Congenital laryngomalacCongenital laryngomalaciaia

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 developmeis present at birth. During fetal development, the structures in the larynx may not fullnt, the structures in the larynx may not fully develop. y develop.

CauseCause

As a result, there is a weakness in these stAs a result, there is a weakness in these structures at birth, causing them to collapse ructures at birth, causing them to collapse during breathing. In children, congenital larduring breathing. In children, congenital laryngeal stridor is the most common cause yngeal stridor is the most common cause of chronic stridor. Sixty percent of infants bof chronic stridor. Sixty percent of infants born with congenital laryngeal stridor will haorn with congenital laryngeal stridor will have symptoms in the first week of life. Most ve symptoms in the first week of life. Most other infants will show symptoms by 5 weeother infants will show symptoms by 5 weeks old.ks 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 ithat is heard as the infant breathes. The stridor is usually heard when the infant breathes in (insps usually heard when the infant breathes in (inspiration), but can also be heard when the infant briration), but can also be heard when the infant breathes out (expiration). Other characteristics of teathes out (expiration). Other characteristics of the stridor may include:he 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 thwhich involves a tube being passed into the airways to allow your child's physician to e airways to allow your child's physician to observe the airways during breathing.observe the airways during breathing.

Treatment for congenital laryngoTreatment for congenital laryngomalaciamalacia

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

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

hich require medical and surgical interventions.hich 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 cLaryngitis is an inflammation of the vocal cords causing speech to become hoarse anords causing speech to become hoarse and/or whisperlike, and often inaudible.d/or whisperlike, and often inaudible.

CauseCause

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

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

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

Acid Acid RefluxReflux

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 hoHoarseness that is worse during and several hours after exposure to the allergen urs 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 neIf severe, physicians will often instruct a person not to speak at all for the next few days.xt few days.

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

Symptoms usually resolve in fewer than seven dSymptoms usually resolve in fewer than seven days in most individuals.ays 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 extreme,to the laryngeal mucosa. At the extreme, it can provoke cancer. 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, eitpesticides, which may cause cancer, either by direct contact with the mucosa oher by direct contact with the mucosa or through a systemic effect, or may act r through a systemic effect, or may act as an irritant.as an irritant.

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

fectious laryngitis is fectious laryngitis is Staphylococcus aureus. HaemoStaphylococcus aureus. Haemophilus influenzaephilus influenzae and pneumococcal species may co and pneumococcal species may complicate the course of viral laryngitis. mplicate the course of viral laryngitis.

Tuberculosis, caused by infection with the tubercle bTuberculosis, caused by infection with the tubercle bacillus acillus Mycobacterium tuberculosis hominis,Mycobacterium tuberculosis hominis, was a c was a common disease of the larynx. Overall incidence has ommon 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 lisputum from pulmonary tuberculosis are the most likely sources of infection.kely 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 occasiocan range from simple edema, in the occasional abuser, to hyperplastic reactions if the stinal abuser, to hyperplastic reactions if the stimuli persist over time. muli persist over time.

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

Environmental factors, such as dust, fuEnvironmental factors, such as dust, fumes, chemicals, and toxins, can cause tmes, chemicals, and toxins, can cause this condition. his 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 iusually follows a stressful period in middle life. This condition is probably a vocal expression of psychoneurotic behavior or a s 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 changeVocal folds atrophy and lose tension with age, causing changes in phonation. Loss of thyroarytenoid ligament elasticity results in phonation. Loss of thyroarytenoid ligament elasticity results in breathiness and loss of breath support because of bowed vs in breathiness and loss of breath support because of bowed vocal folds. ocal folds.

Muscular disorders may contribute to chronic laryngitis. WeaknMuscular disorders may contribute to chronic laryngitis. Weakness of the larynx and the pharynx is present in one third of patiess of the larynx and the pharynx is present in one third of patients with myasthenia gravis.ents 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. Sthe clinical history and a physical exam. Some physicians might wish to do a laryngoome physicians might wish to do a laryngoscopy (visualization of the vocal cords). scopy (visualization of the vocal cords).

TreatmentTreatment

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

CAUSESCAUSES

vocal trauma (more specifically, phonotrauvocal trauma (more specifically, phonotrauma in the case of vocal fold polyps and voma in the case of vocal fold polyps and vocal fold nodules) cal 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 lonAny hoarseness or change in voice that lasts longer than two weeks should be brought to the atteger than two weeks should be brought to the attention of your physician. (Sometimes the hoarsenntion of your physician. (Sometimes the hoarseness may be indicative of laryngeal cancer.)ess may be indicative of laryngeal cancer.)

a complete medical history and physical examina complete medical history and physical examinationation

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

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 largand the mucous is thicker and contains a large amount of soft tissue. This soft tissue is mae amount of soft tissue. This soft tissue is mainly located under the mucous of the aryepiglinly located under the mucous of the aryepiglottic folds, and especially in the subglottic regottic folds, and especially in the subglottic region. ion.

