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ENT Secrets > Chapter 71 - Hoarseness/Dysphonia > Flashcards

Chapter 71 - Hoarseness/Dysphonia Flashcards

1
Q

How long does acute laryngitis take to resolve?

A

1-2 wk

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2
Q

which non-acidic refluxed element is associated with LPR inflammation

A

pepsin

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3
Q

3 systemic diseases affecting larynx and their location

A

Sarcoid (supraglottic)
Amyloid (glottic)
Wegener (subglottic)

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4
Q

Glottic insufficiency

A

closed phase lasts less than 45-50% of vibratory cycle

Or incomplete closure

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5
Q

where do vocal nodules occur?

A

junction of ant/middle thirds TVC

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6
Q

What could be the cause of bilateral VC lesions other than nodules?

A

a dominant subepithelial lesion with a contralateral reactive lesion

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7
Q

Types of HPV causing RRP

A

6, 11

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8
Q

Muscle tension dysphonia typically compensates for which underlying condition?

A

glottic insufficiency

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9
Q

Which requires higher dose/longer treatment … GERD or LPR?

A

Often LPR

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10
Q

Dysphonia

A

Issues with quality of sound, increase in vocal effort/fatigue, pain/discomfort with phonation

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11
Q

Site of pain that suggests muscle tension dysphonia

A

pain in tongue or strap muscles

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12
Q

Causes of glottic insufficiency

A

Paresis/paralysis TVC
Atrophy TVC
Scar TVC

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13
Q

Sulcus vocalis

A

Epithelium scarred down to vocal ligament —> no vibration in that area due to loss of SLP

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14
Q

Common causes of dysphonia

A 
GI with Sec MTD
Phonotrauma (nodule/polyp/cyst/granuloma/hemorrhage)
Leukoplakia/Erythroplakia
SCCa
Neuro: spasmodic dysphonia, essential tremor, párkinson
Inflam: LPR, allergy, irritant, AutoImm
RRP (GI or scarring)
Primary MTD (supraglott hyperfxn)
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15
Q

Treatment of acute laryngitis (viral)

A

Hydration

Voice rest

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16
Q

Chronic laryngitis: DX, Tx

A

4 wk+
Smoking, voice abuse, fungal infection, LPR

Remove irritating factors via smoking cessation, reflux Tx, antifungal, voice rest

17
Q

GI Tx

A 
Voice therapy 
Injection augmentation (fat, acellular debris, hyaluronic acid, carboxymethylcellulose, calcium hydroxyapatite)
Medialization laryngoplasty (Gore-Tex/Silastic implant lateral to VC)
18
Q

Add vs Abd spasmodic dysphonia

A

ADD: voice breaks during voiced vowels, strangled voice. Tx botox to thyroarytenoid/lat cricoarytenoid

ABD: voice breaks during voiceless consonants (P, F), breathy quality. Tx botox to posterior cricoarytenoid

19
Q

Neurologic diseases leading to hoarsenes

A

Parkinson, ALS, Polio, MG, EL, MS (hypofunctional, dysphagia as well)

Dystonia, essential tremor, pseudobulbar palsy (hypofunctional, iregular loudness/pitch/straining)

20
Q

Inflammatory systemic dz leading to hoarseness

A

RA (cricoarytenoid joint, with VC nodules), sarcoid (supraglottic, nodular/turban-like thickening), amyloid (true and false VC), Wegener (subglottic stenosis)

21
Q

Differentiating benign VC lesions causing hoarsenes

A

Polyp: exophytic, soft/smooth, junction of Ant/Mid thirds, opposing reactive lesion (fibrous callous), may be hemorrhagic with trauma

Nodule: bilat, symmetric, junction of Ant/Mid thirds

Cyst: fluid filled or cellular (epidermoid), in SLP

Fibrous: firm, broad, significantly affects wave, Ant/Mid thirds

Varices/ectasias: in middle of VC, singers with intermittent acute dysphonia

Granuloma: fleshy, trauma/glottic insufficiency leading to MTD 2/2 LPR, on vocal process of arytenoids

22
Q

Who gets polypoid corditis/Reinke edema?

A

Swelling of SLP

Smoker, hypothyroidism

23
Q

How often does RRP turn malignant?

A

1-2%

24
Q

Treatment of vocal process granulomas

A

regress spontaneously, become asymptomatic with voice therapy and acid reflux suppression

25
Q

Goals of voice therapy

A

retrain patient to produce best sound with least injury
unload/relieve larynx of hyperfunctional behaviors
Instill muscle memory (like training pitcher with injured arm to pitch right)
4-6 wk

26
Q

Technique for surgical removal of benign VC lesions

A

medial microflap (lift up epithelium, remove growth). If very adherent, may need to remove epithelium with lesion…could use KTP laser in this situation too

27
Q

Diseases treatable with steroid injections

A

scar, nodule, fibrous mass

28
Q

Uses of KTP laser with benign VC pathology

A 
RRP
Ectasia
Reinke edema
hemorrhagic polyp
deep fibrous masses
29
Q

Membranous vs cartilaginous glottis

A

Memb: Ant 2/3 of visible length
Cart: post 1/3 of visible length

30
Q

Why would someone continue to have LPR if on BID PPI?

A

Pepsin also regurgitates, can be active even at neutral pH
Dietary acids may activate pepsin as well
Must have dietary changes as well!

31
Q

Lifestyle interventions for LPR

A 
HOB elevated when sleeping
avoid tomato based, spicy or fatty foods
wait 3-4 hours after eating to go to bed, 60 seconds to stay upright after eating all day
Lose weight 
Don’t exercise after eating 
No caffeine, alcohol, carbonation
Avoid tight clothing 
No excessive water before bed 
Avoid overeating

ENT Secrets (79 decks)

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