Disorders of the Larynx Flashcards
Give 3 broad causes of Larynx disorders
Congenital
Acquired
Tracheostomy
Give 3 Acquired causes of larynx disorders
1) Infection/inflammation: acute epiglottitis, laryngitis
2) Neoplasia: benign or malignant
3) Vocal cord palsy
What is Laryngomalacia?
Give 4 signs
Congenital disorder of the larynx also known as a floppy larynx or congenital laryngeal stridor. Usually settles by 12-18 months
- Inspiratory Stridor: worse on exertion
- Respiratory distress
- Feeding difficulties
- Reflux
What is classically seen in Laryngomalacia
Omega shaped epiglottis
Give a bacteria which commonly causes Acute epiglottitis
Give 5 signs/symptoms and state 3 general treatments
Bacteria: Haemophilus influenza
- VERY ILL (emergency!)
- fever
- Stridor
- pain on swallowing and drooling
- respiratory distress
Treatment: Antibiotics, airway maintenance, fluids
What is Laryngitis and what is the main cause?
What is it associated with and how long does it last?
An infection of the larynx that is usually acute and of viral cause (if >3weeks chronic)
Associated with URTI (commonly occurs following) and lasts 2-3 weeks
Give 5 risk factors/ causes of Laryngitis (SCARV)
- Smoking (main)
- Allergies
- reflux
- voice abuse
- candida
Give 2 benign neoplasms of the vocal cord
How would you treat?
Singers nodules (adults) or ‘screamers’ nodules (children)
Treat with speech therapy to prevent furthur nodule build up
Are polyps and papillomas of the cords usually benign or malignant?
How would you treat?
Can be either, but usually benign.
Difficult to determine so we must remove them to access whether they are cancerous
What is Reinkes oedema and who is at most risk?
fluid build up in the surface of the vocal folds, causing swelling and distension
SMOKERS most at risk!!
What are the main 2 signs associated with most larynx problems?
1) Hoarsness
2) Airway problems
What is the most common malignant neoplasm of the larynx?
Is it more common in males or female?
Squamous cell carcinoma
M:F 5:1
What are the 2 biggest risk factors for neoplasias of the larynx?
Give 2 other risk factors?
MAIN: Smoking and Alcohol
Others: Over 70 and HPV
How can neoplasias of the larynx be divided?
State the 3 divisions and their prognosis
By where they occur:
- Supraglottis
- Glottis (good prognosis)
- Subglottis (poor prognosis)
Give 6 red flags that may indicate malignant neoplasias of the larynx
(SSHH keep it DOWN)
- Sore throat
- SOB
- Hoarse
- Haemoptysis
- Dysphagia
- Otalgia
- Weight loss
- Neck lump
Give the most common signs and history associated with hypopharyngeal/ laryngeal carcinomas
- Hoarseness
- FB sensation in throat
- Dysphagia
- Odynophagia
- Otalgia (referred pain – vagus)
- Coughing (aspiration, haemoptysis)
- Weight loss
- Smoking history (pack/years)
What are we looking for on examination of a suspected hypopharyngeal/ laryngeal carcinoma?
What device is used to examine this?
Loss of laryngeal crepitus (fixed larynx) and cervical lymph node metastasis
Examined using a fibre-optic endoscopy
Give 2 investigations that can be done for a suspected hypopharyngeal/ laryngeal carcinoma
1) CT/MRI (Head, Neck, Chest)
2) Direct pharyngo-laryngo-oespohagoscopy and biopsy
How are hypopharyngeal/ laryngeal carcinomas staged?
Using TNM staging (tumor, node, metastisis)
List 3 potential management options for a hypopharyngeal/ laryngeal carcinoma?
1) Radiotherapy +/- chemotherapy
2) Surgery
3) Palliation
List 3 types of surgeries used to treat a hypopharyngeal/ laryngeal carcinoma
1) Laryngectomy
2) Pharyngo-laryngectomy
3) Radical or selective neck dissections of lymph nodes
What has this patient had?
Laryngectomy- removal of the larynx results in trachea open through a hold in the neck
Give 3 things patients who have had a laryngectomy are limited/can not do
1) can’t sniff or smell (because air cannot be drawn into nose)
2) inhalation of air is cold and dry (because air does not pass through nose) so filter may be required
3) speech difficulties
List 4 ways in which speaking can be achieved after a laryngectomy
1) speaking valve
2) oesophageal speech
3) electronic larynx
4) ilent articulation
A vocal cord palsy is usually caused by damage to what nerve?
Give 6 causes (TIC TAC)
Recurrent Laryngeal Nerve Palsy
- Trauma (thyroidectomy)
- Idiopathic (most common)
- Cancer
- Thyroid disease (benign or malignant)
- Aortic aneurysm
- Cervical lymphadenopathy
- neuropathic (diabetes)
Give 3 cancers that may cause a recurrent laryngeal nerve palsy
1) larynx
2) oesophageal
3) apical lung
Which side is damaged in the image below? (recurrent laryngeal nerve palsy)
Left because we can see the arytenoids are slightly angled in
But difficult to tell because we dont know what stage of phonation they are in
What procedure is done to establish an airway in an emergency and explain what we are trying to achieve?
Tracheostomy in order to bypass the larynx
A tracheostomy provides direct access to the trachea by surgically making an opening in the neck maintained by a tracheostomy tube
Label on the image below the anatomical locations we MUST identify for a tracheostomy and how we do this
We must identify the cricothyroid ligament (between the laryngeal prominence and arch of cricoid cartilage)
This is usually placed between the first to the fourth tracheal rings
Give 4 indications for a tracheostomy
1) obstruction of the upper airway eg. foreign body, trauma, infection, laryngeal tumour, facial fractures.
2) Impaired respiratory function eg. unconsciousness, bulbar poliomyelitis.
3) To assist weaning from ventilatory support in patients in intensive care
4) To help clear secretions in the upper airway.
How we would perform a tracheostomy in an emergency NOT in hospital
a tracheotomy can be performed through the cricothyroid membrane
