Literature Reading:

LARYNGITIS

dr. Ekky Rizky Maulana

Supervisor : Dr. dr. Melati Sudiro Sp.T.H.T.B.K.L Subsp. Rino (K), M. Kes

Department of Otorhinolaryngology-Head & Neck Surgery

Faculty of Medicine Padjadjaran University
Hasan Sadikin General Hospital
Bandung
2022
Introduction  Laryngitis is frequently used to describe an inflamed
appearance of the mucosa and tissues of the larynx.
 A variety of clinical presentations is possible ranging
from dysphonia or dysphagia to airway compromise
depending on pathology.
 Affecting individuals aged 18 to 40, though it may be
seen in children as young as three.
 Treatment is targeted to the specific pathology,
which is usually diagnosed from a thorough history.
physical examination, and detailed laryngoscopy, but
may also require more specific laboratory or
radiologic examination.

Stein, D. and Noordzij, J., 2013. Incidence of Chronic Laryngitis. Annals of Otology, Rhinology & Laryngology, 122(12), pp.771-774.
 The larynx is located in
the anterior compartment of the
neck, suspended from the hyoid
bone, and spanning between C3
ANATOMY and C6. It is continuous inferiorly
with the trachea, and opens
superiorly into the laryngeal part
of the pharynx

Moore, K.L., Dalley, A.I. 2009. Clinically Oriented Anatomy. 6th edition. Philadelphia : Lippincott Williams & Wilkins. 402.
 - Covered :
1. Anterior  infrahyoid muscle
ANATOMY2. Lateral  thyroid glands
3. Posterior  esophagus

4
Moore, K.L., Dalley, A.I. 2009. Clinically Oriented Anatomy. 6th edition. Philadelphia : Lippincott Williams & Wilkins. 402.
 Anatomically, internal
cavity of the larynx can be
divided into:
ANATOMY 1. Supraglottis
2. Glottis
3. Subglottis

Moore, K.L., Dalley, A.I. 2009. Clinically Oriented Anatomy. 6th edition. Philadelphia : Lippincott Williams & Wilkins. 402.
 CARTILAGES

 Sataloff, R.T., Chowdhury, F., Portnoy, J., Hawkshaw, M.J., Joglekar S. Surgical Techniques in Otolaryngology – Head and Neck Surgery: Laryngeal Surgery. New Delhi,
India: Jaypee Brothers Medical Publishers; 2013
MUSCLES Extrinsic Muscle

Intrinsic Muscle
 Venous supply
Arterial supply Superior laryngeal vein 
• Superior laryngeal artery  drains to internal jugular vein
• Inferior laryngeal artery  Inferior laryngeal vein 
drains to brachiocephalic vein

Vasculature

Moore, K.L., Dalley, A.I. 2009. Clinically Oriented Anatomy. 6th edition. Philadelphia : Lippincott Williams & Wilkins. 402.
 Larynx receive both motor
Innervation and sensory innervation via
vagus nerve:
• Recurrent laryngeal nerve
• Superior laryngeal nerve

Moore, K.L., Dalley, A.I. 2009. Clinically Oriented Anatomy. 6th edition. Philadelphia : Lippincott Williams & Wilkins. 402.
 The fuctions of the larynx 
 Protection
 Coughing
 Valsalva maneuver
Physiology  The regulation of airflow
 As a sensory organ  influence the control of
breathing and cardiovascular function
 Speech

Bailey. Chapter 61: Upper Airway Anatomy and Function, Section IV Laryngology .
 Prevent food and liquid from entering the
airway
 Laringeal inlet
 True vocal cords
 False vocal cords
Protection  Laryngeal elevation  opening
cricopharyngeal sphincter  transient
negative pressure in cricopharynx 
prevent aspiration
 Apnea  vocal cords adduct 2,3 seconds 
food contact with posterior pharynx or base
of tongue N.IX

