Laryngitis
Laryngitis is an infection or inflammation of the larynx. The cause can be viral, bacterial, or fungal (candida). Or it can result from acid reflux, cancer radiation therapy, surgery (as temporary post-operative inflammation), or an auto-immune disorder.
Chronic Bacterial Laryngitis
Chronic bacterial laryngitis is a laryngologic problem looking for a more definitive solution. Seen in persons who have undergone radiotherapy or who have an immune defect. The laryngitis can often be improved with antibiotics, but often recurs when antibiotics are discontinued. Sometimes chronic antibiotic administration is needed. Or, laryngeal irrigations.
Bacterial infection? (1 of 5)
This young man has an autoimmune disorder and is taking a immunomodulator drug. He has been chronically hoarse for months. Is this further auto-immunity or a chronic bacterial infection?
Yellow mucus (2 of 5)
Notice yellowish mucus in the subglottis and the intense erythema of the subglottis. Culture shows staph aureus.
Improvement (3 of 5)
After several weeks of dicloxacillin, voice is dramatically improved, as is the laryngeal appearance (compare with photo 1).
Improved voice (4 of 5)
During voicing, excellent vibratory blur, correlating with his much improved voice.
Infection returns (5 of 5)
Some months after discontinuing antibiotics, hoarseness has returned along with infected mucus.
Candida laryngitis, before and after treatment
Candida laryngitis (1 of 4)
Severe laryngeal candidiasis, in a person using inhaled steroids at high dose. Standard light.
Candida laryngitis (2 of 4)
Closer view shows more clearly not only the white areas, but also surrounding inflammation. Standard light.
Candida laryngitis, 15 days after starting treatment (3 of 4)
After 15 days of oral fluconazole. Obvious improvement, but incomplete resolution of tissue changes.
Candida laryngitis, several months later (4 of 4)
After longer-term fluconazole, along with reduction of inhaled steroid dose, complete resolution. Strobe light, closed phase of vibration at high vocal pitch.
Example 2
Candida laryngitis (1 of 4)
Candidiasis in patient using inhaled steroids for asthma. Under standard light, the lesions are vague, hazy, and best seen anteriorly on the right cord (left of image).
Candida laryngitis (2 of 4)
Same patient, narrow-band illumination. This not only emphasizes vascularity, but brings out the candida colonies.
Candida laryngitis, after treatment (3 of 4)
After treatment with fluconazole, the colonies have virtually disappeared.
Candida laryngitis, after treatment (4 of 4)
Same post-treatment examination, under narrow-band illumination. Note that there are normal specks of mucus (such as at the arrows) in the view.
Example 3
Candida laryngitis (1 of 3)
Elderly woman with a history of laryngeal amyloidosis requiring laser sculpting several years earlier. Now using high-dose inhaled steroids, antibiotics, and oral steroids for unrelated pulmonary problem. Marked increase of hoarseness, and whitish discoloration, especially of the left vocal cord (right of image).
Candida laryngitis (2 of 3)
Closer view of hazy white areas and irregular right cord margin (left of image), presumed to be candida overgrowth. Empiric treatment with fluconazole is justified, given history and findings.
Candida laryngitis, after starting treatment (3 of 3)
Two weeks after starting fluconazole; the white areas are completely resolved. The patient’s voice had improved markedly within three or four days of starting the treatment.
Gradual Healing of Ulcerative Laryngitis
Ulcerative laryngitis (1 of 4)
Ulcerated area, free margin of both vocal cords. When diagnosed at this early stage, the patient is notified that recovery will likely require as much as six weeks.
Ulcerative laryngitis (2 of 4)
Same view, but using narrow band illumination to accentuate the ulcers.
1 month later: ulcerative laryngitis healing (3 of 4)
One month later, under narrow band illumination. Ulceration dramatically diminished.
3 months later: ulcerative laryngitis virtually all healed (4 of 4)
At three months, standard illumination. Virtually complete healing, with excellent return of voice. The prominent vascularity at area of ulcer will eventually fade.
