15. Anatomy and physiology of the larynx. Stridor. Acute Subglottic Laryngitis. Acute Epiglottitis. Acute laryngitis. Angioneurotic Laryngeal Edema. Reinke's Edema Flashcards
What does the ANATOMY of the Larynx consist of?
1) Cartilages
2) Joints
3) Membranes
4) Ligaments
5) Muscles
What are the CARTILAGES of the Larynx?
a. Epilglottis
b. Thyroid
c. Cricoid
d. Arytenoids
e. Corniculate
f. Cueniform
What are the JOINTS of the Larynx?
- Cricothyroid
- Cricoarytenoid
What are the MEMBRANES & LIGAMENTS of the Larynx?
- Thyrohyoid
- Cricothyroid
- Cricotracheal
- Elastic Conus
- Quadrangular Membrane
- Vocal Ligament
What are the MUSCLE GROUPS of the Larynx?
0 OPENING MUSCLE = Posterior Cricoarytenoid
0 CLOSING MUSCLES
- Lateral Cricoarytenoid
- Interarytenoid
- Thyreoarytenoid
0 TIGHTENING MUSCLES
- Cricothryoid
- Medial Thyreoarytenoid
What is the BLOOD SUPPLY, INNERVATION & LYMPH DRAINAGE of the Larynx?
0 BLOOD SUPPLY
1) SUPERIOR LARYNGEAL ARTERY = FROM the Superior Thyroid TO the External Carotid
0 INNERVATION
1) SUPERIOR LARYNGEAL NERVE = Supplies the
Cricothyroid
0 LYMPH DRAINAGE
1) ABUNDANT = Supra / Sub-glottis
2) BILATERAL = Supra / Sub-glottis
- Levels 2 - 4
What is the PHYSIOLOGY of the Larynx?
1) Airway
2) Phonation
3) Protection
- Via Elevation
- Tongue Base RETROPULSION
- OPENING the PYRIFORM PROCESS / OESOPHGEAL INLET
- Glottic CLOSURE
4) Cough Reflex
5) Effort Exercise
What are the METHODS OF EXAMINATION for the Larynx?
1) Inspection
2) Palpation = For Crepitations
3) Indirect Laryngoscopy
4) Rigid Laryngoscopy
5) Flexible Laryngoscopy
6) Direct (Suspension) Laryngoscopy
What is STRIDOR?
- Is a HIGH-PITCHED Breath sound, DUE to TURBULENT airflow in the Larynx
- Physical Sign caused by Obstruction in the airway
- Either be Inspiratory / Expiratory / Biphasic, but usually Inspiratory
- Occurs in Children W/ CROUP
- Indicates serious airway obstruction due to, Epiglottis / Foreign Body Lodged / Laryngeal Tumour
0 DIAGNOSIS
- Chest / Neck X-Ray
- Bronchoscopy
- CT Scan / MRIs
What are the MALFORMATIONS of the Larynx?
1) LARYNGOMALACIA
- Constant / Intermittent Low-pitched Stridor
- Affected via Position
- Resolves in first 2 years
2) LARYNGEAL WEB
- Incomplete CANALISATION of Glottis Lumen
- Breathy voice
- Discovered later in life
3) CONGENITAL SUBGLOTTIC STENOSIS
- 2nd Most Common
- Stridor NOT AFFECTED VIA Position
What is DIPHTHERIA?
{Etiology, Pathogenesis, Symptoms, Complications, Diagnosis & Treatment}
- Acute Bacterial Infection
0 DUE to C. Diphtheria
- Soon as a person is infected via cough / sneeze = remains as virulent / persistent lesion for 2 - 4 weeks
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0 PATHOGENESIS
1) Primary Lesion in Upper RT
2) Necrosis of Epithelium, leading to Plasma Leakage
3) Fibrin Network Formation w/ Bacteria, causing Pseudo-membrane Formation
4) Adherent to underlying tissue = Nose / Pharynx / Larynx / Tonsils
0 SYMPTOMS
- Fever / Malaise / Sore Throat / Headache
0 COMPLICATIONS = Reach RF / Blurred Vision
0 DIAGNOSIS = Swab of Oropharynx / Larynx
0 TREATMENT = Antitoxins AND Antibiotics
What is ACUTE SUBGLOTTIC LARYNGITIS?
0 DUE to:
- Parainfluenza 1-3
- Measles
- Varicella Zoster
- Rubella Virus
0 PATHOGENESIS
1) Develops 1-3 Days in Upper Respiratory Viral Disease
2) Transmitted via Droplet Infx
0 SYMPTOMS
- Hoarse Voice
- Dry Barking Cough
- Stridor in evening / night
0 DIAGNOSIS = Laryngoscopy
- Inflammatory Swelling BELOW Vocal Cords AND Upper Part of Cervical Trachea
0 TREATMENT
- Airway Humidification
- Adequate fluid Intake
- Corticosteroids
- Inhalation Therapy w/ Epinephrine
What is ACUTE EPIGLOTTIS?
0 DUE to
- H. Influenzae
- S. Pneumoniae
- Beta-Hemolytic Streptococci
0 PATHOGENESIS = Bacterial Inflammation of Larynx / Laryngeal Inlet
0 SYMPTOMS
- High Fever
- Loud Inspiratory Stridor
- Painful Swallowing (Children)
0 DIAGNOSIS
- BRIGHT RED Posterior Pharyngeal Wall
- SWOLLEN / ERYTHEMATOUS Epiglottis
- LEFT-SHIFT Leucocytosis
0 TREATMENT
- Intubation (Children)
- Sedation
- Antibiotics
What is ACUTE LARYNGITIS?
0 DUE to = Viral / Bacterial Super-infection
0 PATHOGENESIS = Upper Respiratory Tract diseases that DESCEND TO INVOLVE the Larynx
0 SYMPTOMS
- Hoarseness w/ Dry Non-Productive Cough
- Dysponea
0 DIAGNOSIS = Redness, thickening, Oedema of Vocal Cords
0 TREATMENT
- Voice Rest
- Inhalation Therapy
- Mucolytic Agents
- Anti-inflammatory Agents
- Antibiotics (bacterial infx)
What is ANGIONEUROTIC LARYNGEAL OEDEMA?
- Hereditary Disease , where there’s a CONGENITAL DEFICIENCY of C1 Esterase Inhibitor
0 SYMPTOMS
- Rapid Oedematous Swelling of the Larynx
- Inspiratory Stridor
- Changes in Lips / Tongue / Palate / Uvula / Facial Skin
0 DIAGNOSIS
- Indirect Laryngoscopy = Shows Oedematous changes in Entire Larynx
- Serologic Testing = Shows C1 Esterase Inhibitor Deficiency
0 TREATMENT
- Para-Enteral Corticosteroids
- Anti-Histamines
- S.C Epinephrine