Bailey. Chapter 61: Upper Airway Anatomy and Function, Section IV Laryngology .
 Regulation Valsava
Cough
of airflow Maneuver
Rapid and deep Vocal folds firmly
The glottis widens
inspiration  adducted
forceful closure of during inspiration
preventing
both vocal cords  and narrows during expulsion of air
strong activation of expiration and collapse of
expiratory muscles the chest walls

12
Bailey. Chapter 61: Upper Airway Anatomy and Function, Section IV Laryngology .
  Laryngeal receptor influence the control of breathing :
 negative pressure receptors  increases the inspiratory activation
of upper airway dilating muscles maintaining upper airway
patency
 airflow (cold) receptors  decrease respiratory rate or even cause
As a sensory apnea.
 drive receptors  probably proprioceptors that respond to
organ respiratory motion of the larynx
 Circulatory reflex 
 The afferent limb is the superior laryngeal nerve hypertention
 The afferent limb is the vagus nerve  bradycardia

Bailey. Chapter 61: Upper Airway Anatomy and Function, Section IV Laryngology .
  Phonation  Sound is produced by the larynx when expiratory
airflow induces vibration of free edges of the vocal folds as a
result of the interaction of aerodynamic and myoelastic forces.
 The vocal folds in the midline  Exhalation  subglottic pressure
to rise until the vocal folds are pushed apart  rapid decrease in
Speech subglottic pressure  the vocal folds return to the midline
 Resonance  Resonance is controlled by raising or lowering the
larynx
 Articulation  The larynx coordinating the beginnings and
endings of phonation to coordinate with upper articulators

Bailey. Chapter 61: Upper Airway Anatomy and Function, Section IV Laryngology .
Laryngitis

Acute/chronic, infectious/noninfectious, localized/systemic process

involving the larynx.

Bailey’s Head and Neck Surgery – Otolaryngology Fifth Edition. Philadelphia, JB Lippincott Co, 2014, chapter 67, 978-982
CLASSIFICATION

In the acute Inflammatory

form of Laryngitis process of at least
laryngitis, the 3-week duration
onset is usually that encompasses
abrupt with a Acute Chronic a broad range of
self-limiting inflammatory,
course of less infectious, and
than 3 weeks. autoimmune
conditions
Acute Laryngitis

17
 Habitually abusive
High and harsh
and excessive vocal Cigarettes smoking
vocal mileage
behaviors
Risk Factor
of Acute Laryngeal Anticholinergic
Laryngitis: LPR
dehydration medication

Diuretic or ACE Infectious laryngeal

Asthma or COPD
inhibitor medication conditions

Fluctuating Inflammation
History of HiB
systemic medical complications of
infection
conditions laryngeal trauma

History of laryngeal malignancy

Dworkin-Valenti JP, Sugihara E, Stern N, Naumann I, Bathula S, et al. (2015) Laryngeal Inflammation. Ann Otolaryngol Rhinol 2(9): 1058
 Specific: C. diphteria, M.
Infectious tuberculosis
Etiology
Acute Non specific : viral, bacterial,

Laryngitis
Vocal trauma/abuse/misuse
Non-Infectious Allergy
GERD
Asthma
Environmental pollution
Smoking
Inhalational injuries or
functional/conversion disorders
Gupta G, Mahajan K. Acute Laryngitis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan https://www.ncbi.nlm.nih.gov/books/NBK534871/#article-24052.s5
Jetté M. Toward an Understanding of the Pathophysiology of Chronic Laryngitis. Perspect ASHA Spec Interest Groups. 2016;1(3):14-25. doi:10.1044/persp1.sig3.14
 Cigarettes asthma Trigger ( infectious or
smoking non-infectious)