The specific reactivity of the mucous membraThe specific reactivity of the mucous membrane in small children makes them prone to infene in small children makes them prone to infections, especially viral. Some of these infectioctions, especially viral. Some of these infections may cause oedema of the mucus. The resns may cause oedema of the mucus. The respiratory tract in children is relatively narrow in piratory tract in children is relatively narrow in this region and the chondrous ring limits the sithis region and the chondrous ring limits the size of the subglottic region. So, oedema in this ze of the subglottic region. So, oedema in this region may have a dramatic course, leading eregion may have a dramatic course, leading even to acute respiratory distress ven to acute 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 enddirect visualization of the larynx end

oscopy, fiberoscopy and laryngoscopyoscopy, fiberoscopy and laryngoscopy

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

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

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

onths of age or are prolonged or recurrent, a congenital onths of age or are prolonged or recurrent, a congenital defect of the larynx should be suspected, i.e. laryngeal wdefect of the larynx should be suspected, i.e. laryngeal web or haemangioma of the larynx. In these cases direct eeb or haemangioma of the larynx. In these cases direct examination of the larynx is an urgent necessity, because xamination of the larynx is an urgent necessity, because the treatment of these disorders varies. the treatment of these disorders 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 frIntubation:Only intubation is a good method which protects the child fr

om asphyxiation.om asphyxiation. Formerly, tracheotomy was performed, but now it is not often perforFormerly, tracheotomy was performed, but now it is not often perfor

med in this disease. med in this disease. Antibiotics are administrated in those patients in whom bacterial comAntibiotics are administrated in those patients in whom bacterial com

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

In patients older than 4 years of age etiologic factors may be differenIn patients older than 4 years of age etiologic factors may be different e.g. allergy. In these cases administration of anti-histaminic drugs at e.g. allergy. In these cases administration of anti-histaminic drugs and calcium may be suitable. nd 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 melaninogenicus,Bacteroides melaninogenicus, Enterobacter cloacae, Escherichia coli, Fusobacteri Enterobacter cloacae, Escherichia coli, Fusobacterium necrophorum, Klebsiella pneumoniae, Neisseria um necrophorum, Klebsiella pneumoniae, Neisseria meningitidis, Pasteurella multocidameningitidis, Pasteurella multocida),),

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

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) symptupper respiratory infection (URI) symptoms.oms.

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 PeritonsillarPeritonsillar Abscess Abscess

Retropharyngeal AbscessRetropharyngeal AbscessToxicity, Caustic IngestionsToxicity, 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 aMost common benign tumor of the larynx a

nd occurs in patients of all age. nd 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 regiomay affect supraglottic and subglottic regio

ns.ns.

May also involve the trachea and bronchuMay also involve the trachea and bronchu

s.s.

CauseCause

Papillomas in juveniles is more often multiPapillomas in juveniles is more often multi

ple and recurs more frequently than in aduple and recurs more frequently than in adu

lts.lts.

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

may undergo malignant change (may undergo malignant change (HPV 16HPV 16 ，，

1818).).

symptomssymptoms

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

n in infants.n 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 suThe tumor is located in VC, false VC or su

bglottic area. bglottic 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 chilRepeated operations are usually needed in chil

dren. dren.

Co2 laser is favored because of its hemostatic prCo2 laser is favored because of its hemostatic pr

operties and its precision allows for vaporization operties and its precision allows for vaporization

of the lesion.of the lesion.

TreatmentTreatment

⑵ ⑵ Tracheotomy is occasionally indicated iTracheotomy is occasionally indicated i

n children with dyspnea, but should be avon children with dyspnea, but should be avo

ided due to concern about subglottic spreaided due to concern about subglottic sprea

d.d.

TreatmentTreatment

⑶ ⑶ transfer factor, interferon and antivirotictransfer factor, interferon and antivirotic

s. s. Cidofovir , a new antiviral agent approved for Cidofovir , a new antiviral agent approved for

ocular cytomegalovirus infections, has shown procular cytomegalovirus infections, has shown pr

omise as a local injection in adjuvant therapy.omise as a local injection in 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 incrWine (combined smoking and alcohol abuse incr

eases the risk by 50% over the additive rate )eases 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 carciadenocarcinoma and undifferentiated carci

noma is rare.noma is rare.

Clinical classification:Clinical classification:

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

tastasistastasis

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

rly metastasis rly metastasis

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

y metastasisy metastasis

Spread of tumorSpread of tumor

⒈ ⒈ Direct spreadDirect spread

Supraglottic cancer→ epiglottis, pre-epi①Supraglottic cancer→ epiglottis, pre-epi①glottic space, vallecula, and tongue base. glottic space, vallecula, and tongue base.

piriform sinus, lateral wall of hypophary② piriform sinus, lateral wall of hypophary②nx. paraglottic space, ventricle or the V③nx. paraglottic space, ventricle or the V③C.C.

Spread of tumorSpread of tumor

Glottic cancer→ anteriorly, contralateral ①Glottic cancer→ anteriorly, contralateral ①VC. posteriorly, arytenoid cartilage su② ③VC. posteriorly, arytenoid cartilage su② ③periorly, supraglottic area. inferiorly, par④periorly, supraglottic area. inferiorly, par④aglottic space and subglottic area.aglottic space and subglottic area.

