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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Laryngitis that continues for more than three weeks is considered chronic. If laryngeal symptoms last for more than three weeks, a referral should be made for further examination, including direct laryngoscopy. The prognosis for chronic laryngitis varies depending on the cause of the laryngitis.
Treatment is often supportive in nature, and depends on the severity and type of laryngitis (acute or chronic). General measures to relieve symptoms of laryngitis include behaviour modification, hydration and humidification.
Vocal hygiene (care of the voice) is very important to relieve symptoms of laryngitis. Vocal hygiene involves measures such as
- Resting the voice
- Drinking sufficient amounts of water
- Reducing caffeine and alcohol intake
- Stopping smoking
- Limiting throat clearing
Voice hygiene programs are given by speech-language pathologists. These programs typically include the following components:
- Addressing amount and type of voice use
- Reducing behaviours that are damaging to the vocal folds
- Increasing hydration
- Adjusting lifestyle (for example, limiting caffeine and managing medical conditions)
Viral croup is usually a self-limiting disease, with half of cases resolving in a day and 80% of cases in two days. It can very rarely result in death from respiratory failure and/or cardiac arrest. Symptoms usually improve within two days, but may last for up to seven days. Other uncommon complications include bacterial tracheitis, pneumonia, and pulmonary edema.
Croup affects about 15% of children, and usually presents between the ages of 6 months and 5–6 years. It accounts for about 5% of hospital admissions in this population. In rare cases, it may occur in children as young as 3 months and as old as 15 years. Males are affected 50% more frequently than are females, and there is an increased prevalence in autumn.
The incidence of otitis externa is high. In the Netherlands, it has been estimated at 12–14 per 1000 population per year, and has been shown to affect more than 1% of a sample of the population in the United Kingdom over a 12-month period.
Otitis externa responds well to treatment, but complications may occur if it is not treated. Individuals with underlying diabetes, disorders of the immune system, or history of radiation therapy to the base of the skull are more likely to develop complications, including malignant otitis externa. In these individuals, rapid examination by an otolaryngologist (ear, nose, and throat physician) is very important.
- Chronic otitis externa
- Spread of infection to other areas of the body
- Necrotizing external otitis
- Otitis externa haemorhagica
Across all posited aetiologies, contact granulomas are more commonly observed in male patients than in female patients, and more commonly in adult patients than in pediatric patients. In cases where gastroesophageal reflux disease is identified as the most likely cause of the granuloma, the patient is most commonly an adult man in his 30s or 40s. When contact granulomas do occur in female and pediatric patients, they usually occur post-intubation. There are no observable age or gender trends within the category of post-intubation patients suffering from contact granulomas, nor within the causation category of vocal abuse history.
First-generation antihistamine has been suggested as first-line therapy to treat post-nasal drip.
PND is suggested to be a cause of extra-oral halitosis, especially when a sinus infection is also present. Acid reflux or heartburn is believed to aggravate and in some cases cause post-nasal drip. Post-nasal drip can be a cause of laryngeal inflammation and hyperresponsiveness, leading to symptoms of vocal cord dysfunction (VCD).
As of 2013 there had been case reports of using HPV vaccines to prevent laryngeal papillomatosis but it was not known if this was effective. As of 2015 use of the measles-mumps-rubella vaccine to reduce rate of recurrences had been investigated, but had not yielded significant results.
Laryngeal papillomatosis is a rare disease with a bimodal distribution based on age of incidence. The incidence, or number of new cases, of laryngeal papillomatosis cases is at approximately 4.3 cases per 100 000 children and 1.8 cases per 100 000 adults annually. The incidence of laryngeal papillomatosis in children peaks before the age of 5, though the term juvenile papillomatosis refers to all cases occurring before the age of 20. The incidence of adult laryngeal papillomatosis, which has an onset after the age of 20, peaks between the ages of 20 and 40. While there are no gender differences in the incidence of laryngeal papillomatosis in children, adult laryngeal papillomatosis occurs more frequently in males than in females. The incidence of laryngeal papillomatosis also varies according to factors such as socioeconomic status, such that higher rates are observed in groups having a lower socioeconomic status.
There is currently a limited amount of information available on the incidence and prevalence of VCD, and the various rates reported in the literature are most likely an underestimate. Although VCD is thought to be rare overall, its prevalence among the population at large is not known.
However, numerous studies have been conducted on its incidence and prevalence among patients presenting with asthma and exertional dyspnea. A VCD incidence rate of 2% has been reported among patients whose primary complaint was either asthma or dyspnea; the same incidence rate has also been reported among patients with acute asthma exacerbation. Meanwhile, much higher VCD incidence rates have also been reported in asthmatic populations, ranging from 14% in children with refractory asthma to 40% in adults with the same complaint. It has also been reported that the VCD incidence rate is as high as 27% in non-asthmatic teenagers and young adults.
