congenital laryngomalacia

Congenital Congenital laryngomalacialaryngomalacia

先天性喉软化症先天性喉软化症

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CauseCause

Congenital laryngeal stridor is a defect that Congenital laryngeal stridor is a defect that is present at birth. During fetal is present at birth. During fetal development, the structures in the larynx development, the structures in the larynx may not fully develop. may not fully develop.

CauseCause

As a result, there is a weakness in these As a result, there is a weakness in these structures at birth, causing them to structures at birth, causing them to collapse during breathing. In children, collapse during breathing. In children, congenital laryngeal stridor is the most congenital laryngeal stridor is the most common cause of chronic stridor. Sixty common cause of chronic stridor. Sixty percent of infants born with congenital percent of infants born with congenital laryngeal stridor will have symptoms in the laryngeal stridor will have symptoms in the first week of life. Most other infants will first week of life. Most other infants will show symptoms by 5 weeks old.show symptoms by 5 weeks old.

symptomssymptoms The major symptom of this disorder is the stridor The major symptom of this disorder is the stridor

that is heard as the infant breathes. The stridor that is heard as the infant breathes. The stridor is usually heard when the infant breathes in is usually heard when the infant breathes in (inspiration), but can also be heard when the (inspiration), but can also be heard when the infant breathes out (expiration). Other infant breathes out (expiration). Other characteristics of the stridor may include:characteristics of the stridor may include:

The stridor changes with activity. The stridor changes with activity. The stridor is usually less noisy when the child is The stridor is usually less noisy when the child is

laying on his/her stomach. laying on his/her stomach. The stridor gets worse if the infant has an upper The stridor gets worse if the infant has an upper

respiratory infection. respiratory infection.

diagnose diagnose

a complete medical history a complete medical history and physical examinationand physical examination bronchoscopy of the airways - a procedure bronchoscopy of the airways - a procedure

which involves a tube being passed into which involves a tube being passed into the airways to allow your child's physician the airways to allow your child's physician to observe the airways during breathing.to observe the airways during breathing.

Treatment for congenital Treatment for congenital laryngomalacialaryngomalacia

Follow up Follow up In most cases, congenital laryngeal stridor is a harmless In most cases, congenital laryngeal stridor is a harmless

condition that resolves on its own, without medical condition that resolves on its own, without medical intervention. The condition usually improves by the time intervention. The condition usually improves by the time the infant is 18 months old and has no long-term the infant is 18 months old and has no long-term complications. In some cases, the stridor is apparent complications. In some cases, the stridor is apparent until about the age of 5. Each child's case is unique.until about the age of 5. Each child's case is unique.

SurgerySurgery A small percentage develop severe respiratory problems A small percentage develop severe respiratory problems

which require medical and surgical interventions.which require medical and surgical interventions.

Acute laryngitisAcute laryngitis

急性喉炎急性喉炎

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Laryngitis is an inflammation of the vocal Laryngitis is an inflammation of the vocal cords causing speech to become hoarse cords causing speech to become hoarse and/or whisperlike, and often inaudible.and/or whisperlike, and often inaudible.

CauseCause

Viruses -- Influenza A and B, Adenovirus, Parainfluenza, and Viruses -- Influenza A and B, Adenovirus, Parainfluenza, and Rhinovirus are some of the viruses that may cause this condition.Rhinovirus are some of the viruses that may cause this condition.

Bacteria such as Hemophilus influenzae, beta-hemolytic Bacteria such as Hemophilus influenzae, beta-hemolytic streptococcus, andstreptococcus, andMoraxella catarrhalisMoraxella catarrhalis

Inhalation of smoke, chemicals, and excessive use of voice Inhalation of smoke, chemicals, and excessive use of voice

Acid Acid Reflux

AllergiesAllergies

AgingAging

symptomssymptoms

HoarsenessHoarseness

Whisperlike voice Whisperlike voice

loss of voice loss of voice

Bacterial laryngitis:Bacterial laryngitis:

Sore throat Sore throat Fever Fever Painful swallowing Painful swallowing Cough Cough Hoarseness Hoarseness

Viral laryngitisViral laryngitis

General fatigue General fatigue Malaise Malaise Low-grade fever Low-grade fever General body aches General body aches Cough Cough Hoarseness Hoarseness Sore throat Sore throat Dry throat Dry throat

allergic laryngitis allergic laryngitis

Hoarseness that is worse during and several Hoarseness that is worse during and several hours after exposure to the allergen hours after exposure to the allergen

Itchy throat Itchy throat Excess phlegm or mucous in the throat Excess phlegm or mucous in the throat Feeling of dry throat Feeling of dry throat Cough Cough Itchy sensation in the throat Itchy sensation in the throat Sneezing Sneezing

diagnose diagnose

Throat check for pharyngitis (infection)Throat check for pharyngitis (infection)

Neck checked for stridor (wheezing sound Neck checked for stridor (wheezing sound heard by stethoscope)heard by stethoscope)

TreatmentTreatment

Avoid loud speech, such as shouting or singingAvoid loud speech, such as shouting or singing

Humidifiers (cool mist better) and steam (cool to warm, not hot) can help.Humidifiers (cool mist better) and steam (cool to warm, not hot) can help.

