耳鼻咽喉科学英文版ppt课件 congenital laryngomalacia.ppt

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1、Congenital laryngomalacia,先天性喉软化症 Dong pin,Cause,Congenital laryngeal stridor is a defect that is present at birth.During fetal development,the structures in the larynx may not fully develop.,Cause,As a result,there is a weakness in these structures at birth,causing them to collapse during breathing

2、.In children,congenital laryngeal stridor is the most common cause of chronic stridor.Sixty percent of infants born with congenital laryngeal stridor will have symptoms in the first week of life.Most other infants will show symptoms by 5 weeks old.,symptoms,The major symptom of this disorder is the

3、stridor that is heard as the infant breathes.The stridor is usually heard when the infant breathes in(inspiration),but can also be heard when the infant breathes out(expiration).Other characteristics of the stridor may include:The stridor changes with activity.The stridor is usually less noisy when

4、the child is laying on his/her stomach.The stridor gets worse if the infant has an upper respiratory infection.,diagnose,a complete medical history and physical examinationbronchoscopy of the airways-a procedure which involves a tube being passed into the airways to allow your childs physician to ob

5、serve the airways during breathing.,Treatment for congenital laryngomalacia,Follow up In most cases,congenital laryngeal stridor is a harmless condition that resolves on its own,without medical intervention.The condition usually improves by the time the infant is 18 months old and has no long-term c

6、omplications.In some cases,the stridor is apparent until about the age of 5.Each childs case is unique.Surgery A small percentage develop severe respiratory problems which require medical and surgical interventions.,Acute laryngitis,急性喉炎 Dong pin,Laryngitis is an inflammation of the vocal cords caus

7、ing speech to become hoarse and/or whisperlike,and often inaudible.,Cause,Viruses-Influenza A and B,Adenovirus,Parainfluenza,and Rhinovirus are some of the viruses that may cause this condition.Bacteria such as Hemophilus influenzae,beta-hemolytic streptococcus,andMoraxella catarrhalisInhalation of

8、smoke,chemicals,and excessive use of voice Acid RefluxAllergiesAging,symptoms,HoarsenessWhisperlike voice loss of voice,Bacterial laryngitis:,Sore throat Fever Painful swallowing Cough Hoarseness,Viral laryngitis,General fatigue Malaise Low-grade fever General body aches Cough Hoarseness Sore throat

9、 Dry throat,allergic laryngitis,Hoarseness that is worse during and several hours after exposure to the allergen Itchy throat Excess phlegm or mucous in the throat Feeling of dry throat Cough Itchy sensation in the throat Sneezing,diagnose,Throat check for pharyngitis(infection)Neck checked for stri

10、dor(wheezing sound heard by stethoscope),Treatment,Avoid loud speech,such as shouting or singingHumidifiers(cool mist better)and steam(cool to warm,not hot)can help.Avoid smoking,recreational drugs,and alcoholIncrease fluidsIf severe,physicians will often instruct a person not to speak at all for th

11、e next few days.If Hemophilus influenza or Moxarella catarrhalis are suspected,antibiotics will most likely be prescribed.Symptoms usually resolve infewer than seven days in most individuals.,Treatment,If severe,physicians will often instruct a person not to speak at all for the next few days.If Hem

12、ophilus influenza or Moxarella catarrhalis are suspected,antibiotics will most likely be prescribed.Symptoms usually resolve infewer than seven days in most individuals.,Chorinic laryngitis,Dong pin,Defination,Laryngitis is an inflammation of the larynx,the voice box that contains the vocal cords in

13、 the upper portion of the neck.Laryngitis occurs in two forms,acute and chronic.Acute laryngitis typically is a brief illness producing hoarseness and a sore throat.In most cases,an upper respiratory tract infection causes it.Chronic laryngitis is a more persistent disorder that produces lingering h

14、oarseness and other voice changes.It usually is painless and has no significant sign of infection.,Cause,Cigarette smoke is chronically irritating to the laryngeal mucosa.At the extreme,it can provoke cancer.Ethanol contains many impurities,such as mycotoxins,tannins,aldehydes,and pesticides,which m

15、ay cause cancer,either by direct contact with the mucosa or through a systemic effect,or may act as an irritant.,Gastroesophageal reflux disease Infections The bacterium most commonly isolated in chronic infectious laryngitis is Staphylococcus aureus.Haemophilus influenzae and pneumococcal species m

16、ay complicate the course of viral laryngitis.Tuberculosis,caused by infection with the tubercle bacillus Mycobacterium tuberculosis hominis,was a common disease of the larynx.Overall incidence has declined.The hematogenous route and the infected sputum from pulmonary tuberculosis are the most likely

17、 sources of infection.,Voice abuse can be pertinent to professional singers and to occasional shouters.Lesions can range from simple edema,in the occasional abuser,to hyperplastic reactions if the stimuli persist over time.Allergic responses of immediate or delayed hypersensitivity types can cause c

