LARYNGITIS

Definition
• Laryngitis is inflammation that occurs in the vocal cords due to
overuse, due to irritation or due to infection. The vocal cords are an
arrangement consisting of cartilage, muscles and mucous membranes
that form the entrance of the trachea (trachea). Inside the ballot box
there are vocal cords two mucous membranes that are folded in two
wrapping the muscles and cartilage
• Laryngitis can last for a short (acute) or long (chronic) time for more
than 3 weeks.
Classification
1. Acute laryngitis
Laryngitis is an inflammatory process in the larynx that
occurs suddenly and lasts for approximately 3 weeks
which is generally a continuation of upper respiratory
tract infection, namely acute rhinopharyngitis
(common cold)
2. Chronic laryngitis
Chronic laryngitis is inflammation of the laryngeal mucous membrane
located in the upper respiratory tract, called chronic if it occurs more
than 3 weeks.
continuous irritation occurs due to excessive alcohol use, lots of
smoking or acid from the stomach that flows back into the esophagus
and throat, a condition called gastroesophageal reflux disease (GERD).
Some patients may have experienced attacks of recurrent acute
laryngitis, exposure to irritating dust or fumes or using sounds not
appropriate in the neuromuscular context. Smoking can cause edema
and laryngeal erythema.
Epidemiology
• laryngitis mainly attacks at the age of 18-40 years for adults while in
children it is generally affected by ages above 3 years.
• The national epidemiology of laryngitis in Indonesia is still unknown.
A cross-sectional study at Mintohardjo Hospital in Jakarta found that
of 96 patients with acute respiratory infections, 1.1% were cases of
acute laryngitis.
Etiology
Acute laryngitis Chronic laryngitis
1. Rhinovirus 1. Bacterial infection
2. Parainfluenza virus 2. Tuberculosis infection
3. Adenovirus 3. Syphilis
4. Mumps virus 4. Leprae
5. Varisella zooster virus 5. Virus
6. Use of inhaler asthma 6. Mushrooms
7. Use of excessive voice in work: Singing, Speaking 7. Actinomycosis
publicly Teaching 8. Use of excessive sound
8. Allergy 9. Allergy
9. Group A Streptococcus 10. Environmental factors such as smoke, dust
10. Moraxella catarrhalis 11. Systemic disease: wegener granulomatosis,
11. Gastroesophageal reflux amyloidosis
12. Alcohol
13. Gatroesophageal reflux
Etiology of Acute Laryngitis
1. This acute laryngitis can occur from the continuation of respiratory
tract infections such as influenza or common cold. influenza virus
infection (type A and B), parainfluenza (type 1,2,3), rhinovirus and
adenovirus. Other causes are Haemofilus influenzae, Branhamella
catarrhalis, Streptococcus pyogenes, Staphylococcus aureus and
Streptococcus pneumoniae.
2. This disease can occur due to seasonal / weather changes
3. Excessive use of sound
4. Trauma
5. Chemicals
6. Smoking and drinking alcohol
7. Allergy
Patofisiology Parainfluenza virus

Enter through inhalation

Infecting ciliated local airway epithelium cells

Edema of the lamina propria, submucosa, and adventitia.

Cellular infection with histocytes, lymphocytes, plasma cells and
polymorphonuclear leukocytes (PMN)

Edema and hyperemia from the airways occur mainly on the lateral wall of
the trachea under the vocal cords (occurs in the lumen of the airway)

There was a narrowing, even just a gap

The vocalist's protective membrane is usually hyperemic & edema

Classification of Acute Laryngitis
1. Viral laryngitis
a. Viral laryngotracheitis (Croup)
b. Viral laryngitis
c. Herpes simplex virus

2. Bacterial laryngitis
a. Supraglottitis bacterial (Epiglottitis)
b. Diphtheria Laryngitis
Clinical Symptoms
1. Sound impairment:
• Hoarse
• Rude
• Hard to get out
• Tone> low
2. Shortness of breath & stridor
3. Throat pain → when swallowing & talking
Signs and symptoms
Laryngotrakeitis Supraglotitis

Under 3 years 3-6 years

Onset in a few days Onset in a few hours (2-6 hours)

Suara serak (barking cough) Clear voice

There is no dysphagia Dysphagia

No drool Drool

Lying position Sitting position

Can relapse again Rarely relapse

Lost in weeks Fast travel, lost in 2-3 days

Radiogram “steeple sign” “Thumb sign”

Etilogy virus Bacteria

Physical examination

Laryngoscope
Indirect and direct

• The laryngeal mucosa is edema, hyperemic to the

upper & lower vocal cords
• In epiglottitis there is edema in epiglottis,
aryepiglitis fold, and false vocal fold with cherry
red
Signs of airway obstruction in children

• Restless

• Air hunger (gasping)

• Shortness gets worse with cyanosis

• Suprasternal & epigastric retraction

Supporting Examination
X-rays: AP neck (antero-posterior) and lateral
soft tissue photos
“Thumb sign” “Steeple sign”
 Treatment
• The goal of therapy is to reduce edema of the larynx.
• Acute laryngitis caused by a virus can usually heal itself

Non
Medical

Medical
Management

Take care
of the
hospital
Non Medical

• Vocal rest by not speaking much or speaking

• Hydration
• he use of humidification is warm or cold

Medical

 Antipyretic
 Decongestant
 Oral corticosteroids
 In secondary infections (membranous croup) antibiotics can
be given: erythromycin 3x500mg
Indications for care

Epiglotitis
Progressive stridor
Emergency breathing
 Hypoxemia, restlessness, cyanosis, pallor
Sensorium depression and high fever
Prognosis
• The prognosis for patients with acute laryngitis is generally good
and recovery for one week.

• In general the length of hospital stay and mortality rates for cases
of upper respiratory tract obstruction increase when the infection
extends and involves a larger respiratory tract, except for
epiglottitis, where local infection is proven to be deadly.

• Most cases of croup death are caused by laryngeal obstruction or

by complications of tracheostomy. Untreated epiglotitis has a
mortality rate of 6%.