Ch. 12 Progressively Hoarse Voice Flashcards
What is the differential diagnosis for hoarseness (6)?
At what point should hoarseness warrant consultation with an otolaryngologist?
Most common cause of hoarseness = viral laryngitis
** self-limited and usually resolves after 1-2 weeks
Any hoarseness persisting for longer than 3 or 4 weeks necessitates timely otolaryngic referral
Would you expect bloody sputum?
Vast majority of noncancerous causes of hoarseness NOT associated with bloody sputum
Hemoptysis = red flag for malignancy in upper aerodigestive tract or the lungs
What is the most common type of laryngeal cancer?
SCC
Pathogenesis is closely linked to tobacco use in any form / likely related to chronic inflammation and increased cellular turnover causing metaplasia, dysplasia, and eventual carcinoma
What is the most common site of malignant lesions of the larynx?
Glottis
What is the innervation of the larynx?
Nerve: Superior laryngeal nerve
- Branch: Vagus
- Sensory: Supraglottis
- Motor: Inferior constrictor, cricothyroid muscles
Nerve: Recurrent laryngeal nerve
- Branch: Vagus
- Sensory: Glottis and subglottis
- Motor: All intrinsic laryngeal muscles except cricothyroid
Do laryngeal papillomas cause cancer?
Laryngeal papilloma = caused by HPV 6 & 11
Infection with virus –> benign papillary tumors of the larynx and presents primarily with hoarseness
Adults tend to have a single papilloma, while children develop multiple lesions
Though possible, papillomas rarely give rise to laryngeal carcinoma
Algorithm for diagnosis and mgmt of hoarseness
If laryngeal cancer is suspected, what additional tests are warranted?
CXR to r/o concurrent primary lung cancer or pulmonary mets
**imp as majority of laryngeal and lung cancers are attributed to smoking
**in addition, the most common location for distant mets of H&N SCC = lungs
CT of neck can reveal mets to cervical lymph nodes, although CT is not routinely obtained for early-stage laryngeal cancer
What is the staging for laryngeal cancer?
Tumor, Node, Metastases (TNM) system
T: location, size, extent of primary tumor
N: presence and degree of metastasis to cervical lymph nodes
M: presence of distant metastases
What treatments are available for laryngeal cancer?
Early-stage (TNM stage groups I and II) = single-modality therapy–either surgery or radiation–effective in eradicating the disease
Late-stage H & N cancer = combined-modality therapy (surgery and radiation, chemo and radiation, or a combo of all three) is often required to eradicate disease
