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larynx is the voice box that allows us to speak, shout, whisper, and sing. The larynx consists of
a cartilage skeleton that houses the vocal cords, which are covered by amucus lining. Muscles inside the larynx
adjust the position, shape, and tension of the vocal cords, allowing us to make different sounds. Any change in
the air flow (which is generated by the lungs) across the vocal cords will affect the voice and the quality of the
sound.
The larynx is located at the junction of the mouth and trachea and has a flap-like covering called the epiglottis,
whose job it is to prevent food and saliva from entering the larynx during swallowing.
Laryngitis (larynx + itis = inflammation) is an inflammation of the voice box, causing a hoarse or gravelly-
sounding voice or even an inability to speak.
Laryngitis is an inflammation of the vocal cords. Most commonly, acute laryngitis is caused by an infection that
inflames the vocal cords.
In infants and young children, the classic signs and symptoms of an inflamed larynx include:
croup,
fever.
Similarly, in adults, a viral upper respiratory tract infection may be associated with:
runny nose,
a loss of voice.
Rarely, since most people are immunized and protected against this infection,diphtheria may cause laryngitis-like
symptoms.
Laryngitis may also be caused by voice overuse with excess talking, singing, or shouting.
Chronic laryngitis, often described as lasting for more than three weeks, may be caused by prolonged alcohol
use, smoking, and excess coughing.
Chronic irritation of the vocal cords may also cause polyps or nodules to form on the vocal cords, which may
affect the ability of the vocal cords to vibrate, again causinghoarseness.
The muscles that control vocal cord shape and position need to work properly for the voice to sound normal.
Damage to the muscles or to the nerves that control them will lead to hoarseness. These nerves may be
damaged if there has been trauma to the neck or if surgery has been performed and the nerves inadvertently
irritated or severed.
Tumors in the neck and chest may compress the nerves and cause them to function poorly.
Thyroid inflammation and enlargement can also cause irritation of nerves that supply the vocal cord
muscles.
Stroke may also cause vocal cord muscle paralysis and lead to a weak, hoarse voice and swallowing problems.
If the cause of laryngitis is infectious, patients most often will also present with symptoms of upper respiratory
tract infection or cold. There may also be:
a dry cough,
sore throat,
fever,
In children with croup, there may also difficulty breathing. Since the way we get air into our lungs functions like a
bellows, as the child tries to breathe through a swollen and narrow larynx, the cartilage may collapse, just like
when attempting to breathe through a straw. As we age, the cartilage becomes stiffer and is able to withstand
deeply indrawn breaths, but in children the cartilage is weaker and with each inspiration, the child may need to
work hard to inhale.
Laryngitis
Laryngitis is swelling and irritation (inflammation) of the voice box (larynx) that is usually associated
withhoarseness or loss of voice.
Causes
The voice box (larynx) is located at the top of the airway to the lungs (trachea). The larynx contains
the vocal cords. When the vocal cords become inflamed or infected, they swell. This can cause
hoarseness, and may sometimes block the airway.
The most common form of laryngitis is an infection caused by a virus. It may also be caused by:
Allergies
Bacterial infection
Bronchitis
Common cold
Flu
Injury
Irritants and chemicals
Pneumonia
Several forms of laryngitis occur in children that can lead to dangerous or fatal respiratory blockage.
These forms include:
Croup
Epiglottitis
Symptoms
Fever
Hoarseness
Swollen lymph nodes or glands in the neck
A physical examination can determine whether hoarseness is caused by a respiratory tract infection.
Patients with lasting hoarseness (especially smokers) will need to see an ear, nose, and throat doctor
(otolaryngologist) for tests of the throat and upper airway.
Treatment
Because most common laryngitis is caused by a virus, antibiotics may not help. Your health care
provider will make this decision.
Resting your voice helps by reducing inflammation of the vocal cords. A humidifier may soothe the
scratchy feeling that comes with laryngitis. Decongestants and painkillers may relieve the symptoms
of an upper respiratory infection, if you have one.
Outlook (Prognosis)
Possible Complications
Rarely, severe respiratory distress may develop. This will require medical attention.
