1. 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

2. 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

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

4. 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

5. 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

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

8. 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

9. 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

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

11. 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

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

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

14. 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

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

16. 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

17. 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 )

18. 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

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