Cough- Inhaler use  Inflammation and

Hygroscopic variant chemical congestion of the larynx
effects asthma iritating

Dry laryngeal Repetitive vocal cord edema 

injury affects vibration adversely
mucosal
viscoelasticity

Phonation threshold pressure can increase  the generation of

adequate phonation pressure becomes more difficult

Pathophysiology
dysphonia
Gupta G, Mahajan K. Acute Laryngitis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan https://www.ncbi.nlm.nih.gov/books/NBK534871/#article-24052.s5
Jetté M. Toward an Understanding of the Pathophysiology of Chronic Laryngitis. Perspect ASHA Spec Interest Groups. 2016;1(3):14-25. doi:10.1044/persp1.sig3.14
 Initial symptoms (Abrupt in onset and worsen over two or
three days) :
1.Change in quality of voice, discomfort and pain in the
throat
2.Dysphagia
3.Odynophagia
History Taking 4.Dry cough
5.General symptoms
6.Frequent throat clearing
7.Early voice fatigue
8.History of medication
9.History of chronic disease

Gupta G, Mahajan K. Acute Laryngitis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan
https://www.ncbi.nlm.nih.gov/books/NBK534871/#article-24052.s5
Physical
Examination Indirect examination:
1.Early stage  erythema and edema
of the epiglottis, aryepiglottic folds,
arytenoids
2.Disease progresses  the vocal cords
can become erythematous as well as
edematous.
3.Reinke’s edema
4.Submucosal hemorrhage

Gupta G, Mahajan K. Acute Laryngitis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan
https://www.ncbi.nlm.nih.gov/books/NBK534871/#article-24052.s5
Evaluation

• Formal voice analysis and fiberoptic laryngoscopy  confirm the diagnosis in cases that are
refractory to treatment or otherwise convoluted. 
• Stroboscopy  relatively normal or may reveal asymmetry, aperiodicity, and reduced mucosal
wave patterns 
• Further imaging or laboratory studies are not required unless an atypical pathogen or neoplasm are
suspected.
• Culture  if the patient has exudate in the oropharynx or vocal cords

Gupta G, Mahajan K. Acute Laryngitis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan
https://www.ncbi.nlm.nih.gov/books/NBK534871/#article-24052.s5
Treatment Treatment  supportive in nature and depends on the severity
of laryngitis and airway patency
● Voice rest
● Steam Inhalation
● Avoidance of irritant
● Dietary modification
● Medication 
○ Antibiotics  for high-risk patients and patients with severe
symptoms
○ Antifungal  fluconazole  usually required for three weeks
period and may be repeated if needed.
○ Mucolytics  for clearing secretions
○ LPR-related laryngitis  anti-reflux medications (proton pump
inhibitor)
18
Gupta G, Mahajan K. Acute Laryngitis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan
https://www.ncbi.nlm.nih.gov/books/NBK534871/#article-24052.s5
 • The most common cause of infectious
Viral laryngitis
• Typically self-limited with a normal duration
Laryngitis of 5 to 7 days
• Patients are usually dysphonic but may also
present with odynophagi.
• History may include a viral prodrome with
upper respiratory tract symptoms
• Physical examination : edematous,
erythematous vocal folds with loss of normal
vibratory pliability.

Parainfluenza Respiratory syncytial

Rhinovirus Coronavirus Adenovirus Influenza
virus virus
Possible for bacterial superinfection to occur in the setting of viral laryngitis
19
Bailey’s Head and Neck Surgery – Otolaryngology Fifth Edition. Philadelphia, JB Lippincott Co, 2014, chapter 67, 978-982
Laryngotracheobronchitis
 Etiology :
Commonly caused by the parainfluenza virus.
Other viruses that are known to cause croup
include the respiratory syncytial virus (RSV),
rhinovirus, enterovirus, influenza, and adenovirus
 Affects the subglottic airway
 Symptoms: Fever, “barking” cough, stridor
 Sign: Retraction, cyanosis
 Treatment
o Nebulized epinephrine
o Corticosteroid
o Observation
o Rehidration
o Intubation / Tracheostomy

Bailey’s Head and Neck Surgery – Otolaryngology Fifth Edition. Philadelphia, JB Lippincott Co, 2014, chapter 67, 978-982
Bacterial
Laryngitis