Vocal Cord Ulcer
Vocal cord ulcer (1 of 2)
In a patient who had had hoarseness lasting several months, this inflammatory lesion of the right vocal cord (left of image) was identified. There is hazy leukoplakia surrounding a central intensely erythematous ulcer. It most resembles an aphthous ulcer, though these are not previously reported on the vocal cord, and this lesion’s duration is longer than the typical aphthous ulcer.
Vocal cord ulcer (2 of 2)
Closer view, under narrow-band light. The vessel pattern looks inflammatory and not neoplastic. There is heaped-up leukoplakia surrounding the lesion. After this lesion persisted for more than four months, it was removed. Tissue examination showed inflammatory response and keratosis without atypia.
Laryngitis Sicca
Laryngitis sicca (1 of 2)
Laryngitis sicca, with crusting of dry, green mucus especially undersurface of the folds. Though a rare long-term complication, may be seen after laryngeal irradiation for cancer (Lab).
Laryngitis sicca (2 of 2)
Same patient, from slightly higher view (Lab).
Pachyderma, Caused by Laryngitis Sicca
Heaped up Mucosa (1 of 3)
Pachyderma, here referring to the heaped up mucosa in the interarytenoid area, in a patient with laryngitis sicca.
Pachyderma (2 of 3)
Adducted (voicing) position. Note that the pachyderma does not interfere with closure of the cords. In this case, it does not directly affect the patient’s voice, which is typical, but the more generalized inflammatory condition (see the redness of the cords) does.
Stippled Vascular Markings (3 of 3)
Narrow-band lighting. This shows some stippled vascular markings, often seen with chronic inflammation or HPV infection.
Acid Reflux
Phonation (1 of 2)
Open phase of vibration, strobe light, with white mucus sometimes but not always suggestive of acid reflux laryngitis.
Acid reflux (2 of 2)
Closed phase of vibration, strobe light, with same mucus findings.
Example 2
Acid reflux (1 of 2)
Phonation under strobe light. Mild capillary prominence.
Excessive mucus (2 of 2)
As phonation proceeds, appearance of large amounts of viscous white mucus.
Acid Reflux + Laryngitis
Acid reflux laryngitis (1 of 2)
Panoramic view, shows interarytenoid pachyderma (“elephant skin”) at upper blue arrow; arytenoid redness at green arrows; and mucus retention cyst at lower blue arrow.
Acid reflux laryngitis (2 of 2)
During phonation, interarytenoid pachyderma and mucus retention cyst are typically obscured.
Croup, aka Laryngotracheitis
Croup, aka laryngotracheitis (1 of 4)
Though croup is most often seen in children, this woman developed a barking cough and mild, non-anxiety provoking stridor in the context of an upper respiratory infection. In this panoramic view note in particular the prominence and redness of the conus part of the vocal cords (indicated by white lines).
Croup, aka laryngotracheitis (2 of 4)
Closer view. Dotted lines signify normal airway diameter.
Croup, aka laryngotracheitis (3 of 4)
Even closer view showing redness and narrowing of the posterior subglottic airway.
Croup, aka laryngotracheitis (4 of 4)
View within the posterior subglottic narrowing.
Acute Laryngitis “Redness”
Occasionally, the findings of acute laryngitis are not as “dramatic” as the voice change would suggest. There is not necessarily a lot of swelling, but instead, a diffuse pinkness or redness along with a change in secretions.
A normal larynx (1 of 4)
This larynx is seen here in its normal state of health. Study the vascular markings and color at locations marked “1” (right false vocal cord) and “2” (anterior subglottis). We see a normal capillary pattern with relatively “white” areas between.
A normal larynx during voicing (2 of 4)
During voicing, healthy larynx.
Acute laryngitis (3 of 4)
The same larynx during acute laryngitis. Look at the increased amount of fine capillaries, taking away the “white” areas. The entire larynx is more pink/red. Compare locations “1” and “2” between photos 1 and 3 of this series.
Secretions in the larynx (4 of 4)
A cough brings copious secretions to the subglottis and trachea (*).
