1. ACUTE INFLAMMATIONS OF LARYNX
BY-KCSUDEEP,DR

2. Anatomy Clinical subdivision Supraglottis: Glottis: Subglottis:
from epiglottic tip to floor of laryngeal ventricle.
Glottis:
ant. commissure, TVC, post commissure
Subglottis:
at the inf. surface of TVC to inferior edge of cricoid

3. Diseases of the Larynx Inflammatory Infectious Granulomatous Mucosal
Congenital
Neoplastic

4. Anatomy

5. ACUTE LARYNGITIS
Acute laryngitis may be infectious or non- infectious.

6. AETIOLOGY
Infectious type is more common and usually follows upper respiratory infection.
To begin with, it is viral in origin but soon bacterial incasion takes place with sretp.pneumoniee, H.infuenzae and haemolytic streptococci or Staph. Aureus.
Exanthematous fevers like measles, chickenpox and whooping cough are also associated with laryngitis.

7. NON –INFECTIOUS TYPE
It is due to vocal abuse , allergy, thermal or chemical burns to larynx due to inhalation or ingestion of various substances, or laryngeal trauma such as endotracheal intubation.

8. CLINICAL FEATURES
SYMPTOMS are usually abrupt in onset and consists of :
Hoarseness which may lead to complete loss of voice
Discomfort or pain in throat, particularly after talking
Dry, irritating cough which is usually worse at night .
General symptoms of head , cold rawness or dryness of throat, malaise and fever if laryngitis has followed viral infection of upper respiratory tract.

9. Hoarseness which may lead to complete loss of voice.
Discomfort or pain in throat, particularly after talking.
Dry, irritating cough which is usually worse at night
General symptoms of head, cold, rawness or dryness of throat, malaise and fever if laryngitis has followed viral infection of upper respiratory tract.

10. Laryngeal appearance vary with severity of disease.
In early stages there is erythema and oedema of epiglottis, aryepiglottic folds, arytenoids and ventricular bands, but the vocal cords appear white and near normal and stand out in contrast to surrounding mucosa, betraying the degree of hoarseness patient has.
Later, hyperaemia and swelling increase. Vocal cords also become red and swollen. Subglottic region also gets involved. Sticky secretions are seen between the cords and interarytenoid region .
In case of vocal abuse, submucosal haemorrhages may be seen in the vocal cords.

11. TREATMEN VOCAL REST AVOIDANCE OF SMOKING AND ALCOHOL STEAM INHALATIONS
COUGH SEDATIVE
ANTIBIOTICS
ANALGESICS
STEROIDS

12. ACUTE MEMBRANOUS LARYNGITIS
THIS CONDITION IS SIMILAR TO ACUTE MEMBRANOUS TONSILLITIS AND IS CAUSED BY PYOGENIC NON-SPECIFIC ORGANISMS.
IT MAY BEGIN IN THELARYNX OR MAY BE AN EXTENSION FROM THE PHARYNX. IT SHOULD BE DIFFERENTIATED FROM LARYNGEAL DIPTHERIA.

13. STRIDOR INSPIRATORY EXPIRATORY BIPHASIC SUPRAGLOTTIC OR PHARYNX
LESION OF THORACIS TRACHEA, PRI. OR SEC. BRONCHI
BIPHASIC
GLOTTIS, SUBGLOTTIS AND CERVIAL TRACHEA

14. STRIDOR ACQUIRED CONGENITAL Afebrile Laryngomalacia Laryngeal web
Papillomatosis
Injury
Laryngeal web
Foreign body
Subglottic stenosis
Laryngeal oedema
Haemangioma
Adenotonsillar hypertrophy
Vocal cord paralysis
Febrile
Tongue and jaw abnormalities
Epiglottis
Acute laryngitis
Laryngotracheitis
Diptheria
Retropharyngeal abscess
Infectious mononucleosis
Peritonsillar abscess

15. Diseases associated with acute stridor
COMMON
Acute laryngothracheitis.
Acute laryngotracheobronchitis.
Acute epiglottitis.
Bacterial tracheitis.
Foreign body.
Uncommon
Peritonsillar abscess.
Retropharyngeal abscess.
Diphtheria

16. Viral Croup Common respiratory illness in young children.
Anglo-Saxon word Kropan; cry aloud.
Hoarse voice; dry barking cough; inspiratory stridor; and variable amount of respiratory distress that develops over a brief period of time.

17. Croup Syndrome
Group of diseases that varies in anatomic involvement and etiologic agents.
Laryngotracheitis.
Spasmodic croup.
Bacterial tracheitis.
Laryngotracheobronchitis.
Laryngotracheobronchopneumonitis.

18. Croup (Acute laryngotracheo-bronchitis)
Disease of viral origin causing subglottic & tracheal swelling.
The narrowed airway is responsible for the hallmark of clinical picture.
The cricoid ring in the upper trachea which is subglottic, has a narrow diameter which renders children vulnerable to inflammation.

