalworld.com
 CLINICAL FEATURES AND TEATMENT

 MOSTLY AFFECTS MALES OF 30-50 YEARS

 HOARSENESS,DRY COUGH AND TIREDNESS OF
VOICE ARE PRESENTING COMPLAINTS
 EXAMINATION REVEALS RED LARYNGEAL MUCOSA
 VOCAL CORDS APPEAR RED AND SWOLLEN
 CORDS BCOME BULKY AND GIVE NODULAR
APPEARANCE
 MOBILITY OF CORDS GET IMPAIRED
 CONSERVATIVE TREATMENT IS SIMILAR TO THAT
OF LARYNGITIS WITHOUT HYPERPLASIA
 SURGICALLY STRIPPING OF VOCAL
CORDS,REMOVING OFHYPERPLASTIC AND
OEDEMATOUS MUCOSA IS CARRIED OUT
pgmedicalworld.com
pgmedicalworld.com
pgmedicalworld.com
pgmedicalworld.com
 VOCAL NODULES
 ALSO CALLED SINGERS NODULES
 RARELY OCCURS IN GOOD SINGERS
 MOSTLY AFFECTS HOUSEWIVES
 TEACHERS MAY DEVELOP VOCAL NODULES

PATHOLOGY
SINGING IN HIGH NOTES AT END OF BREATH LEADS TO
HYPERKERATOSIS OF FREE EDGES OF VOCAL CORDS
THEY ARE USUALLY BILATERAL

pgmedicalworld.com
pgmedicalworld.com
 SIGNS AND SYMPTOMS

 SYMPTOMS SIMILAR TO OTHER FORMS OF

CHRONIC LARYNGITIS
 IDL SHOWS SMALL, SMOOTH AND WHITE NODULE
ON ONE OR BOTH VOCAL CORDS AT JUNCTION OF
ANTERIOR AND MIDDLE 1/3RD

TREATMENT
VOICE REST, SPEECH THERAPY
EXCISION IF HOARSENESS PERSISTS

pgmedicalworld.com
 CONTACT ULCERS

 IT IS UNCOMMON CONDITION RESULTING FROM

VOCAL ABUSE
 ULCERATIONS AND GRANULATIONS OCCUR ON
VOCAL PROCESSES OF ARYTENOID CARTILAGE
 VOICE REST ADVICED, STEROIDS, EXCISION OF
GRANULATIONS

POLYPUS
IT OCCURS AS SMOOTH SESSILE, PEDUNCULATED
SWELLING FROM VOCAL CORD, MAY BE DUE TO
LOCALISED EDEMA
MICROLARYNGIOSCOPIC EXCISION IS PERFORMED
pgmedicalworld.com
pgmedicalworld.com
 REINKE’S EDEMA

 IT IS ALSO KNOWN AS POLYPOID DEGENERATION

OF VOCAL CORDS
 BILATERAL SYMMETRICAL SWELLING OF WHOLE
OF MEMBRANOUS PART OF VOCAL CORDS
 THIS IS DUE TO EDEMA OF SUBEPITHELIAL SPACE
OF VOCAL CORDS

ETIOLOGY
1. CHRONIC IRRITATION OF VOCAL CORDS
2. HEAVY SMOKING
3. CHRONIC SINUSITIS
4. LARYNGOPHARYNGEAL REFLEX
pgmedicalworld.com
pgmedicalworld.com
 CLINICAL FEATURES
 HOARSENESS
 PATIENT USES FALSE CORDS ,THIS GIVES HIM
LOW PITCHED AND ROUGH VOICE
 ON IDL VOCAL CORDS APPEAR AS FUSUFORM
SWELLINGS WITH PALE TRANSLUCENT LOOKS,
VENTRICULAR BANDS SHOW HYPERAEMIC AND
BECOME HYPERTROPHIED AND HIDE VIEW OF
TRUE CORDS

