Disorders of the Larynx

Question 1

Give 3 broad causes of Larynx disorders

Answer 1

Congenital

Acquired

Tracheostomy

Question 2

Give 3 Acquired causes of larynx disorders

Answer 2

1) Infection/inflammation: acute epiglottitis, laryngitis
2) Neoplasia: benign or malignant
3) Vocal cord palsy

Question 3

What is Laryngomalacia?

Give 4 signs

Answer 3

Congenital disorder of the larynx also known as a floppy larynx or congenital laryngeal stridor. Usually settles by 12-18 months

1. Inspiratory Stridor: worse on exertion
2. Respiratory distress
3. Feeding difficulties
4. Reflux

Question 4

What is classically seen in Laryngomalacia

Answer 4

Omega shaped epiglottis

Question 5

Give a bacteria which commonly causes Acute epiglottitis

Give 5 signs/symptoms and state 3 general treatments

Answer 5

Bacteria: Haemophilus influenza

• VERY ILL (emergency!)
• fever
• Stridor
• pain on swallowing and drooling
• respiratory distress

Treatment: Antibiotics, airway maintenance, fluids

Question 6

What is Laryngitis and what is the main cause?

What is it associated with and how long does it last?

Answer 6

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

Question 7

Give 5 risk factors/ causes of Laryngitis (SCARV)

Answer 7

1. Smoking (main)
2. Allergies
3. reflux
4. voice abuse
5. candida

Question 8

Give 2 benign neoplasms of the vocal cord

How would you treat?

Answer 8

Singers nodules (adults) or ‘screamers’ nodules (children)

Treat with speech therapy to prevent furthur nodule build up

Question 9

Are polyps and papillomas of the cords usually benign or malignant?

How would you treat?

Answer 9

Can be either, but usually benign.

Difficult to determine so we must remove them to access whether they are cancerous

Question 10

What is Reinkes oedema and who is at most risk?

Answer 10

fluid build up in the surface of the vocal folds, causing swelling and distension

SMOKERS most at risk!!

Question 11

What are the main 2 signs associated with most larynx problems?

Answer 11

1) Hoarsness
2) Airway problems

Question 12

What is the most common malignant neoplasm of the larynx?

Is it more common in males or female?

Answer 12

Squamous cell carcinoma

M:F 5:1

Question 13

What are the 2 biggest risk factors for neoplasias of the larynx?

Give 2 other risk factors?

Answer 13

MAIN: Smoking and Alcohol

Others: Over 70 and HPV

Question 14

How can neoplasias of the larynx be divided?

State the 3 divisions and their prognosis

Answer 14

By where they occur:

1. Supraglottis
2. Glottis (good prognosis)
3. Subglottis (poor prognosis)

Question 15

Give 6 red flags that may indicate malignant neoplasias of the larynx

(SSHH _{keep it} DOWN)

Answer 15

1. Sore throat
2. SOB
3. Hoarse
4. Haemoptysis
5. Dysphagia
6. Otalgia
7. Weight loss
8. Neck lump

Question 16

Give the most common signs and history associated with hypopharyngeal/ laryngeal carcinomas

Answer 16

1. Hoarseness
2. FB sensation in throat
3. Dysphagia
4. Odynophagia
5. Otalgia (referred pain – vagus)
6. Coughing (aspiration, haemoptysis)
7. Weight loss
8. Smoking history (pack/years)

Question 17

What are we looking for on examination of a suspected hypopharyngeal/ laryngeal carcinoma?

What device is used to examine this?

Answer 17

Loss of laryngeal crepitus (fixed larynx) and cervical lymph node metastasis

Examined using a fibre-optic endoscopy

Question 18

Give 2 investigations that can be done for a suspected hypopharyngeal/ laryngeal carcinoma

Answer 18

1) CT/MRI (Head, Neck, Chest)
2) Direct pharyngo-laryngo-oespohagoscopy and biopsy

Question 19

How are hypopharyngeal/ laryngeal carcinomas staged?

Answer 19

Using TNM staging (tumor, node, metastisis)

Question 20

List 3 potential management options for a hypopharyngeal/ laryngeal carcinoma?

Answer 20

1) Radiotherapy +/- chemotherapy
2) Surgery
3) Palliation

Question 21

List 3 types of surgeries used to treat a hypopharyngeal/ laryngeal carcinoma

Answer 21

1) Laryngectomy
2) Pharyngo-laryngectomy
3) Radical or selective neck dissections of lymph nodes

Question 22

What has this patient had?

Answer 22

Laryngectomy- removal of the larynx results in trachea open through a hold in the neck

Question 23

Give 3 things patients who have had a laryngectomy are limited/can not do

Answer 23

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

Question 24

List 4 ways in which speaking can be achieved after a laryngectomy

Answer 24

1) speaking valve
2) oesophageal speech
3) electronic larynx
4) ilent articulation

Question 25

A vocal cord palsy is usually caused by damage to what nerve? Give 6 causes (TIC TAC)

Answer 25

Recurrent Laryngeal Nerve Palsy 1. Trauma (thyroidectomy) 2. Idiopathic (most common) 3. Cancer 4. Thyroid disease (benign or malignant) 5. Aortic aneurysm 6. Cervical lymphadenopathy 7. neuropathic (diabetes)

Question 26

Give 3 cancers that may cause a recurrent laryngeal nerve palsy

Answer 26

1) larynx 2) oesophageal 3) apical lung

Question 27

Which side is damaged in the image below? (recurrent laryngeal nerve palsy)

Answer 27

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

Question 28

What procedure is done to establish an airway in an emergency and explain what we are trying to achieve?

Answer 28

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

Question 29

Label on the image below the anatomical locations we MUST identify for a tracheostomy and how we do this

Answer 29

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

Question 30

Give 4 indications for a tracheostomy

Answer 30

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.

Question 31

How we would perform a tracheostomy in an emergency NOT in hospital

Answer 31

a tracheotomy can be performed through the cricothyroid membrane