A. Chronic non specific laryngitis:
(1) Hypertrophic
(a) Chronic diffuse hypertrophic laryngitis.
Etiology:
- Repeated acute laryngitis
- predisposing factors
Symptoms:
- Dysphonia.
- Cough & expectoration.
- Hemming (desire for frequent throat clearing).
Signs:
- Congested thickened V.F
- In oedematous type (Reinke’s oedema) :polypoidal VF.
Treatment:
- Remove predisposing factor.
- Like acute but no antibiotics.
- VF stripping: MLS or laser in resistant cases
(b) Chronic localized hypertrophic laryngitis.
| (i) Vocal cord nodules | (ii) Vocal cord polyp | |
|---|---|---|
| Etiology | Voice abuse,Gastroesophageal reflux | Voice abuse |
| Incidence | More in females, children. | More in males |
| Pathology | Epithelial hyperplasia of free edge of V.F Fresh: soft& red Mature :hard& white | Localized subepithelial oedema or vascular engorgement followed by fibrosis |
| Symptoms | Hoarseness, weakness | Hoarseness Rarely stridor if large Chocking |
| Signs | Bilateral Small tiny nodules Sessile White or pink At free margin of V.F. At junction of ant 1/3 & post 2/3 | Unilateral Small or large Usually pendunculated Grey, white or red From undersurface of V.F. Site as nodule |
| Treatment | Voice rest, avoid misuse Speech therapy +/- removal by MLS, or Laser Voice rest, avoid misuse Speech therapy | Removal by MLS or Laser |
(iii) Leukoplakia
Definition: White patch on laryngeal mucosa.
Etiology: Irritation.
Pathology: Epithelial hyperplasia & hyperkeratinization.
Symptoms: Persistent hoarseness.
Signs: White patch on V.F. May appear as diffuse, villous, or verrucous.
Treatment: Excision by MLS or Laser, follow up as it is pre-cancerous.
(2) Atrophic.
Etiology:
- Dusty atmosphere
- Industrial fumes
- Post irradiation therapy
Incidence: more in women.
Symptoms: hoarseness, offensive breath &dyspnea (crusts)
Signs: dry pale atrophic mucosa, & crusts.
Treatment:
Avoid predisposing factors, moisture, menthol inhalation, laryngoscopy to remove crusts.
(B) Chronic specific laryngitis (Granuloma).
(1) Laryngoscleroma.
Definition: Chronic specific inflammation affecting upper respiratory tract.
Etiology: gram – ve bacilli; Klebsiella rhinoscleromatis.
Incidence: Endemic in Egypt. Usually 2ry to nasal scleroma may be 1ry.
Usually subglottic region.
Symptoms:
- Stridor & dyspnea
- Hoarseness may be present
- Cough & expectoration
Signs:
Pale pinkish smooth swelling on both side of subglottis covered by greenish crusts >> fibrosis & subglottic stenosis.
Investigations:
- DL & biopsy
- CT for length & degree of stenosis.
Treatment:
- Medical as in rhinoscleroma.
- Voice rest & humidification.
- Tracheostomy, if severe distress.
- Treatment of stenosis by either:
-Laser radial incisions and dilatation.
-External: graft & stent
-Resection anastomosis.
(2) T.B. laryngitis.
Etiology: 2ry to pulmonary T.B. Pathology: Affect posterior part of larynx.
Symptoms:
I- General: 1- T.B toxaemia: night fever, night sweat, loss of weight, loss of appetite.
2- Pulmonary T. B cough, expectoration, haemoptysis.
II- Local:
1- Hoarseness: progressive, phonoasthenia( weak voice.)
2- Stridor & dyspnea.
3- Pain & referred otalgia.
4- Odynophagia (marked).
Signs:
I- External: Tenderness due to perichondritis.
II- Indirect Laryngoscopy or flexible laryngoscopy:
1- T.B granulations on arytenoids.
2- T.B ulcer: thin undermined edge, yellow caseous floor.
3- Impaired V.F mobility.
Investigations:
1- DL & biopsy. 2- Chest X ray for T.B. 3- Tuberculin test: good negative test.
Treatment:
1- Tracheostomy in severe distress.
2- Antituberculous drugs e.g. rifampicin, PASA, streptomycin & pyrazinamide.
3- Local anesthetic spray before meals.
(3) Syphilis of the larynx.
Etiology: Treponema pallidum (spirochete). Incidence: Very rare.
Pathology: 1ry: chancre. 2ry: mucous patches. 3ry: gumma (commonest).
Symptoms: - Hoarseness.
- Stridor.
- Cough & discomfort (no pain).
Signs: Syphilis affects anterior part of larynx.
- Gumma of epiglottis appears swollen & ulcerated.
- Diffuse symmetrical infiltration without ulceration.
Investigations:
1- DL & biopsy. 2- Radiology. 3- Serology.
Treatment: 1- Tracheostomy if needed. 2- Penicillin.
(4) Lupus
Etiology: Attenuated T.B. Incidence: Mostly 2ry to nasal lupus.
Pathology: Apple jelly nodule.
Ulceration on one side.
Fibrosis, notched epiglottis.
Symptoms: vague discomfort.
Signs: see pathology.
Investigation: - DL & biopsy. - X ray chest.
Treatment: like T.B + vit. D.
(5) Leprosy
- Lepromatous or tuberculoid types.
- Nodules ulceration fibrosis.
- Treatment: Dapson and rifampicin.
(6) Fungal infection (mycosis).
(a) Candidiasis (moniliasis)
- Caused by candida albicans, whitish grey fibrinous membrane.
Treatment: Remove the underlying cause, topical nystatine or miconazole.
(b) Aspergillosis.