Avoid smoking, recreational drugs, and alcoholAvoid smoking, recreational drugs, and alcohol

Increase fluidsIncrease fluids

If severe, physicians will often instruct a person not to speak at all for the If severe, physicians will often instruct a person not to speak at all for the next few days.next few days.

If Hemophilus influenza or Moxarella catarrhalis are suspected, antibiotics If Hemophilus influenza or Moxarella catarrhalis are suspected, antibiotics will most likely be prescribed.will most likely be prescribed.

Symptoms usually resolve in fewer than seven days in most individuals.Symptoms usually resolve in fewer than seven days in most individuals.

TreatmentTreatment

If severe, physicians will often instruct a person If severe, physicians will often instruct a person not to speak at all for the next few days.not to speak at all for the next few days.

If Hemophilus influenza or Moxarella catarrhalis If Hemophilus influenza or Moxarella catarrhalis are suspected, antibiotics will most likely be are suspected, antibiotics will most likely be prescribed.prescribed.

Symptoms usually resolve in fewer than seven Symptoms usually resolve in fewer than seven days in most individuals.days in most individuals.

Chorinic laryngitisChorinic laryngitis

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DefinationDefination

Laryngitis is an inflammation of the larynx, the Laryngitis is an inflammation of the larynx, the "voice box" that contains the vocal cords in the "voice box" that contains the vocal cords in the upper portion of the neck. Laryngitis occurs in upper portion of the neck. Laryngitis occurs in two forms, acute and chronic. Acute laryngitis two forms, acute and chronic. Acute laryngitis typically is a brief illness producing hoarseness typically is a brief illness producing hoarseness and a sore throat. In most cases, an upper and a sore throat. In most cases, an upper respiratory tract infection causes it. Chronic respiratory tract infection causes it. Chronic laryngitis is a more persistent disorder that laryngitis is a more persistent disorder that produces lingering hoarseness and other voice produces lingering hoarseness and other voice changes. It usually is painless and has no changes. It usually is painless and has no significant sign of infection.significant sign of infection.

CauseCause

Cigarette smoke is chronically irritating Cigarette smoke is chronically irritating to the laryngeal mucosa. At the to the laryngeal mucosa. At the extreme, it can provoke cancer. extreme, it can provoke cancer.

Ethanol contains many impurities, such Ethanol contains many impurities, such as mycotoxins, tannins, aldehydes, and as mycotoxins, tannins, aldehydes, and pesticides, which may cause cancer, pesticides, which may cause cancer, either by direct contact with the either by direct contact with the mucosa or through a systemic effect, mucosa or through a systemic effect, or may act as an irritant.or may act as an irritant.

Gastroesophageal reflux disease Gastroesophageal reflux disease Infections Infections The bacterium most commonly isolated in chronic The bacterium most commonly isolated in chronic

infectious laryngitis is infectious laryngitis is Staphylococcus aureus. Staphylococcus aureus. Haemophilus influenzaeHaemophilus influenzae and pneumococcal species and pneumococcal species may complicate the course of viral laryngitis. may complicate the course of viral laryngitis.

Tuberculosis, caused by infection with the tubercle Tuberculosis, caused by infection with the tubercle bacillus bacillus Mycobacterium tuberculosis hominis,Mycobacterium tuberculosis hominis, was a was a common disease of the larynx. Overall incidence has common disease of the larynx. Overall incidence has declined. The hematogenous route and the infected declined. The hematogenous route and the infected sputum from pulmonary tuberculosis are the most sputum from pulmonary tuberculosis are the most likely sources of infection.likely sources of infection.

Voice abuse can be pertinent to professional Voice abuse can be pertinent to professional singers and to occasional shouters. Lesions singers and to occasional shouters. Lesions can range from simple edema, in the can range from simple edema, in the occasional abuser, to hyperplastic reactions occasional abuser, to hyperplastic reactions if the stimuli persist over time. if the stimuli persist over time.

Allergic responses of immediate or delayed Allergic responses of immediate or delayed hypersensitivity types can cause chronic hypersensitivity types can cause chronic laryngitis. Although the authors found no laryngitis. Although the authors found no data quantifying the exact number of people data quantifying the exact number of people affected, current thought seems to indicate affected, current thought seems to indicate an increasing prevalence.an increasing prevalence.

Environmental factors, such as dust, Environmental factors, such as dust, fumes, chemicals, and toxins, can cause fumes, chemicals, and toxins, can cause this condition. this condition.

Systemic diseases, mostly autoimmune, Systemic diseases, mostly autoimmune, may cause chronic laryngitis. may cause chronic laryngitis.

Wegener granulomatosis. Wegener granulomatosis. Amyloidosis. Amyloidosis. Relapsing polychondritis.Relapsing polychondritis.

Chronic laryngitis may be associated with Chronic laryngitis may be associated with cutaneous diseases. cutaneous diseases. The larynx and the The larynx and the skin share similar microcharacteristics skin share similar microcharacteristics and macrocharacteristics.and macrocharacteristics.

