1.

Acute and chronic diseases of larynx

Department of Ear, Nose and Throat Diseases

Sechenov University
Moscow, Russia
1.1. Part 1 Acute and chronic diseases of larynx

Lecturer Eremeeva Ksenia Vladimirovna, PhD, Associate

Professor
Department of Ear, Nose and Throat Diseases
Sechenov University
Moscow, Russia
 Disease of larynx can be both an
particular disease and a symptom of
the pathology of other organs and
body systems
 Inflammatory diseases of the larynx

• Acute laryngitis (catarrhal, submucous or edematous-catarrhal, phlegmonous)

• Chronic laryngitis (catarrhal, atrophic, hyperplastic)
• Specific laryngitis (tuberculosis, syphilitic, chlamydia)
• Secondary laryngitis (reflux-laryngitis, laryngeal amyloidosis, laryngitis with
lymphoproliferative diseases)
 Acute catarrhal laryngitis

Predisposing factors:
• general and local hypothermia
• excessive voice loads
• viral infections
• contact with irritants
• respiratory tract infection
• prolonged mouth breathing

Archive of the Department of Diseases of the Ear, Throat, and Nose of

Sechenovsky University
 Clinical picture

• voice change - hoarseness (dysphonia), up to the complete

disappearance of the voice (aphonia);
• sensation of burning, scratching, foreign body in the throat;
• Hacking non-productive cough
 Laryngoscopic picture:

• hyperemia and edema of the mucous membrane of all

floors of the larynx, incomplete closure of the vocal folds
 Treatment of acute catarrhal laryngitis
• Voice mode (silent)
• Diet: elimination of spicy, sour, salty and hot foods,
• Elimination of bad habits: alcohol, smoking
• Antiviral treatment
• Inhalation (alkaline)
• Antihistamines, with an allergic history
• Aerosol forms of antiseptics and antibiotics
 Acute subglottic laryngitis (false croup)

The main cause of the disease is acute respiratory viral infections,

parainfluenza, a combination of various respiratory viruses.
                
  Predisposing factors:
• Abnormalities of the constitution
• Hypertrophy and chronic inflammation of the elements of the
lymphadenoid pharyngeal ring
• Burdened allergic history
 Clinical picture

• Acute onset, in the form of a breathless attack, mostly at night,

usually in a supine position
• Inspiratory dyspnea, stridor breathing, restless behavior
• Barking cough, sometimes interrupted by laryngospasm
• Acrocyanosis, participation in the act of breathing auxiliary muscles
• Endolaryngal picture: red rollers protruding under the vocal folds
• Relapse of seizures may occur
 Differential diagnostics of subglottic laryngitis

Subglottic laryngitis Diphtheria of larynx

Study guides of Department of Ear, Throat and Nose Diseases, Sechenov

University, 1977
 Признак False croup Diphtheric croup
Acute, ni Acute, night time Gradual deterioration of
breathing

Voice clear Hoarseness to aphony

Cough Barking cough Loud, then soundless

Lymphadenitis no cervical

Fibrinous pellicle no Tonsills, larynx

Intoxication Expressed due to Poor, grown on

common cold

Study guides of Department of Ear, Throat and Nose Diseases, Sechenov

University, 1977
 Pre-doctor care:
 take the baby in your arms and calm
 put the baby in a room with warm, humid air
 give a spoonful of warm water or milk
 hot foot baths
 antihistamines
 inhalation of hormones through a compression nebulizer

Medical assistance:
intravenous administration of corticosteroids (prednisone at the rate of 1-2 mg
per kg of body weight of the child)
Hospital treatment:
• humidified oxygen
• antihistamines
• sedatives
• corticosteroids
• inhalation therapy
• at accession of a secondary infection - antibiotics
• with treatment failure - prolonged intubation up to 5 days;
with inefficiency - tracheotomy
Acute stenosing laryngotracheitis
Infectious-allergic inflammation of the mucous membrane and
muscles of the larynx, combined with inflammation of the mucous
membrane of the trachea

• Usually increases in winter

• Most often occurs at the age from 6 months to 4 years
• More common in boys
• Caused by influenza viruses, parainfluenza, adenovirus and RS -
virus
 Acute stenosing laryngotracheitis
The clinical picture is a sudden onset of the disease, symptoms of
intoxication, "barking" cough, accompanied by stenosis of the larynx,
until asphyxia.

