DR. IDA SJAILANDRAWATI HRP, Sp.

THT-KL
 ACUTE LARYNGITIS
1. Infection
2. Non Infetion

Etiology :
1. Infection Type :
- More common
- Usually follows Upper Respiratory Infection
- Viral Bacterial Invasions
- Streptococcus Pneumoniae
- H. Influenza
- Streptococcus Haemolytic
- Streptoccus Aureus
2. Non Infections Type
- Vocal abuse
- Allergy
- Thermal/chemical burn to larynx
- Laryngeal trauma : endotracheal tube
- Inhalation/ingestion

Clinical Features
• Symptom : 1. Hoarseness aphonia
2. Pain/discomfort in the throat (after talking)
3. Dry, irritating cough (worse at night)
4. Malaise, dryness of throat ; cold; fever ( if
viral infection of URI )
 Laryngeal appearance
- Erythema & edema of epiglottis, aryepiglotis, fold, arythenoid,
ventricular band
- Vocal cord : white & near normal Red & swollen
- Sticky secretion (+) between the vocal cord & interarythenoid

Therapy
1. Vocal rest
2. Avoidance smoking & alkohol
3. Steam inhalation
4. Antibiotics
5. Analytics
6. Obat Batuk ( cough sedative )
7. Steroid
ACUTE EPYGLOTTIS
( SUPRAGLOTTIS LARYNGITIS)
Acyte inflamatory to supraglottis structures ( epiglottis,
aryepiglottis fold & arythenoid )
Etiology
- Serious condition
- Children : 2- 7 years of age (can also affect adult )
- The most common : H. Influenza ß

Clinical features :
1. Onset of symptom : Rapid progression
2. Sore throat & dysphagia
3. Dyspnoe & stridor
4. Fever 40° C
Lanjutkan....
Examination
1. Epiglottis : Red & Swollen, Better done in operation room
with facilities for intubation
2. Neck X-Ray lateral soft tissue Epiglottis swollen
( Thumb Sign )
Therapy :
1. Hospitalisation : danger of respiratory obstruction
2. Antibiotic ( IM/IV ) : Ampicilin, Cephalosporin
3. Stridor : Hydrocortison / dexamethason ( IM/ IV ) Relieve
Oedem
4. Adequate hydration : Parentral fluid
5. Humidification & O2
6. Intubation / tracheostomy for Respiratory obstruction
Tabel 56.1
Acute epiglottitis Acute laryngo-tracheo-
bronchitis (or group)
• Causative organism Haemophilus in fuenzae Parainfluenza virus type I
• Age type B and II
• Pathology 2-7 years 3 months to 3 years
• Prodromal symptoms Suproglottic larynx Subglottic area
• Onset Absent Present
• Fever Sudden Slow
• Patient's look High Low grade or no fever
• Cough Toxic Non-toxic
• Stridor Usually absent Present, (Barking seal-
• Odynophagia Present and may be like)
• Radiology marked Present
• Treatment PI'esent, with drooling of Usually absent
secretions Steeple sign on
' Thumb sign on lateral anteroposterior view of
view neck
Humidified oxygen, third Humidified O 2 tent,
generation steroids
cephalospor'in
(ceftriaxone) or
amoxicillin
ACUTE LARYNGO-TRACHEO BRONCHITIS
 Inflamatory of the larynx, trachea, bronchi
 Common than acute
Etiology :
- Viral infection (moostly)
- 6 month – 3 years of age
- Laki-laki > perempuan
Pathology :
- Loose areolan time in subglottic region oedem
Respiratory obstruction & stridor
- Thick secretion & crusts occlude the airway
Symptom :
- URI & hoursness & croupy cough Obstruction :
- Fever 39 – 40°C Suprasternal
- Difficulty in breathing & stridor Intercostal
Threatment :
1. Hospitalization ( because of microlaring difficult in
breathing )
2. Antibiotic : Ampicilin 50 mg/kg/day
3. Humidification to soften the crust & thick
secretion
4. IVFD ( dehydration )
5. Steroid : hydrocortison 100 mg iv to relieve oedem
6. Adrenalin via respiratory ( bronchodilator
Relieve dyspnoe & evert tracheostomy )
7. Intubation / tracheostomy
 LARYNGEAL DIPHTERIA
Etiology :
1. Secondary to faucial diphteria
2. Children < 10 years of age
3. Due to immunisation

Pathology
1. Pseudomembrane over larynx & trachea Obstruct the airway
2. Exotoxim Myocarditis death

Clinical Features
- General Symptom : - Low grade fever ( 100°-101°F)
- Sore throat, malaise
- Tachycardi, very toxaemia, thready
pulse
- Larygeal symptomp : - Horsness
- Croupy cough
- Stridor inspiratory
- Dyspnoe obstruction airway