19. Viral Croup ( Acute laryngotracheobronchitis)
Etiology:
Respiratory viruses e.g. parainfluenza viruses 1,2,and 3, RSV, Influenza viruses A & B.
Clinical picture:
Age 6mths- 3 years, M>F, Fall & winter.
Gradual onset of low grade fever,URTI, barking cough, inspiratory stridor & respiratory distress.
Hoarseness & aphonia may occur.

20. Croup, diagnosis & treatment
Clinically
Lateral neck X-ray ( steeple sign).
Fluid intake
Cool mist/ hot steamy bathroom.
Aerosolized adrenaline.
Steroids( controversial)
Endotracheal intubation.
Helium-Oxygen Mixture.
Antibiotics

21. Acute epiglottitis, etiology
Bacterial infection of the supraglottic structures( epiglottis, aryepiglottic folds & arytenoids soft tissues) causing rapid airway obstruction.
Haemophilus Influenza type B in prevaccination era.
Bacteria associated with epiglottitis in the Hib vaccine era include: HiA, Str. Pn, Staph aureus, ß-hemolytic streptococci Gps A,B,C,and F

22. Acute epiglottitis, clinical picture
Age usually 2- 7 years.
Sudden onset.
High fever.
Apprehensive, sitting forward, drooling saliva, hyperextended neck & protruded chin.
Stridor, dysphagia.

23. Acute epiglottitis, diagnosis
Direct visualization.
X-RAY; shows THUMB sign on Lat view
Blood cultures.
Latex agglutination of serum or urine.

24. Acute epiglottitis, treatment
Hospitalization
Treatment is a medical emergency.
Ventilatory support, intubation.
Steroids for e.g. hydrocortisone 100mg i.v. may be useful to relieve oedema.
IV antibiotics, 2nd or 3rd generation cephalosporin's or chloramphenicol till cultures & sensitivity are known.

25. Croup Vs Epiglottitis
Characteristics of Laryngotracheitis and Epiglottitis
Feature Laryngotracheitis Epiglottitis
Age <3 years >3 years
Onset Gradual (days) Acute (hours)
Cough Barky Normal
Posture Supine Sitting
Drooling No Yes
Radiograph Steeple sign, narrowed subglottis Thumb sign, enlarged
epiglottis,dilated hypopharynx
Cause Viral Bacterial
Treatment Supportive (croup tent) Airway management (intubation or
tracheotomy), antibiotics

26. Diffuse tonsillar & pharyngeal
Erythema seen here as a non
Specific finding that can be produced
By a variety of pathogens

27. Intense erythema seen in association
With acute tonsillar enlargement
& palatal petichiae is highly suggestive
Of Gp A beta-streptococcal
Infection, though other pathogens
Can produce these findings.

28. Exudative tonsillitis
Seen with either Group A
Beta hemolytic streptococcal
Or EB virus infection.

29. Peritonsillar abscess
Photograph taken in the OR
Shows an intensely inflamed
Soft palatal mass that obscures
The tonsil & bulges forward &
Toward the midline deviating
The uvula .

30. Retropharyngeal abscess This young child presented
With high fever, drooling,
Opisthotonous posture.
Pharyngeal examination in
The OR reveals an intensely
Erythematous unilateral
Swelling of the posterior
Pharyngeal wall.

31. Retropharyngeal abscess, a lateral neck XR shows prominent
Prevertebral swelling displacing the trachea forward.

32. Croup
This radiograph shows a long area of narrowing extending below the
Normally narrowed area at the level of the vocal cords.

33. Croup
Direct visualization revealed subglottic narrowing that was so severe
Only tracheostomy would enable establishment of an adequate airway.

34. Epiglottitis
A 3 year old seen a few hours after
Onset of symptoms.
She was anxious but with no positional
Preference or drooling.

35. Epiglottitis
This 5 year old holds his neck
Extended, head forward, is mouth
Breathing, drooling, and shows
Signs of tiring.

36. Epiglottitis This 2-year old was in Severe distress and was
Too exhausted to hold
His head up.
IN the OR the epiglottis
Appears intensely red &
Swollen.

37. ?

38. Questions
A 12 yr old boy with 4 days of sore throat comes to your office. Afebrile with rhinorrhea, cough, and one day diarrhea associated with his sore throat. Throat is mildly erythematous a with normal appearing tonsils. The best course of action is:
Swab the throat and give 10 days AB.
Swab his throat and wait for results.
Symptomatic Rx.
AB without testing for gp A strept.

39. Question 2
A 3 yr old fussy boy , febrile with proffuse rhinorrhea. Shallow ulcers are noted on the soft palate and vesicles are noted on one palm and both soles of the feet. The etiology of this infection is
Gp A strept
Acranobacterium hemolyticum
Coronavirus.
Coxackie virus