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


1.
2.
3.
4.

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



1.
2.
3.

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

1.
2.
3.

Conservative
Avoid misuse of voice
Speech therapy / proper use of
voice  No shouting / No whisper
? May change the profession
Surgical  Microlaryngoscopy &
LASER