Larynx (Human Anatomy): Image, Function, Diseases, and Treatments

The larynx is a tube-like structure that is part of the respiratory system and is located between the pharynx and the rest of the body. Because it protects your vocal chords and enables you to securely swallow, it is sometimes referred to as the voice box.

The thyroid cartilage, the epiglottis cartilage, and the cricoid cartilage are the only ones in the larynx that do not have a matched counterpart. There are also three cartilages in the larynx that are coupled up with one another. These cartilages are the arytenoid, corniculate, and cuneiform cartilages.

The epiglottis is the fold of skin that covers the opening to your larynx and is located in the back of the throat. Food and other particles are unable to enter the respiratory system because of this protection.

False vocal cords, often referred to as vestibular folds, are responsible for closing down your larynx as you swallow. Because of this, food will not be able to reach your trachea and lungs. The folds of the velopharynx are another name for the false vocal cords.Adam's apple is a frequent name for the thyroid cartilage, which is the portion of cartilage that lies in front of your larynx and is referred to as the Adam's apple by some.

Vocal cords In order for you to make sounds and speak, the vocal cords in your mouth and throat, which are also referred to as the vocal folds, must alternately open and close while vibrating in response to the movement of air passing through them.

• Acute Epiglottitis: Acute epiglottitis is a quickly progressing cellulitis of the epiglottis that can result in deadly airway blockage. Because the epiglottis is a member of the supra glottis, epiglottitis is also known as acute supraglottic laryngitis. In the past, acute epiglottitis was most usually caused by H. influenzae type b (Hib), but this is no longer the case because of the Hib vaccination that is given as part of the universal immunisation programme. There has been a general decline in the incidence of acute epiglottitis.
• Laryngo-Tracheo-Bronchitis (CROUP): It is the infectious agent that causes airway blockage in children more frequently than any other. Infections with viruses, most frequently with the parainfluenza virus, are the root cause of this condition. It begins in the larynx, mostly affecting the subglottis and causing oedema of the subglottis, and then spreads to the trachea and the bronchi.
• Pachydermia Laryngis/Contact Ulcer/Kiss Ulcer: Because it has the appearance of an ulcer, the contact ulcer gets its name from the piling that occurs on the medial edge of one vocal cord and causes an indentation in the form of a saucer on the medial edge of the other vocal cord. It is not a real ulcer since the epithelium has not been broken; rather, it is only an indentation.
• Reflux Laryngitis/Gastroesophageal Reflux Disease (GERD): In addition to the classic symptoms of heartburn and regurgitation, gastroesophageal reflux disease (GERD) has been linked to the different problems of the larynx which includes Chronic inflammation of the larynx (patient presents with pain throat, mild hoarseness, repeated throat clearing tendency and chronic cough) and also condition of Posterior glottic stenosis
• Laryngeal Pseudosulcus: A foreign body sensation in the throat (globus) Aggravation of a lot of laryngeal inflammatory conditions e.g. pachydermia laryngitis, Reinke oedema, vocal nodule, etc.
• Keratosis Pharyngis /Leukoplakia: It is a condition known as hyperkeratosis of the epithelium of the voice cords. It is brought on by smoking, which causes inflammation of the larynx on a continual basis. in contrast to Pachydermia laryngitis. Keratosis laryngitis is a disorder that might lead to cancer in the future. The condition can be treated surgically with tools or with a LASER. The material that was removed is sent in for a biopsy.
• Reinke's Oedema: This condition is known as chronic oedema of the Reinke's space, also known as the sub-mucosal space of the membrane real voice cords along their tree medial edge. It cannot be reversed. It can be the result of any persistent irritation of the larynx, but the most prevalent cause is smoking; for this reason, it is sometimes referred to as smoker's larynx. Abuse of the voice and pharyngolaryngeal reflux are two other causes of persistent irritation that can lead to Rienke's oedema.
• Atrophic Laryngitis/Laryngitis Sicca: Atrophic rhinitis has spread into the larynx, causing this condition. Hoarseness and a dry, annoying cough are just two of the many symptoms that can accompany this bacterial infection, which is caused by Klebsiella. Atrophy of the laryngeal mucosa was seen during the laryngoscopy examination. With an excessive amount of crust forming, it may be noticed.
• Reflux Laryngitis/Gastroesophageal Reflux Disease (GERD): In most cases, it is a complication of TB of the lungs. The first indicator of a vocal cord infection is a weakening of the voice, which is followed by hoarseness, which demonstrates other signs and symptoms of the infection.
• Scleroma Of Larynx: This is the Rhinoscleroma extension that has occurred. Granulomas are typically found in the subglottic area and are brought on by Klebsiella, which causes the condition. The primary symptoms are a hoarse voice and shortness of breath.
• Intubation Granuloma: Intubation, rigid bronchoscopy, or direct laryngoscopy are all procedures that have the potential to cause abrasion or pressure on the arytenoid perichondrium. a necrosis in the region of the vocal process (cartilaginous part of true vocal cord). In the aftermath of this process, a reparative granuloma that is known as an intubation granuloma arises in this region. It is possible for it to result in posterior glottic incompetence.
• Laryngomalacia (Congenital Laryngeal Stridor): This is the most common congenital anomaly Of thc larynx and also the most common cause of stridor in infants. Clinical Features Initially the child does not show any signs of respiratory abnormality at birth. But after a few days to a few weeks the child develops intermittent inspiratory stridor (hunting the cause to be supraglottic). 'l his inspiratory stridor is initially mild and raises by around 6 months.
• Laryngocele: Any chronic increase in transglottic pressure as in trumpet players, glass blowers or weight litters or any carcinoma at the site Of ventricle that allows entry Of air in the saccule but prevents its exit, leads to enlargement of thc saccule
• Laryngeal Web: Laryngeal webs are formed because of incomplete re- canalisation of the laryngotracheal groove during development. MC site of location of these webs are at the level of glottis and here 904%, ot them are located anteriorly. The child presents with weak cry since birth. Severe cases Unilateral recurrent laryngeal nerve paralysis (RI. N): This is also known as unilateral incomplete palsy (called so since the superior laryngeal nerve is intact). This is also known as U /L abductor palsy as abduction of VC is not possible and the VC remains in median position.
• Laryngeal Papillomatosis: This is the most common benign tumour of the larynx. There is bimodal age occurrence tor laryngeal papillomas; more common in children than adults.
• Carcinoma Of The Larynx: Like elsewhere in ENT, the most common carcinoma of the larynx is squamous cell carcinoma. It is seen more commonly in males between 50 and 70 years
• Supraglottic Carcinoma: Carcinoma of the supraglottis remains asymptomatic for a long time and since this area is richest in lymphatics in the whole of the larynx so by the time the parent is born he is already in an advanced stage.