Data on the prevalence of VCD is also limited. An overall prevalence of 2.5% has been reported in patients presenting with asthma. Among adults with asthma considered "difficult to control", 10% were found to have VCD while 30% were found to have both VCD and asthma. Among children with severe asthma, a VCD prevalence rate of 14% has been reported. However, higher rates have also been reported; among one group of schoolchildren thought to suffer from exercise-induced asthma, it was found that 26.9% actually had VCD and not asthma. Among intercollegiate athletes with exercise-induced asthma, the VCD rate has been estimated at 3%.
In patients presenting with symptoms of dyspnea, prevalence rates ranging from 2.8% to 22% have been reported in various studies. It has been reported that two to three times more females than males suffer from VCD. VCD is especially common in females who suffer from psychological problems. There is an increased risk associated with being young and female. Among patients suffering from VCD, 71% are over the age of 18. In addition, 73% of those with VCD have a previous psychiatric diagnosis. VCD has also been reported in newborns with gastroesophageal reflux disorder (GERD).
Inflammatory issues associated with contact granuloma include gastroesophageal reflux, allergy or infection. There is some disagreement among researchers as to whether inflammatory issues are a direct cause. Some researchers identify reflux and infection as indirect causes due to aggressive coughing that usually occurs as a result.
The following increase an individual's chances for acquiring VCD:
- Upper airway inflammation (allergic or non-allergic rhinitis, chronic sinusitis, recurrent upper respiratory infections)
- Gastroesophageal reflux disease
- Past traumatic event that involved breathing (e.g. near-drowning, suffocation)
- Severe emotional trauma or distress
- Female gender
- Playing a wind instrument
- Playing a competitive or elite sport
Up to now, prevalence studies investigating rates of dysphonia on a large-scale level have been limited. According to a large sample of 55 million patients seeking health-care treatment in the United States, dysphonia can be found in approximately 1% of the population. Higher rates are reported in females and elderly adults, however, dysphonia can be found in both sexes and across age groups. It is proposed that higher rates in females are due to anatomical differences of the vocal mechanism.
Certain occupational groups may be more prone to developing voice disorders, namely dysphonia. Occupations that require extensive use of voice may be at a greater risk such as teachers and singers. However, the evidence is highly variable and must be interpreted carefully.
LPR is often regarded as a subtype of GERD that occurs when stomach contents flow upward through the esophagus and reach the level of the larynx and pharynx. However, LPR is associated with a distinct presentation of symptoms. LPR and GERD frequently differ in the relative prevalence of heartburn and throat clearing. While heartburn is present in over 80% of GERD cases, it occurs in only 20% of LPR cases. Throat clearing shows the opposite prevalence pattern, occurring in approximately 87% of LPR cases and in fewer than 5% of GERD cases. Unlike GERD, LPR also poses a risk for bronchitis or pneumonitis as reflux of stomach acid to the level of the larynx can result in aspiration. LPR is also commonly associated with erythema, or redness, as well as edema in the tissues of the larynx that are exposed to gastric contents. In contrast, most cases of GERD are nonerosive, with no apparent injury to the mucosal lining of the esophageal tissue exposed to the refluxed material.
Differences in the molecular structure of the epithelial tissue lining the laryngopharyngeal region may be partly responsible for the different symptomatic manifestations of LPR in comparison to GERD. In contrast to the resistant stratified squamous epithelium lining the esophagus, the larynx is lined by ciliated respiratory epithelium, which is more fragile and susceptible to damage. While the epithelium lining the esophagus is capable of withstanding as many as 50 instances of exposure to gastric contents each day, which is the uppermost estimate considered to be within the range of normal physiologic functioning, injury to laryngeal epithelium can occur following exposure to only small amounts of acidic gastric contents.
Ressurance to the patient when no cause can be found.
In case of a cause treat the cause.
LPR was not discussed as a separate condition from GERD until the 1970s and 1980s. However, at around the same time that GERD was first recognized as a clinical entity in the mid-1930s, a link between gut symptoms and airway disease was suggested. Later, acid-related laryngeal s and granulomas were reported in 1968. Subsequent studies suggested that acid reflux might be a contributory factor in other laryngeal and respiratory conditions. In 1979, the link between these airway symptoms and reflux of gastric contents was first documented. At the same time, treatment of reflux disease results was shown to eliminate these airway symptoms.
The "lump in the throat" sensation that characterizes globus pharyngis is often caused by inflammation of one or more parts of the throat, such as the larynx or hypopharynx, due to cricopharyngeal spasm, gastroesophageal reflux (GERD), laryngopharyngeal reflux or esophageal versatility.