• Etiology:
Haemophilus influenzae (most common)
Streptococcus species,
Staphylococcus species (methicillin-resistant Staphylococcus aureus):
• History : may be similar to viral laryngitis, but symptoms worsen
• Physical examination: increased work of breathing and/ or stridor
• Endoscopic examination
• Radiologic imaging : "thumb-print" sign of supraglottic inflammation.
• Culture
• Medical treatment is targeted to the pathogen identified by culture
Bailey’s Head and Neck Surgery – Otolaryngology Fifth Edition. Philadelphia, JB Lippincott Co, 2014, chapter 67, 978-982
  Etiology: H. influenza
Acute Epiglotitis  In children, the epiglottic mucosa
contains more loose tissue, the rima
glottis is narrower and the angle
between the rima glottis and the
epiglottis is relatively smaller.
 History: Dyspnea, dysphagia,
dehydration, fever, tachycardia, hot
potato voice, prefers to sit leaning
 Evaluation: neck soft tissue x ray AP
lateral, direct laryngoscopy and blood
culture

Bailey’s Head and Neck Surgery – Otolaryngology Fifth Edition. Philadelphia, JB Lippincott Co, 2014, chapter 67, 978-982
Diphteria
Laryngitis  Expansion of diphtheria
tonsillopharyngitis was found
 Pseudomembranes and edema of the
vocal cord mucosa can close the rima
glottis, can be fatal due to laryngeal
obstruction
 History : Hoarsness, subfebrile,
inspirational shortness of breath,
inspirational stridor
 Treatment: ADS, Penicillin, isolation,
tracheotomy

Bailey’s Head and Neck Surgery – Otolaryngology Fifth Edition. Philadelphia, JB Lippincott Co, 2014, chapter 67, 978-982
Chronic Laryngitis

30
 Infectious Bacterial infection
Mycobacterial infections
Etiology Dimorphic fungal infections
Viral chronic laryngitis
Inflammatory Laryngopharyngeal reflux
Idiopathic ulcerative laryngitis
Laryngitis sicca
Allergic
Systemic Sarcoidosis
inflammatory
disorder Amyloidosis
Autoimmune Granulomatosis with Polyangitis
Relapsing polychondritis
Rheumatoid arthritis
Sjorgren Syndrome
SLE
Mucous Membrane Pemphigoid
Zhukhovitskaya, A. and Verma, S., 2019. Identification and Management of Chronic Laryngitis. Otolaryngologic Clinics of North America, 52(4), pp.607-616.
Bacterial
 Chronic bacterial laryngitis is suspected in patients with prolonged
Infection voice changes and laryngeal exudates and crusting
 Etiology
○ Methicillin-susceptible and methicillin-resistant
Staphylococcus aureus
○ Pseudomonas aeruginosa
○ Serratia marcescens
 Symptoms include
o Stridor
o Dyspnea
o Dysphonia.

Zhukhovitskaya, A. and Verma, S., 2019. Identification and Management of Chronic Laryngitis. Otolaryngologic Clinics of North America, 52(4), pp.607-616.
Bacterial
Infection  Endoscopic findings:
o Edema
o Erythema
o Alteration in vocal fold vibrations
 CT with contrast  edema laryngeal of cartilages, airway
narrowing, and abscess formation
 Treatment :
o Antibiotics
o Incision and drainage of abscess
o Tracheostomy

Zhukhovitskaya, A. and Verma, S., 2019. Identification and Management of Chronic Laryngitis. Otolaryngologic Clinics of North America, 52(4), pp.607-616.
Laryngeal
• Associated with active pulmonary disease but can
Tuberculosis present as isolated laryngitis
• Most commonly present as lesions in the
posterior glottis.
• History: dysphonia, dysphagia, and odynophagia,
cough, hemoptysis, unintentional weight loss,
fever, night sweats
• Physical examination : exophytic masses that
mimic malignancy
• Pathologic examination : caseating granulomas
• Treatment : multidrug regimens with culture
guidance

