Adult Stridor Flashcards
the larynx begins its descent into its final position between the age of ___
18-24 mos
the foregut is the origin of the ___
larynx, trachea, and esophagus
____: sole abductor
___: major adductor and modules tone and volume
posterior cricoarytenoids: sole abductor
lateral cricoarytenoids: adducts vocal folds and modulates tone and volume
cricothyroid muscle: ___ nerve
all other intrinsic laryngeal muscles: __ nerve
cricothyroid: superior laryngeal nerve
all other laryngeal muscles: recurrent laryngeal nerve
blood supply of the larynx
superior thyroid artery -> superior laryngeal artery ->cricothyroid artery (laryngeal cartilage)
inferior thyroid artery -> inferior laryngeal arteries
voice production
thyroarytenoid lowers the pitch
cricothyroid + thyroarytenoid raises the pitch
cricothyroid makes falsetto
aberrations in the microanatomy of the vocal fold causes __
dysphonia, aphonia with or without airway compromise
microanatomy of the vocal fold
reinke’s space/ superficial lamina propria: acellular and gelatinous
intermediate and deep lamina propria: elastin and collagen
bernoulli’s principle
read it girl
cough reflex
- inspiratory phase
- intrathoracic pressure exceeds extrathoracic pressure + expiratory muscle contraction
- opening of the glottis
protective functions of the cough reflex
- clean the tracheobronchial tree
- maintain patency of lower airways
most common cause of acute laryngopharyngitis
infectious (viral)
- rhinovirus most common
- coronavirus and parainfluenza
pathophysio of acute laryngopharyngitis
- inflammatory mediators -> edema and hyperemia of laryngopharyngeal mucosa
- inability to phonate, swallow, breathe properly and pain
death from influenza a is from ___
bacterial pneumonia (s aureus or gbs)
clinical course of influenza type a
- abrupt onset of fever, headache, myalgia
- symptoms resolve in 3-5 days
treatment for influenza type a
antiviral with m2 ion channel blockers: amantadine
neuraminidase inhibitors: zanamivir, oseltamivir
cause of bacterial acute laryngopharyngitis
gabhs transmitter by aerosolized microdroplets
clinical course of bacterial al
- contagious during acute illness until 1 week after
- resolution in 3-7 days
treatment for bacterial al
- antibiotic within 24-48 hours of symptom onset
- penicillin or amoxicillin for 10 days
- clindamycin is an acceptable alternative
types of chronic laryngopharyngitis
- chronic bacterial
- chronic fungal (blastomyces, histoplasma, coccidioides, paracoccidioides, cryptococcus)
- chronic mycobacterial laryngitis (myobacterium leprae)
what is chronic mycobacterial laryngitis
- m leprae transmitted via aerosolized droplet
- dx: tissue biopsy and tissue staining
- tx: multidrug therapy
most common symptoms of laryngeal tb
hoarseness with or without
- odynophagia
- dysphagia, cough, otalgia, and/or stridor
lesions of laryngeal tb are more commonly found in ___
glottis and anterior glottis
diagnosis and treatment of laryngeal tb
- direct laryngoscopy with biopsy
- histopathologic examination is required
- tx: extrapulmonary tb
cause of recurrent respiratory papillomatosis
hpv 6 and 11 (11 more aggressive)
hpv 16 and 18 = more malignancy
childhood vs adulthood rrp
childhood: hoarseness and stridor, grape like structures, more anterior
adulthood: solitary or carpet
gold standard for diagnosing rrp
direct laryngoscopy with tissue biopsy
treatment for rrp
- carbon dioxide laser or laryngeal microdebrider!!!
- cryotherapy, irradiation, photodynamic therapy
- vaccines (gardasil)
- indole 3 carbinol
- intralesional cidofovir
what are vocal fold nodules
- benign mid-membranous lesions
- symmetrical, hour glass closure
- minimally reduced mucosal wave
- tx: voice therapy
what is vocal fold cyst
- blocked mucus gland or congenital
- unilateral
- hourglass pattern
- tx: excision only
what is vocal fold polyp
- exophytic or pedunculated (gelatinous material)
- videostroboscopy: hourglass closure, normal or minimal reduction of mucosal wave
what is fibrous mass
- accumulation of fibrous fluid
- hourglass closure
- tx: surgical only
what is a reactive lesion
- in the submucosa
- response to a contralateral vocal fold lesion
- hourglass closure
- tx: voice rest and therapy
what is a polypoid corditis (reinke’s edema)
- gelatinous like fluid
- asymmteric
- always bilateral
- most common cause: tobacco abuse
what is sulcus vocalis
- from severe abnormality of lamina propria
- replacement of extracellular matrix proteins of lamina propria = furrowing of vf ligament
white plaques of questionable risk having excluded other known causes, no increased risk for cancer
leukoplakia of true vocal cords
t/f there is a clear association between smoking and excessive alcohol and development of malignancy in the upper aerodigestive tract
true
treatment for laryngeal squamous cell carcinoma
radiotherapy, conservation laryngectomy, total laryngectomy with/without radiotherapy
gold standard for diagnosis of laryngeal squaca
direct laryngoscopy with biopsy
causes of reflux laryngitis
- acidic injury
- bile and pepsin: doesn’t respond to antacid therapy
diagnosis for reflux laryngitis
rigid laryngeal endoscopy or flexible laryngeal endoscopy + clinical history
- posterior pachyderma and erythema of arytenoids
treatment for reflux laryngitis
acid neutralization, dietary and hebavioral changes, adequate hydration
- h2 receptor antagonists, ppi, mucosal protectants, hydration
most common inciting event that can cause chronic aspiration
cerebrovascular accidents, especially brainstem with bilateral cranial nerve deficits
most common cause for chronic aspiration in pedia
severe neurologic dysfunction
diagnosis of chronic aspiration
- indirect mirror exam
- fiberoptic nasopharyngoscopy
- esophagoscopy
- pulmonary function tests (for functional reserve)
- functional endoscopic evaluation of swallowing (for dysphagia)
treatment for chronic aspiration
- enteral feeding (alternative routes)
- parenteral hyperalimentation
- surgery: tracheostomy!!, vocal cord medialization, laryngectomy
functions of tracheostomy
- provide comfortable airway
- facilitate pulmonary toilet in patients with copious secretions
- reduce pulmonary dead space