In some cases the cause is unknown and symptoms may be attributed to a cause "i.e." a somatoform or anxiety disorder. It has been recognised as a symptom of depression, which responds to anti-depressive treatment.
Differential diagnosis must be made from Eagle syndrome which uses the patient's description of "something caught in my throat" as a diagnostic tool. Eagle syndrome is an elongation of the styloid process causing irritation to nerves and muscles in the region resulting in a number of unusual symptoms.
The results of recent studies have strongly suggested that GERD is a major cause of globus, though this remains under considerable debate.
A less common cause, distinguished by a "lump in the throat" accompanied with clicking sensation and considerable pain when swallowing, may be due to thyroid-cartilage rubbing against anomalous asymmetrical laryngeal anatomy "e.g." the superior cornu abrading against the thyroid lamina, surgically trimming the offending thyroid-cartilage provides immediate relief in all cases. However this cause is frequently misdiagnosed, despite requiring a simple clinical examination involving careful palpation of the neck side to side which elicits the same click sensation (laryngeal crepitus) and pain as when swallowing, most cases are due to prior trauma to the neck. High resolution computed tomographic (CT) or MRI scan of the larynx is usually required to fully understand the anomalous laryngeal anatomy. Anterior displacement of the thyroid ala on the affected side while swallowing can help resolve symptoms.
Adenitis is a general term for an inflammation of a gland. Often it is used to refer to lymphadenitis which is the inflammation of a lymph node.
"Lymph adenitis" or "lymph node adenitis" is caused by infection in lymph nodes. The infected lymph nodes typically become enlarged, warm and tender. A swelling of lymph nodes due to growth of lymph cells is called lymphadenopathy. Types include:
- Neck
- Cervical adenitis is an inflammation of a lymph node in the neck.
- Tuberculous adenitis (scrofula) is a tuberculous infection of the skin of the neck caused by "Mycobacterium tuberculosis". Non-tuberculous adenitis can also be caused by "Mycobacterium scrofulaceum" or "Mycobacterium avium".
- Abdomen
- Mesenteric adenitis is an inflammation of the mesenteric lymph nodes in the abdomen. It can be caused by the bacterium "Yersinia enterocolitica". If it occurs in the right lower quadrant, it can be mistaken for acute appendicitis, often preceded by a sore throat.
Although this is a congenital lesion, airway sounds typically begin at age 4–6 weeks. Until that age, inspiratory flow rates may not be high enough to generate the sounds. Symptoms typically peak at age 6–8 months and remit by age 2 years.
Late-onset laryngomalacia may be a distinct entity, which can present after age of 2 years
Perichondritis is inflammation of the perichondrium, a layer of connective tissue which surrounds cartilage. A common form, auricular perichondritis ("perichondritis auriculae") involves infection of the pinna due to infection of traumatic or surgical wound or the spread of inflammation into depth. It may lead to severe deformation of the pinna if not treated vigorously with IV antibiotics. The causative organism is usually "Pseudomonas aeruginosa". A rare form is laryngeal perichondritis ("perichondritis laryngis"). It develops suddenly due to an injury, virulent organisms or compromised immune status of the host, and also affects cartilage of the larynx. This may result in deformations and stenoses.
Around 75% of cases are caused by alcohol and tobacco use.
Tobacco smoke is one of the main risk factors for head and neck cancer and one of the most carcinogenic compounds in tobacco smoke is acrylonitrile. (See Tobacco smoking). Acrylonitrile appears to indirectly cause DNA damage by increasing oxidative stress, leading to increased levels of 8-oxo-2'-deoxyguanosine (8-oxo-dG) and formamidopyrimidine in DNA (see image). Both 8-oxo-dG and formamidopyrimidine are mutagenic. DNA glycosylase NEIL1 prevents mutagenesis by 8-oxo-dG and removes formamidopyrimidines from DNA.
However, cigarette smokers have a lifetime increased risk for head and neck cancers that is 5- to 25-fold increased over the general population.
The ex-smoker's risk for squamous cell cancer of the head and neck begins to approach the risk in the general population twenty years after smoking cessation. The high prevalence of tobacco and alcohol use worldwide and the high association of these cancers with these substances makes them ideal targets for enhanced cancer prevention.
Smokeless tobacco is cause of oral and pharyngeal cancers (oropharyngeal cancer). Cigar smoking is an important risk factor for oral cancers as well.
Other environmental carcinogens suspected of being potential causes of head and neck cancer include occupational exposures such as nickel refining, exposure to textile fibers, and woodworking. Use of marijuana, especially while younger, is linked to an increase in squamous-cell carcinoma cases while other studies suggest use is not shown to be associated with oral squamous cell carcinoma, or associated with decreased squamous cell carcinoma.
Immunotherapy with immune checkpoint inhibitors is being investigated in head and neck cancers.