18、hronic laryngitis.Although the authors found no data quantifying the exact number of people affected,current thought seems to indicate an increasing prevalence.,Environmental factors,such as dust,fumes,chemicals,and toxins,can cause this condition.Systemic diseases,mostly autoimmune,may cause chroni

19、c laryngitis.Wegener granulomatosis.Amyloidosis.Relapsing polychondritis.,Chronic laryngitis may be associated with cutaneous diseases.The larynx and the skin share similar microcharacteristics and macrocharacteristics.,Neurologic causes may contribute to chronic laryngitis.Spastic dysphonia is a di

20、screte vocal disorder characterized by strained,choked vocal attacks(laryngeal stuttering).The onset usually follows a stressful period in middle life.This condition is probably a vocal expression of psychoneurotic behavior or a CNS and/or proprioceptive disorder of the larynx.Vocal folds atrophy an

21、d lose tension with age,causing changes in phonation.Loss of thyroarytenoid ligament elasticity results in breathiness and loss of breath support because of bowed vocal folds.Muscular disorders may contribute to chronic laryngitis.Weakness of the larynx and the pharynx is present in one third of pat

22、ients with myasthenia gravis.,symptoms,Hoarseness Sore throat Weak or absent voice Sensation of a lump in the throat or constant need to clear the throat Dry cough Fever,diagnose,Diagnosis is based upon a combination of the clinical history and a physical exam.Some physicians might wish to do a lary

23、ngoscopy(visualization of the vocal cords).,Treatment,If laryngitis is caused by a bacterial infection,antibiotics will be prescribed.Some palliative measures that can be taken include:Avoid public speaking during recovery Be aware that whispering puts greater strain on the vocal cords than normal s

24、peaking Inhale steam from a bowl of hot water or from a warm shower Drink warm,soothing liquids(but do not drink alcoholic beverages)Try a cool-mist humidifier;avoid air conditioning Use throat lozenges to ease the discomfort Avoid cigarettes until the symptoms have subsided,Vocal Cord Disorders voc

25、al nodules vocal polyps,Dong pin,Vocal cord disorders are often caused by vocal abuse or misuse,such as excessive use of the voice when singing,talking,smoking,coughing,yelling,or inhaling irritants.Some of the more common vocal cord disorders include laryngitis,vocal nodules,vocal polyps,and vocal

26、cord paralysis.,vocal nodules AND vocal polyps,Vocal nodules are benign(non-cancerous)growths on the vocal cords caused by vocal abuse.Vocal nodules are a frequent problem for professional singers.The nodules are small and callous-like and usually grow in pairs(one on each cord).The nodules usually

27、form on areas of the vocal cords that receive the most pressure when the cords come together and vibrate(similar to the formation of a callous).Voice nodules cause the voice to be hoarse,low,and breathy.,vocal nodules AND vocal polyps,A vocal polyp is a soft,benign(non-cancerous)growth,similar to a

28、blister.A polyp usually grows alone on one vocal cord and is often caused by long-term cigarette smoking.Other causes of vocal polyps include hypothyroidism(underactive thyroid gland),gastroesophageal reflux,and continuous voice misuse.Voice polyps cause the voice to be hoarse,low,and breathy.Vocal

29、polyps are also called Reinkes edemas or polypoid degeneration.,CAUSES,vocal trauma(more specifically,phonotrauma in the case of vocal fold polyps and vocal fold nodules),symptoms,a voice change.Typical presenting symptoms include generalized and persistent hoarseness,change in voice quality,and inc

30、reased effort in producing the voice.The laryngeal examination may show either unilateral or bilateral lesions.,diagnose,Any hoarseness or change in voice that lasts longer than two weeks should be brought to the attention of your physician.(Sometimes the hoarseness may be indicative of laryngeal ca

31、ncer.)a complete medical history and physical examinationexamine the vocal cords internally with a small,long-handled mirror(indirect laryngoscopy)or laryngoscopy,Treatment,eliminating the behavior that caused the vocal cord disorder a referral to a speech-language pathologist who has specialized tr

32、aining in treating voice,speech,language,or swallowing disorders that affect communication medication surgery to remove growths,Acute laryngitis in children,Dong pin,Cause,Laryngitis is a group of disorders in which the inflammatory process covers the mucous membrane of all or particular levels of t

33、he larynx.These disorders have a different course in children under 4 years old than in children above 4 years old.WHY?,specific variations of the structure of the larynx in children under 4 years old AND above 4 years old,The larynx of a small child is located higher,and the mucous is thicker and c

34、ontains a large amount of soft tissue.This soft tissue is mainly located under the mucous of the aryepiglottic folds,and especially in the subglottic region.,The specific reactivity of the mucous membrane in small children makes them prone to infections,especially viral.Some of these infections may

