39. Larynx Flashcards
layers of the vocal fold
between the cricoid and cricotracheal ligament, or between tracheal rings
cricothyrotomy vs tracheostomy
airway protection, speech, swallowing
function of the larynx
appropriate vocal fold approximation, too loose leads to breathiness, too tight leads to strained voice, adequate expiratory force, control of length and tension, intact laye structure of lamina propria for mucosal mobility, adequate vocal fold bulk, vocalis muscle may become atrophic with aging, neuropathy, or disuse, resonance of the vocal tract
requirements for normal phonation
quality of voice change as a change in sound, increased effort, or vocal fatigue, time course, contributing factors like trauma, intubation, systemic illness, GERD, allergy/rhinitis, neurological problems, medications like an inhaler, substance use like tobacco and alcohol, professional voice demands or vocal abuse
clinical evaluation of hoarseness
cannot go down the esophagus, gets a view of the true vocal cords, trachea, vocal cords
flexible fiber optic aryncoscope
sleeves, can be suspended,
direct laryngoscopy
videostrobe
laryngitis, nodules, polyps, immobility/paralysis ***
benign disorders of the larynx
etiologies often infectious due to laryngeal inflammation, typically indirect like coughing, noxious chemicals, angioedema, vocal trauma, allergy, irritants, treated with voice rest, hydration, cough suppressants, decongestatins for nasal obstruction, mucolytics, reflux medications, steroids
acute laryngitis
globus, dysphona, dysphagia, chronic cough, throat clearing, mucous, diagnosis by resolution of symptoms with medication and lifestyle adjustments, flexible laryngoscopy findings, 24 hour pH probe, upper esophagoscopy, barium esophagogram, treatment with diet and behavioral modifications, H2 blockers and PPIs, and surgical management with fundoplication, posterior commisue hypertrophy, puffy with edema,
laryngopharyngeal reflux
due to vocal abuse,phonating too loudly too much, severe coughing, raspy reduced vocal range, opposing polypoid massess middle portion of membranous vocal folds, typically conservative management with voice therapy, optimize irritants, and surgery
vocal cord nodules
vocla cord polyp
unilateral or bilateral, almost always smoking related, treatment usually surgical, recurrence rate is high with continued smoking
reinke’s edema
warty tumor, HPV, benign which can have malignant transformation, juvenile onset due to maternal transmission, adult onset is most likely from sexual transmission, treatment with surgery, opften repeat debridements due to nature as a recurrent disease
recurrent respiratory papillomatosis
leukoplakia
most common symptom with dysphonia and vocal fatigue, treatment is observation, voice therapy, and augmentation
laryngeal paresis
most often breathy voice and vocal fatigue, swallowing and aspiration, etiologies inlcude cancer, surgery like thyroidectomy or cardiothoracic surgery, central nervous system disease like stroke or multiple sclerosis, idiopathic, treatment is to imptove glottic closure
unilateral laryngeal paralysis
respiratory distress with minimal impact on the voice, gold standard treatment is tracheostomy, posterior cordotomy, arytenoidectomy, reinnervation, etiologies are surgical, CNS, cancer, inflammatory like sarcoid, lyme, syphillis, mechanical fixation with posterior scarring and prolonged intubation
bilateral laryngeal paralysis
intermittent involuntary spasms, unknown etiology, adductor is the most frequent, strained strangled voice with frequent voice breaks, often occurs with onset of words starting with vowels, abductor form has whispering or breathy voice, treatment is speech therapy or botox injection to thyroaryenoid muscle
spasmodic dysphonia
episodic, inappropriate vocal cord adduction during inspiration, treatment is with speech therapy
paradoxical vocal cord dysfunction
