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Senior - ENT > 6 - Larynx > Flashcards

6 - Larynx Flashcards

1
Q

anatomy of larynx?

A

Pic on 5

Words on 6-9

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2
Q

Voice production is from?

A

Vocal cords/vocal folds

Description on 10

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3
Q

Pitch of voice?

A

Pitch - controlled by tension of the folds

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4
Q

Which cartilage is seen on nasopharyngeal endoscopy?

A

Arytenoid cartilage

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5
Q

Larynx is innervated by?

A

Vagal nerve

- recurrent laryngeal nerve

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6
Q

Dysphonia?

A
  • Any abnormality in the speaking voice, such as hoarseness

- The primary symptoms of laryngeal disease are hoarseness and stridor

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7
Q

Hoarsness

A
  • abnormal vocal quality caused by abnormal vibrations of the vocal coards

reflects a variety of complaints of voice

  • tremor
  • weakness
  • fatigue
  • altered pitch
  • breathiness
  • raspy, rough or strained voice
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8
Q

Types of voices?

A

Breathy - too much air
Harsh - stiff and vibrate irregularly
Heavy - edematous vocal folds produce a rough low pitched quality

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9
Q

Harsh voice can be?

A

Laryngitis

Malignancy

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10
Q

Stridor?

A
  • high pitched
  • inspiratory
  • turbulent airflow through narrowed glottis
  • warrant specialist exam
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11
Q

Rapid onset stridor?

A

Emergency

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12
Q

Stridor is narrowing but if above or below vocal cords it changes, describe

A

Above: inspiratory stridor

Below - expiratory or biphasic stridor

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13
Q

Hoarsness ddx?

A

Long list - slide 14

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14
Q

If hoarsness last longer than 2 weeks?

A

Refer fro complete otolaryngologic exam

  • laryngeal cancer
  • lung cancer
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15
Q

Worrisome symptoms w hoarseness?

A 
Severe cough
Hemoptysis
Unilateral ear/throat pain
Odynophagia/dysphagia
Unexplained wt loss
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16
Q

Acute vs chronic laryngitis?

A

Acute: <3 weeks

  • URi
  • usually viral
  • can by laryngopharyngeal reflux

Chronic: >3 weeks

  • vocal cord lesions
  • inhailed toxins
  • GERD
  • ETOH
  • voice strain
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17
Q

MC cause of hoarseness?

A

Acute laryngitis

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18
Q

Acute laryngitis is?

A

Self limited inflammatory condition lasting < 3 weeks usually associated with:

  • URI
  • acute vocal strain
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19
Q

Tx for acute larygitis?

A

Education (the more you know ….)

Abx not recommended
Glucocorticoids reserved for pts who need their voice

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20
Q

Chronic laryngitis?

A

> 3 weeks

Usually caused by irritants , over time lead to laryngeal injury

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21
Q

Common irritants causing chronic laryngitis?

A 
Inhaled toxins
Reflux
Chronic sinusitis w post nasal drip
Chronic alcohol use
Chronic vocal strain
Tobacco smoke
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22
Q

How does tobacco smoke affect the vocal cords?

A

Irritates the vocal folds and can cause benign changes such as keratosis and polypoid corditis

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23
Q

Chronic laryngitis tx?

A

Remove the irritant

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24
Q

S/S of epiglottitis or supraglottitis?

A

Rapidly developing sore throat
Odynophagia out of proportion to exam findings
Drooling

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25
Q

Drooling is concerning bc?

A

Its a signal of impending airway compromise

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26
Q

Causes of epiglottitis/supraglottitis?

A

Viral or bacterial

Seen more in diabetics

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27
Q

Dx of epiglottitis or supraglottitis?

A

Adults:

  • Indirect laryngoscopy
  • lateral neck soft tissue x ray

Kids
- lateral neck soft tissue x ray

Looking for enlarged epiglottis (thumb sign)

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28
Q

Tx for epiglottitis/supraglottitis?

A
  • Admit
  • IV ceftriaxone
  • IV dexmethasone
  • Intubation (only 10% need this)

Once it calms down:

  • Corticosteroid - 10 day taper
  • PO abx
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29
Q

diagnosis for laryngopharyngeal reflux? (LPR)

A

Response to PPI is how diagnosis is made

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30
Q

What is LPR?