Spread of tumorSpread of tumor

Subglottic cancer→ superiorly, glottis. ①Subglottic cancer→ superiorly, glottis. ① anteriorly and laterally, strap muscle an② anteriorly and laterally, strap muscle an②

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

Spread of tumorSpread of tumor

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 metaGenerally, the risk of occult or actual meta

stases from T1, T2, T3 and T4 tumors is 2stases from T1, T2, T3 and T4 tumors is 2

0, 40, 60, and 80%.0, 40, 60, and 80%.

Spread of tumorSpread of tumor

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

mphatics, involvement of cervical nodes at mphatics, involvement of cervical nodes at

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

＜＜ 8% of patients with T1 and T2 tumors w8% of patients with T1 and T2 tumors w

ill have nodal involvement.ill have nodal involvement.

Spread of tumorSpread of tumor

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

relaryngeal nodes, paratracheal nodes anrelaryngeal nodes, paratracheal nodes an

d other cervical nodes could be involved.d other cervical nodes could be involved.

Spread of tumorSpread of tumor

Subglottic cancer →tend to spread to paraSubglottic cancer →tend to spread to para

tracheal lymphatics and then to superior mtracheal lymphatics and then to superior m

ediastinual nodes.ediastinual nodes.

Spread of tumorSpread of tumor

⒊ ⒊ Distant metstases via bloodDistant metstases via blood

Distant metastasis only occurs in the very lDistant metastasis only occurs in the very l

ater stage of laryngeal carcinoma .ater 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 eaThere are no definitive symptoms in the ea

rly stage. rly stage.

Dyspnea and lymph nodes metastasis is tDyspnea and lymph nodes metastasis is t

he late symptomshe late symptoms

diagnose diagnose

Physical examinationPhysical examination

Laryngoscopic examination can find a masLaryngoscopic examination can find a mas

s on one or both vocal cordss 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 fchest X-ray f

ilmilm

Papilloma of the larynxPapilloma of the larynx

Syphilis of the larynxSyphilis of the larynx

TreatmentTreatment

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

naged with single modality of treatment and respnaged with single modality of treatment and resp

onds well to radiation, transoral laser resection,oonds well to radiation, transoral laser resection,o

r partial laryngeal surgery.r 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 useGenerally, combined therapy is widely use

d, as it shows better survival rates than sind, as it shows better survival rates than sin

gle-modality treatment.gle-modality treatment.

Surgery + radiotherapy or radiotherapy + sSurgery + radiotherapy or radiotherapy + s

urgery are two commonly used modalities.urgery are two commonly used 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, intercostdepression of suprasternal fossa, intercost

al and supraclavicular space or epigastriual and supraclavicular space or epigastriu

m while inspirationm 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

classification:classification:

ⅡⅡ°°slight inspiratory dyspnea during quiet rslight inspiratory dyspnea during quiet r

espiration, and exaggeration on exertion. espiration, and exaggeration on exertion.

Sleeping and taking the meal is nearly norSleeping and taking the meal is nearly nor

mal , no evidence of hypoxia.mal , no evidence of hypoxia.

classification:classification:

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

ud stridor, depression of suprasternal and ud stridor, depression of suprasternal and

supraclavicular fossae and intercostal spasupraclavicular fossae and intercostal spa

ces, cyanosis, restless and struggles for aices, cyanosis, restless and struggles for ai

r hunger, with quick pulse, high blood presr hunger, with quick pulse, high blood pres

sure and refuse meals.sure and refuse meals.

classification:classification:

ⅣⅣ°° ：： extremely dyspneic, restless, sweatiextremely dyspneic, restless, sweati

ng, cyanoticsis. Pulse is rapid, irregular, wng, cyanoticsis. Pulse is rapid, irregular, w

eak and thready. B.P. drops. Finally circuleak and thready. B.P. drops. Finally circul

atory collapse may occur or may die of asatory collapse may occur or may die of as

phyxia or cardiac failure.phyxia 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, trauma,in case of tumors of the larynx, trauma,

bilateral vocal cords paralysis, tracheotom bilateral vocal cords paralysis, tracheotom

y is indicated.y 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 shouldyspnea is not relieved, tracheotomy shoul

d be performed immediately.d be performed immediately.

TreatmentTreatment

ⅣⅣ°° ：： TracheotomyTracheotomy

TracheotomyTracheotomy

Dong pin Dong pin

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

Tracheotomy is often temporary and reverTracheotomy is often temporary and reversible if the patient is able to breathe througsible if the patient is able to breathe through an unobstructed upper airwayh 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 tSecretion obstructed in lower respiratory t

ract (coma)ract (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 betwMaking an opening in the membrane betw

een the cricoid cartilage and thyroid cartilaeen the cricoid cartilage and thyroid cartila

ge and insert a cannula. ge and insert a cannula.

After the situation becomes stable, ordinarAfter the situation becomes stable, ordinar

y tracheotomy should be performed.y tracheotomy should be performed.