Laryngitis

 OVERVIEW

Laryngitis is inflammation of the larynx (or voicebox). Irritation or infection of the vocal chords
causes them to swell and cause hoarseness or complete loss of voice.

 PATHOPHYSIOLOGY
Inflammation of the vocal cords caused by URI, vocal Cord abuse, smoking or reflux esophagitis
vocal cord become edematous due to inflammation that restricts the normal movement of the
larynx. Inflammatory response to cell damage by viruses results in hyperemia and fluid
exudation kinins and other inflammatory mediators induce Upper airway smooth muscle
spasm.

 CLINICAL MANIFESTATION
o Hoarse/weak voice or voice loss
o Tickling sensation and rawness of throat
o Sore throat, dry throat
o Dry cough

 DIAGNOSTIC TEST
o Direct and indirect laryngoscopy
- To visualize the vocal cords
o Videotroboscopy
- To observe vocal cord and movement through the use of fiberoptic
laryngoscopy
o Electromyography
- To determine innervations of vocal cord

 Medical Management : Acute Stage

o Resting the voice
o Avoiding irritants (including smoking),
o Resting
o Inhaling cool steam or an aerosol

 medical management : chronic stage

o Resting the voice
 o Eliminating any primary respiratory tract infection
o Eliminating smoking
o Avoiding second hand smoke

 PREVENTION
o AVOID SMOKING!!!
o Keep alcohol consumption minimal
o Do not overuse voice (yelling, singing, even talking excessively)

 Nursing Management
o Encourage to rest his/her voice as much as possible and avoid whispering.
Provide alternative means of communication during this time.
o Assess respiratory status, including breath sounds, ABG, pulse Oximetry level,
rate and depth of respiration
o Provide instruction on the administration, dosage and side effects of
medications, if indicated
o Ensure availability of emergency equipment, such as endotracheal intubation set
and emergency tracheostomy tray
o Instruct client to avoid exposure to individuals with URI tell client not to perform
strenuous activities because this can increase airway edema, resulting to distress
o Encourage client to eat food with thick consistency rather than liquids
o Elevate the HOB and provide supplemental humidification
o Provide comfort measures such as ice collar and throat irrigation.
 Obstruction and trauma of the upper respiratory airway

 Sleep apnea
 Sleep apnea, is a sleep disorder characterized by pauses in breathing or periods of
shallow Breathing during sleep.
 Each pause can last for a few seconds to a few minutes and they happen many times a
night.
 In the most common form, this follows loud snoring.
 There may be a choking or snorting sound as breathing resumes.

 Obstructive sleep apnea (OSA)

 OSA is a disorder that is characterized by obstructive apneas and hypopneas due to
repetitive collapse of the upper airway during sleep.
Untreated OSA has many potential consequences and adverse clinical associations:
o excessive daytime sleepiness
o impaired daytime function
o metabolic dysfunction
o and an increased risk of cardiovascular disease and mortality

 Pathophysiology Of OSA
 OSA is characterized by recurrent, functional collapse during sleep of the velopharyngeal
and/or Oropharyngeal airway, causing substantially reduced or complete cessation of
airflow despite ongoing breathing efforts.
 This leads to intermittent disturbances in gas exchange (eg, Hypercapnia and
hypoxemia) and fragmented sleep.

 Sign/symptoms
o Obstructive apneas, hypopneas, or respiratory effort related arousals
o Daytime symptoms attributable to disrupted sleep, such as sleepiness, fatigue, or poor
concentration
o Signs of disturbed sleep, such as snoring, restlessness or resuscitative snorts
  Diagnostic test
 Polysomnography, a type of sleep study, is a multi-parametric test used in the study of
sleep and as a diagnostic tool in sleep medicine.
 Nocturnal, laboratory-based Polysomnography (PSG) is the most commonly used test in
the diagnosis of obstructive sleep apnea syndrome (OSAS)

 Continuous positive Airway pressure (CPAP)

 CPAP therapy is the mainstay of therapy for adults with OSA.
 The mechanism of CPAP involves maintenance of a positive pharyngeal transmural
pressure so that the intraluminal pressure exceeds the surrounding pressure
 CPAP also stabilizes the upper airway through increased end-expiratory lung volume.
 As a result, respiratory events due to upper airway collapse (eg, apneas, hypopneas) are
prevented.