 Greyish white membrane on :

- - Tonsil
- Pharunx, soft palate
- Removal bleeding
- Larynx, trachea
 Cervical lymphadenophaty bull-neck

Diagnosis : - Smear, culture Corynebacterium

dyphtheria
- Clinical feature
• Threatment :
1. Dyphteria antitoxin : 20.000 – 100.000 unit IV
2. Antibiotic : Benzylpenicillin; Erythromicyn
3. Maintenance of airways Tracheostomy,intubation
4. Bed rest 2 – 4 weeks

• Complication
1. Asphyxia & death due to airway obstruction
2. Toxic myocarditis & circulatory failure
3. Palatal paralysis with nasal regurgitation
4. Laryngeal & pharyngeal paralysis
OEDEM LARYNX
( OEDEM GLOTTIDIS )
 Involves the supraglottic & subglottic ( where laryngeal
muccosa is loose )
 Vocal cord oedem Rarely because subepithel
connective tissue
Etiology :
1. Infection : - Acute epiglottis, laryngotracheobronchitis,
tuberculosis, syphilis of the larynx
- Perytonsilar abses, retrofaryngeal abses &
ludwig’s angina
2. Trauma : Surgery of tounge, floor of mouth, laryngeal
trauma, foreign body, endoscopy, intubation,
thermal or caustic burn, onhalation/irritan
gas/fumes
3. Neoplasma : Ca of larynx / laryngopharynx
4. Allergy
5. Radiation : Cauter of larynx
6. Sistemic diseases : Heart failure, Nephritis
Symptom & Sign
1. Airway obstruction Tracheostomy
2. Inspiratory atridor
3. Laryngoscopy indirect : oedem supraglottic / subglottic
Therapy
- Airway onstruction Intubation /
tracheostomy
- Injection adrenalin ( 1 : 1000 ) 0,3 – 0,5 IM Repeated
15 minutes if necessary Useful in oedem
CHRONIC LARYNGITIS
A. Chronic Hyperameic Laryngitis :
Diffuse inflamatory, symetrical involving the whole
larynx Vocal cord, ventricular band, inter
arythenoid & epiglottis
Etiology
1. Follow incompletely resolve acute laryngitis / recurrent
attack
2. Chronic infection in paranasal sinuses teeth, tonsils
3. Occupational factors : dust, fumes (iron ; gold ), workers
in chemical industries
4. Alcohol / smooking
5. Persistent trauma : chronic lung disease Cough
6. Vocal abuse trauma in larynx
 Clinical features :
1. Hoarness ( voice tired & aphonic )
2. Dryness & intermittent tickling in the throat to clear
the throat repeatedly
3. Discomfort in the throat
4. Cough ( dry & irritating )

Laryngeal examination : hyperemia of laryngeal structure

, vocal cord dull red, muccus (+) in the vocal cord &
interarythenoid
Therapy
- Infection of upper & lower respiratory tract
should be treated
- Avoidance if irritating factors
- Voice Rest / Speech Therapy Training
- Steam inhalation : to loosen secretion & give relief
- Expectorants : to loose viscid secretion
B. Chronic hyperplastic / hypertrophic laryngitis
Diffuse & symetrical procces or a localised, appearing like a tumor
of the larynx : vocal noduls, vocal polyp, Reinke’s oedema,
contact ulcers
Etiology
- Same as Chronic laryngitis without hyperplasia
Pathology :
- Begin from glottic region extend to ventricular band, base
glottict & subglottic mucousa Sub mucousa
mucous gland Intrinsik laryngeal muscle & joints
- Hyperaemia, oedem sub mucousa
- Pseudosratified ciliated epith of the respirstory mocous
Change squamous type and squamous epith of vocal cord
change becaome hyperplasia & keratinisation
- Mucous gland hypertrophy ( at first ) later atrophy ;
dryness of larynx
 Clinical Feature
- Man : women = 8:1 at 30 – 50 years of age
- Hoarness ; clear the throat ; dry cough ; tired of voice ; discomfort
in the throat
 Examination
1.Laryngeal mocosa ; dusky red & thickened
2. Vocal cord : red & swallen. In late stage become bulky & irregular
giving modullar appearance
3. Ventricular band : Red & swallen
4. Mobility of cord inpaired due to oedem & infiltration, later
muscular atrophy or arthrities of crichoarythenoid joint.
Therapy
- Conservative
- Surgical One cord is operated at a time ; removing the
hyperplastic
 PHACYDERMIA LARYNGITIS
 A chronic hyperplatis laryngitis affecting :
- Posterior part of interarythenoid
- Posterior part of vocal cord
• Clinically :
- Hoarness / husky voice
- Irritation in the throat
• Indirect laryngoscopy
- Red/grey granulation tissue in the interarythenoid region &
posterrior third of vocal cord
- Sometimes ulceration / contact ulcer
- Bilateral / symetrical
• Diagnosis :
Biopsy to differentiate form carsinoma & tubercullosis
 Etiology :
- Uncertain
- >> man – alcohol & smoking
- Forcefull talking & gastro – esophageal reflux
• Therapy :
- Removal granulation tissue Repetition
- Control acid reflux
- Speech therapy
ATROPHIC LARYNGITIS ( Laryngitis Sicca )
• Atrophy laryngeal mucosa & crust formation
• Often in women & associated with atrophic rhinitis &
pharyngitis
• Symptomp :
Hoarnes, Coughing, Removal crusts, dry irritation cough,
sometimes dyspnoe ( due to obstructive crusts )
 Examinatoon :
- Atrophic mucosa
- Foul smelling crusts
- Crusts expelled Mucosa excoriation & bleeding
• Therapy :
- Elimination the causative factor
- Humidification
- Loosen the crusts ( expectorant )