Neurologic causes may contribute to chronic laryngitis. Neurologic causes may contribute to chronic laryngitis. Spastic dysphonia is a discrete vocal disorder characterized by Spastic dysphonia is a discrete vocal disorder characterized by

strained, choked vocal attacks (laryngeal stuttering). The onset strained, choked vocal attacks (laryngeal stuttering). The onset usually follows a stressful period in middle life. This condition usually follows a stressful period in middle life. This condition is probably a vocal expression of psychoneurotic behavior or a is probably a vocal expression of psychoneurotic behavior or a CNS and/or proprioceptive disorder of the larynx. CNS and/or proprioceptive disorder of the larynx.

Vocal folds atrophy and lose tension with age, causing Vocal folds atrophy and lose tension with age, causing changes in phonation. Loss of thyroarytenoid ligament changes in phonation. Loss of thyroarytenoid ligament elasticity results in breathiness and loss of breath support elasticity results in breathiness and loss of breath support because of bowed vocal folds. because of bowed vocal folds.

Muscular disorders may contribute to chronic laryngitis. Muscular disorders may contribute to chronic laryngitis. Weakness of the larynx and the pharynx is present in one third Weakness of the larynx and the pharynx is present in one third of patients with myasthenia gravis.of patients with myasthenia gravis.

symptomssymptoms

Hoarseness Hoarseness Sore throat Sore throat Weak or absent voice Weak or absent voice Sensation of a lump in the throat or Sensation of a lump in the throat or

constant need to clear the throat constant need to clear the throat Dry cough Dry cough Fever Fever

diagnose diagnose

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

TreatmentTreatment

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

Some palliative measures that can be taken include: Some palliative measures that can be taken include: Avoid public speaking during recovery Avoid public speaking during recovery Be aware that whispering puts greater strain on the Be aware that whispering puts greater strain on the

vocal cords than normal speaking vocal cords than normal speaking Inhale steam from a bowl of hot water or from a warm Inhale steam from a bowl of hot water or from a warm

shower shower Drink warm, soothing liquids (but do not drink Drink warm, soothing liquids (but do not drink

alcoholic beverages) alcoholic beverages) Try a cool-mist humidifier; avoid air conditioning Try a cool-mist humidifier; avoid air conditioning Use throat lozenges to ease the discomfort Use throat lozenges to ease the discomfort Avoid cigarettes until the symptoms have subsidedAvoid cigarettes until the symptoms have subsided

Vocal Cord Disorders Vocal Cord Disorders vocal nodulesvocal nodules vocal polypsvocal polyps

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Vocal cord disorders are often caused by Vocal cord disorders are often caused by vocal abuse or misuse, such as excessive vocal abuse or misuse, such as excessive use of the voice when singing, talking, use of the voice when singing, talking, smoking, coughing, yelling, or inhaling smoking, coughing, yelling, or inhaling irritants. Some of the more common vocal irritants. Some of the more common vocal cord disorders include laryngitis, vocal cord disorders include laryngitis, vocal nodules, vocal polyps, and vocal cord nodules, vocal polyps, and vocal cord paralysis. paralysis.

vocal nodulesvocal nodules AND AND vocal polypsvocal polyps

Vocal nodulesVocal nodules are benign (non-cancerous) are benign (non-cancerous) growths on the vocal cords caused by vocal growths on the vocal cords caused by vocal abuse. Vocal nodules are a frequent problem for abuse. Vocal nodules are a frequent problem for professional singers. The nodules are small and professional singers. The nodules are small and callous-like and usually grow in pairs (one on callous-like and usually grow in pairs (one on each cord). The nodules usually form on areas each cord). The nodules usually form on areas of the vocal cords that receive the most pressure of the vocal cords that receive the most pressure when the cords come together and vibrate when the cords come together and vibrate (similar to the formation of a callous). Voice (similar to the formation of a callous). Voice nodules cause the voice to be hoarse, low, and nodules cause the voice to be hoarse, low, and breathy. breathy.

vocal nodulesvocal nodules AND AND vocal vocal polypspolyps

A vocal polypA vocal polyp is a soft, benign (non-cancerous) is a soft, benign (non-cancerous) growth, similar to a blister. A polyp usually grows growth, similar to a blister. A polyp usually grows alone on one vocal cord and is often caused by alone on one vocal cord and is often caused by long-term cigarette smoking. Other causes of long-term cigarette smoking. Other causes of vocal polyps include hypothyroidism vocal polyps include hypothyroidism (underactive thyroid gland), gastroesophageal (underactive thyroid gland), gastroesophageal reflux, and continuous voice misuse. Voice reflux, and continuous voice misuse. Voice polyps cause the voice to be hoarse, low, and polyps cause the voice to be hoarse, low, and breathy. Vocal polyps are also called Reinke's breathy. Vocal polyps are also called Reinke's edemas or polypoid degeneration. edemas or polypoid degeneration.

