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Chronic laryngitis

Chronic hyperplastic laryngitis/ Chronic hypertrophic laryngitis

  1. Diffuse/ Symmetrical
  2. Localized variety
  • Etiology:
  1. May follow incompletely resolved acute simple laryngitis/ recurrent attacks of it
  2. Chronic sinusitis, tonsillitis, dental infection, lower respiratory tract infections
  3. Occupational factors: Exposure to dust, fumes
  4. Smoking, alcohol
  5. Vocal abuse
Pathological changes start in the glottic region and latter may extend to ventricular band, base of epiglottis and ven subglottis. Mucosa, submucosa, mucous glands and in later stages intrinsic laryngeal muscles and joints may be affected.
  • Clinical features:
  1. Hoarseness - Male: Female =8:1
  2. Age group 30-5Oyrs
  3. Constant desire to clear the throat
  4. Discomfort in the throat
  5. Cough
  • Laryngeal examination:
Hyperemia & thickening of the mucosa of the laryngeal structures with dusky red discoloration
  1. Vocal cord : Appear red and swollen
  2. Mobility of the cord: impaired due to oedema
  • Conservative:
    Avoidance of the irritant
  • Surgical:  Stripping of vocal cords, removing the hyperplastic and oedematous mucosa, may be done in selected cases. Damage to underlying vocal ligament should be carefully avoided. One cord is operated at a time.
Vocal Nodules: (singer’s nodule/ screamer’s nodule)
  1. Chronic misuse of vocal cords causes haemorrhage in sub mucosal space. This leads to hyalinisation and firbosis & hyperplasia of the over lying epithelium called nodule.
  2. Bilaterally symmetrical                                              
  3. Seen in: teachers, singers/ actors, vendors
  4. Age group :          
    1. Children and adolescents: Spindle shaped thickening
    2. Adults : Localized thickening
Fig: Vocal nodules. Typically, they form at the junction of anterior one-third with posterior two-thirds of vocal cord

  1. Site: junction of anterior 1/3 with middle 1/3
  2. Etiology: Overuse and improper use
  3. Features: Submucous transudation/haemorrhage followed by in growth of vessels hyalinization and fibrous organization
Differences between Early Nodule & Late Nodule
Early Nodule Late nodule
Is soft Is Hard
Pinkist tinge / the mucosa Whitist / gneishtinge in the mucosa
Mucosa moves during speech during speech No movement of mucosa
Rx in speach thempy Rx in surgery
  1. Clinical symptoms:
    1. Hoarseness
    2. Vocal fatigue
    3. Pain in the neck on prolonged
    4. phonation
  2. Treatment:
    1. Early nodules: Re-education of voice by suitable training programme (Vocal hygiene)
    2. Late nodules: Surgery F/B speech therapy (Microlaryngeal surgery)

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