• Indirect Laryngoscopy: Examination of the larynx in the ENT OPD may be performed using indirect laryngoscopy (l/L), rigid or flexible fibre optic endoscopy. Indirect laryngoscopy is performed with the use of a laryngeal mirror that is positioned in the oropharynx against the soft palate. The glass surface of the laryngeal mirror is pre-warmed before it is used by positioning it such that it is in close proximity to the bulb of a Bull's eye lamp, on a flame, or in warm water. This is done so that breathing won't cause the environment to get foggy.
• Direct Laryngoscopy: there is an together with direct visualisation of the larynx and hypopharynx using instruments such as the rigid or flexible fiberoptic endoscope. It is also possible to do laryngeal operations with the help of direct laryngoscopy, which is performed using a hard laryngoscope. Gutzmann's pressure test if positive confirms puberphonia. In this test, thyroid prominence is pressed backwards and downwards producing low tone voice

• Decortication: A circumscribed strip of epithelium is removed from one side of vocal cord while preserving the vocal ligament. Otherside to be operated after 3 to 4 weeks.
• Microlaryngoscopic Excision Of Granuloma: whenever there is formation of different types of abnormal nodules in region of larynx then this situation is cleared through this procedure
• Kashima's Operation: It is endoscopic posterior glottic cordectomy. Here n wedge shaped resection is done in the posterior VC tor making the airway,
• Cordectomy: A cordectomy is a surgical procedure that removes part or all of the vocal cords if you have laryngeal cancer. This cancer affects the voice box, or larynx, which you use for breathing, talking and swallowing. The voice box is located above your trachea (windpipe).
• Tracheoesophageal diversion with a permanent tracheostomy: This a permanent procedure, This is the gold standard surgical procedure for prevention of chronic aspiration. Here the trachea is divided horizontally at the level of 2nd and 3rd tracheal rings. The upper end of the trachea is anastomosed to the cervical oesophagus and the lower end of the trachea is brought out and sutured to the skin making a permanent tracheostome. The voice of the patient will be lost after this procedure.
• Tracheostomy: A tracheostomy is an opening created at the front of the neck so a tube can be inserted into the windpipe (trachea) to help you breathe.

• Steroids for reducing inflammation of Larynx: Drugs with anti-inflammatory properties work by preventing the recruitment of polymorphonuclear leukocytes (PMNs) to areas of cellular and tissue injury, hence reducing inflammation, especially in the region of larynx. Methylprednisolone, hydrocortisone, dexamethasone are examples of effective corticosteroids.
• Analgesics for pain in Larynx:: Analgesics such as aspirin, ibuprofen, and acetaminophen are all examples of medications that are able to provide at least some relief from the discomfort caused by inflammation of the laryngeal muscles and vocal cords . A further example of an analgesic combination is paracetamol, and naproxen is another.
• Muscle relaxants for stiffness in Larynx: Orphenadrine, metaxalone, methocarbamol, orphenadrine, tizanidine, and carisoprodol are some of the muscle relaxants that a specialist may give for stiffness and pain in laryngeal region Other options include methocarbamol and orphenadrine.
• Antibiotics for infection in Larynx: One of the most common Conditions that Antibiotics are used to treat is cellulitis.
• Gram-positive staining bacteria: Vancomycin and bacteria that do not stain with the Gram stain: 3rd Gen Cephalosporin (or Cefepime if concern for Pseudomonas) when Gram stain does not appear to be disclosing Vancomycin Ceftriaxone in combination with either azithromycin or doxycycline. all are helpful in treatment of laryngeal inflammation.
• Antivirals for treating infection of Larynx: Seltamivir or inhaled zanamivir are the Antiviral drugs that are known for treating rhinitis and other forms of rhinovirus infection.
• Chemotherapeutic medicines for Larynx: Cisplatin, doxorubicin, mitomycin, and 5-fluorouracil are some examples of medications that could be prescribed for oropharyngeal and laryngeal carcinoma