CAUSESCAUSES

vocal trauma (more specifically, vocal trauma (more specifically, phonotrauma in the case of vocal fold phonotrauma in the case of vocal fold polyps and vocal fold nodules) polyps and vocal fold nodules)

symptomssymptoms

a voice change. Typical presenting a voice change. Typical presenting symptoms include generalized and symptoms include generalized and persistent hoarseness, change in voice persistent hoarseness, change in voice quality, and increased effort in producing quality, and increased effort in producing the voice. The laryngeal examination may the voice. The laryngeal examination may show either unilateral or bilateral lesions. show either unilateral or bilateral lesions.

diagnose diagnose

Any hoarseness or change in voice that lasts Any hoarseness or change in voice that lasts longer than two weeks should be brought to the longer than two weeks should be brought to the attention of your physician. (Sometimes the attention of your physician. (Sometimes the hoarseness may be indicative of laryngeal hoarseness may be indicative of laryngeal cancer.)cancer.)

a complete medical history and physical a complete medical history and physical examinationexamination

examine the vocal cords internally with a small, examine the vocal cords internally with a small, long-handled mirror (indirect laryngoscopy) or long-handled mirror (indirect laryngoscopy) or laryngoscopylaryngoscopy

TreatmentTreatment

eliminating the behavior that caused the eliminating the behavior that caused the vocal cord disorder vocal cord disorder

a referral to a speech-language a referral to a speech-language pathologist who has specialized training in pathologist who has specialized training in treating voice, speech, language, or treating voice, speech, language, or swallowing disorders that affect swallowing disorders that affect communication communication

medication medication surgery to remove growths surgery to remove growths

Acute laryngitis in Acute laryngitis in childrenchildren

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CauseCause

Laryngitis is a group of disorders in which Laryngitis is a group of disorders in which the inflammatory process covers the the inflammatory process covers the mucous membrane of all or particular mucous membrane of all or particular levels of the larynx. levels of the larynx.

These disorders have a different course in These disorders have a different course in children under 4 years old than in children children under 4 years old than in children above 4 years old. above 4 years old.

WHY?WHY?

specific variations of the structure of specific variations of the structure of the larynx in children under 4 years the larynx in children under 4 years

old AND above 4 years oldold AND above 4 years old

The larynx of a small child is located higher, The larynx of a small child is located higher, and the mucous is thicker and contains a and the mucous is thicker and contains a large amount of soft tissue. This soft tissue is large amount of soft tissue. This soft tissue is mainly located under the mucous of the mainly located under the mucous of the aryepiglottic folds, and especially in the aryepiglottic folds, and especially in the subglottic region. subglottic region.

The specific reactivity of the mucous The specific reactivity of the mucous membrane in small children makes them membrane in small children makes them prone to infections, especially viral. Some of prone to infections, especially viral. Some of these infections may cause oedema of the these infections may cause oedema of the mucus. The respiratory tract in children is mucus. The respiratory tract in children is relatively narrow in this region and the relatively narrow in this region and the chondrous ring limits the size of the subglottic chondrous ring limits the size of the subglottic region. So, oedema in this region may have a region. So, oedema in this region may have a dramatic course, leading even to acute dramatic course, leading even to acute respiratory distress respiratory distress

CauseCause

viral infection viral infection parainfluenza virus parainfluenza virus influenza virusinfluenza virus rubella virus and varicella-zoster virusrubella virus and varicella-zoster virus

symptomssymptoms

dyspnoea, dyspnoea, inspiratory stridor,inspiratory stridor, hoarseness hoarseness characteristic barking cough characteristic barking cough

diagnose diagnose

general examinationsgeneral examinations laryngological examinations laryngological examinations direct visualization of the larynx direct visualization of the larynx

endoscopy, fiberoscopy and laryngoscopyendoscopy, fiberoscopy and laryngoscopy

Differential diagnosisDifferential diagnosis Foreign body of the larynx :Foreign body of the larynx : The most general symptoms of laryngitis occur also The most general symptoms of laryngitis occur also

in other disorders of the larynx which occur with in other disorders of the larynx which occur with dyspnoea like the foreign body of the larynx. So the dyspnoea like the foreign body of the larynx. So the precise diagnosis is a good base for planning of further precise diagnosis is a good base for planning of further treatment.treatment.

Congenital defect of the larynx:Congenital defect of the larynx: When the symptoms of laryngitis occur at under 6 When the symptoms of laryngitis occur at under 6

months of age or are prolonged or recurrent, a months of age or are prolonged or recurrent, a congenital defect of the larynx should be suspected, i.e. congenital defect of the larynx should be suspected, i.e. laryngeal web or haemangioma of the larynx. In these laryngeal web or haemangioma of the larynx. In these cases direct examination of the larynx is an urgent cases direct examination of the larynx is an urgent necessity, because the treatment of these disorders necessity, because the treatment of these disorders varies. varies.