TUBERCULOSIS OF LARYNX
• Etiology :
- Secondary to pulmonary tuberculosis
- Man middle age group
- Bronchogenic / haemotogenic
Pathology :
- Affect posterior part larynx >> anterior
1. Interarythenoid fold
2. Ventricular band
3. Vocal cord
4. Epiglottis
- Bronchus + sputum ( BTA (+)) penetrate the laryngeal
mucosa in the interarythenoid region ( bronchogenic spread )
Tubercle the mucosal ulcerate
- Laryngeal mucosa : Red & swallen
- Stadium perychondritis & cartilage necrosis Not common
Symptoms & sign :
- Depend on the stage of tuberculosis
- Weakness of the voice (earliest symptom ) Hoarseness
- Ulcer in the larynx - severe pain to the ear
- Painfull in swallowing
dyspepsia
 Laryngeal examination :
1. Whole vocal cord hypereami or posterior part impairment of
adduction
2. Swelling in inter arythenoid region
3. Vocal cord : ulceration (+) mouse bite / nibbled
4. Ulceration (+) in arythenoid & interarythenoid region
5. Granulation tissue in interarythenoid region
6. Turban epiglottis
7. Swelling of ventricular band & aryepiglottic fold
8. Marked pattor of surrounding mucosa

• Diagnosis
- X – ray chest
- Sputum examination
- Biopsy laryngeal lesion
 Therapy :
- Voice rest ( important )
- Anti tuberculosis drugs

SYPHILIS OF THE LARYNX

• Rare condition
• Tertiary stage : gumma (+)
• Any part of the larynx : smooth swelling ulcer

Diagnosis
1. Biopsy
2. Serological test
 Complication :
Laryngeal stenosis

LEPROSY OF THE LARYNX

Biopsy, Deformity of laryngeal inlet Stenosis
Complication : Laryngeal stenosis

SCLEROMA OF THE LARYNX

Biopsi Klebsiella Rhinoscleromatis
Complication : Laryngeal stenosis
DR. IDA SJAILANDRAWATI HRP, Sp. THT – KL
 I. PAROTID ABSCESS
 Parotid space contents :
- Parotid gland
- Facial nerve
- External carotid artery
- Retromandibullar vein
• Facial layer is very thick ( superficially ) Parotid gland

very thin on the deep side

parotid abscess

burst

Parapharyngeal abscess

to mediastinum
 Etiology :
- Dehydration ( in post surgical ) stasis salyvary flow
- Infection oral cavity to stensons duct parotid gland
- Staph aureus, streptococci
- Anaerobic organism
- Gram negative ( rarely )
• Clinical features :
- Usually 5 – 7 days after operation
- swelling , redness, induration, tendeseness in the parotid
- Usually unilateral, bilateral ( rarely )
- Fluctuations difficult ( because thick capsule )
- Toxic, high fever, dehydrated
• Diagnosis : USG,
CT-SCAN
Aspirasi Abscess : Culture & Sensitivity test
 Therapy : -Dehydration
- Correct -Oral hygine
- Intravenous antibiotic -Salyvary flow
- Surgical drainage

II. LUDWIG’S ANGINA

 Is infection of submandibular space

 Submandibular space : between mucous membrane floor of
mouth and tounge band superficial layer of
deep cervical between hyoid bone and
mandibular
 Etiology :
1. Dental infection ± 80%
Premolar root above the mylohioid sublingual space

infection
Root of molar teeth extend up/below mylohyoid
causes sub maxilarry space infection(Picture 51.2 next
slide)
2. Submandibular sialodenitis : injury oral muccosa & fractur
mandibula
 Bacteriology :
- Aerob & anaerob
- Alpha haemolytic streptocci
Staphylococci Common
Bacteroidess
- H. Influenza
Esch. Coli Rarely
Pseudomonas