A

Gastroesophageal reflux into the larynx

Chronic hoarseness when other causes have been excluded by laryngoscopy

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31
Q

Presentation of LPR?

A 
§ Hoarseness	or	voice	quality	change
§ Throat clearing or discomfort
§ Persistent	cough	
§ Sensation	of	post	nasal	drip
§ Esophageal	spasm
§ Asthma	(symptoms)
§ Half	of	patients	lack	heartburn and dyspepsia
§ Globus	sensation	(lump	feeling in	back	of	throat),
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32
Q

Gold standard test for LPR?

A

None

But typically diagnosis comes form empiric trial w PPI
- omeprazxol 40mg bid x 3 mo

Or

24hr pH monitoring of pharynx
- costly and difficult

33
Q

What are recurrent respiratory papillomatosis?

A

Papillomas
- common lesions of larynx and other sites where ciliated and squamous epithelia meet

Generally benign

34
Q

Recurrent respiratory papillomatosis is caused by?

A

HPV 6 and 11 are MC

35
Q

Symptoms of recurrent respiratory papillomatosis?

A

Hoarseness
- progresses to stridor over weeks to months

Can extend to trachea and lungs

Multiple warty lesions on vocal cords

36
Q

Tx for papillomatosis?

A

Repeated laser vaporizations or cold knife resections
- q 6 wks for airway patency

Cure is rare, goal is to keep their voice and avoid tracheotomy

37
Q

Prevention of papillomatosos?

A

Gardasil 9

38
Q

Traumatic (benign) lesions of. The vocal cords?

A
  • vocal cord nodules
  • vocal cord polyps
  • vocal cord cysts
  • polypoid corditis
39
Q

Vocal fold nodules are aka?

A

Singer’s nodules - adults
Screamers nodules - kids

Common cause of hoarseness from vocal abuse

40
Q

Describe vocal fold nodules?

A

Smooth, paired lesions that form at the junction of the anterior 1/3 and posterior 2/3 of the vocal folds

41
Q

Tx for vocal fold nodules?

A

Modify voice habits
Speech therapist
Behavior modifications
Excision of recalcitrant nodules

42
Q

What are vocal fold polyps?

A

Unilateral masses that form with the superficial lamina propria of the vocal fold

  • related to vocal trauma (yelling)
43
Q

Tx for vocal fold polyps?

A

Small polyps

  • conservative tx,
  • vocal rest
  • corticosteroids

Large polyps

  • irreversible
  • operative removal
44
Q

Vocal fold cysts are?

A

True cyst w epithelial lining or pesudocyts

Formed in the mucous-secreting glands on the inferior aspect of the vocal folds

45
Q

Tell tale sign of vocal fold cysts?

A

Fluctuate in size from week to week and are common cause of harseness

46
Q

Problem with Tx for vocal fold cyst?

A

They rarely resolve completely

- if do leave a scar/sulcus

47
Q

Reinke’s edema is?

A

Polypoid corditis

48
Q

Polypoid corditis is?

A
  • Loss of elastin fibers
  • loosening of the intracellular junctions w/in the lamina propria
  • swollen and floppy vocal folds
  • respiratory symptoms (maybe)
49
Q

Polypoid corditis is associated w?

A

Smoking
Vocal abuse
Chemical irritants
Hypothyroidism

  • middle age woman who complains of a husky, low-pitched voice
50
Q

Tx for polypoid corditis

A

Smoking cessation
Reflux management
Voice therapy

W stridor or airway obstruction
- Surgical debulking/reconturing

51
Q

What is laryngeal leukoplakia?

A

Larynx mass
- Hoarseness in smokers

May be benigh, precancer, or cancer

52
Q

Laryngeal leukoplakia tx?

A 
Stop smoking
PPI (mainstay)
Laryngovideostroboscopy
Serial resection
External beam radiation therapy
53
Q

Presentation of squamous cell carcinoma of larynx

A 
New (>2 weeks) hoarseness in smoker
Persistent throat/ear pain esp w:
- swallowing
- neck mass
- hemoptysis
- stridor 
- compromised airway
54
Q

MC malignancy of larynx?

