慢性喉炎講座

1、慢性喉炎講座Definition:Is a chronic inflammation of the mucosa of the larynx.EtiologyFollows repeated acute attacks but usually it arise insidiously due to :Faulty use of voice.Infection of teeth, tonsil, sinus, and lower respiratory tract infection.Excessive alcohol consumption or smoking.Dust or irritan

2、t fumes.Clinical classification:Chronic nonspecific laryngitis:Chronic simple laryngitis.Hyper keratosis of larynx (chronic keratosis or leukoplakia).Pachydermia laryngis.Contact granuloma.Atrophic laryngitis.Chronic specific laryngitis:Tuberculous laryngitisSyphilitic laryngitis.Leprosy of the lary

3、nx.Scleroma of the larynx.Wegeners (malignant) granuloma of the larynx.Mycosis of the larynx.Chronic Nonspecific laryngitisSimple chronic laryngitisPathology: Hyperaemia of vocal cord.Edema.Myositis occurs in the intrinsic muscles.Excessive secretion due to hyper activity of the mucous gland.Hyperae

4、mic and edematous stage often passes to a hypertrophic one and rarely to an atrophic one.Clinical Features:-Hoarseness (intermittent then persistent). -Cough (slightly dry). -Sore throat (very common). Chronic laryngitis: there is hyperemia of mucus membrane.Odema of the margins of the vocal cord(Ri

5、enkes edema)Laryngeal appearanceThree types:Hyperaemic.Hypertrophic.Edematous.In all types the larynx is always affected bilaterally & symmetrically.Treatment:Vocal restElimination of irritating factors such as dust and smoking. Systemic antibiotics.Carbocisteine ( a mucolytic ) when secretion are t

6、hick.Stripping of the vocal cords is performed endoscopically in persistent cases.Chronic Nonspecific laryngitisHyperkeratois of the larynx (leukoplakia)Definition: A localized form of epithelial hyperplasia characterized by leukoplakic raised patches on the vocal cord.Pathology: There is hyperplast

7、ic change in the epithelium, together with extension of the papillae into the cornium; and basement membrane remains intact.Clinical features:Hoarseness ( gradual onset).Examination :there is a white raised patch on one or both vocal cords the anterior and middle thirds are usually involved. Mobilit

8、y of cords is not impaired.Treatment: -Infection in the mouth, throat and nose treated. -Stripping of the cords can sometimes be done through a direct laryngoscope but recurrence is usualConstant supervision is essential to detect early malignant change demanding radical removal or radiotherapy. -Bi

9、opsy is mandatory in suspicious cases and may require repetition. Leukoplakia of vocal cordChronic Nonspecific laryngitisPachydermia Laryngis:Definition: A form of chronic hypertrophic laryngitis affecting the epithelium and subepithelium of the posterior part of the larynx.Etiology:-A rare conditio

10、n more common in men.-The cause usually unknown but aggravating factors includes excessive alcohol and tobacco.Pathology: Hypertrophy occur both in the epithelium and subepithelial connective tissue. An inflammatory reaction may be seen. Neoplastic changes does not occur.Clinical features:Hoarseness

11、Sore throatGranular or papilliferous appearance which occur in the posterior sites and is bilateral and symmetricalTreatment: Similar to that for simple chronic laryngitis. surgical removal and diathermy of the masses give little relief and are inadvisable.Chronic Nonspecific laryngitisContact Granu

12、loma:Unilateral.Situated medially or superiorly on the vocal process of the arytenoid cartilage.Confused with contact ulcer.The granuloma has a typical polypoid appearance which is a local reaction to trauma.Granulation tissue can develop if the perichondrium is damaged either vocal trauma or throug

13、h trauma from an endotracheal tube.Slight hoarseness, with history of previous surgery or usage of excessive voice.Treated by simple removal by microlaryngoscopy but local recurrence are common.Contact granulomaChronic Nonspecific laryngitisAtrophic Laryngitis:Uncommon . usually associated with atro

14、phic rhinitis and pharyngitis.Aggravating factors : dusty atmosphere, industry fumes and chronic infection of the paranasal sinuses.Hoarseness and sore throat both of which are improved temporarily by hawking and coughing up the crust. Sometimes dyspnea. On examination :the mucosa will be dry and at

15、rophic, crusts different sizes lie over the mucosa which may be excoriated when they are removed.Treatment : Treatment of infection any whereChange of atmospheric conditionsRemoval of crust will give some local relief. This is aided by:Inhalation of mentholCarbocisteine by mouth.Hormones (results ar

16、e uncertain) Laryngeal spray e.g. Benadryl, or 0.5% solutions of sodium bicarbonate.Chronic Specific LaryngitisTuberculous Laryngitis:Acute miliary tuberculosis of larynx: the laryngeal lesion are accompanied by lesion in the pharynx.Tubercles appear on the swollen mucosa of the epiglottis and aryte

17、noids, these break down and form greyish ulcer.Severe pain is usually present.Treatment is that of general infection. Chronic tuberculosis of the larynx (laryngeal phthisis):EtiologyIt is almost always secondary to the pulmonary lesion. It may be:Sputogenic.Or hematogenicOr carried by lymph stream.P

18、athology: with sputogenic type of infection the tubercle bacillus can infect the intact laryngeal mucosa, the submucosal layer become infected and small round cell infiltration occur. One or more surface nodules soon appear which caseate and leads to ulceration and later on there will be formation o

19、f granulation tissue and cellular swellings which is called pseudo-edema.Clinical features:Weakness of voice with periods of aphonia.HoarsenessCough is a prominent symptom.Pain on swallowing if the laryngeal inlet is involved.Referred otalgia is common.Dyspnea rare.Localized tenderness is rare unles

20、s perichondritis is present.Laryngoscopic appearance:Slight impairment of adduction.Marked injection of one vocal cord may involve the whole of the cord or the posterior part of it.Ulceration of the edge of the cord (mouse-nibbled)Granulation in the interarytenoid region or on the vocal process of t

21、he arytenoid cartilage.Edema of the mucosa of the ventricle.Pseudo-edema of the epiglottis and arytenoids (turban larynx) of a pale sausage-like appearance, with occasional small bluish superficial ulcers.Vocal cord paralysis may occur from apical pulmonary disease, this affect the right side more c

22、ommonly than the left.:Diagnosis:CXR must always be taken when there are persistant laryngeal symptoms to exclude TB of the lungs.Sputum will usually contain tubercle bacilli.Biopsy when any doubt exist. The lesions most often confused with TB laryngitis are Carcinoma, ulcerative type of syphilis, lupus, pachyder