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Full text of "Diseases Of The Nose Throat And Ear"

CHAPTER 34
CHRONIC LARYNGEAL DISEASES

CHRONIC LARYNGITIS

The aetiology of this condition is quite unknown. In a minority of instances
repeated attacks of acute laryngitis will cause the chronic state to
occur. In others, excessive smoking, or occupational pollution, cause
metaplasic changes which alter the lining of the larynx enough to
warrant a diagnosis of chronic laryngitis. It is true, however, that only a
small proportion of those who smoke or are exposed to pollution suffer from
chronic laryngitis. Some cases have associated chronic sinusitis with or with-
out chronic bronchitis but, again, not all cases of sinusitis and bronchitis
have laryngitis.

In summary, therefore, while a lot of associated features are recognized, the
underlying cause of chronic laryngitis is unknown. Different types are
recognized and described according to the laryngeal appearances. Many cases
look very like cancer of the larynx, but the important diagnostic point in
chronic laryngitis is that the changes are bilateral and symmetrical. There are
several varieties.

1.  Chronic Hyperaemic Laryngitis. The characteristic appearance is that the
whole larynx, including the vocal cords, is red and there are increased
secretions. It looks rather like a subacute laryngitis.

2. Chronic Hypertrophic Laryngitis. In addition to redness, this type displays a
hypertrophy in the supraglottis and glottis.

3.  Chronic Oedematous Laryngitis. In this variety the outstanding feature is
the polypoidal swelling of the glottis and also of the false cords. It can be
mimicked by myxoedematous laryngitis.

4.  Chronic Atrophic Laryngitis. This condition is usually seen in laundry
workers and cooks and is characterized by an atrophy of all laryngeal
structures including the mucous glands of the supraglottis. The result of this is
an excessive crusting within the larynx and trachea.

SYMPTOMS. The common symptom to all the above conditions is
continuous hoarseness. If there is any degree of myositis there will be air
wastage resulting in a breathy voice. There will also be a feeling of dryness and
irritation in the throat and a frequent desire to clear the throat.

TREATMENT.

a.  Voice Rest. This forms an important part of the treatment especially in
professional voice users who could do permanent damage to their voice if they
did not rest it. If vocal abuse plays a part in the aetiology then voice rest must
be enforced.

b. Speech Therapy. This service must be offered to patients who do not use
their voices properly.

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