Bailey’s Head and Neck Surgery – Otolaryngology Fifth Edition. Philadelphia, JB Lippincott Co, 2014, chapter 67, 978-982
Syphylis • Etiology: Treponema pallidum
Laryngitis • The primary stage : a painless oropharyngeal
chancre.
• The secondary stage, patients can present with
laryngeal manifestations, including
leukoplakia, exophytic mass, and very rarely,
decreased vocal fold mobility
• Diagnosis involves serologic studies and/or
dark-field microscopy to visualize the
pathopneumonic spirochetes sampled from
suspect mucosal lesions.
• Treatment : penicillin.

Bailey’s Head and Neck Surgery – Otolaryngology Fifth Edition. Philadelphia, JB Lippincott Co, 2014, chapter 67, 978-982
Lahav, Gil et al. “Laryngeal syphilis: a case report.” Archives of otolaryngology--head & neck surgery 137 3 (2011): 294-7
Leprosy
Laryngitis
1. Etiology: M. Leprae
2. Pathology: there are three types, namely nodular (lepromatous), neural
(anesthetic), tuberculoid.
3. Clinical manifestations: hoarseness and dyspnea
4. Diagnosis: biopsy and aspiration of cervical lymph nodes
5. Therapy :
Tracheostomy
Given dapsone, clofazimine and rifampicin

Cumming C.W. : Otolaryngology-Head and Neck Surgery. 2nd ed. Vol. 3. St Louis. Mosby Year Book. 193. page 1854-1862, 2389-2391
Fungal
Laryngitis • Immunocompromised patients and
steroid inhaler user
• Etiology: Candida sp., blastomycosis,
coccidioidomycosis, and histoplasmosis
• History : dysphagia and dysphonia.
• Physical examination : white plaque-like
epithelial lesions of the mucosa surfaces,
which may be focal or diffuse
• Treatment with a systemic antifungal
such as amphotericin or triazole

38
Bailey’s Head and Neck Surgery – Otolaryngology Fifth Edition. Philadelphia, JB Lippincott Co, 2014, chapter 67, 978-982
Dimorphic Fungal Infections
Coccidioidomycosis Parakoksidioidomikosis Histoplasmosis Actnomycosis

Etiology Coccidiodes. immitis Paracoccidioides brasiliensis Histoplasma Capsulatum Actinomyces.israeli

Finding Nodular granulomatous lesions of Pathology First attacks the reticuloendothelial Pathology : the area of
the supraglottis. Diagnosis: fungal Upper respiratory tract mucosal system. Granulomatous lesions occur in infection is affected by chronic
isolation from sputum, exudate or ulceration with cervical lymph soft tissues. Examination granulomatous inflammation producing
tissue biopsy node lymphedenopathy. Lesions in the larynx in the form of a purulent exudate containing fungi
Ulcerations when healed can nodular masses of hard granulomatous Examination : area of local
lead to strictures. tissue resembling tumors, brown in inflammation with yellow subepithelial
color, which can become necrotic and granules
ulcerate.
Diagnosis
Established by examination of sputum
cultures, ulcers, exudate, biopsy, or
blood

Symptoms Fatigue (tiredness); Cough; Fever; Confirmed by examination of Shortness of breath and dysphagia and hoarseness, productive cough and bad
Shortness of breath; Headache; sputum pain breath
Night sweats; Muscle aches or
joint pain;Rash on upper body or
legs

Treatment amphotericin B Amphotericin B Amphotericin B i.v. 30-50 mg, 4-6 Tetracycline

times/day

Zhukhovitskaya, A. and Verma, S., 2019. Identification and Management of Chronic Laryngitis. Otolaryngologic Clinics of North America, 52(4), pp.607-616.
Laryngopharyngeal
reflux
• A common cause of chronic laryngitis
• Caused by incompetence or transient relaxation of lower
esophageal sphincter resulting in retrograde flow of acid,
pepsin, and possibly bile salts