TREATMENT
1. DECORTICATION OF VOCAL CORDS
2. VOICE REST
3. SPEECH THERAPY
pgmedicalworld.com
 PACHYDERMIA LARYNGIS

 FORM OF CHRONIC HYPERTROPHIC LARYNGITIS

AFFECTING POSTERIOR PART OF LARYNX IN THE
REGION OF INTRA ARYTENOID AND POSTERIOR
PART OF VOCAL CORDS
 ETIOLOGY IS UNCERTAIN, MOSTLY SEEN IN MEN
WHO INDULGE IN EXCESSIVE ALCOHOL AND
SMOKING,GERD
 IT IS BILATERALLY SYMMETRICAL DOESN’T
UNDERGO MALIGNANT CHANGES
 BIOPSY OF LESION IS ESSENTIAL TO
DIFFERENTIATE FROM CARCINOMA AND TB

pgmedicalworld.com
CLINICAL FEATURES AND TREATMENT

 ON IDL HEAPING UP OF RED AND GREY

GRANULATION TISSUE IN THE INTRA AYTENOID
REGION AND POSTERIOR THIRD OF VOCAL CORDS
 IT MAY LEAD TO CONTACT ULCER
 TREATMENT

1. REMOVAL OF GRANULATION TISSUE

2. CONTROL OF ACID REFLUX
3. SPPECH THERAPY

pgmedicalworld.com
 ATROPHIC LARYNGITIS

 CHARACTERISED BY ATROPHY OF LARYNGEAL

MUCOSA AND CRUST FORMATION
 CONDITION OFTEN SEEN IN WOMEN AND
ASSOCIATED WITH ATROPHIC RHINITIS AND
PHARYNGITIS
 SYMPTOMS INCLUDE HOARSENESS WHICH
TEMPORARILY IMPROVES ON COUGHING AND
REMOVAL OF CRUSTS
 DRY IRRITATING COUGH AND DYSPNOEA

pgmedicalworld.com
pgmedicalworld.com
 LARYNGEAL HYPERKERATOSIS

 WHITE PATCHES APPEAR ON THE VOCAL CORDS

 IT’S A PRE MALIGNANT CONDITION
 MAINLY OCCURS IN MALES OF AGE GROUP
FOURTH DECADE
 SMOKING AND SYPHILLIS MAY LEAD TO
LEUCOPLAKIA
 CLINICAL FEATURES INCLUDE
HOARSENESS,LEUKOPLAKIC RAISED PATCHES ON
THE ANTERIOR AND MIDDLE 1/3RD OF VOCAL
CORDS
 THE PATIENT MUST BE UNDER CONTINUOUS
SUPERVISION FOR MALIGNANT CHANGES

pgmedicalworld.com
pgmedicalworld.com
 TREATMENT

 VOICE REST
 SMOKING SHOULD BE STOPPED
 STEAM INHALATION
 EXCISION OF LEUCOPLAKIC PATCHES BY
MICROLARYNGOSCOPY
 LASER MAY BE USEFUL

pgmedicalworld.com
CLINICAL FEATURES AND TREATMENT

 ATROPHIC MUCOSA WITH FOUL SMELLING

CRUSTS
 WHEN CRUSTS HAVE BEEN EXPELLED MUCOSA
SHOWS BLEEDING
 TREATMENT IS ELIMINATION OF CAUSATIVE
FACTOR AND HUMIDIFICATION
 LARYNGEAL SPRAYS WITH GLUCOSE IN
GLYCEROL TO LOOSEN CRUSTS
 ASSOCIATED NASAL AND PHARYNGEAL
CONDITIONS SHOULD BE TREATED
 EXPECTORANTS CONTAINING AMMONIUM
CHLORIDE OR IODIDE TO LOOSEN CRUSTS

pgmedicalworld.com
 GRANULOMATOUS
CONDITIONS OF
LARYNX
1. TUBERCULOSIS OF LARYNX
2. LUPUS OF LARYNX
3. SYPHILIS OF LARYNX
4. LEPROSY OF LARYNX
5. SCLEROMA OF LARYNX
6. LARYNGEAL MYCOSIS

pgmedicalworld.com
 LARYNGEAL TUBERCULOSIS

 IT IS ALMOST SECONDARY TO PULMONARY

TUBERCULOSIS
 IT OCCURS IN 3 FORMS

1. ACUTE MILIARY TUBERCULOSIS – MULTIPLE

TUBERCLES BREAKING TO FORM ULCERS (RARE)
2. LUPUS
3. CHRONIC TUBERCULOSIS – MOST COMMON

pgmedicalworld.com
pgmedicalworld.com
 ETIOLOGY AND PATHOLOGY
 AGE – 20 – 40 YEARS
 BOTH SEXES ARE AFEECTED EQUALLY
 TUBERCLE BACILLI REACHES THE LARYNX
WITH SPUTUM OR IT REACHES BY
LYMPHATIC OR BLOOD VESSELS
 TUBERCLE FORMATION IS SEEN INITIALLY
 ULCERATION OF THE TUBERCLES OCCURS
SOON
 PERICHONDRITIS AND COLD ABSCESS
FORMATION MAY OCCUR IN ADVANCED
CASES
pgmedicalworld.com
 SIGNS SYMPTOMS

