​Kembara Xtra - Medicine - Laryngitis

​Kembara Xtra - Medicine - Laryngitis 
Laryngitis is characterized by hoarseness, loss of voice, throat pain, coughing, and frequently a significant impact on a person's quality of life and everyday activities. It is an inflammation, erythema, and edema of the mucosa of the larynx and/or vocal cords.
There are various degrees of severity, but the majority of instances are acute and linked to viral upper respiratory infections, irritability, or acute vocal strain.
Affected systems include the lungs, ears, nose, and throat. Acute laryngitis, chronic laryngitis, croup, or laryngotracheitis (in children) are some synonyms.

Epidemiology 
Children are more vulnerable than adults because smaller airways carry a higher chance of developing symptoms of inflammation.
Incidence
Common
Common; 1.7% of the population has dysphonia, with acute laryngitis accounting for 50% of cases.
Although prevalence rates are rising, they are challenging to assess since many people do not seek medical care.

Pathophysiology and Etiology 

Viral: adenovirus, coronavirus, rhinovirus, human papillomavirus, cytomegalovirus, varicella-zoster virus, herpes simplex virus, respiratory syncytial virus, coxsackievirus, influenza A, B, parainfluenza, adenovirus, coronavirus, rhinovirus, - Fungal: uncommon but underdiagnosed, possibly representing 10% of presentations in both immunocompromised and immunocompetent patients; risk factors include recent antibiotic or inhaled corticosteroid use (1): histoplasmosis, blastomycosis, Coccidioides, Cryptococcus, and Candida.
Hemolytic streptococcus, Streptococcus pneumoniae, Haemophilus influenzae, leprosy, tuberculosis (TB), Moraxella catarrhalis, Mycoplasma pneumoniae, and Chlamydophila pneumoniae are among the unusual bacteria.
Methicillin-resistant Staphylococcus aureus (MRSA) should be taken into consideration as a potential cause in patients with chronic laryngitis.
- Secondary syphilis if untreated - Leprosy (laryngitis affects 30–55 percent of leprosy patients in tropical and warm areas) Inhaling irritants including air pollution or cigarette smoke; inhaling caustic chemicals; and having gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux disease (LPRD). - An atmosphere that is very dry - Pollen exposures
 Anatomical aging changes include vocal cord bowing, larynx moisture loss, and muscular atrophy. - Vocal cord nodules or polyps, also known as "singer's nodes"
Localized cancer
Iatrogenic conditions include surgical wounds, endotracheal intubation injuries, and inhaled steroids used to treat asthma. Idiopathic conditions include stroke and neuromuscular conditions like myasthenia gravis.
Rheumatoid arthritis Trauma (such as a piercing or blunt neck injury)


Acute risk factors include:
- Injury or infection
- Viral infection of the upper respiratory tract (such as influenza, rhinovirus, adenovirus, and parainfluenza). Voice overuse, excessive singing, or shouting, and viral or bacterial pneumonia
Coughing, Immunocompromised, Lack of Diphtheria or Pertussis Immunization, Recent Endotracheal Intubation or Local Surgery
Chronic (lasting longer than three weeks): Chronic rhinitis/sinusitis with postnasal drip (PND) and allergic laryngitis
abuse of one's voice; GERD/LPRD- Primary or secondhand smoking
- Abuse of alcohol in excess
- Immune system problems, such as rheumatoid arthritis- Granulomatous conditions, such as sarcoidosis Stroke - Pollution of the environment; continual exposure to dust or other irritants like pesticides at work - Drugs: anabolic steroids, anticholinergics, antihistamines, and steroids for inhalation 

Aspects of Geriatrics

Consider neoplasm as they may be more sick and heal more slowly.

Common pediatric considerations: Take congenital/anatomic reasons into account.

Basic Prevention 

 Refrain from overusing your voice (speech therapy and voice training are beneficial for vocal performers and public speakers).
The influenza virus vaccine is advised, along with other standard vaccinations.
 Give up smoking and steer clear of passive smoking.
Limit or stay away from alcohol, coffee, and acidic meals.
 Manage GERD and LPRD.
Maintain adequate hydration levels.
 Keep allergies away.
 When around chemical or environmental irritants, wear a mask.
 Proper hand washing to avoid infections

Pharyngitis caused by a virus and diphtheria (rare) are associated conditions. Membrane can enter the larynx.
bronchitis, pneumonia, epiglottitis in children, pertussis, which affects the larynx as part of the respiratory system

Diagnosis includes symptoms such as hoarseness, throat "tickle," dry cough, and rawness; dysphonia (abnormal-sounding voice); constant urge to clear the throat; possible fever; malaise; dysphagia/odynophagia; regional cervical lymphadenopathy; stridor; or potential airway obstruction in children; and cough that gets worse at night in children.
Hemoptysis, laryngospasm, or a sense of choking, allergic rhinitis, rhinorrhea, or PND, voice overuse due to a job or other factors, smoking history, blunt or piercing neck injuries, and GERD/LPRD

clinical assessment 
Visualization of the larynx, preferably with a flexible or rigid endoscope or with an indirect mirror examination as a screening approach to suggest additional relevant testing. Head and neck exam, including airway patency, cervical nodes, and cranial nerve exam. Take note of the voice's quality (i.e., if it is harsh, breathy, watery, "hot potato like," asthenic [weak], or strained).