Direct acid-peptic injury to larynx

and surrounding tissue
LPR

Acid in esophagus  Chronic throat Laryngeal

Vagal mediated clearing & lesions and
reflexes coughing symptoms

Zhukhovitskaya, A. and Verma, S., 2019. Identification and Management of Chronic Laryngitis. Otolaryngologic Clinics of North America, 52(4), pp.607-616.
Laryngopharyngeal
reflux

• Treatment
o Lifestyle modification
o Medication : PPI inhibitor, prokinetics agent
o Surgery
Zhukhovitskaya, A. and Verma, S., 2019. Identification and Management of Chronic Laryngitis. Otolaryngologic Clinics of North America, 52(4), pp.607-616.
Bailey. Chapter 66: Laryngopharyngeal Reflux, Section IV Laryngology
Idiopathic
Ulcerative
Laryngitis
• Idiopathic ulcerative laryngitis presents as
dysphonia and cough.
• Laryngoscopic findings consist of bilateral
ulceration of the midmembranous vocal folds.
• The condition is unresponsive to medical
management;

Zhukhovitskaya, A. and Verma, S., 2019. Identification and Management of Chronic Laryngitis. Otolaryngologic Clinics of North America, 52(4), pp.607-616.
Laryngitis Sicca

● Condition characterized by excessive dryness of the larynx,

which may lead to significant crusting of laryngeal tissues
● Present with

○ Throat clearing

○ Sensation of throat dryness

○ Dysphonia.

Zhukhovitskaya, A. and Verma, S., 2019. Identification and Management of Chronic Laryngitis. Otolaryngologic Clinics of North America, 52(4), pp.607-616.
Allergic Laryngitis
● Allergic may be misdiagnosed as laryngopharyngeal reflux
given the overlap in symptoms.
● Symptom  thick laryngeal secretions, transient vocal fold
edema, erythema, and hyperemia resulting in voice changes,
globus sensation, and frequent throat clearing.
● The concept of a unified airway: upper and lower airways share
common mediators and epithelial responses—stimulation at
one site of the pathway may lead to sequelae in another (eg.
IgE-mediated allergic reactions).
● Allergy workup  if allergic laryngitis is suspected,
particularly if thick endolaryngeal mucus is present

Zhukhovitskaya, A. and Verma, S., 2019. Identification and Management of Chronic Laryngitis. Otolaryngologic Clinics of North America, 52(4), pp.607-616.
 Exposure to an
inhaled allergen

Local inflammation
of the larynx, nose or
paranasal sinuses
upregulation of production of
inflammatory local mucus  edema of the
mediators that pass mucosa
through the circulation
trafficking of mucus
through the larynx
systemic spread of local
inflammation involving the
entire respiratory tract Compensatory
mechanism (e.g throat
clearing and coughing)
Laryngeal
Amyloidosis  Laryngeal amyloidosis may be present with
other systemic conditions such as multiple
myeloma
 History: cough, dysphonia. dysphagia. and
possible stridor.
 Patients usually present with bulky
deposition of amyloid protein with variable
degrees of infiltration of the vocal fold,
paraglottic space, and the supraglottis
 Biopsy : pathognomonic apple green
birefringence after staining with Congo red

Bailey’s Head and Neck Surgery – Otolaryngology Fifth Edition. Philadelphia, JB Lippincott Co, 2014, chapter 67, 978-982
  Autoimmune condition defined pathologically
by noncaseating granulomas.
Laryngeal  Most commonly affected are young adult
Sarcoidosis African American women.
 Usually affects the supraglottis
 History : nonproductive cough and dyspnea
 Laryngoscopic evaluation, with hallmark exam
findings of submucosal infiltration in the
infraglottic, paraglottic space, and the
supraglottis -> turban epiglottis.
 Treatment : corticosteroids, other
immunomodulators, such as azathioprine
 Surgical intervention is limited to diagnostic
biopsy, excision of symptomatic lesions, or
management of obstructive airway lesions.