TreatmentTreatment HospitaliseHospitalise systemic anti-inflammatory drugs,systemic anti-inflammatory drugs, humidification and cooling the air in the room. humidification and cooling the air in the room. hydrocortisone in high dose (10 mg per kg b. w.), preferably i.v., may hydrocortisone in high dose (10 mg per kg b. w.), preferably i.v., may

be necessary. be necessary. Intubation:Only intubation is a good method which protects the child Intubation:Only intubation is a good method which protects the child

from asphyxiation.from asphyxiation. Formerly, tracheotomy was performed, but now it is not often Formerly, tracheotomy was performed, but now it is not often

performed in this disease. performed in this disease. Antibiotics are administrated in those patients in whom bacterial Antibiotics are administrated in those patients in whom bacterial

complications develop. It should be underlined that the antibiotics complications develop. It should be underlined that the antibiotics given for uncomplicated laryngitis in small children do not bring given for uncomplicated laryngitis in small children do not bring improvement, so should be avoided.improvement, so should be avoided.

In patients older than 4 years of age etiologic factors may be In patients older than 4 years of age etiologic factors may be different e.g. allergy. In these cases administration of anti-histaminic different e.g. allergy. In these cases administration of anti-histaminic drugs and calcium may be suitable. drugs and calcium may be suitable.

Acute epiglottitisAcute epiglottitis

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DefinitionDefinition

A very rapidly progressive infection A very rapidly progressive infection causing inflammation of the epiglottis (the causing inflammation of the epiglottis (the flap that covers the trachea) and tissues flap that covers the trachea) and tissues around the epiglottis that may lead to around the epiglottis that may lead to abrupt blockage of the upper airway and abrupt blockage of the upper airway and death. death.

CauseCause Infection:Infection:H influenzaeH influenzae Haemophilus parainfluenzaeHaemophilus parainfluenzae Streptococcus pneumoniae,Streptococcus pneumoniae, and group A streptococci. and group A streptococci. Less common infectious bacteria (eg, Less common infectious bacteria (eg, Staphylococcus Staphylococcus

aureus,aureus, mycobacteria, mycobacteria, Bacteroides Bacteroides melaninogenicus, Enterobacter cloacae, Escherichia melaninogenicus, Enterobacter cloacae, Escherichia coli, Fusobacterium necrophorum, Klebsiella coli, Fusobacterium necrophorum, Klebsiella pneumoniae, Neisseria meningitidis, Pasteurella pneumoniae, Neisseria meningitidis, Pasteurella multocidamultocida),),

herpes simplex virus (HSV), other viruses, infectious herpes simplex virus (HSV), other viruses, infectious mononucleosis, mononucleosis, CandidaCandida (in immunocompromised (in immunocompromised patients), and patients), and AspergillusAspergillus (in immunocompromised (in immunocompromised patients). patients).

Noninfectious factors:Noninfectious factors:thermal causes thermal causes crack cocaine smoking crack cocaine smoking marijuana smoking marijuana smoking throat burns affecting the epiglottis of bottle-fed infants)throat burns affecting the epiglottis of bottle-fed infants)caustic insults (eg, automatic dishwasher soap ingestion) caustic insults (eg, automatic dishwasher soap ingestion) foreign body ingestion foreign body ingestion head and neck chemotherapy. head and neck chemotherapy. Before widespread Hib vaccination, Before widespread Hib vaccination, H influenzaeH influenzae caused almost caused almost

all pediatric cases. all pediatric cases.

AllergyAllergy

symptomssymptoms

Sore throat (95%) Sore throat (95%) Odynophagia/dysphagia (95%) Odynophagia/dysphagia (95%) Muffled voice (54%) Muffled voice (54%) Usually, no prodromal symptoms occur Usually, no prodromal symptoms occur

in children. Adults may have preceding in children. Adults may have preceding upper respiratory infection (URI) upper respiratory infection (URI) symptoms.symptoms.

General symptomsGeneral symptoms Fever Fever Drooling/inability to handle secretions Drooling/inability to handle secretions Cervical adenopathy Cervical adenopathy Stridor - A late finding indicating advanced airway obstruction Stridor - A late finding indicating advanced airway obstruction Muffled voice (54%) Muffled voice (54%) Tripod position - Sitting up on hands with the tongue out and the head Tripod position - Sitting up on hands with the tongue out and the head

forward forward Hypoxia Hypoxia Respiratory distress Respiratory distress Severe pain on gentle palpation over the larynx Severe pain on gentle palpation over the larynx Mild cough Mild cough Fever Fever Irritability Irritability Tachycardia Tachycardia Toxic appearance of patientToxic appearance of patient

diagnose diagnose Differential DiagnosesDifferential Diagnoses Peritonsillar Abscess

Retropharyngeal AbscessToxicity, Caustic Ingestions

Other Problems to Be ConsideredOther Problems to Be Considered Airway obstructionAirway obstruction

Foreign body aspirationForeign body aspirationBacterial laryngotracheobronchitis Bacterial laryngotracheobronchitis LaryngotracheobronchopneumonitisLaryngotracheobronchopneumonitisRetropharyngeal abscessRetropharyngeal abscessPeritonsillar abscessPeritonsillar abscessLaryngitisLaryngitisLaryngeal diphtheriaLaryngeal diphtheriaCaustic ingestionsCaustic ingestionsAcute angioedemaAcute angioedemaSepsisSepsis

TreatmentTreatment

Antibiotics Antibiotics Antivirus Antivirus hydrocortisonehydrocortisone adequate airwayadequate airway nasotracheal intubation nasotracheal intubation intubation intubation tracheostomytracheostomy Skilled nursing care. Skilled nursing care.