Archive of the Department of Diseases of the Ear, Throat, and Nose of

Sechenovsky University
 Acute stenosing laryngotracheitis

Forms:
• Edematous-infiltrative
• Fibrous purulent
• Hemorrhagic
• Necrotic
 Pathogenesis

Swelling of the mucous membrane

larynx and trachea

Hypersecretion glands
Muscle spasm of the mucous membrane
larynx, larynx, trachea and
  trachea and bronchi bronchi
 Treatment
• Etiotropic
      - antiviral
      -antibacterial
• Pathogenetic
    anti-inflammatory (NSAIDs)
     -dehydration
     desensitizing
     - antitussive
• Symptomatic
     - antipyretics
     - sedatives
     - analgesics
With an increase in laryngeal stenosis - intubation
no more than 5 days, with inefficiency - tracheotomy
 Acute epiglottitis
A special form of edema-catarrhal laryngitis with predominant lesion
of the epiglottis

 Incidence - year-round
 Occurs in both children and adults (more often in men)
   H. Influenzae is caused - type B - in children, in adults -
pneumococcus, GABHS, meningococcus
 Clinical picture
• Acute onset
• Severe general hyperthermia
• Inspiratory dyspnea and stridor
• Severe sore throat
• Dysphagia
• Hypersalivation
• Ortopnea
• Muffled or muffled voice
 Forms:
• Edematous

• Infiltrative

• Abscessing

Archive of the Department of Diseases of the Ear,

Throat, and Nose of Sechenovsky University
Acute eppiglottiеis should be differentiated with:
• lingual angina
•   pharyngeal abscess
• acute stenosing laryngotracheitis
•   sublingual laryngitis
•   foreign body
•   trauma to the pharynx and larynx
•   laryngeal edema
 Treatment
• Urgent hospitalization
• When the infiltrative form - make "notches" of the mucous
membrane of the epiglottis in the place of the greatest infiltration.
• With abscess form of epiglottitis - opening of an abscess
• Antibiotics of choice - “protected” penicillins or cephalosporins
• Corticosteroids
• NSAID
 
With decompensated laryngeal stenosis - intubation or tracheotomy
1.2. Part 2 Acute and chronic diseases of larynx

Lecturer Eremeeva Ksenia Vladimirovna, PhD, Associate Professor

Department of Ear, Nose and Throat Diseases

Sechenov University
Moscow, Russia
 Allergic swelling of the larynx
• develops due to sensibilization of the body to various allergens
• begins acutely, sometimes - lightning, on the background of general health, in
the absence of catarrhal phenomena, normal body temperature
• complaints of marked difficulty in breathing, difficulty in swallowing,
hypersalivation

Archive of the Department of Diseases of the Ear,

Throat, and Nose of Sechenovsky University
 Treatment

• Allergen elimination
•  Antihistamine drugs
•  Corticosteroids
•  Inhalation with corticosteroids
•  In extreme situations - conicotomy
 Monochorditis

Types of monochorditis:
• Nonspecific: vasomotor,
traumatic
• Specific: tuberculosis, syphilis
or precancer

Archive of the Department of Diseases of the Ear,

Throat, and Nose of Sechenovsky University
 Definition

Chronic laryngitis - a chronic inflammatory disease of the

mucous membrane of the larynx lasting more than 3 weeks
 Forms of chronic laryngitis

• Catarrhal
• Hypertrophic
• Atrophic
• Edematous Polyposis
• Reflux Laryngitis
• Fungal laryngitis
• Specific
 Etiology of chronic laryngitis

