10.2 Conditions Affecting the Larynx

Question 1

What are 3 conditions affecting the larynx that have no immediate threat to the airway?

Answer 1

• Laryngitis
• Laryngeal nodules
• Laryngeal cancer

Question 2

What is laryngitis?

Answer 2

Inflammation of the larynx involving TVCs

• Diagnosed from history
• Usually following URTI
• Typically viral
• Can be from repeated abrasion such as singing
• Self-limiting, fully resolves in 2-3 weeks, take OTC medication, paracetamol

Question 3

What are laryngeal nodules?

Answer 3

Small, benign growths on TVC

Question 4

What causes laryngeal nodules and how does it present?

Answer 4

Acute trauma or chronic irritation

Presents with hoarseness of voice >3weeks

Requires visualisation of cords to rule out laryngeal cancer +/- biopsy

Question 5

What does Laryngeal cancer look like?

Answer 5

Small white nodules on the TVC

Question 6

What conditions affecting the larynx cause swelling that can present an immediate threat to the airway?

Answer 6

Laryngeal Oedema
Epilottitis
Croup

Question 7

What causes laryngeal oedema?

Answer 7

Anaphylaxis
Swallowed foreign body

Question 8

What causes epiglottitis?

Answer 8

-Usually Haemophilus Influenzae B, rare due to HIb vaccination

-Usuaully in children 2-6, stridor, difficulty breathing, swallowing (may dribble), high fever, sore throat and sitting up in ‘sniffing position’

-DO NOT EXAMINE AS EPIGLOTTIS MAY SNAP SHUT refer to ENT for intubation

Question 9

What is the sniffing position?

Answer 9

Nose pointing upwards, lifts tissues off larynx to help breathing

Question 10

How do you treat epiglottitis?

Answer 10

Antibiotics after intubation (if needed)

Question 11

What is croup? (Acute laryngotracheobronchitis)

Answer 11

• Usually viral, parainfluenza virus, affecting larynx and trachea
• Common in 6 months to 3 years
• Barking cough made worse on agitation and at night
• Stridor can also occur when upset and cyanosis

Question 12

How do you treat croup?

Answer 12

-Dealt with at home, give single dose corticosteroid, calm them down and sit them up

-If respiratory distress or stridor, give nebulised oxygen and adrenaline with corticosteroids

Question 13

How does a patient with a compromised upper airway present?

Answer 13

Stridor
Raised respiratory rate
Distress
Hypoxia
+/- Cyanosis

Question 14

Why is airway management crucial?

Answer 14

Hypoxia kills

Question 15

What normally holds the airway open?

Answer 15

General tone in muscles of upper pharynx,larynx, tongue

Question 16

What are 3 protective reflexes of the airway?

Answer 16

Gag
Cough
Swallow

Question 17

What can cause the airway to be at risk?

Answer 17

Decreased concious levels cause decreased tone and suppression of reflexes

Question 18

How can the airway be managed?

Answer 18

Planned- preparation for surgery involving general anaesthetic

Emergency- acute/immediate threat to airway- concious e.g. laryngeal oedema/ unconscious patient e.g. cardiac arrest

Question 19

What is Ludwig’s Angina?

Answer 19

Infection of the floor of the oral cavity, swelling of the floor, pushes tongue upwards and compromises the airways

Question 20

What are 2 simple airway manoeuvres?

Answer 20

Head tilt
Chin tilt

No protection of LRT, vomit/secretions as airway held open

Question 21

What else can we use to open the airway?

Answer 21

Airway adjuncts
-Oropharyngeal airway (Guedel) (don’t use if semi-conscious, causes gag reflex)
-Nasopharyngeal airway

Allows for spontaneous ventilation, offers no protection of LRT

Both hold the tongue down

Question 22

When do you use airway adjuncts or simple airway manoeuvres?

Answer 22

When the patient is able to breathe spontaneously

Question 23

What do you use if airway adjuncts don’t work?

Answer 23

Supraglottic airway e.g. iGel

Question 24

What is a supraglottic airway?

Answer 24

iGel, forms cuff around laryngeal inlet, moulds to the anatomy as it becomes warm inside the body
* Maintains airway
* Minimal technical skills needed
* First line in cardiac arrest
* Not for long-term ventilation e.g. ITU

Question 25

What is the definitive airway?

Answer 25

Intubation- Absolute gold standard for most airway compromisations
* Insert laryngoscope into valecula
* Insert endotracheal tube through oral cavity on top of laryngoscope into the laryngeal inlet
* Protects LRT from secretions/vomit
* Requires technical skill need to visualise the vocal cords from behind

Question 26

When is intubation performed?

Answer 26

If patient is not in cardiac arrest, anaesthetised prior to insertion

Question 27

Label the image

Answer 27