A small child who is not teething has difficulty breathing, swallowing, or is drooling
A child less than 3 months old has hoarseness
Hoarseness has lasted for more than 1 week in a child, or 2 weeks in an adult
Prevention
Try to avoid people who have upper respiratory infections during cold and flu season.
Wash your hands regularly.
Avoid crowded places.
Stopping smoking may help prevent tumors of the head and neck or lungs, which may lead to
hoarseness.
Epiglottitis
From Wikipedia, the free encyclopedia
Epiglottitis
ICD-10 J05.1
ICD-9 464.3, 476.1
DiseasesDB 4360
eMedicine emerg/169 emerg/375ped/700
MeSH D004826
Epiglottitis is inflammation of the epiglottis - the flap that sits at the base of the tongue, which keeps food
from going into the trachea (windpipe). Due to its place in the airway, swelling of this structure can interfere
with breathing and constitutes amedical emergency. The infection can cause the epiglottis to either obstruct
or completely close off the windpipe.
With the advent of the Hib vaccine, the incidence has been reduced,[1] but the condition has not been
eliminated.[2]
Contents
[hide]
1 Signs and
symptoms
2 Cause
3 Diagnosis
4 Management
5 Complications
6 References
7 External links
[edit]Cause
[edit]Diagnosis
Diagnosis is confirmed by direct inspection using laryngoscopy, although this may provoke airway spasm. If
it is suspected, attempts to visualise the epiglottis using atongue depressor are STRONGLY discouraged
for this reason. A paediatric, anaesthesia or ENT specialist should be alerted immediately. Imaging is rarely
useful, and treatment should not be delayed for this test to be carried out [4].
The epiglottis and arytenoids are cherry-red and swollen. The most likely differential diagnostic candidates
are croup, peritonsillar abscess, and retropharyngeal abscess.
On lateral C-spine X-ray, the thumbprint sign (or just "thumb sign") describes a swollen enlarged epiglottis.
[5]
By: Herberth Solorzano RCC, Oklahoma City Ok.
Epiglottitis Causes
Conditions that cause epiglottitis include infectious, chemical, and traumatic agents. Infectious is the
most common. H influenzaetype b was once the most common cause prior to vaccination. Currently,
other organisms such as bacteria, viruses, and fungi are the causes, especially among adults.
Other types of epiglottitis that are not caused by infection include hot things that
may injure the epiglottis. Heat damage that results in epiglottitis is also known as thermal
epiglottitis. Thermal epiglottitis occurs from drinking hot liquids, eating solid foods, or using illicit
drugs such as inhalation of metal pieces from crack cocaine pipes or the tip of marijuanacigarettes.
In these cases the epiglottitis from thermal injury is similar to the illness caused by infection.
Unusual causes of epiglottitis include brown recluse spider bites to the ear, which may result
in swelling or eating buffalo fish, which may cause an allergiclike reaction and swelling. Blunt
trauma or something blocking the throat may also lead to epiglottitis.
Causes
By Mayo Clinic staff
Throat anatomy
Infection
A common cause of swelling and inflammation of the epiglottis and surrounding tissues is infection
with Haemophilus influenzae type b (Hib) bacteria. Hib isn't the germ that causes the flu, but it's
responsible for other serious conditions — including respiratory tract infections and meningitis.
Hib spreads through infected droplets coughed or sneezed into the air. It's possible to harbor Hib
in your nose and throat without becoming sick — though you still have the potential to spread the
bacteria to others.
Other bacteria and viruses also can cause inflammation of the epiglottis, including:
Streptococcus A, B and C, a group of bacteria that cause diseases ranging from strep
throat to blood infections
Candida albicans, the fungus responsible for vaginal yeast infections, diaper rash and
oral thrush
You also may develop signs and symptoms similar to those of epiglottitis if you:
"Sore throat" redirects here. For other uses, see Sore throat (disambiguation).
Pharyngitis
Viral pharyngitis.