Papilloma of larynxPapilloma of larynx

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CauseCause

Most common benign tumor of the larynx Most common benign tumor of the larynx

and occurs in patients of all age. and occurs in patients of all age.

The causative agent is thought to be HPV.The causative agent is thought to be HPV.

Papillomas usually regress during puberty.Papillomas usually regress during puberty.

CauseCause

Usually involving the true vocal cords but Usually involving the true vocal cords but

may affect supraglottic and subglottic may affect supraglottic and subglottic

regions.regions.

May also involve the trachea and May also involve the trachea and

bronchus.bronchus.

CauseCause

Papillomas in juveniles is more often Papillomas in juveniles is more often

multiple and recurs more frequently than in multiple and recurs more frequently than in

adults.adults.

Papillomas in adults are usually single but Papillomas in adults are usually single but

may undergo malignant change (may undergo malignant change (HPV HPV

1616 ，， 1818).).

symptomssymptoms

Aphonia or weak cry is usually the first Aphonia or weak cry is usually the first

sign in infants.sign in infants.

Dyspnea and stridor are seen.Dyspnea and stridor are seen.

Hoarseness is the most common symptom Hoarseness is the most common symptom

in adults. in adults.

diagnose diagnose

Laryngoscopic examinationLaryngoscopic examination ：： the tumor is pink or dark red in color. The the tumor is pink or dark red in color. The

surface of the tumor is rough and papillary. surface of the tumor is rough and papillary.

The tumor is located in VC, false VC or The tumor is located in VC, false VC or

subglottic area. subglottic area.

TreatmentTreatment

⑴ ⑴ excision under microlaryngoscopy is the most excision under microlaryngoscopy is the most

commonly employed treatment modality.commonly employed treatment modality.

Repeated operations are usually needed in Repeated operations are usually needed in

children. children.

Co2 laser is favored because of its hemostatic Co2 laser is favored because of its hemostatic

properties and its precision allows for properties and its precision allows for

vaporization of the lesion.vaporization of the lesion.

TreatmentTreatment

⑵ ⑵ Tracheotomy is occasionally indicated Tracheotomy is occasionally indicated

in children with dyspnea, but should be in children with dyspnea, but should be

avoided due to concern about subglottic avoided due to concern about subglottic

spread.spread.

TreatmentTreatment

⑶ ⑶ transfer factor, interferon and transfer factor, interferon and

antivirotics. antivirotics. Cidofovir , a new antiviral agent Cidofovir , a new antiviral agent

approved for ocular cytomegalovirus infections, approved for ocular cytomegalovirus infections,

has shown promise as a local injection in has shown promise as a local injection in

adjuvant therapy.adjuvant therapy.

⑷ ⑷ Autogenous vaccine.Autogenous vaccine.

Carcinoma of the larynxCarcinoma of the larynx

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EpidemiologyEpidemiology

Accounts for 1% of all new cancers diagnosed in the Accounts for 1% of all new cancers diagnosed in the

U.S. and 0.75% of all cancer deaths.U.S. and 0.75% of all cancer deaths.

Accounts for 30% in all head and neck cancers. Accounts for 30% in all head and neck cancers.

More frequently happened in patients at 50~70 years of More frequently happened in patients at 50~70 years of

age.age.

M:F ratio: 5~10:1 (foreign country)M:F ratio: 5~10:1 (foreign country) ，， 6.75:1(shanghai).6.75:1(shanghai).

EtiologyEtiology

CigaretteCigarette

Wine (combined smoking and alcohol abuse Wine (combined smoking and alcohol abuse

increases the risk by 50% over the additive rate )increases the risk by 50% over the additive rate )

air pollutionair pollution

Virus (HPV)Virus (HPV)

precancerous lesions (precancerous lesions (Leukoplakia, PapillomaLeukoplakia, Papilloma))

sex hormonessex hormones

PathologyPathology

Nearly 98% are squamous cell carcinoma. Nearly 98% are squamous cell carcinoma.

adenocarcinoma and undifferentiated adenocarcinoma and undifferentiated

carcinoma is rare.carcinoma is rare.

Clinical classification:Clinical classification:

Glottic (60%)Glottic (60%) ：： well differentiated, late well differentiated, late

metastasismetastasis

Supraglottic (30%)Supraglottic (30%) ：： poor differntiated, poor differntiated,

early metastasis early metastasis

Subglottic (6%)Subglottic (6%) ：： poor differentiated, poor differentiated,

early metastasisearly metastasis

Spread of tumorSpread of tumor

⒈ ⒈ Direct spreadDirect spread

Supraglottic cancer→ epiglottis, pre-①Supraglottic cancer→ epiglottis, pre-①

epiglottic space, vallecula, and tongue epiglottic space, vallecula, and tongue

base. piriform sinus, lateral wall of ②base. piriform sinus, lateral wall of ②

hypopharynx. paraglottic space, ③hypopharynx. paraglottic space, ③

ventricle or the VC.ventricle or the VC.