Diphtheria, vocal nodules or polyps, laryngeal cancer, thyroid cancer, and upper airway cancer are among the differential diagnoses (3),(4).[A]
 Autoimmune (rheumatoid arthritis), Epiglottitis, Pertussis, Laryngeal Nerve Trauma/Injury, Foreign Body (in youngsters),


Laboratory Results: Viral culture (rarely required), WBCs increased in bacterial laryngitis Tests in the Future & Special Considerations
If a foreign body is detected, simply perform a barium swallow. If a CT scan is recommended, wait until a laryngoscopy may be used to see the larynx. 

Other/Diagnostic Procedures
Fiber-optic or indirect laryngoscopy: look for rounded margins and exudate (Reinke edema), as well as red, irritated, and occasionally hemorrhagic vocal cords. Laryngitis lasting more than two weeks in adults with a history of smoking or alcohol misuse should be evaluated by an otolaryngologist and biopsied to rule out cancer.
No difference was seen in the prevalence of pharyngeal reflux, as determined by a pH probe during a 24-hour period, between individuals with chronic reflux laryngitis and healthy people.
Strobo video laryngoscopy is used to diagnose minor abnormalities, such as nodules or polyps on the vocal cords.


Management 

 There is some evidence, though it is sparse, that additional treatment is unsuccessful.Hydration, voice rest, humidification, and caffeine restriction are all parts of supportive care.
Since viral etiologies account for the majority of cases of acute laryngitis, antibiotics don't seem to help. In cases of prolonged laryngitis, take MRSA-causing bacteria into account.
 Corticosteroids to lessen inflammation in croup-like situations of severe laryngitis If voice overuse occurs, voice training may be necessary (5).
Nebulized epinephrine lessens croup symptoms 30 minutes after administration; there is no evidence to support the use of racemic, L-, or IPPB epinephrine or IPPB over simple nebulization. Croup symptoms are lessened by racemic epinephrine after 30 minutes, although the effect only lasts for two hours.
 Injections of botulinum toxin for spasmodic dysphonia

General Actions 

Acute: Usually a self-limited illness that lasts no longer than three weeks.
- Ineffective antibiotics (6)[A]
- Refrain from talking too loudly or whispering.
- Humidifiers with cool mist or steam inhalation
- Drink more water, especially if you're feeling especially dehydrated.
- Steer clear of smoking (or passive smoking).
- Gargles with warm saltwater

The chronic
- Similar symptomatic therapy as above
- Voice treatment (for those who suffer from vocal abuse and sporadic dysphagia) - Quitting smoking
- Reducing or quitting alcohol use
- If exposure-driven, a change in occupation or modification
- Avoiding allergens
- Take into account stopping the offending medicine (such as inhaled steroids).
 Laryngitis due to reflux
- Raise the bed's head.
- A shift in diet
- Other management of antireflux lifestyle change
Inhibitors of the proton pump

Usually no medication First Line
Analgesics, uncommon antipyretics, cough medicines, throat lozenges, cough drops, and lots of fluids
Next Line
 Inhaled corticosteroids (only use if allergies are present) (3) Oral corticosteroids: evidence of benefit has been studied with single-dose dexamethasone in children aged 6 months to 5 years for moderate-severity croup; symptoms are reduced within 6 hours; hospitalizations, hospital length of stay, and office visits are reduced with oral corticosteroids: only if urgent need exists in adults (presenter, singer, actor); standard of care is to prescribe proton pump inhibitors for chronic laryngitis if GERD or LP
Treat the underlying, nonviral infectious causes.
Candidal laryngitis treatment options include fluconazole, an oral antifungal, for mild instances, and amphotericin B or echinocandin for life-threatening cases.


Problems to Refer 

Consider otolaryngologic evaluation and biopsy for laryngitis lasting more than three weeks in adults, especially in those with a history of smoking or alcohol abuse to rule out malignancy. Consider GI consult to rule out GERD/LPRD. Immediate emergency ENT referral for patients with stridor or respiratory distress. ENT referral for persistent symptoms (>2 to 3 weeks) or concern for foreign body.


Surgical Procedures Removal of nodules or polyps if voice therapy is unsuccessful Vocal cord biopsy of hyperplastic mucosa and regions of leukoplakia if malignancy or TB is suspected 

Medical Alternatives
Although not thoroughly researched, the following remedies have been suggested by some experts: barberry, black currant, Echinacea, Eucalyptus, German chamomile, goldenrod, goldenseal, warmed lemon and honey, licorice, marshmallow, peppermint, saw palmetto, slippery elm, vitamin C, and zinc.

Modification of Lifestyle 

 Spread awareness of the value of voice rest, which includes whispering.
Offer support for quitting smoking.
 Assist the patient in changing any additional risky behaviors or workplace dangers.

Assessment and Complication 
Complete resolution of the inflammation without any aftereffects and persistent hoarseness

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