ANATOMY AND DISEASES OF THE

LARYNX

DR AMINA SEGUYA
Ear, Nose and Throat (ENT) surgeon
Anatomy of the larynx
• Aka voice box

• It is an air passage that connects

the hypopharynx to the trachea

• Extends from epiglottis to

cricoid cartilage

• Made of cartilages, muscles and

ligaments
Framework of the larynx
 Functions of the larynx
• Respiration

• Voice production

• Prevent aspiration during swallowing

The larynx is innervated by branches of the vagus nerve

• Recurrent laryngeal nerve
• Superior laryngeal nerve
Diseases of the larynx
 Acute laryngitis
• Is inflammation of the larynx for less
than 3 weeks

• Commonly occurs as part of a viral

upper respiratory tract infection

• Symptoms include
– Hoarse voice
– Fever
– Cough
– Painful swallowing
– Frequent throat clearing
 Acute laryngitis
Diagnosis
• Usually made from history
• Laryngoscopy can be done to visualise cords

Management
• Conservative management usually sufficient
– Voice rest
– Plenty of oral fluids
– Humidification of air
• Analgesia
• Antibiotics
– Only if bacterial cause
 Epiglottis
• Inflammation of the epiglottis

• Rapid onset inflection

Causes
• Bacteria
– H. influenza type b infection (commonest)
– Streptococcus pneumoniae
– Streptococcus pyogenes
– Staphylococcus aureus
• Trauma e.g. burns
 Presentation
• A very sick and anxious • Stridor
• Fever • Cyanosis
• Sore throat • Asphyxia
• Dysphagia – Complete airway
obstruction
• Drooling saliva
– Death – 6%
• Hoarse voice
• Difficulty in breathing
 Diagnosis
• From history and Lateral neck x ray
examination

Investigations
• Laryngoscopy
– Swollen edematous
epiglottis
• X rays
– Thumb print sign
 Laryngoscopy
Normal epiglottis Acute epiglottitis

- epiglottis
 Management
• It’s an emergency
– ABC’s

• Secure airway
– Tracheal intubation
– Tracheostomy or or Cricothyroidotomy

• IV antibiotics
– Ceftriaxone with vancomycin or clindamycin
– Clindamycin if penicillin allergy

• Corticosteroids
– Dexamethasone
 Croup
• Aka laryngotracheobronchitis

• Inflammation of the larynx, trachea and bronchi causing

airway narrowing

• Common peadiatric infection

– 15% of children

• Is a viral infection commonly caused by;

– Parainfluenza virus
– Influenza virus
– Respiratory Syncytial Virus (RSV)
 Presentation
Symptoms
• Barking cough
• Stridor
• Hoarse voice
• Difficulty in breathing
• Fever
• Coryza

Diagnosis
• From history and exam
• Neck X ray – steeple sign
 Management
• Oxygen therapy
– If saturations < 92%

• Corticosteroids
– E.g. dexamethasone, budesonide

• Nebulised epinephrine
 Chronic laryngitis
• Inflammation of the larynx Diagnosis
for > 3 weeks • On laryngoscopy;
– Red, Edematous vocal
Causes cords
• Smoking – Stiff vocal cords
• Infections e.g. TB, syphilis – Secretions on vocal cords
• Allergies
• Acid reflux • Other investigations
• Auto immune e.g. – Pus swab
sarcoidosis – Tissue biopsies
• Voice abuse – Antibody tests
 Management
Treat cause If symptoms persist
• Acid reflux
• REFER for further
– dietary changes
– PPIs e.g. omeprazole
investigations
• Allergic – direct laryngoscopy
– Antihistamines – Biopsy
– Inhaled corticosteroids – Imaging investigations
• Auto immune and
granulomatous:
– Corticosteroids
• Tuberculosis:
– Anti TB treatment
THE END