• recurrence of acute laryngitis

•  long voice load
•  smoking and alcohol abuse
•  occupational hazards
•  chronic inflammatory diseases of the broncho-pulmonary
system, nose and paranasal sinuses
•  chronic gastrointestinal diseases, renal failure, hypothyroidism,
diabetes mellitus, radiotherapy
 Clinical picture

complaints:
• hoarseness
• fatigue of voice when
talking
• cough

[Link]
kataralniylaringitosobennostitecheniyait_0D5E42D3.jpg
 Laryngoscopic picture and treatment
• slight hyperemia and
infiltration of the vocal folds,
injection of vessels of the
mucous membrane

   Treatment:
• in the period of exacerbation
- therapy as in acute
laryngitis;
• during remission - elimination
of etiological factors leading
to the disease
 Chronic atrophic laryngitis

Laryngoscopic:

• dull dry mucosa,

• viscous sputum possible

• hypotension and disconnection of

vocal folds during phonation
 Treatment of chronic atrophic laryngitis

• elimination of the cause and treatment of a background disease (diabetes

mellitus, chronic renal failure, vasculitis)
• stimulating and tonic therapy
• vitamins (A, B, C) and antioxidants
• neuromuscular transmission enhancers
• secretory and mucolytics systematically and locally
• inhalation with mineral water 2-4 times a day for 5-10 minutes to 1 month
• indoor air humidification

Clinical recommendations of the Ministry of Health of the Russian Federation

(2013)
 Chronic hyperplastic laryngitis

Complaints
• tickling, foreign body
sensation in the throat
• cough
• viscous mucus sputum
• voice change
(from hoarseness to
aphonia, especially in Archive of the Department of Diseases of the Ear,
Throat, and Nose of Sechenovsky University
the morning)
 Morphological changes

• persistent morphological changes in the

tissues of an organ with impaired
innervation, blood circulation and secretion;
• long persistent flow;
• background and predisposing disease to
malignancy;
• lack of lasting positive effect on the
background of conservative therapy

37
 Clinical and morphological types
Singers’ nodes
• Connective tissue formations
covered with flat keratinizing
epithelium

• Located on the border of the front

and middle third of the vocal folds

Pathogenesis:
• dyskinesia of the folds, so that
their mechanical irritation in the
place of maximum contact
[Link]
• Infringement of microcirculation uploaded/[Link]

with inflammatory reaction

 Chronic edematous polypous laryngitis

Pathogenesis factors:

• smoking
• increased voice load

When laryngoscopy:
from light spindle-like vitreous edema to severe,
accompanying flotation hyperplasia of the
mucous, causing asphyxiation
swelling of the submucous layer of the vocal fold
from the voice process of the scapular-shaped
cartilage to the anterior commissure
 Laryngoscopic picture

During exacerbation:

• hyperemia and infiltration

• laryngeal mucosa,

• uneven and vascular-injected

vocal folds

•   no phase closure during

phonation
 Clinical and morphological types

1. Pachydermia

• Limited hyperplasia of the

laryngeal mucosa
• Localization - most often voice
and interchordal folds
 Clinical and morphological types
2. Leukokeratosis of
vocal folds

• Mucosal lesion - whitish-

gray focal keratinization of
stratified squamous
epithelium
 Clinical and morphological types

3. Hyperkeratosis

Superficial keratosis of the

left vocal fold
 Treatment
• To give up smoking
• Observance of a sparing diet and voice mode
• Treatment of inflammatory diseases of the nose, paranasal
sinuses and nasopharynx
• Inhalations with antiseptic solutions, mucolytics and alkaline
mineral water
• Physiotherapy treatment - phonophoresis of 1% potassium
iodide, lipid or calcium chloride in the larynx, therapeutic laser,
magnetic therapy
• Secret and mucolytic (ambroxol, acetylcysteine, fluimucil)
drugs.
• Surgical treatment - when hyperkeratosis is soldered to the
underlying layers and stenotic laryngitis Reinke-Hayek