A

SCC

55
Q

SCC of larynx pt population?

A

50-70yo men w hx of

  • tobacco
  • ETOH
  • HPV 16,18 (MC in non-smokers)
56
Q

S/s of SCC of larynx?

A
  • Change in voice quality
  • persistent hoarseness
  • throat/ear pain
  • neck mass
  • hemoptysis
  • stridor
  • wt loss
57
Q

Dx for SCC or larynx?

A

Complete head and neck exam

  • Laryngoscopy w biopsy (by ent)
  • CT/MRI
  • PET/CT-PET for metastasis
58
Q

METS of SCC are common in? Not common in?

A

Common in supraglottic carcinoma

  • false vocal folds,
  • aryepiglottic folds
  • epiglottis

Not common in
- true vocal cords if cords are mobile

59
Q

Goals of tx for SCC?

A

Cure
Preserve swallowing
Preservation of voice
Avoid permanent tracheostoma

60
Q

Tx for SCC

?

A

Early glotic/supraglottic cancer
- radiation

Later, large tumor or mets
- multimodal therapy

61
Q

Causes of vocal cord paralysis?

A

Lesion or damage to vagus

unilateral recurrent laryngeal nerve

  • surgeries
  • mediastinal/apical lung ca
  • skull base tumors
62
Q

Common MCC cause of unilateral vocal cord paralysis?

A

2 is idiopathic

Iatrogenic injury

63
Q

Describe vocal cord paralysis presentation

A

Breathy dysphonia or effortful voicing

64
Q

Pts with vocal cord paralysis need?

A

CN exam
CT w contrast
MRI (if cranial neuropathy present)

65
Q

What nerve runs on either side of the trachea?

A

Right/Left recurrent laryngeal nerve

66
Q

unilateral recurrent laryngeal nerve injury?

A

True vocal cord rests in paramedial position

Contralateral vocal fold to compensate

Glottal incompetence - risk of aspiration

67
Q

Why does RLN make coughs ineffectual?

A

They require transient tight glottic closure

68
Q

Tx for unilateral vocal cord paralysis

A

Early surgy indications

  • aspiration pneumonia
  • disabling breathy hypophonia
  • ineffective cough
  • disabling dyspnea

Mild sx

  • voice/speech therapy
  • evidence of little activity on laryngeal electromyography
69
Q

Surgery for unilateral vocal cord paralysis?

A

surgical procedures can reposition the immobile vocal fold to achieve adquate glottal closure

70
Q

What causes bilateral vocal fold paralysis?

A

Total thyroidectomy

- usually w re-operations

71
Q

Symptoms of bilateral vocal fold paralysis?

A

Position dependent

  • narrow glottic aperture
  • resp function compromised
  • dyspnea or inspiratory stridor
  • respiratory distress

Voice is usually spared

72
Q

Tx for bilateral vocal fold paralysis?

A

Preserve airway

  • intubation
  • Tracheostomy

Permanent bilateral vocal cord paralysis

  • posterior cordectomy
  • laser surgery (restore air flow)
73
Q

What is vocal cord dysfunction (VCD) or paradoxical vocal fold movement (PVFM)

A

Syndrome of acute and chronic upper airway obstruction characterized by paradoxical cord adduction

Sudden or gradual

74
Q

VCD triggers?

A 
GERD
Inhaled allergens
Post nasal drip
Exercise
Neurological conditions
Psychosocial d/o and stress
75
Q

Key features of vocal cord dysfunction?

A

Dyspnea and wheezing
Co-occurs w asthma (40%)

Dont respond to bronchodilator

76
Q

VCD is often confused w?

A

Asthma

77
Q

Diagnosis of VCD?

A

Direct visualization of vocal cords showing adduction w both inspiration and expiration (abnormal)

Spirometry - evidence of upper airway obstruction

Bronchial provocation test = normal

78
Q

VCD tx?

A

stop unnecessary tx

  • steroids
  • asthma meds

Acute

  • CPAP
  • Breathing exercises

Chronic

  • speech therapy
  • botox
  • tracheotomy
79
Q

What do you call a pony w a sore throat?

A

A little horse

Senior - ENT (8 decks)

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