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    Laringitis book

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    10 views9 pages

    Laringitis

    Uploaded by

    andinimaryzka
    Laringitis book

    Copyright:

    © All Rights Reserved
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    of 9
    Head & Neck Surgery— OTOLARYNGOLOGY FOURTH EDITION VOLUME ONE == BYRON J. BAILEY, MD Chair Emeritus, Department of Otolaryngology University of Texas Medical Branch at Galveston Galveston, Texas == JONAS T. JOHNSON, MD Chair, Department of Otolaryngology Professor, Departments of Otolaryngology and Radiation Oncology University of Pittsburgh School of Medicine Professor, Department of Oral and Maxillofacial Surgery University of Pittsburgh School of Dental Medicine Pittsburgh, Pennsylvania t= SHAWN D. NEWLANDS, MD, PhD, MBA Wiess Professor and Chairman Department of Otolaryngology University of Texas Medical Branch at Galveston Galveston, Texas 335 Contributors Illustrated by Victoria J. Forbes, Anthony Pazos, and Christine Gralapp @ Dipindai dengan CamScanner Sumeer K. Gupta Gregory N. Postma Jamie A. Koufman Laryngitis, frequently misused as a synonym for hoarseness, refers to any acute or chronic, infectious of noninfectious, localized or systemic inflammatory process involving the larynx. The dinical presentation of laryngitis depends on its cause, the amount of tissue edema, the region ofthe larynx primarily involved, and the patient's age. Patients with laryngitis may present with one or more symptoms: dyspho- nia, odynophonia, dysphagia, odynophagia, cough, dysp "nea, or stridor. An understanding that carcinoma ofthe lr- | ynx often presents with similar symptoms is central to the evaluation of laryngitis. The diagnosis is based on the hhistory and the laryngeal examination, but it sometimes requires special diagnostic tests, such as cultures, blood tests, skin tests, pH monitoring, biopsies, or radiographs (Table 59.1). Laryngitis in children will be dealt with in a different chapter. Laryngitis in adults is usually les serous than in children because the larger adult lannx can accommodate ‘swelling without obstructing as readily. Although there are ‘many infectious, autoimmune, and inflammatory causes | of laryngitis (Table 59.2), adult laryngitis is most com- i monly caused by a viral upper respiratory infection, smok- | ‘ing, or laryngopharyngeal reflux (LPR) (1). t . INFECTIOUS LARYNGITIS INFEC eee Viral Laryngitis Infectious laryngitis in adults is most commonly associ- ated with a viral upper respiratory infection. Patients pres- ‘ent with a generalized viral syndrome and dysphonia that is characterized by voice breaks, episodic aphonia, and a lowering of the vocal pitch, Rhinoviruses are the most © common causative agents. Cough and throat pain ae often seen with infectious laryngitis. CCharacterstically, the vocal fold mucosa is erythematous and edematous. The disease is self-limited and is treated With humidification, voice rest, hydration, smoking cessa- tion, cough suppressants and expectorants. Antibiotics are indicated only for secondary bacterial infection. During the time petiod of acute laryngitis the vocal folds are swollen and heavy voice use can often lead to vocal injury; thus, re- duced voice use or voce resis extremely important. Bacterial Laryngitis Supraglotits, also referred to as acute epiglotits, is mani- fested by fever, sore throat, muffled voice, odynophagia, and dyspnea. The diagnosis is made by observing the swollen, red supraglotts by fiberoptic laryngoscopy or by detecting a swollen supraglots (thumbprint sign) on stan- dard lateral neck radiographs. Fiberoptic laryngoscopy ex- amination is dearly superior toa lateral neck radiograph. ‘The issues of airway safety and where these procedures are done must be considered carefully. Because Haemophilus influnaa type B vaccination has become pat of childten’s immunization, the incidence of acute epilotttis has de- creased dramatically; however, for unclear reasons, the inc dence in adults may be increasing (2), Haemophilus influenzae is the most common organ- ism, but Streptococcus pneumoniae, Staphylococcus aureus, B-hemolytic srepococ, and Klebsiella pneumoniae have also been identified as causative organisms. Patients with se- vere airway symptoms such as dyspnea, severe stridor, or ‘cyanosis require immediate establishment of an airway. ‘Management of less severe cases with medical manage- ment, close observation, and serial fiberoptic examina- tions has been shown to reduce the number of patients ‘requiring airway intervention without increasing mortality rates (2.3), Patients whose symptoms progres rapidly over @ Dipindai dengan CamScanner 830 Section V: Voice ae! pasos IBY ovcnosis LaRYNGITIS History Grad or sudden onset Stidor fseclted upper est neton or “eabur* Duan dency of amptone ltemitent or progress smptons Examination Listen to voice, breathing Indirect, mito laryngoscopy Fiberoptic assessment Radiographic studies Skin tests Laboratory tests Biopsy less than 24 hours or present with drooling are at higher tisk for airway compromise requiring intervention, Med- ical treatment includes humidification, hydration, cort- costeroids, and intravenous antibiotics (2,3). Epiglottic abscess is an uncommon complication of supraglottits, and it ocurs more commonly in adults than in children. Epiglttic abscesses usually occur on the lin ‘gual side of the epilotts and may be diagnosed by direct visualization or computerized tomographic evaluation. AEA LARYNGITIS IN ADULTS Infectious laryngitis Vial-

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