 MOVEMENTS OF VOCAL  APHONIA – VOICE

CORDS AFFECTED . BECOMES WEAK WITH
 VOCAL CORDS CONGESTED INTERMITTENT APHONIA
AND ULCERATED IN
 HOARSENESS
POSTERIOR 1/3RD
 GRANULOMA MAY FORM IN
 COUGH IS ALWAYS
INTRA ARYTENOID REGION PRESENT
 PSEUDO EDEMA OF  PAIN , IT INCREASES ON
EPIGLOTTIS AND ARYTENOIDS SWALLOWING, MAY BE
 PEREICHONDRITIS IS SEEN IN REFFERED TO EAR
ADVANCED CASES
 INSPIRATORY DYSPNOEA IN
LATE STAGES

pgmedicalworld.com
 INVESTIGATIONS
 SPUTUM EXAMINATION FOR AFB
 RADIOGRAPH OF CHEST
 BIOPSY CLINCHES THE DIAGNOSIS

TREATMENT
1. ANTI TUBERCULAR DRUGS
2. VOICE REST IS ADVICED
3. ANALGESICS

LARYNGEAL MYCOSIS
•FUNGAL INFECTIONS SUCH AS CANDIDIASIS , HISTOPLASMOSIS
AND BLASTOMYCOSIS
•DIAGNOSIS MADE ON BIOPSY OR FINDING SIMILAR LESIONS IN
OTHER PARTS OF THE BODY

pgmedicalworld.com
 SYPHILLITIC LARYNGITIS
 IT IS VERY RARE CONDITION NOW
 IN TERITIARY STAGE GUMMA MAY BE
ENCOUNTERED, AFFECTING EPIGLOTTIS AND
ANTERIOR 1/3RD OF VOCAL CORDS
 HOARSENESS IS COMPLAINT
 DIFFUSE INFILTRATION RESEMBLING
HYPERTROPHIC LARYNGITIS
 ULCERATION
 PERICHONDRITIS
 LARYNGEAL STENOSIS DUE TO SCARRING AND
ADHESIONS
 TREATMENT INCLUDES ANTI SYPHILLITIC DRUGS,
TRACHEOSTOMY IF REQUIRED, LARYNGOPLASTY
FOR STENOSIS
pgmedicalworld.com
•LARYNGEAL LEPROSY IS VERY RARE
•DIFFUSE NODULAR INFILTRATION OF
EPIGLOTTIS,ARYTENOIDS AND FALSE CORD MAY OCCUR
•IT MAY RESULT IN STENOSIS AND DEFORMITY OF LARYNX

•LUPUS OF LARYNX IS AN INDOLENT

TUBERCULAR INFECTION ASSOCIATED WITH LUPUS OF
NOSE AND PHARYNX , A PAINLESS AND ASYMPTOMATIC
CONDITION
•IT AFFECTS MAINLY ANTERIOR PART OF LARYNX
•LESION SPREADS TO ARYEPIGLOTTIC FOLDS AND
VENTRICULAR BANDS
•TREATMENT IS ANTITUBERCULAR DRUGS

pgmedicalworld.com
pgmedicalworld.com
 LARYNGEAL SCLEROMA

 RHINOSCLEROMA OF NOSE MAY RARELY EXTEND

TO INVOLVE THE SUBGLOTTIC REGIONS OF
LARYNX
 INFILTRATION IN SUBMUCOSA LEADS TO
SUBGLOTTIC STENOSIS
 TREATMENT

1. STREPTOMYCIN OR DOXYCYCLINE
2. STEROIDS REDUCE FIBROSIS AND STENOSIS
3. TRACHEOSTOMY IF NECESSARY
4. LARYNGEAL DILATATION
5. LASER EXCISION MAY BE HELPFUL
pgmedicalworld.com
pgmedicalworld.com