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Acute Laryngitis types, causes, symptoms, signs, treatment

Laryngitis generically refers to inflammation of the tissues of the larynx, it is one of the most common conditions identified in the larynx and it manifests in both acute and chronic presentations.

In acute presentation the onset is usually abrupt, and the course of the illness is typically self-limiting; that is, less than 3 weeks.
acute-laryngitis
In chronic presentation, signs and symptoms usually develop gradually over very long periods of time when the larynx is repetitively exposed to the offending agent over a longer duration.

Classification of laryngitis:
I- Acute
  • Non specific: in adults, in children, epiglottitis & laryngotracheobronclitis
  • Specific: Diphtheria
II- Chronic
(A) Non specific:
Hypertrophic Diffuse, or Localized (nodule, polyp, and leukoplakia)
Atrophic
(B) Specific (granulomas): Scleroma, TB, Syphilis, leprosy, & mycosis

I- Acute Laryngitis

a. Acute non specific laryngitis:

(1) Acute non specific laryngitis in adults


Definition: Acute catarrhal inflammation of laryngeal mucous membrane.
Etiology: Follows upper respiratory tract infection:
  • Viral: influenza, rhinovirus 
  • Bacteria: Strept. pneumonia, strept., staph
Predisposing factors:
  • Voice abuse
  • Smoking
  • GERD
  • Postnasal discharge as in sinusitis. 
  • Dust & fumes

Incidence: see above 
Pathology: congestion and edema.

Symptoms:
General: Fever (occasionally), headache, malaise, and fatigue.
Local:
  • Dysphonia or hoarseness.
  • Discomfort & pain on phonation.
  • Dry cough + yellow sputum.


Signs: 
  • Diffuse symmetrical congestion & oedema.
  • +/- mucoid secretions.

Treatment:
  • Voice rest 
  • Fluids
  • Anti reflux medications
  • Humidification: steam, tincture benzoini
  • Systemic antibiotics (usually not needed)
  • Mucolytics

(2) Acute non specific laryngitis in children



Pathology:
 Difference between adult & child larynx.
1. Anatomical factors.
  • Lumen is relatively smaller.
  • Loose submucosal tissue.
  • Funnel shaped lumen.
  • More abundant lymphatic supply in mucosa.
  • >> More oedema causes marked obstruction.
2. Immature immune system.
3. Immature nervous regulation = spasm.

Symptoms:
General: as usual.
Local:
  • Hoarseness. 
  • Dry cough.
  • Stridor, dyspnea.
Signs: 
  • Diffuse congestion and oedema. 
  • +/- mucoid secretion.
  • Subglottic oedema
Differential diagnosis: 
causes of stridor in children

Treatment: as adult +
  • Hospitalization, oxygen.
  • Steroids to decrease edema.
  • Careful observation of respiratory obstruction if severe distress → intubation, or rarely tracheostomy (avoided in children unless no other way).

(3) Acute Epiglottitis

Definition: Acute non specific laryngitis affecting mainly the epiglottis.
Etiology: Haemophilus influenza type B, Streptococcus pneumonia.
Incidence: more in infants & children (now it is less common due to vaccination).

Symptoms:
General: High fever, malaise, headache, and anorexia.
Local: 
  • Severe odynophagia, drooling of saliva.
  • Muffled voice (hot potato).
  • Rapidly progressive stridor, baby sits in a tripod position.
Signs:
  • Oedema of supraglottis
  • Epiglottis appears as red swollen mass
  • Pharyngeal oedema & congestion
  • Enlarged UDCLN (Upper deep cervical lymph nodes)
  • X ray Epiglottis thicker than 8mm is diagnostic
Treatment: as before, care for the airway is very crucial to avoid suffocation.

(4) Acute viral laryngo tracheobronchitis (croup)

Definition: Acute respiratory infection spreading to entire respiratory system.
Etiology: The Parainfluenza viruses (types 1, 2, 3) are responsible for about 80% of cases.

Clinical picture: usually affects children presenting as laryngitis + cough, expectoration. The type affecting adults is more common to be bacterial
Treatment: as laryngitis.

b. Acute specific laryngitis (Diphtheria):

Since the introduction and widespread use of diphtheria toxoid it is encountered infrequently but it can still appear in children and adults who are immunecompromised or have not been vaccinated.

Symptoms:
General: Toxemia, low-grade fever and chills, headache, malaise, weakness and prostration.
Local: hoarseness, stridor, dyspnea, cough.
Signs: grayish, white, dirty membrane.

Treatment: as usual. + Tracheostomy.

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