ICD-10 J02., J31.2
ICD-9 462, 472.1
DiseasesDB 24580
MedlinePlus 000655
eMedicine emerg/419
MeSH D010612
Like many types of inflammation, pharyngitis can be acute – characterized by a rapid onset and typically a
relatively short course – or chronic. Pharyngitis can result in very large tonsils which cause trouble
swallowing and breathing. Pharyngitis can be accompanied by a cough or fever, for example, if caused by
an upper respiratory tract infection.
Most acute cases are caused by viral infections (40–80%), with the remainder caused
by bacterial infections, fungalinfections, or irritants such as pollutants or chemical substances.[2]
[3]
Treatment of viral causes are mainly symptomatic while bacterial or fungal causes may be amenable
to antibiotics and anti-fungal respectively.
Contents
[hide]
1 Classification
2 Cause
o 2.1 Viral
o 2.2 Bact
erial
o 2.3 Othe
r causes
3 Diagnostic
approach
4 Management
o 4.1 Med
ications
o 4.2 Alter
native
5 Epidemiology
6 References
[edit]Classification
Pharyngitis is a type of upper respiratory tract infection that involves inflammation of the pharynx.[4] It may
include tonsillitis in which case it is known as pharyngotonsillitis.[4] Another sub classification
is nasopharyngitis (the common cold).[5]
[edit]Cause
The majority of cases are due to an infectious organism acquired from close contact with an infected
individual.
[edit]Viral
A throat infection which tested negative for streptococcus, thus presumably of viral origin. Note the white exudate on the
tonsils which frequently also occurs with a viral infection.
These comprise about 40–80% of all infectious cases and can be a feature of many different types of viral
infections.[2][3]
Adenovirus – the most common of the viral causes. Typically the degree of neck lymph
node enlargement is modest and the throat often does not appear red, although it is very painful.
Measles
Primary HIV
[edit]Bacterial
A number of different bacteria can infect the human throat. The most common is Group A streptococcus,
however others include Corynebacterium diphtheriae, Neisseria gonorrhoeae, Chlamydophila pneumoniae,
and Mycoplasma pneumoniae.[6]
[edit]Streptococcal pharyngitis
[edit]Fusobacterium necrophorum
[edit]Diphtheria
[edit]Others
A few other causes are rare, but possibly fatal, and include parapharyngeal space infections: peritonsillar
abscess ("quinsy"), submandibular space infection (Ludwig's angina), and epiglottitis.[10][11][12] Some
medications may produce pharyngitis such as pramipexole and antipsychotics.[13][14]
[edit]Other causes
Some cases of pharyngitis are caused by fungal infection such as Candida albicans causing oral thrush.
[citation needed]
[edit]Diagnostic approach
It is hard to differentiate a viral and a bacterial cause of a sore throat based on symptoms alone. Thus often
a throat swab is done to rule out a bacterial cause.[15]
[edit]Management
The majority of time treatment is symptomatic. Specific treatments are effective for bacterial, fungal, and
herpes simplex infections.
[edit]Medications
Steroids ( such as dexamethasone ) have been found to be useful for severe pharyngitis.[17][18]
Antibiotics are useful if group A streptococcus is the cause of the sore throat. For viral infections,
antibiotics have no effect.[20]
[edit]Alternative
Alternative medicines are promoted and used for the treatment of sore throats.[21] They are however poorly
supported by evidence, and UpToDate, an evidence-based peer-reviewed resource, recommends that they
not be used to treat pharyngitis.[21][22]
1. Common viruses, and even the viruses that causemononucleosis (mono) and the flu, can cause a sore
throat. Some viruses can also produce blisters in the mouth and throat ("aphthous stomatitis").
2. Breathing through the mouth can produce throat dryness and soreness.
4. A sore throat can also be caused by bacteria. The two most common bacteria to cause a sore throat
areStreptococcus (which causesstrep throat) andArcanobacterium
haemolyticum.Arcanobacterium causes sore throats mainly in young adults and is sometimes
associated with a fine red rash.
6. A sore throat lasting for more than two weeks can be a sign of a serious illness, such as throat cancer or
AIDS.
causes:
Most sore throats are caused by viruses, although a few are due to bacterial infections. You can
breathe in bacteria or a virus that are spread in the air when someone sneezes or coughs, or you
can transfer the organisms to your mouth or nose by touching a surface with germs on them.
