Dysphonia and Obstructive Sleep Apnoea Flashcards
What causes snoring?
Obstructive sleep apnoea and snoring can be considered as a spectrum of disease. Snoring is caused by partial obstruction to the upper airway during sleep from anywhere from the level of the nose to the larynx.
What is obstructive sleep apnoea?
In obstructive sleep apnoea there is a complete obstruction of the airway which requires the patient to wake up to alter their position in order to open up the airway again. Repeated apnoea in a night leads to a poor night’s sleep and strain on the cardiovascular system, tiredness during the day and a compensated respiratory acidosis.
What are the risk factors for obstructive sleep apnoea?
Obesity
Macroglossia from acromegaly, hypothyroidism and amyloidosis
Large tonsils
Marfan’s syndrome
How should obstructive sleep apnoea be investigated?
BMI
TFT – for Hypothyroidism
CXR – for signs of obstructive lung disease
ECG – for signs of right ventricular failure
Sleep study – polysomnography including pulse oximetry, ECG, respiratory flow, chest and abdomen movement and snoring
Epworth sleepiness scale – questionnaire completed by the patient and partner
Multiple sleep latency test – measures the time to fall asleep in a dark room using EEG criteria
How is obstructive sleep apnoea managed?
Advice and lifestyle changes including weight loss
CPAP – Continuous Positive Airway Pressure (mainstay of OSA treatment)
Mandibular positioning devices in patients where CPAP is not tolerated or for patients with mild disease where there is no daytime sleepiness
DVLA should be informed if daytime sleepiness is excessive
Surgery – adenotonsillectomy in children, rarely a treatment for adults
What is dysphonia?
This means hoarseness which occurs as a result of difficulty producing sound resulting in changes in pitch or quality of speech.
What presentation requires immediate investigation in relation to hoarseness?
It is vitally important to investigate hoarseness in smokers where its lasted >3 weeks.
What specific queries should be made in a history of a person with dysphonia?
Should also ask about GORD, dysphagia, smoking, stress, singing and shouting.
How is dysphonia investigated?
Laryngoscopy to assess cord mobility
What causes dysphonia?
Laryngeal cancer – progressive and persistent gruff voice
Vocal cord palsy causing a weak breathy sound
Laryngitis – viral, strain, bacterial or secondary to GORD
Reinke’s Oedema – chronic cord irritation from smoking – most commonly seen in hypothyroid female smokers.
Vocal cord nodules – occur due to vocal abuse resulting in a husky voice. Fibrous nodules form at the junction of the cords. Treat with speech therapy and surgical excision.
What is spasmodic dysphonia?
Spasmodic dysphonia – unknown cause that results in involuntary spasms of the vocal cords producing a strained strangled break in connected speech. Treat with botox into the laryngeal muscles.
What is muscle tension dysphonia?
Muscle tension dysphonia – functional disorder as a result of abnormal laryngeal muscle tension. Husky voice that tires easily. Associated with voice misuse and psychological stress. Refer to speech therapist.
What muscles does the recurrent laryngeal nerve innervate?
Intrinsic laryngeal muscles are all innervated by the recurrent laryngeal nerve (apart from cricothyroideus) which is a branch of the vagus nerve.
How does recurrent laryngeal nerve palsy present?
A weak breathy voice with a weak cough
Repeated coughing/aspiration
Exertional dyspnoea (because a narrow glottis reduces airflow) but note whilst at rest the contralateral cord may abduct to compensate.
What causes recurrent laryngeal nerve palsy?
Cancers – 30%, larynx, thyroid, oesophagus, hypopharynx or bronchus (Pancoast tumours)
Iatrogenic – 25% occur after surgery
CNS disease such as polio or syringomyelia
TB
Aortic aneurysm
