Cummings
Chapters 63 & 64
Acute and Chronic Laryngitis
Laryngeal and Tracheal Manifestations
of Systemic Disease
Travis Shiba
12/6/13
Acute and Chronic Laryngitis
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Key Points
#1 cause of acute laryngitis = viral
 #1 cause of chronic laryngitis = reflux
 Candidal laryngitis can occur in non immuno
compromised
 Even in setting of likely neoplasm, still consider
infection
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Laryngitis
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Inflammation of the larynx
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Can impair swallowing, phonating and breathing
Acute Laryngitis
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Phonotrauma
Viral Laryngitis
Acute Bacterial Laryngitis
Acute Fungal Laryngitis
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Supepithelial hemorrhage from phonotrauma
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Supepithelial hemorrhage of R VC polyp
Acute Laryngitis
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Phonotrauma
Viral Laryngitis
Acute Bacterial Laryngitis
Acute Fungal Laryngitis
Viral Laryngitis
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Pathogens: rhinovirus, parainfluenza,
RSV, adenovirus, influenza,
adenovirus…
SSx: dysphonia, hoarse voice, cough
Rx: supportive care: hydration, antiinflam, voice rest, PPI +/- steroids
Croup: laryngotracheobronchitis
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Typically parainfluenza 1,3
Steeple sign
Acute Laryngitis
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Phonotrauma
Viral Laryngitis
Acute Bacterial Laryngitis
Acute Fungal Laryngitis
Acute Bacterial Laryngitis
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Supraglottitis (epiglottitis)
Pathogens: H influenza, Strep
PNA, Staph Aureus, Beta
hemolytic strep
 Decreased incidence with h flu B
vaccine
 Rx: airway control. Humid air, IV
antibiotics, monitored bed,
steroids
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Acute Bacterial Laryngitis
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Whooping cough
bordetella pertusis
 Vaccine protects ~ 3 yrs
 Rx: erythromycin to prevent spread
Diptheria
 Corynebacterium diptheria
 SSx: acetone breath, thick grey
membranous and friable plaque
 Rx: airway via trach, diptheria anti
toxins, PCN & clinda
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Acute Laryngitis
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Phonotrauma
Viral Laryngitis
Acute Bacterial Laryngitis
Acute Fungal Laryngitis
Acute Fungal Laryngitis
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Candiasis (moniliasis)
usually seen with oral/esophageal sx or in a pt taking
oral inhaled steroids
 White sessile plaques on erythematous base
 Rx: Fluconazole
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Chronic Laryngitis
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Bacterial
Fungal
Mycobacterial
Non infectious
Chronic Bacterial Laryngitis
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Rhinoscleroma
Klebsiella rhinoscleromatosis
 Path: Mikulicz Cells
 Rx: fluouroquinolones/TCN
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Syphillis
Secondary: painless edema
 Tertiary: gummas + cartil destruction
 Rx: PCN
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Chronic Bacterial Laryngitis
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Actinomycosis
Actinomycosis israelii
 Chronic suppurative infxn, rarely involves layrnx
 Histo:
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Sulfur Granules
Rx: PCN or Clinda
Chronic Laryngitis
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Bacterial
Fungal
Histoplasmosis
 Blastomycosis
 Cryptococcus
 Coccidiomycosis
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Mycobacterial
Non infectious
Histoplasmosis
Histoplasmosis
SCCA
Histoplasmosis
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Histoplasma capsulatum
Mississippi River Valley
 Acute/Chronic, Pulmonary/systemic
 Laryngeal Lesions: anterior larynx and epiglottis
 Bx: poorly defined granulomas, multinucleated giant
cells and pseudoepitheliomatous hyperplasia
 Grows on Sabouraouds agar
 Tx: Ampho/Azoles
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Blastomycosis
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Blastomyces Dermatitides
Central america/Midwest
 Airborne to lung, to larynx hematogenously
 Larynx involved 2% - exophytic/ulcerative mass
usually on TVC
 Histo: Broad based buds
 Rx: ampho/azoles
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Cryptococcus
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Cryptococcus neoformans
