Disorders of the Larynx and Upper Trachea Flashcards
Dysphonia
any change in voice, most cases resolve with out tx w/in a month
Hoarseness
difficulty making sounds when trying to speak. Vocal sounds may be weak, breathy, scratchy, or husky, and the pitch or quality of the voice may change.
Stridor
noisy breathing caused by airflow through a narrow airway (implies airway obstruction)
Congenital Disorders
laryngomalacia
tracheomalacia
subglottic stenosis
Infectious Disorders
epiglottitis laryngotracheobronchitis (croup) membranous tracheitis TB syphilis fungal infections
Neoplastic Disorders
laryngeal carcinoma
recurrent respiratory papillomatosis
Traumatic Disorders
can occur with or with out open neck injury
signs and symptoms: dyspnea/stridor dysphonia/aphonia cough/hemoptysis neck pain dysphagia/odynophagia tenderness of larynx subcutaneous emphysema
What is the “thumbprint sign”?
acute epiglotitis
What is the “steeple sign”?
croup
What are the typical signs and symptoms of glottis cancer?
hoarseness and voice change respiratory difficulty throat pain otalgia (ear pain) cough, hemoptysis dysphagea weight loss
Laryngeal Neoplasm:
males more common
> 90% SCCA
Tx of a laryngeal neoplasm:
radiation- good for smaller cancer (>85% cure rate), maybe be used in combo with surgery
GERD
acid from the stomach in the larynx or esophagus
symptoms: dysphagia dysphonia chronic throat clearing excessive throat mucus voice fatigue globus
Tx of GERD:
modify diet and lifestyle
H2 blockers
proton pump inhibitor
anti reflux inhibitor
Voice Abuse:
contact ulcer of larynx or nodules
symptoms:
hoarseness
neck pain on exertion
Tx of voice abuse:
ENT referral
- voice therapy
- voice rest
- microlaryngoscopy
- rarely excision of lesion
What are the types of stridor?
inspiratory- supraglottic
expiratory- trachea or distal airway (wheezing as in asthma)
biphasic- glottic or subglottic
How do we dx GERD?
clinically with flexible laryngoscopy
gold standard is 24 hr double pH probe monitor
How do we diagnose laryngeal trauma?
neck CT- look for fracture of laryngeal cartilages
How do we tx laryngeal trauma?
if airway is unstable plan for tracheostomy
if no fx: voice rest, humidified O2, steroids
if fracture: consult
Laryngomalacia
stridor- usually insiratory, occuring several weeks after birth
MOST COMMON CONGENITAL ANOMALY CAUSING AIRWAY OBSTRUCTION
immature laryngeal cartilage
spontaneous resolution, tracheotomy if not/laser surgery
Tracheomalacia
Immature tracheal rings
trachea collapses on exhalation
young children with multiple bouts of pneumonia
Tx for tracheomalacia:
observation
CPAP
possible tracheostomy
Subglottic Stenosis:
congenital or acquired
prolonged intubation
prevention with proper sized endotracheal tube, avoid prolonged intubation, tracheotomy
Acute epiglottitis:
rapidly progressing acute laryngitis
etiology: H influenza B (less common with vaccine)
MEDICAL EMERGENCY- fatal with in hours
Signs and symptoms of epiglottitis:
sore throat with rapid progression to dysphagia, refusal of feeds, “hot potato” voice
prefer to be upright slightly leaning forward (“flower sniffing position”)
DO NOT USE TONGUE BLADE
Tx of epiglottitis:
ENT consult
blood culture if adult
OR for oral intubation, direct laryngoscopy, possible tracheostomy (if unable to intubate)
broad spectrum abx (IV) if : h. influenza, staph, strep
Acute Laryngotracheobronchitis:
CROUP
infection of lower respiratory passage way
viral in etiology, most likely para influenza
Symptoms of Croup:
barking cough, fever
Tx of Croup:
hospitalize and observe
steroids, racemic epinephrine
consider broad spectrum abx
when in doubt intubate
Membranous tracheitis
Atypical croup
staph aureus, strep pneumo
symptoms similar to croup but with a higher fever
Tx of membranous tracheitis:
broad spectrum abx
pts do not respond to epinephrine
Risk Factors for Laryngeal Carcinoma:
smoking and alcohol (HUGE FACTORS)
AA/whites > asian/latino
HPV
GERD
YOU CAN ONLY RADIATE AND AREA ONCE!
KNOW THAT
What is the most common benign neoplasm of the larynx?
recurrent respiratory papillomatosis (a/w hpv 6 & 11)
Tx of recurrent respiratory papillpmatosis?
excision w/ cold instruments or laser, intralesional cidofovir, intralesional bevacizumab (avastin)