 Clinical recommendations of the Ministry of Health of the Russian

Federation (2013)
1.3. Part 3 Acute and chronic diseases of larynx

Lecturer Eremeeva Ksenia Vladimirovna, PhD, Associate Professor

Department of Ear, Nose and Throat Diseases

Sechenov University
Moscow, Russia
 Reflux laryngitis (extra-esophageal
manifestation of GERD)
• voice change - minor
• burning sensation,
perspiration, foreign
body in the throat and
larynx
• dry, unproductive
paroxysmal cough after
eating, especially when
lying down

[Link]
 Reflux laryngitis
When laryngoscopy:
•  hyperemia of the
mucosa and
proliferation of the
mucous of the posterior
larynx
•   accumulation of
viscous sputum
• Treatment by a
gastroenterologist
 Fungal laryngitis

•Rarely isolated, often combined

with fungal pharyngitis

Complaints:

•  hoarseness
•  burning and itching of the larynx
•  paroxysmal cough with sputum
with crusts and foul odor
 Fungal laryngitis
• When laryngoscopy:
Specific whitish mycotic plaque

• Treatment:
  exclusion of etiological factors
  antifungal drugs topically or
systemically

• Prevention:
  Rational antibiotic therapy [Link]
20170828/563db999550346aa9a9ee07a/[Link]
 Laryngomalacia

• 60-75% cause severe stridor in children

• Anatomical and physiological features
of the larynx in children:
•   internal retraction scooped-up the
nodular folds and tubular epiglottis,
• displacement of scarplike cartilages
anterior and midline,
• rear caudal displacement of the
epiglottis,
• shortening scoops
•   extremely acute angle between the
epiglottis and the entrance to the larynx
Garashchenko T.I., 2009

50
 Surgical treatment of children with
laryngomalacia

• Supraglottoplasty, epiglottopexy

Indications:
• dysphagia,
• respiratory distress syndrome
• life-threatening bouts of apnea
Garashchenko T.I., 2009
 Paresis and palsy of larynx

neurogenic

central peripheral
organic functional unilateral bilateral

Myogenic palsy - limited inflammatory changes in the

internal muscles of the larynx
 MYOGENIC PARALITIES OF THE LARYNX

m. vocalis m. interarythenoidea [Link]

latеralis

m. vocalis и [Link]
m. interarythenoidea lateralis и m. vocalis

[Link]
%3B&text=&etext=1796.i9fH
 Etiology of posttraumatic paralysis of the larynx

• surgery on the thyroid gland for

cancer or goiter Hashimoto
(more than 90%)

• surgery on the heart, lung,

mediastinum, esophagus,
vessels of the neck and
cervical spine
 Diagnostics of laryngeal paralysis

• Full examination of the

head and neck, chest (CT,
MRI)
• Fibrolaryngoscopy
• Video stroboscopy
• Spirometry (FER)

• Assessment of the position

of the folds:
• median,
• paramedian,
• Intermediate,
• lateral
• back third of the glottis
during phonation
Clinical picture of bilateral laryngeal paralysis
• Inspiratory stridor

• The sonorous voice in the

middle position of the vocal Вдох
folds

• Violation of the protective

function (choking when taking
liquid food) with paralysis of
the upper and lower laryngeal Выдох
nerves
Clinical picture of unilateral paralysis of the larynx

• hoarseness or aphonia
depending on the position
of the vocal fold

• slight difficulty breathing Inhale

during exercise

• gagging when taking

liquid food

Phonation
Treatment of unilateral paresis of the larynx

• reflexology

• breathing exercises

• anticholinesterase drugs (prozerin, neuromidine)

• B vitamins

• sinusoidal modulated currents on the laryngeal area

 Stages of surgical treatment
bilateral paralysis of the larynx
• I - tracheostomy

• II - delayed lateral fixation of the

vocal fold with arytenoidotomy,
redressing of the cricoid arc and
stenting of a T-shaped tube
•       [Pat. № 2284773 RF]

• III - suturing laryngotrachephissis

 Hysterical laryngospasm
• shortness of breath short (minutes
- hours), or long (weeks - months
- years)

• more often - in young women

with unstable mentality and
children of school age

• the result of a subconscious

attempt to avoid a stressful
situation, which is especially
evident in adolescence