CASE ABSTRACT

LARYNGITIS

Submitted to:

Dioni Herson C. Viloria, RN

Clinical Instructor

Submitted by:

Mark Lloyd C. Miranda

Student

Overview of the Disease

Laryngitis is an inflammation of the mucous membrane lining the larynx (voice box), which is
located in the upper part of the respiratory tract.

It causes hoarseness, and possibly a temporary loss of speech.

Description of Laryngitis
Laryngitis, an inflammation of the larynx, occurs in two forms. Acute, which lasts only a few
days; and chronic, which persists over a period of weeks or months.

The most common symptom of either form is hoarseness that may, within several days, progress
to partial or total loss of voice. Fever, sore throat, and swallowing difficulty may occur as well.

Children face the added risk of encountering breathing difficulty, because the opening of a
child's larynx is narrow to begin with, and inflammation restricts the air passages even further.

Php. Statistic ***********************************************

Signs and Symptoms

 Hoarseness (harshness sound)

 Weak voice or voice loss
 Tickling sensation and rawness of your throat (prickle/itchiness and complexity/roughness of
throat)
 Sore throat
 Dry throat
 Dry cough
 Difficulty breathing (in children)
 Difficulty swallowing
 Swollen lymph glands in the throat, chest, or face
 Difficulty eating
 Fever

 Dysphonia is the medical term for disorders of the voice: an impairment in the ability to
produce voice sounds using the vocal organs (it is distinct from dysarthria which means
disorders of speech, that is, an impairment in the ability to produce spoken words). Thus,
dysphonia is a phonation disorder. The dysphonic voice can be hoarse or weak, or
excessively breathy, harsh, or rough, but some kind of phonation is still possible
(contrasted with the more severe aphonia where phonation is impossible).

 Dysphonia has either organic or functional causes due to impairment of any one of the
vocal organs. However, typically it is caused by some kind of interruption of the ability
of the vocal folds to vibrate normally during exhalation. Thus, it is most often observed
in the production of vowel sounds. For example, during typical normal phonation, the
vocal folds come together to vibrate in a simple open/closed cycle modulating the airflow
from the lungs. Weakness of one side of the larynx can prevent simple cyclic vibration
and lead to irregular movement in one or both sides of the glottis. This irregular motion is
heard as roughness. This is quite common in vocal fold paresis.
Diagnostic Procedures and Laboratory Tests

Diagnosis is based upon a combination of the clinical history and a physical exam. Some
physicians might wish to do a laryngoscopy (visualization of the vocal cords).

The most common sign of laryngitis is hoarseness. Changes in voice that is different with
the degree of infection or irritation, ranging from mild hoarseness to almost total loss of voice.
The doctor may ask whether a smoker or if have any health conditions — such as a cold or
allergies — that may be causing vocal irritations, and the doctor may also ask if overuse of
vocal cords — such as singing or shouting that may have irritated the vocal cords.

In chronic hoarseness, the doctor may listen to your voice for examination and to
examine the vocal cords. These techniques are sometimes used to help diagnose laryngitis:

 Laryngoscopy. Visually examine of vocal cords in a procedure called laryngoscopy, by using a

light and a tiny mirror to look into the back of throat. Or the doctor may use fiber-optic
laryngoscopy. This involves inserting a thin, flexible tube (endoscope) with a tiny camera and
light through the nose or mouth and into the back of throat. Then the doctor can watch the
motion of vocal cords as you speak.
 Biopsy. If the doctor sees a suspicious area, biopsy may occur— taking a sample of tissue for
examination under a microscope.

Acute laryngitis

 Investigations are rarely helpful in primary care. A swab for microbiological analysis may be
contributory if excessive exudate is present.
 Clinicians with the skill to perform indirect laryngoscopy will typically find redness and small
dilated vasculature on the inflamed vocal folds.

Chronic laryngitis

 Laboratory Tests:
o Full blood count with differential to exclude infection
o Sputum culture for bacteria, fungi and viruses
o Laryngeal mucosal swab for microbiological analysis
o Serology for autoimmune markers
o Tests for syphilis and tuberculosis if clinically indicated
 Radiology:
o Lateral Xray of neck - may show supraglottic or retropharyngeal swelling, or soft tissue
density in subglottic airway
o Chest radiograph
o CT scanning and MRI may be appropriate if detailed morphology of the larynx required
o Barium swallow study, double-contrast upper GI series, and manometry - may be
required to exclude GORD

Videostrobe - unit consists of stroboscopic unit (light source and microphone), a video camera, an
endoscope, and a video recorder, useful in diagnosing vocal cysts, polyps and nodules.

