17. Laryngeal Trauma. Recurrent Laryngeal Nerve Paralysis. Basic Principles of Speech. Dysphonia. Vocal Cord Paralysis. Stridor. Cough.

Question 1

What is LARYNGEAL TRAUMA?

Answer 1

• MANUAL STRANGULATION
• Low-velocity, High Amplitude Injury resulting in multiple fractures WITHOUT displacement of Cartilage
• Early Presentation of Hematoma / Endolaryngeal Mucosal Tears

Question 2

What are the TYPES of LARYNGEAL TRAUMAS?

Answer 2

1) HYOID BONE DAMAGE
- Swallowing Pain
- Fracture

2) THYROID CARTILAGE FRACTURE
- Depends on Calcification of Cartilage

3) INHALATION INJURIES
- Hot air / smoke / steam
- Glottis closes by stopping inhalation
- Oedema

4) INGESTIONAL INJURIES
- Mucosal Burns
- Direct damage due to Acid Reflux

Question 3

What is RECURRENT LARYNGEAL PARALYSIS?

Answer 3

0 RECURRENT LARYNGEAL NERVE = Branch of Vagus Nerve (CN 10) which supplies all intrinsic muscles of Larynx EXCEPT FOR Cricothyroid Muscles

0 There are 2 RLN - Left / Right
- Left = Loops UNDER Aortic Arch
- Right = Loops UNDER Subclavian Artery then upwards

0 PARALYSIS
- Injury to 1 or both RLNs
- Vocal Fold Paresis
- Rough Voice quality

0 DUE to, Neck Trauma / Thyroid Disease

0 SYMPTOMS
- Swallowing Disability
- Weak Cough
- SOB
- Neurogenic Hoarseness

Question 4

What are the BASIC PRINCIPLES OF SPEECH?

Answer 4

• Refers to how Tongue / Lips / Jaw / Vocal Cords & other Speech organs are used to produce sounds
• Categorised via :
  a. manner of articulation = Speech organs interact (how closely air is restricted)

b. place of articulation = where airstream in mouth is constricted

• Normal Speech is PULMONIC = Produced with pa from Lungs, creating Phonation in Glottis in Larynx

Question 5

What is DYSPHONIA?

Answer 5

• ABNORMAL CHANGES in Voice
• Aka HOARSENESS
• Sound breathy / raspy / strained
• A Symptom for following diseases:
  a) Benign Vocal Cord Lesion
  b) Vocal Haemorrhage
  c) GERD
  d) Laryngopharyngeal Reflux

Question 6

What is STRIDOR?

Answer 6

• 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