• Clinical features :
- Odynophagia
- Trismus
- Floor of mouth swollen
Tounge to be push up & back - Infection in sublingual space

- Submental & submandibular region swollen & tender &

woody hard feel( infection in submaxillary space )
- Cellulitis (+)
- Laryngeal oedem (±)
 Therapy :
1. Sistemic antibiotic Intraoral (infection sublingual space)
2. Incision & drainage
3. Tracheostomy External ( if infecton submaxillary
space )

• Complication :
1. Spread parapharyngeal & retropharyngeal space ± to
mediastinum
2. Airway obstruction ( laryngeal oedem / swelling & push back
the tounge )
3. Septicaemia
4. Aspiration pneumonia
 III. PERITONSILLAR ABSCESS ( QUINSY )

 Collection of pus in the paritonsillar space between capsule tonsill

and the superior constrictor muscle
 Etiology :
- Follows acute tonsilitis
- Infection of tonsillar crypts Intratonsillar abscess Burst
through tonsillar capsule peritonsilitis abscess
- Culture pus : ^ Strept. Pyogenes ; Staph. Aureus, anaerob
^ Mixed aerob & anaerob
• Clinical Features :
^ Adult >>, children rarely
^ Usually unilateral
^ Fever up to 107°F ; Chills, rigors, malaise, body aches,
headache, nausea, constipation, odynophagia, muffled/hot potato
voice, foul breath, ipsilateral earache ( via N IX ), trismus
(pterygoid muscle & constrictor superior )

 Examination :
1. Tonsil, ant pillar, soft palate congested & swallen
2. Uvula : swallen & oedem to the opposite
3. Cervical lymphadenopathy ( jugulodigatric symphnodes )
4. Torticollis ( keep the neck tilted to the side of abscess )
• Therapy :
- Hospitalisation
- IFVD
- Antibiotic IV dan analgetic
- Oral hygine ( saline mouth washes, ect )
- Incision, drainage
- Tonsilectomy :
^ 4 – 6 weeks after quinsy
^ Abscess tonsilectomy / hot tonsilectomy the risle
of rupture of the abscess & bleeding at the time of
operation
 IV. RETROPHARYNGEAL ABSCESS

 Behind the pharynx, between buccopharyngeal fascia and

prevertebral facia
 Can pass down into yhe mediastinum

 Etiology :
- Commonly in children
^ < 3 years of age
^ Suppuration of retropharyngeal lymph node
^ Infection of adenoid, nasopharynx, nasal sinus, nasal cavity
- In adult
^ Injury posterior pharyngeal wall, cdervical, oesophagus
^ Tubercullosis cervical lymph node; caries cervical spine
 Clinical features :
1. Dysphagia & difficult in breathing
2. Stridor & croky cough
3. Torticollis : neck stiff and the head kept extended
4. Posterior pharyngeal wall bulgyng (+) on the site or midline

• Diagnosis :
X- Rays soft tissue lateral neck

• Therapy :
1. Incision & drainage abscess
2. Sistemic antibiotic / anti tuberculloosis .
3. Tracheostomy if large abscess obstruction the airway
or laryngeal oedem
 V. PARAPHARYNGEAL ABSCESS
 Abscess of pharyngomaxillary = Lateral pharyngeal space

 Parapharyngeal space :
- Pyramidal shape
- Its base at the base of skull
- Its apex at the hyoid bone ( Pic. 51.7 next slide )
• Parapharyngeal space communicate :
- Retropharyngeal space
- Submandibular space
- Parotid space
- Visceral
• Etiology form :
1. Pharynx : acute/chronic infection of tonsil & adenoid
peritonsilar abscess
2. Teeth : dental infection usually lower last molar tooth
3. Ear : bezold’s abscess, petrositis
4. Infection of parotid space, retropharyngeal space,
submaxillary space
5. External trauma : Penetrating injury neck, infection of
local anastesy, mandibular nerve block
Clinical feature :

- Depen on hte compartment involved

- Anterior compartmen :
^ Trismus
^ External swelling behind the angle if jaw odynophagia
- Posterior compartment :
^ Pharynx behind the posterior pillat bulge
^ Paralysis N IX, X, XI, XII
^ Swelling parotid region
^ Trismus (±)
- Fever, odynophagia, sore throat, torticollis
Complication
1. Oedem larynx respiratory obstruction
2. Thrombophlebitis of jugular vein + septicaemia
3. Spread infection to : Retropharyngeal space and mediastinum
4.Carotid blow massive haemorage

• Therapy :
- Antibiotic systemic
- Drainage

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