Viruses that can cause sore throat include the common cold, the flu, and mononucleosis (often
called "mono"). Bacteria like Group A streptococcus (commonly known as strep throat) can also
cause pharyngitis.
Causes
Viruses are the most common cause of pharyngitis. Many different viruses can cause
pharyngitis.
Bacteria that can cause pharyngitis include Group A streptococcus, which leads to strep
throat in some cases. Other, less-common bacteria that cause sore throats include
corynebacterium, arcanobacterium,Neisseria gonorrhoeae, and Chlamydia pneumoniae.
nusitis
From Wikipedia, the free encyclopedia
Sinusitis
side.
ICD-10 J01., J32.
ICD-9 461, 473
DiseasesDB 12136
eMedicine emerg/536
MeSH D012852
[hide]
1 Classification
o 1.1 By
duration
o 1.2 By
location
2 Signs and
symptoms
o 2.1 Hea
dache
o 2.2 Com
plications
3 Causes
4 Pathophysiology
5 Diagnosis
o 5.1 Acut
o 5.2 Chro
nic
6 Treatment
o 6.1 Cons
ervative
o 6.2 Anti
biotics
o 6.3 Corti
costeroids
o 6.4 Surg
ery
o 6.5 Othe
7 Epidemiology
8 References
9 External links
[edit]Classification
[edit]By duration
Sinusitis can be acute (going on less than four weeks), subacute (4–8 weeks) or chronic (going on for 8
weeks or more).[2] All three types of sinusitis have similarsymptoms, and are thus often difficult to
distinguish. Acute sinusitis is very common. Roughly ninety percent of adults have had sinusitis at some
point in their life.[3]
[edit]Acute
Chemical irritation can also trigger sinusitis, commonly from cigarette smoke and chlorine fumes.[citation
needed]
Rarely, it may be caused by a tooth infection.[4]
[edit]Chronic
Chronic sinusitis, by definition, lasts longer than three months and can be caused by many different
diseases that share chronic inflammation of the sinuses as a common symptom. Symptoms of chronic
sinusitis may include any combination of the following: nasal congestion, facial pain, headache, night-time
coughing, an increase in previously minor or controlled asthma symptoms, general malaise, thick green or
yellow discharge, feeling of facial 'fullness' or 'tightness' that may worsen when bending over, dizziness,
aching teeth, and/or halitosis.[citation needed] Each of these symptoms has multiple other causes. Unless
complications occur, fever is not a feature of chronic sinusitis.[citation needed] Often chronic sinusitis can lead
to anosmia, a reduced sense of smell.[citation needed] In a small number of cases, acute or chronic maxillary
sinusitis is associated with a dental infection. Vertigo, lightheadedness, and blurred vision are not typical in
chronic sinusitis and other causes should be investigated.
Chronic sinusitis cases are subdivided into cases with polyps and cases without polyps. When polyps are
present, the condition is called chronic hyperplastic sinusitis; however, the causes are poorly
understood[4] and may include allergy, environmental factors such as dust or pollution, bacterial infection, or
fungus (either allergic, infective, or reactive). Non-allergic factors, such as vasomotor rhinitis, can also
cause chronic sinus problems.[citation needed] Abnormally narrow sinus passages, such as having a deviated
septum, can impede drainage from the sinus cavities and be a contributing factor.[citation needed] A combination
of anaerobic and aerobic bacteria are detected in conjunction with chronic sinusitis,
including Staphylococcus aureus and coagulase-negative Staphylococci. Typically antibiotic treatment
provides only a temporary reduction in inflammation, although hyperresponsiveness of the immune system
to bacteria has been proposed as a possible cause of sinusitis with polyps (chronic hyperplastic sinusitis).
[citation needed]
Attempts have been made to provide a more consistent nomenclature for subtypes of chronic sinusitis. The
presence of eosinophils in the mucous lining of the nose and paranasal sinuses has been demonstrated for
many patients, and this has been termed Eosinophilic Mucin RhinoSinusitis (EMRS).[citation needed] Cases of
EMRS may be related to an allergic response, but allergy is not often documented, resulting in further
subcategorization into allergic and non-allergic EMRS.