Glottic cancer→ anteriorly, contralateral ①Glottic cancer→ anteriorly, contralateral ①

VC. posteriorly, arytenoid cartilage ② ③VC. posteriorly, arytenoid cartilage ② ③

superiorly, supraglottic area. inferiorly, ④superiorly, supraglottic area. inferiorly, ④

paraglottic space and subglottic area.paraglottic space and subglottic area.


Subglottic cancer→ superiorly, glottis. ① ②Subglottic cancer→ superiorly, glottis. ① ②

anteriorly and laterally, strap muscle and anteriorly and laterally, strap muscle and

thyroid gland. posteriorly, esophagus.③thyroid gland. posteriorly, esophagus.③


⒉ ⒉ Lymph nodes metastasesLymph nodes metastases

Supraglottic cancer →have a propensity to Supraglottic cancer →have a propensity to

spread to cervical lymph nodes bilaterally spread to cervical lymph nodes bilaterally

at the early stages. at the early stages.

Generally, the risk of occult or actual Generally, the risk of occult or actual

metastases from T1, T2, T3 and T4 metastases from T1, T2, T3 and T4

tumors is 20, 40, 60, and 80%.tumors is 20, 40, 60, and 80%.


Glottic cancer →CV is virtually devoid of Glottic cancer →CV is virtually devoid of

lymphatics, involvement of cervical nodes lymphatics, involvement of cervical nodes

at the early stages is not common. at the early stages is not common.

＜＜ 8% of patients with T1 and T2 tumors 8% of patients with T1 and T2 tumors

will have nodal involvement.will have nodal involvement.


Glottic cancer →Only at the later stages, Glottic cancer →Only at the later stages,

prelaryngeal nodes, paratracheal nodes prelaryngeal nodes, paratracheal nodes

and other cervical nodes could be and other cervical nodes could be

involved.involved.


Subglottic cancer →tend to spread to Subglottic cancer →tend to spread to

paratracheal lymphatics and then to paratracheal lymphatics and then to

superior mediastinual nodes.superior mediastinual nodes.


⒊ ⒊ Distant metstases via bloodDistant metstases via blood

Distant metastasis only occurs in the very Distant metastasis only occurs in the very

later stage of laryngeal carcinoma .later stage of laryngeal carcinoma .

symptomssymptoms

Supraglottic carcinomaSupraglottic carcinoma ：： Might be asymptomaticMight be asymptomatic

Foreign body sensationForeign body sensation

Pain while swallowingPain while swallowing

Throat burnsThroat burns

Enlargement of cervical lymph nodesEnlargement of cervical lymph nodes

symptomssymptoms

Glottic carcinomaGlottic carcinoma ：：

Hoarsenenss is the early symptomHoarsenenss is the early symptom

Respiratory obstruction will happen in late Respiratory obstruction will happen in late

stagestage

symptomssymptoms

SubgSubglottic carcinomalottic carcinoma ：：

There are no definitive symptoms in the There are no definitive symptoms in the

early stage. early stage.

Dyspnea and lymph nodes metastasis is Dyspnea and lymph nodes metastasis is

the late symptomsthe late symptoms

diagnose diagnose

Physical examinationPhysical examination

Laryngoscopic examination can find a Laryngoscopic examination can find a

mass on one or both vocal cordsmass on one or both vocal cords

fixation of the vocal cords is commonfixation of the vocal cords is common

mass in the neckmass in the neck

Differential diagnosisDifferential diagnosis

Tuberculosis of the larynx Tuberculosis of the larynx ：： chest X-ray chest X-ray

filmfilm

Papilloma of the larynxPapilloma of the larynx

Syphilis of the larynxSyphilis of the larynx

TreatmentTreatment

Early laryngeal carcinoma (T1/T2) is usually Early laryngeal carcinoma (T1/T2) is usually

managed with single modality of treatment and managed with single modality of treatment and

responds well to radiation, transoral laser responds well to radiation, transoral laser

resection,or partial laryngeal surgery.resection,or partial laryngeal surgery.

Primary cure rates of 80 to 85% are expected.Primary cure rates of 80 to 85% are expected.

TreatmentTreatment

The management of advanced laryngeal The management of advanced laryngeal

carcinoma is more controversial.carcinoma is more controversial.

The aim is to optimize disease-free and The aim is to optimize disease-free and

overall survival while preserving quality of overall survival while preserving quality of

life.life.

TreatmentTreatment

Generally, combined therapy is widely Generally, combined therapy is widely

used, as it shows better survival rates than used, as it shows better survival rates than

single-modality treatment.single-modality treatment.

Surgery + radiotherapy or radiotherapy + Surgery + radiotherapy or radiotherapy +

surgery are two commonly used surgery are two commonly used

modalities.modalities.

