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ENT > 2: Vocal Cord Paralysis > Flashcards

2: Vocal Cord Paralysis Flashcards

1
Q

What causes vocal cord paralysis

A

recurrent laryngeal nerve palsy

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2
Q

What is the rule of 1/3s with vocal cord paralysis

A

1/3 Idiopathic
1/3 Malignant
1/3 Iatrogenic

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3
Q

What is the idiopathic cause of vocal cord paralysis

A

Post-viral neuropathy

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4
Q

What are neoplastic causes of vocal cord paralysis

A 
Laryngeal Cancer 
Thyroid Cancer 
Oesophageal Cancer 
Hypopharyngeal Cancer 
Bronchial Cancer
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5
Q

What 3 surgical procedures can cause vocal cord paralysis

A

Thyroidectomy
Parathyroidectomy
Pharyngeal pouch surgery

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6
Q

Why is it common to have recurrent laryngeal nerve post thyroidectomy

A

Due to relationship of recurrent laryngeal nerve and inferior thyroid artery

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7
Q

How will unilateral vocal cord paralysis present

A
  • Weak, breathy, hoarse voice

- Airway maintained

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8
Q

How will bilateral vocal cord paralysis present

A
  • Compromised airway
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9
Q

How will unilateral congenital recurrent laryngeal nerve palsy present

A

Weak, Breathy Hoarse Cry. Feeding difficulties - result in aspiration.

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10
Q

How will bilateral recurrent laryngeal nerve palsy present in an infant

A

Respiratory distress

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11
Q

What is the role of the recurrent laryngeal nerve

A

Innervates intrinsic muscles of larynx except cricothyroid

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12
Q

Explain pathophysiology of unilateral recurrent laryngeal nerve palsy

A

Unilateral - means the other side vocal cords are still able to abduct-adduct to enable phonation.

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13
Q

Explain pathophysiology of bilateral recurrent laryngeal nerve palsy

A

Bilateral - both vocal cords are stuck in a partially adducted position - causing rims glottis to close and airway compromised

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14
Q

What artery does the right recurrent laryngeal nerve hook around

A

Subcalvian.a

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15
Q

What structure does the left recurrent laryngeal nerve hook around

A

Ligmanetum arteriosum

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16
Q

If no recent surgery, explain how vocal cord paralysis is investigated

A

CXR. If negative:

  • CT Skull Base
  • US thyroid
  • OGD
17
Q

How should all vocal paralysis be managed

A

Treat underlying cause

18
Q

If unilateral palsy explain management

A

The other vocal cord can be trained to compensate to enable speech - requires SALT

19
Q

If vocal cord paralysis is due to trauma, what may be done

A

Re-attach ansa cervicalis to recurrent laryngeal nerve

20
Q

If bilateral vocal cord paralysis what management is required

A

Emergency airway obstruction and tracheostomy

21
Q

Explain management of obstructed airway

A
  1. Oxygen-Heliox
  2. Neb Adrenaline
  3. Tracheostomy

ENT (16 decks)

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