A more recent, and still debated, development in chronic sinusitis is the role that fungus plays in this
disease. Fungus can be found in the nasal cavities and sinuses of most patients with sinusitis, but can also
be found in healthy people as well.[citation needed] It remains unclear if fungus is a definite factor in the
development of chronic sinusitis and if it is, what the difference may be between those who develop the
disease and those who remain symptom free. Trials of antifungal treatments have had mixed results.[4]
[edit]By location
There are several paired paranasal sinuses, including the frontal, ethmoid, maxillary and sphenoid sinuses.
The ethmoid sinuses is further subdivided into anterior and posterior ethmoid sinuses, the division of which
is defined as the basal lamella of the middle turbinate. In addition to the severity of disease, discussed
below, sinusitis can be classified by the sinus cavity which it affects:
Sphenoid' - can cause pain or pressure behind the eyes, but often refers to the vertex, or top of
the head (J01.3/J32.3)
Recent theories of sinusitis indicate that it often occurs as part of a spectrum of diseases that affect
the respiratory tract (i.e., the "one airway" theory) and is often linked to asthma.[7][8] All forms of sinusitis
may either result in, or be a part of, a generalized inflammation of the airway, so other airway symptoms,
such as cough, may be associated with it.
Headache/facial pain or pressure of a dull, constant, or aching sort over the affected sinuses is common
with both acute and chronic stages of sinusitis. This pain is typically localized to the involved sinus and may
worsen when the affected person bends over or when lying down. Pain often starts on one side of the head
and progresses to both sides.[9]
Acute and chronic sinusitis may be accompanied by thick nasal discharge that is usually green in colour
and may contain pus (purulent) and/or blood.[citation needed]Often a localized headache or toothache is present,
and it is these symptoms that distinguish a sinus-related headache from other types of headaches, such as
tension and migraine headaches. Infection of the eye socket is possible, which may result in the loss of
sight and is accompanied by fever and severe illness. Another possible complication is the infection of the
bones (osteomyelitis) of the forehead and other facial bones - Pott's puffy tumor.[9]
Sinus infections can also cause inner ear problems due to the congestion of the nasal passages. This can
be demonstrated by dizziness, "a pressurized or heavy head", or vibrating sensations in the head.
Recent studies suggest that up to 90% of "sinus headaches" are actually migraines.[10][11][verification needed] The
confusion occurs in part because migraine involves activation of the trigeminal nerves, which innervate
both the sinus region and the meninges surrounding the brain. As a result, it is difficult to accurately
determine the site from which the pain originates. Additionally, nasal congestion can be a common result of
migraine headaches, due to the autonomic nerve stimulation that can also cause in tearing (lacrimation)
and a runny nose (rhinorrhea).[citation needed] A study found that patients with "sinus headaches" responded to
triptan migraine medications, but stated dissatisfaction with their treatment when they are treated with
decongestants or antibiotics.[12]
[edit]Complications
The close proximity of the brain to the sinuses makes the most dangerous complication of sinusitis,
particularly involving the frontal and sphenoid sinuses, infection of the brain by the invasion of anaerobic
bacteria through the bones or blood vessels. Abscesses, meningitis, and other life-threatening conditions
may result. In extreme cases the patient may experience mild personality changes, headache, altered
consciousness, visual problems, and, finally, seizures, coma, and possibly death.[9]
[edit]Causes
Another cause of chronic sinusitus can be from the maxillary sinuses that are situated within the
cheekbones. Infections and inflammation are more common here than in any of the other paranasal
sinuses. This is because the drainage of mucous secretions from the maxillary sinus to the nasal cavity is
not very efficient.
Maxillary sinusitis may also be of dental origin[14] and constitutes a significant percentage, given the
intimacy of the relationship between the teeth and the sinus floor. Complementary tests based on
conventional radiology techniques and modern are needed. Their indication is based on the clinical context.