Bird droppings
H&N Sx: meningitis (SNHL), membranous
Npharyngitis; larynx (only TVC)
Dx: india ink stain showing capsules
Tx: ampho/azoles
Coccidiomycosis
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Coccidioides Immitis
“valley fever” Southwest US and North Mexico
 H&N: lesions (nodules/erosions) of skin, mucous
membranes, epiglottis, trachea, salivary glands
 Histo: “Sac with bugs”
 Rx: ampho/azole
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Chronic Laryngitis
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Bacterial
Fungal
Mycobacterial
Non infectious
Mycobacterial Laryngitis
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Tubercolosis
Direct from lungs or via blood
 Dx: PPD/Quant/AFB
 Tx: INH/Rifampin/voice rest
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Leprosy (Hansen’s)
AFB and granulomas
 Ulcerative supraglottis
 Dx: foamy leprous cells
 Rx: dapsone & CS
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Chronic Laryngitis
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Bacterial
Fungal
Mycobacterial
Non infectious
Non Infectious Laryngitis
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Smoking
Pollution
Vocal Abuse
Rhinosinusitis
Laryngopharyngeal Reflux
LPR
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Etiologies: acid/bile/pepsin
RF: obsity, EtOH, hiatial hernia, preg,
scleroderma, feeding tube
SSx: Hoarse (am>pm), globus, dysphagia
Dx: trial of PPI/NP scope
Barium swallow
 24 hour dual pH probe
 esophagoscopy
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LPR
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Rx:
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Behavioral: smoking cessation, elevate HOB, avoid
late meals, overeating, avoid tight close/loose weight
Decrease caffiene, EtOH, mints, chocolate,
 Avoid ASA, nitrates, CCB
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Medications
PPI (usually 2x dose for LPR versus GERD)
 H2 blockers
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Surgery
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Fundoplication
Laryngeal and Tracheal
Manifestations of Systemic Disease
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Key Points
Symptoms: hoarseness, cough, stridor, airway
compromise
 Mimic laryngeal carcinoma
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Wegener’s
Granulomatosis
Relapsing Polychondritis
Sarcoidosis
Rheumatoid Arthritis
Pemphigus/pemphigoid
Amyloidosis
Wegener’s Granulomatosis
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Idiopathic necrotizing granulomatous vasculitis
Types:
Limited (no renal)
 Systemic (pulm and renal)
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Laryngeal SSx: subglottic mass, dyspnea,
biphasic stridor
Rx: Steroids + cyclophosphamide then
MTX/Azathiaprine
Wegener’s Granulomatosis
Replapsing Polychondritis
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Idiopathic inflammation of cartilage
Laryngeal SSx: 14% present with laryngeal sx;
50% eventually have laryngeal sx
Radiology: non erosive arthopathy
Histo: non specific inflammation
Rx: steroids, dapsone, azathiaprine,
cyclophosphamide, cyclosporine
Sarcoidosis
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Systemic granulomatosis
Laryngeal SSx (1-5%): suprglottic submucosal
mass (“turbin like thickening”)
Dx: biopsy, incr ACE, hypercalcemia,
hypergammaglobulinemia
Histo: noncaseating granulomas
Rx: endoscopic removal of mass if symptomatic
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Systemic v injected steroids
Sarcoidosis
Rheumatoid Arthritis
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Autoimmune
25% Laryngeal involvement
Acute: tender/erythematous larynx
 Chronic: cricoarytenoid ankylosis, submucosal
nodules
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Increased RF, ESR; decreased C’
Rx: steroids and antireflux
Pemphigus/Pemphigoid
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Autoimmune
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Pemphigus vulgaris: anti desmosome tonofilament
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Bullous Pemphigoid: anti basement membrane
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Intracellular bridges disrupted->intraepithelial blisters
Subepidermal blistering
Laryngeal SSx: can occur on the mucosa if other
oral lesions. Usually does not extend to SG
Rx: corticosteroids
Pemphigus/Pemphigoid
Amyloidosis
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Abnormal deposition of fibrillar
protein and polysaccharide
complexes
Laryngeal SSx: anterior subglottic
mass
Dx: biopsy (congo red)
Rx: endoscopic removal