Chronic laryngitis (慢性喉炎)

Chronic non-specific laryngitis (慢性非特異性喉炎)

Aetiology:

Common. Usually associated with vocal abuse, smoking or sepsis elsewhere in the respiratory tract, e.g. chronic sinusitis.

Clinical features:

Hoarseness may be accompanied by sore throat. Indirect laryngoscopy may distinguish localized forms, e.g. singer’s nodules, Reinke’s oedema or laryngeal polyps, from the generalized forms, e.g. chronic hypertrophic laryngitis.

Management:

Treatment involves the removal of any precipitating factors and speech therapy is important. Localized polyps or nodules may merit endoscopic removal.

Chronic specific laryngitis (慢性特異性喉炎)

Rare. Most of the granulomatous diseases can involve the larynx, e.g. tuberculosis, syphilis, sarcoidosis, scleroma or Wegener’s granulomatosis.

Management:

The lesions may mimic a carcinoma and a direct laryngoscopy and biopsy is mandatory. Treatment is that of the underlying systemic condition.

Leukoplakia (聲帶白斑)

Usually affects the true cords. The aetiology is as for chronic non-specific laryngitis. Microscopically, the findings of hyperkeratosis and dysplasia are common, although in situ or invasive carcinoma can only be excluded by an adequate biopsy.

Management:

Endoscopy should be undertaken in all cases. Leukoplakia should be regarded as having the potential to undergo malignant change.

Leukoplakia and tongue carcinoma (舌白斑和舌癌)

Leukoplakia (舌白斑)
A white patch which cannot be wiped away and for which no other diagnosis is apparent. Risk factors in the development of oral cavity or tongue leukoplakia include alcohol, smoking, spice and betel nut chewing, syphilis and dental trauma. About 5% of cases become malignant. Exclusion of an associated carcinoma is essential.

Tongue carcinoma (舌癌)

Almost all tongue carcinomas are squamous in origin. There need not be any pre-existing leukoplakia.

Clinical features:

May present as an exophytic or infiltrative lump on the tongue. Pain and dysphagia are common. Referred otalgia (via lingual and glossopharyngeal nerves) may also occur. At presentation most tumours are greater than 2cm diameter and 50% have palpably involved lymph nodes.

Management:

Small lesions – Radiotherapy, using external beam or interstitial implant techniques, or surgery, in the form of a partial or hemiglossectomy are equally effective.

Large lesions – Treatment is with radiotherapy or surgery alone or a planned combination of the two. Both modalities produce quite severe functional disability in the oral cavity, especially regarding speech and swallowing.