Chronic laryngitis Chronic laryngitis refers to an inflammatory process that determines irreversible alterations of the laryngeal mucosa Reactive and reparative processes of the larynx represent the main pathogenetic factor, which can persist even when the causative stimulus ends

Non specific : No specific detectable cause Chronic hyperemic Ch Hypertrophic Atrophic Pachydermia (contact granuloma / contact ulcer ) Specific  Chronic granulomatous lesions e.g. Tuberculosis, Syphilis, Scleroma, leprosy, fungal infections & amyloidosis

Chronic Hyperemic laryngitis Diffuse inflammatory condition involving the whole larynx particularly true & False vocal cords

Causes Recurrent acute laryngitis / Incompletely resolved Ac laryngitis more than 3 weeks Chronic infection in the vicinity sinusitis, tonsillitis, bad orodental hygiene , Ch Bronchitis Occupational factors  dust & Fumes Smoking & Alcohol Voice abuse GERD

Clinical Features Males affected more than females Hoarseness of voice Fatigue of voice Hawking & irritation larynx Dry irritating cough Laryngoscopy Hyperemia , Vocal cords appear dull & edges are rounded, Viscid secretions on VC / interarytnoid region

Treatment Eliminate The cause  infection / irritating factors Complete voice rest / Observe proper vocal hygiene Medicated steam inhalation ? Expectorants

Chronic hypertrophic laryngitis Advanced stage of hyperemic laryngitis Cellular infiltrate in the submucosa Epithelium may undergo hyperplasia / metaplasia May be generalized involvement False VC (ventricular bands)  “Dysphonia plica ventricularis” True vocal cords  Rinke’s Edema

Causes  As for hyperemic chronic laryngitis Laryngoscopy  Laryngeal mucosa is thickened & dusky red in colour Vocal cords red & swollen, Edges loose sharp demarcation In Dysphonia plica venticularis false vocal cords swollen, may cover true VCs

Treatment Conservative Surgical  Stripping of edematous mucosa with micro-scissor Ablation with LASER One side done at a time to prevent Web

Atrophic laryngitis Common in women Associated with Atrophic Rhinitis Laryngitis Sicca Exact cause not known  Hormonal disturbance, Dietary deficiency, Autoimmune disorder Bacillus ozaenae secondary infection

Clinical features Hoarseness Dry irritating cough Dyspnoea due to crusts Laryngoscopy  Laryngeal mucosa is dry & atrophic Covered with foul smelling crusts

Treatment Primary condition  Atrophic rhinitis Steam inhalation 25% glucose in glycerin sprays Expectorants containing Iodides to loosen the crusts

Tuberculous laryngitis Secondary to Pulmonary tuberculosis Common in adult males Brochogenic / hematogenous route Bronchogenic route affects posterior larynx --- Interarytnoid region, submucosal tubercles & granuloma Hematogenous  Multiple painful ulcers in larynx & pharynx

Clinical features Hoarseness Painful ulcers / referred otalgia Odynophagia Laryngoscopy  Pale granulations in the interarytnoid region

Ulcers of vocal cords  mouse eaten appearance Swelling of false VCs & Aryepiglottic folds X-Ray chest Sputum for AFB Biopsy Treatment : As for pulmonary tuberculosis

Vocal Nodules Singer‘ nodules Common in voice misusers  Teachers, singers, preachers & Vendors Vocal trauma  submucosal hemorrhage  fibrosis & hyalinization At the junction of anterior 1/3 7 posterior 2/3 ( subject to maximum trauma )

Clinical features H/o misuse of voice Hoarseness Vocal fatigue Laryngoscopy  Symmetrical nodular pinkish or grey masses at junction of ant 1/3 & post 2/3 of true vocal cords

treatment Conservative Avoid misuse of voice Speech therapy / proper use of voice  No shouting / No whisper ? May change the profession Surgical  Microlaryngoscopy & LASER