Bailey’s Head and Neck Surgery – Otolaryngology Fifth Edition. Philadelphia, JB Lippincott Co, 2014, chapter 67, 978-982
Wagener
Granulomatosis • Associated with necrotizing granulomatous
inflammation and vasculitis of small blood
vessels.
• Affect the upper airway, the lungs, and the
kidneys
• History : nonhealing ulcers in the nasal cavity
or, more rarely, subglottic airway stenosis.
• Diagnosis relies on thorough physical
examination. nasal and laryngeal endoscopy,
and testing for classical antineutrophil
cytoplasm antibody (c-ANCA).

Bailey’s Head and Neck Surgery – Otolaryngology Fifth Edition. Philadelphia, JB Lippincott Co, 2014, chapter 67, 978-982
Wagener
Granulomatosis • Treatment : systemic corticosteroids and/or
cyclophosphamide is used to obtain
remission, and medications such as
methotrexate, trimethoprim methoxazole,
or azathioprine are used for maintenance
therapy
• Surgical treatments include subglottic
expansion (subglottic releasing incisions with
balloon or rigid dilation) and intralesional
injection of corticosteroids .

Bailey’s Head and Neck Surgery – Otolaryngology Fifth Edition. Philadelphia, JB Lippincott Co, 2014, chapter 67, 978-982
 • Females.
Rhematoid • History : higher frequency phonation. generalized
Arthritis dysphonia, decreased vocal fold mobility, and
laryngeal edema.
• a substantial laryngitis with erythematous
arytenoid mucosa, bamboo nodes on the
superior surface of the membranous vocal fold.
• more specifically affect the cricoarytenoid joint
causing ankylosis and possible joint fixation
• Treatment: serial vocal fold steroid injections
• Surgical management : to manage airway
symptoms or to judiciously remove reumatoid
nodules to improve phonation

Bailey’s Head and Neck Surgery – Otolaryngology Fifth Edition. Philadelphia, JB Lippincott Co, 2014, chapter 67, 978-982
Systemic
Lupus Erythematous
• Females.
• History: dysphonia and dyspnea.
• Physical signs ranging from edema or
ulceration to vocal fold paralysis can be seen
on examination
• Direct causal relationship between SLE and
the above laxyngeal pathology has yet to be
demonstrated.

Todic, J. and Leuchter, I., 2018. Lupus of the larynx: when bamboo nodes lead to diagnosis….
  Pemphigus autoantibodies : intraepithelial
targets
Pemphigus and  Pemphigoid autoantibodies : subepithelial
Pemphigoid targets
 Patients may present with signs of disease within
the nasal cavity or the larynx.
 Both pemphigus and pemphigoid appear to have
a predilection for supraglottic mucosa
 Immunofluorescence of tissue biopsy
 Treatment: high-dose corticosteroids and other
immunomodulators, such as azathioprine.
cyclophosphamide, and cyclosporine
 Surgical intervention is limited to diagnostic
biopsy and or airway intervention, such as
tracheotomy or less invasive airway sugery
(dilation) to provide a stable airway.

Bailey’s Head and Neck Surgery – Otolaryngology Fifth Edition. Philadelphia, JB Lippincott Co, 2014, chapter 67, 978-982
CONCLUSION
 There are many different types and causes of laryngitis
 Effective management largely depends upon the associated etiology, clinical course of
the problem, and coexisting medical history of the patient afflicted.
 Infectious laryngitis is most commonly viral in etiology, bacterial, fungal, and
mycobacterial infection is considerably more rare.
 Inflammatory and infiltrative processes of the larynx can occur from Wegener
granulomatosis (typically subglottic involvement), sarcoidosis (typically supraglottic
involvement), amyloidosis, and autoimmune processes (such as rheumatoid arthritis,
SLE, and pemphigus/pemphigoid)
THANK YOU