Chronic sinusitis can also be caused indirectly through a common but slight abnormality within the auditory
or Eustachian tube, which is connected to the sinus cavities and the throat. This tube is usually almost level
with the eye sockets but when this sometimes hereditary abnormality is present, it is below this level and
sometimes level with vestibule or nasal entrance. This almost always causes some sort of blockage within
the sinus cavities ending in infection and usually resulting in chronic sinusitis.
[edit]Pathophysiology
It has been hypothesized that biofilm bacterial infections may account for many cases of antibiotic-
refractory chronic sinusitis.[15][16][17] Biofilms are complex aggregates of extracellular matrix and inter-
dependent microorganisms from multiple species, many of which may be difficult or impossible
to isolate using standard clinical laboratory techniques.[18] Bacteria found in biofilms have their antibiotic
resistance increased up to 1000 times when compared to free-living bacteria of the same species. A recent
study found that biofilms were present on the mucosa of 75% of patients undergoing surgery for chronic
sinusitis.[19]
[edit]Diagnosis
[edit]Acute
Bacterial and viral acute sinusitis are difficult to distinguish. However, if symptoms last less than 7 days, it
is generally considered viral sinusitis. When symptoms last more than 7 days, it is considered bacterial
sinusitis (usually 30% to 50% are bacterial sinusitis).[citation needed] Hospital acquired acute sinusitis can be
confirmed by performing a CT scan of the sinuses.
[edit]Chronic
For sinusitis lasting more than eight weeks,[2] diagnostic criteria are lacking. A CT scan is recommended,
but this alone is insufficient to confirm the diagnosis. Nasal endoscopy, a CT scan, and clinical symptoms
are all used to make a positive diagnosis.[4] A tissue sample for histology and cultures can also be collected
and tested. Allergic fungal sinusitis (AFS) is often seen in people with asthma and nasal polyps. Examining
multiple biopsy samples can be helpful to confirm the diagnosis.[20]
Nasal endoscopy involves inserting a flexible fiber-optic tube with a light and camera at its tip into the nose
to examine the nasal passages and sinuses. This is generally a completely painless (although
uncomfortable) procedure which takes between five to ten minutes to complete.
[edit]Treatment
[edit]Conservative
[edit]Antibiotics
The vast majority of cases of sinusitis are caused by viruses and will therefore resolve without antibiotics.
[4]
However, if symptoms do not resolve within 7 days,amoxicillin is a reasonable antibiotic to use first for
treatment[4] with amoxicillin/clavulanate (Augmentin) being indicated when the patient's symptoms do not
improve on amoxicillin alone. Fluoroquinolones, and some of the newer macrolide antibiotics such
as clarithromycin and doxycycline, are used in patients who are allergic to penicillins.[23] Antibiotics are
usually ineffective and overall may be no more effective than placebos, as one study found 60 to 90% of
people do not experience resolution of symptoms using antibiotics.[24] Thus, antibiotics may not improve the
long-term clinical outcomes of sinusitis.[25] A short-course (3–7 days) of antibiotics seems to be effective for
patients who present without severe disease or any complicating factors.[26]
[edit]Corticosteroids
[edit]Surgery
For chronic or recurring sinusitis, referral to an otolaryngologist specialist may be indicated, and treatment
options may include nasal surgery. Surgery should only be considered for those patients who do not
experience sufficient relief from optimal medication.[28][29]
Another recently developed treatment is balloon sinuplasty. This method, similar to balloon
angioplasty used to "unclog" arteries of the heart, utilizes balloons in an attempt to expand the openings of
the sinuses in a less invasive manner. The utility of this treatment for sinus disease is still under debate but
appears promising.[citation needed]
For persistent symptoms and disease in patients who have failed medical and the functional endoscopic
approaches, older techniques can be used to address the inflammation of the maxillary sinus, such as
the Caldwell-Luc radical antrostomy. This surgery involves an incision in the upper gum, opening in the
anterior wall of the antrum, removal of the entire diseased maxillary sinus mucosa and drainage is allowed
into inferior or middle meatus by creating a large window in the lateral nasal wall.)[32]
[edit]Other