35、cause oedema of the mucus.The respiratory tract in children is relatively narrow in this region and the chondrous ring limits the size of the subglottic region.So,oedema in this region may have a dramatic course,leading even to acute respiratory distress,Cause,viral infection parainfluenza virus inf

36、luenza virus rubella virus and varicella-zoster virus,symptoms,dyspnoea,inspiratory stridor,hoarseness characteristic barking cough,diagnose,general examinationslaryngological examinations direct visualization of the larynx endoscopy,fiberoscopy and laryngoscopy,Differential diagnosis,Foreign body o

37、f the larynx:The most general symptoms of laryngitis occur also in other disorders of the larynx which occur with dyspnoea like the foreign body of the larynx.So the precise diagnosis is a good base for planning of further treatment.Congenital defect of the larynx:When the symptoms of laryngitis occ

38、ur at under 6 months of age or are prolonged or recurrent,a congenital defect of the larynx should be suspected,i.e.laryngeal web or haemangioma of the larynx.In these cases direct examination of the larynx is an urgent necessity,because the treatment of these disorders varies.,Treatment,Hospitalise

39、systemic anti-inflammatory drugs,humidification and cooling the air in the room.hydrocortisone in high dose(10 mg per kg b.w.),preferably i.v.,may be necessary.Intubation:Only intubation is a good method which protects the child from asphyxiation.Formerly,tracheotomy was performed,but now it is not

40、often performed in this disease.Antibiotics are administrated in those patients in whom bacterial complications develop.It should be underlined that the antibiotics given for uncomplicated laryngitis in small children do not bring improvement,so should be avoided.In patients older than 4 years of ag

41、e etiologic factors may be different e.g.allergy.In these cases administration of anti-histaminic drugs and calcium may be suitable.,Acute epiglottitis,Dong pin,Definition,A very rapidly progressive infection causing inflammation of the epiglottis(the flap that covers the trachea)and tissues around

42、the epiglottis that may lead to abrupt blockage of the upper airway and death.,Cause,Infection:H influenzae Haemophilus parainfluenzae Streptococcus pneumoniae,and group A streptococci.Less common infectiousbacteria(eg,Staphylococcus aureus,mycobacteria,Bacteroides melaninogenicus,Enterobacter cloac

43、ae,Escherichia coli,Fusobacterium necrophorum,Klebsiella pneumoniae,Neisseria meningitidis,Pasteurella multocida),herpes simplex virus(HSV),other viruses,infectious mononucleosis,Candida(in immunocompromised patients),and Aspergillus(in immunocompromised patients).,Noninfectious factors:thermal caus

44、es crack cocaine smoking marijuana smoking throat burns affecting the epiglottis of bottle-fed infants)caustic insults(eg,automatic dishwasher soap ingestion)foreign body ingestion head and neck chemotherapy.Before widespread Hib vaccination,H influenzae caused almost all pediatric cases.Allergy,sym

45、ptoms,Sore throat(95%)Odynophagia/dysphagia(95%)Muffled voice(54%)Usually,no prodromal symptoms occur in children.Adults may have preceding upper respiratory infection(URI)symptoms.,General symptoms,Fever Drooling/inability to handle secretions Cervical adenopathy Stridor-A late finding indicating a

46、dvanced airway obstruction Muffled voice(54%)Tripod position-Sitting up on hands with the tongue out and the head forward Hypoxia Respiratory distress Severe pain on gentle palpation over the larynx Mild cough Fever Irritability Tachycardia Toxic appearance of patient,diagnose,Differential Diagnoses

47、Peritonsillar AbscessRetropharyngeal AbscessToxicity,Caustic IngestionsOther Problems to Be ConsideredAirway obstructionForeign body aspirationBacterial laryngotracheobronchitisLaryngotracheobronchopneumonitisRetropharyngeal abscessPeritonsillar abscessLaryngitisLaryngeal diphtheriaCaustic ingestion

48、sAcute angioedemaSepsis,Treatment,Antibiotics Antivirus hydrocortisoneadequate airway nasotracheal intubation intubation tracheostomy Skilled nursing care.,Papilloma of larynx,Dong pin,Cause,Most common benign tumor of the larynx and occurs in patients of all age.The causative agent is thought to be

49、 HPV.Papillomas usually regress during puberty.,Cause,Usually involving the true vocal cords but may affect supraglottic and subglottic regions.May also involve the trachea and bronchus.,Cause,Papillomas in juveniles is more often multiple and recurs more frequently than in adults.Papillomas in adul

50、ts are usually single but may undergo malignant change(HPV 16，18).,symptoms,Aphonia or weak cry is usually the first sign in infants.Dyspnea and stridor are seen.Hoarseness is the most common symptom in adults.,diagnose,Laryngoscopic examination：the tumor is pink or dark red in color.The surface of