 Prevention
o No-Caffine
o No-Sleeping pills
o NO DRUGS
o No-Alcohol
o No-Drugs
o No- Cholesterol

 Management of OSA
Behavior modification: sleep position
 During the diagnostic sleep study, some patients will be observed to have OSA that
develops or worsens during sleep in the supine position.
 Sleeping in a non-supine position (eg, lateral recumbent) may correct or improve OSA in
such patients and should be encouraged but not generally relied upon as the sole
therapy
Behavior modification: alcohol avoidance
 All patients with untreated OSA should avoid alcohol as it can depress the CNS,
exacerbate OSA, worsen sleepiness, and promote weight gain.
 Epistaxis
 A hemorrhage from the nose
 Caused by the rupture of tiny, distended vessels in the mucous membrane of any area
of the nose

 Pathophysiology
 Mostly originated on: anterior nasal bleeding occurs on the anterior nasal septum.
 Posterior nasal bleeding occurs high in the nasal septum or in the woodruff’s plexus
under posterior, inferior turbinate.
 Nasal infection produces inflammation and bleeding of nasal mucosa.
 Blood disorders that can cause epistaxis
o Hemophilia
o Immunodeficiency
 Other contributing factors:
o Atherosclerosis
o Hypertension- due to altered contraction of blood vessels and increased BP

 Clinical manifestation
o Nasal bleeding
o Mouth breathing secondary to nasal obstruction
o Hypotension secondary to blood loss
o Increased pulse rate and respiration rate

 Immediate Medical Management

o Applying direct pressure
o Sit upright with head tilted forward - to prevent swallowing and aspiration of blood
o Directed to pinch the soft outer portion of the nose against the midline for 5-10 min
o for anterior nosebleed treat with silver nitrate applicator and Gelfoam or by
Electrocautery.

 Medical-Surgical Interventions
o IV hydration and administration of blood products
o Incertion of nasal packing (impregnated with petrolatum jelly/antibiotic)
- packing remain in place for 2-6 days if necessary
o Administration of supplemental humidified oxygen through face mask.
o Cotton pledgets soaked in a vasoconstricting solution (ie, epinephrine,
 - Ephedrine, cocaine) may be inserted into the nose to reduce the blood flow
o Suction may be used to remove excess blood and clot

 PREVENTION
o Use Nasal saline sprays or lubricants to keep inside of the nose moist
o Avoid smoking
o Don’t pick your nose too often as well as don’t blow it too hard
o Steam inhalation can moisten and protect the nasal cavity as well as reduce nasal
irritation

 Nursing Care of Patients with Epistaxis

o Assessment of bleeding
o Monitor airway and breathing
o Vital signs
o Reduce anxiety
o Patient teaching
- Avoid nasal trauma, nose picking, and nose blowing
- Air humidification
- Pressure on the nose to stop bleeding. If bleeding does not stop in 15 minutes,
seek medical attention.

 Nasal Obstruction
 Is a sense of blockage within the nose or difficulty breathing out of one or both nostrils.

 Pathophysiology
Triggering factors:
 Viral infections, bacterial infections, allergies, Fungus, chronic inflammation, asthma,
Chronic sinus infections, hayfever, sinusitis.
 Allows fluid to build up in the cells of nose and sinuses.
 Over time, as gravity pulls on these fluid filled cells.
 Nasal polyp developed.
 Clinical manifestation
o Breathing difficulty
o Mouth breathing
o Dryness of the oral mucosa and associated problems including persistent dry, cracked
lips.
o Patients with chronic nasal congestion often suffer from sleep deprivation due to
difficulty maintaining an adequate airway while lying flat and during sleep

 Diagnostic
o Nasal exam, including the use of endoscopes, X-rays, CT scans and/or other imaging
tests
o Allergy testing, when indicated
 Prevention
o Avoid nasal irritants
o Practice good hygiene
o Humidify your home
o Use a nasal rinse

 MANAGEMENT
o Nasal steroid spray
o oral leukotriene inhibitors, such as montelukast.
o Antibiotics for the treatment of underlying infection or antihistamines for management
of allergies.
o Functional rhinoplasty – reconstruction and reshaping of the nose
o Septoplasty

 Laryngeal obstruction
 refers to narrowing of the laryngeal airway at the glottic or supraglottic level that occurs
during exercise

 Pathophysiology
 Characterized by either glottic or supraglottic obstruction which is not present at rest.
Normally, exercise is associated with abduction of the vocal folds and aryepiglottic folds,
 which expands the laryngeal aperture during inhalation. The precise mechanism of EILO
is not well-characterized, and a number of factors may contribute.
 Anatomic factors
 Neurologic factors
 Other factors

 Clinical manifestation
o Hoarseness
o Dyspnea
o Aspiration of food/saliva
o Neck swelling
o Inability to speak
o Cough

 Treatment
: etiological treatment.
 In case of tumors of the larynx, trauma, Bilateral vocal cords paralysis, tracheotomy is
Indicated.

 Prevention
o Avoid drinking a lot of alcohol before eating.
o Eat small bites of food.
o Eat slowly.
o Supervise small children when eating.
o Chew thoroughly before swallowing.
o Keep small objects away from children.
o Don’t smoke.

 Management
 A thorough history can be very useful in diagnosing and treating the patient with a
laryngeal obstruction.
 Maintain airway
 Avoid heavy alcohol or tobacco consumption, current medications, history of airway
problems, recent infections, pain or fever, dental pain or poor dentition, and any
previous surgeries, radiation therapy, or trauma.
 Rarely, patients with nasogastric tubes in place develop a postcricoid ulceration
(referred to as “nasogastric tube syndrome”).
- This ulceration affects the posterior cricoarytenoid muscles, causing vocal cord
abduction paralysis and ultimately upper airway obstruction.