TreatmentTreatment

Partial laryngectomyPartial laryngectomy

Total laryngectomyTotal laryngectomy

Rehabilitation of speech after total laryngectomyRehabilitation of speech after total laryngectomy

Blom- Singer valveBlom- Singer valve

Esophageal speechEsophageal speech

Electrical larynxElectrical larynx

Neck dissectionNeck dissection

Laryngeal obstructionLaryngeal obstruction

Dong pin Dong pin

CauseCause

InfectionInfection

TumorsTumors

Foreign bodiesForeign bodies

Trauma Trauma

AllergyAllergy

MalformationMalformation

Laryngeal paralysisLaryngeal paralysis

symptomssymptoms

inspiratory dyspneainspiratory dyspnea

inspiratory stridorinspiratory stridor

depression of suprasternal fossa, depression of suprasternal fossa,

intercostal and supraclavicular space or intercostal and supraclavicular space or

epigastrium while inspirationepigastrium while inspiration

hoarseness and even cyanosishoarseness and even cyanosis

classification:classification:

ⅠⅠ°°there is no symptoms at rest. But slight there is no symptoms at rest. But slight

inspiratory dyspnea and stridor may occur inspiratory dyspnea and stridor may occur

during crying or on exertionduring crying or on exertion


ⅡⅡ°°slight inspiratory dyspnea during quiet slight inspiratory dyspnea during quiet

respiration, and exaggeration on exertion. respiration, and exaggeration on exertion.

Sleeping and taking the meal is nearly Sleeping and taking the meal is nearly

normal , no evidence of hypoxia.normal , no evidence of hypoxia.


ⅢⅢ°° ：： with marked inspiratory dyspnea, with marked inspiratory dyspnea,

loud stridor, depression of suprasternal loud stridor, depression of suprasternal

and supraclavicular fossae and intercostal and supraclavicular fossae and intercostal

spaces, cyanosis, restless and struggles spaces, cyanosis, restless and struggles

for air hunger, with quick pulse, high blood for air hunger, with quick pulse, high blood

pressure and refuse meals.pressure and refuse meals.


ⅣⅣ°° ：： extremely dyspneic, restless, extremely dyspneic, restless,

sweating, cyanoticsis. Pulse is rapid, sweating, cyanoticsis. Pulse is rapid,

irregular, weak and thready. B.P. drops. irregular, weak and thready. B.P. drops.

Finally circulatory collapse may occur or Finally circulatory collapse may occur or

may die of asphyxia or cardiac failure.may die of asphyxia or cardiac failure.

TreatmentTreatment

ⅠⅠ°° ：： etiological treatment, antibiotics andetiological treatment, antibiotics and

corticosteroid.corticosteroid.

TreatmentTreatment

ⅡⅡ°° ：： etiological treatment . etiological treatment .

in case of tumors of the larynx, in case of tumors of the larynx,

trauma, bilateral vocal cords paralysis, trauma, bilateral vocal cords paralysis,

tracheotomy is indicated.tracheotomy is indicated.

TreatmentTreatment

ⅢⅢ°° ：： If the laryngeal obstruction is caused If the laryngeal obstruction is caused

by inflammation, medical treatment can be by inflammation, medical treatment can be

administrated under close observation. administrated under close observation.

Tracheotomy should be prepared. If Tracheotomy should be prepared. If

dyspnea is not relieved, tracheotomy dyspnea is not relieved, tracheotomy

should be performed immediately.should be performed immediately.

TreatmentTreatment

ⅣⅣ°° ：： TracheotomyTracheotomy

TracheotomyTracheotomy

Dong pin Dong pin

Tracheotomy is a surgical procedure in Tracheotomy is a surgical procedure in which an opening is made in the anterior which an opening is made in the anterior wall of the trachea to establish an airway.wall of the trachea to establish an airway.

Tracheotomy is often temporary and Tracheotomy is often temporary and reversible if the patient is able to breathe reversible if the patient is able to breathe through an unobstructed upper airwaythrough an unobstructed upper airway

AnatomyAnatomy

22ndnd-4-4th th ring of trachearing of trachea

IndicationIndication ：：

⒈⒈ Laryngeal obstructionLaryngeal obstruction

⒉⒉ Secretion obstructed in lower respiratory Secretion obstructed in lower respiratory

tract (coma)tract (coma)

⒊⒊ Before some major head & neck surgeryBefore some major head & neck surgery

ComplicationsComplications

HemorrhageHemorrhage

Subcutaneous emphysemaSubcutaneous emphysema

PneumothoraxPneumothorax

Difficulty of decannulationDifficulty of decannulation

Laryngeal or tracheal stenosisLaryngeal or tracheal stenosis

CCricothyrotomyricothyrotomy

Employed in first-aid cases.Employed in first-aid cases.

Making an opening in the membrane Making an opening in the membrane

between the cricoid cartilage and thyroid between the cricoid cartilage and thyroid

cartilage and insert a cannula. cartilage and insert a cannula.

After the situation becomes stable, After the situation becomes stable,

ordinary tracheotomy should be ordinary tracheotomy should be

performed.performed.

congenital laryngomalacia

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