Management

Acute laryngitis

 Most cases are mild and self-limiting.

 Non-drug measures found to be helpful include inhaling humidified air and minimal use of the
voice.
  Inhaling humidified air promotes moisture of the upper airway, helping to clear secretions and
exudate.
 Use of antihistamines and corticosteroids is not supported by evidence. Indeed these
treatments may cause temporary respite leading to overuse of the voice, as well as drying of the
larynx.
 Antibiotics may be helpful in patients who have persistent symptoms or who have other
problems such as immune system deficiency.
 Acute laryngitis is unusual in children under the age of 18. Failure to respond to symptomatic
relief should raise the possibility of other conditions, such as tracheobronchitis, especially if
there are other features such as dyspnoea.

Chronic laryngitis

 Supportive measures - these include hydration (approximately 2 litres per day), steam
inhalation, avoidance of pollutants and cigarette smoke, and avoidance or limitation of exposure
to environmental or occupational sensitisers.
 Treat the underlying condition - e.g. gastro-oesophageal reflux disease GORD may need
appropriate lifestyle advice, prokinetic drugs and proton pump inhibitors.
 Hospital admission - be prepared to arrange hospital admission if the patient develops stridor,
becomes systemically unwell, or is at risk of food aspiration.
 Surgery - this may be contributory in the relief of laryngeal stenosis, and the treatment of GORD.

Treatment of Laryngitis
If laryngitis is caused by a bacterial infection, antibiotics will be prescribed.

Some palliative measures that can be taken include:

 Avoid public speaking during recovery

 Be aware that whispering puts greater strain on the vocal cords than normal
speaking
 Inhale steam from a bowl of hot water or from a warm shower
 Drink warm, soothing liquids (but do not drink alcoholic beverages)
 Try a cool-mist humidifier; avoid air conditioning
 Use nonprescription pain relievers and throat lozenges to ease the discomfort

Avoid cigarettes until the symptoms have subsided

Anatomy and Physiology

The Voice Production

Larynx
Highly specialized structure atop the windpipe responsible for sound production, air passage
during breathing and protecting the airway during swallowing

Vocal Folds (also called Vocal Cords)

"Fold-like" soft tissue that is the main vibratory component of the voice box; comprised of a
cover (epithelium and superficial lamina propria), vocal ligament (intermediate and deep laminae
propria), and body (thyroarytenoid muscle)

Glottis (also called Rima Glottides)

Opening between the two vocal folds; the glottis opens during breathing and closes during
swallowing and sound production

Understanding for Voice Disorders

Knowing how normal voice is produced and the roles the voice box and its parts play in speaking
and singing helps patients understand their voice disorders.

Voice "As We Know It"

The "spoken word" results from three components of voice production: voiced sound, resonance,
and articulation.

 Voiced sound: The basic sound produced by vocal fold vibration is called "voiced
sound." This is frequently described as a "buzzy" sound. Voiced sound for singing differs
significantly from voiced sound for speech.
 Resonance: Voice sound is amplified and modified by the vocal tract resonators (the
throat, mouth cavity, and nasal passages). The resonators produce a person's recognizable
voice.
 Articulation: The vocal tract articulators (the tongue, soft palate, and lips) modify the
voiced sound. The articulators produce recognizable words.

Voice Mechanism

Speaking and singing involve a voice mechanism that is composed of three subsystems. Each
subsystem is composed of different parts of the body and has specific roles in voice production.

Three Voice Subsystems

Subsystem Voice Organs Role in Sound Production

Air pressure Diaphragm, chest muscles, Provides and regulates air pressure to cause vocal
system ribs, abdominal muscles folds to vibrate

Lungs

Vibratory Voice box (larynx) Vocal folds vibrate, changing air pressure to sound
system waves producing "voiced sound," frequently
Vocal folds described as a "buzzy sound"

Varies pitch of sound

Resonating Vocal tract: throat Changes the "buzzy sound" into a person's
system (pharynx), oral cavity, recognizable voice
nasal passages

The key function of the voice box is to open and close the glottis (the space between the two
vocal folds).
  Role in breathing: Open glottis
 Role in cough reflex: Close, then open glottis
 Role in swallowing: Close glottis
 Role in voice: Close glottis and adjust vocal fold tension (plus additional functions for
singing)

Key Components of the Voice Box

 Cartilages
 Muscles
 Nerves
 Vocal folds

Pathopysiology