ENT Flashcards
what is the aetiology of laryngeal cancer?
no known cause but there are risk factors such as
- age
- excessive alcohol consumption
- smoking
- HPV infection
- family history
- acid reflux
What are the symptoms of laryngeal cancer?
hoarseness/change in voice for over 3 weeks
weight loss
difficulty in swallowing
lump in neck
What is the diagnosis process of laryngeal cancer?
- see GP
- be referred to ENT where they will give you an endoscopy and may biopsy
- once cancer has been confirmed then they will test for its stage, this might include CT, MRI or PET
what is the management process for laryngeal cancer?
dependent on type of cancer and stage
T1&2= transoral laser surgery, partial laryngectomy, radio
T3 = chemoradiotherapy, potentially surgery
T4 = chemo, radiotherapy, total laryngectomy and removal of lymph nodes
Discuss speech restoration after a laryngectomy
patients are no longer able to breathe through their mouths but instead breathe through the hole in their throat called a STOMA.
Pre-surgery they will have an SLT consult
Post-surgery there are three types of alternative communication
what are the three types of alternative communication available after a total laryngectomy?
- tracheo oesophageal puncture TEP/voice prosthesis
- oesophageal speech
- electrolarynx
what is a TEP?
when the surgeon makes a fistula at the back of the stoma, then inserts a speech valve (or voice prosthesis).
when the patient puts their finger over the stoma, the air is diverted through the puncture and up through the oesophagus. The muscles of the pharynx vibrate as air passes through, producing phonation needed.
what are the disadvantages of TEP?
the muscles of the pharynx can go into spasm
you cannot breath whilst your finger is over the stoma so speech is very segmented as time for breathing is allowed.
what is oesophageal speech?
it is when you move air down your oesophagus, as the air passes it vibrates the muscles in the throat, and the articulators move as you are speaking
what are the advantages of oesophageal speech?
you need no equipment
what are the disadvantages of oesophageal speech?
it can be very hard to learn
what is an electrolarynx?
a battery operated machine that produces vibration for you in order that you may have voicing.
It is useful if you cannot have a speech valve for medical reasons, however they can sound very mechanical and not like ‘normal’ speech
what are the functions of the larynx?
- to prevent choking
- protection of the LRT
- phonation
when doing an oral exam, what kind of findings would be abnormal?
lesions dry/cracked lips red, inflammation of tongue, cheeks or gums bleeding gums swollen tonsils/uvula exudate
a grayish membrane covering the tonsils, uvula and soft palate is indicative of what?
glandular fever
what are the symptoms of laryngitis?
hoarseness
sore throat
mild fever
what causes laryngitis?
- viral infection e.g. cold/flu
- damage to larynx - usually by straining your voice
how is laryngitis treated?
told not to smoke, drink plenty water, rest voice
what is a tracheostomy?
it is an opening created at the front of the neck so a tub can be inserted into the trachea TO AID BREATHING
Why would a tracheostomy be used?
to allow breathing if
- muscles are too weak
- if your throat is blocked
to reduce the risk of aspiration
how is a trache carried out?
incision made below the vocal chords
what is the difference between a tracheostomy and a laryngectomy?
in a trache there is still a continuation - the tube may bypass the larynx but the larynx is still there.
in a laryngectomy there is no epiglottis or larynx at all, the base of tongue is connected right to the oesophagus
what allows voicing in a tracheostomy?
fenestration
what are some complications of a trache tube?
- ulceration/bleeding due to movement of fenestration tube
- pneumothorax
what causes snoring?
relaxed upper respiratory tract (tongue, mouth, throat)
risk factors of snoring are
being overweight smoking drinking sleeping on your back -- more seriously sleep apnoea can cause snoring --
what are the five functions of the nose?
- airway
- filtration
- humidification
- temperature control
- smell (olfaction)
what causes sinusitis?
an upper respiratory tract infection (e.g. cold)
what are the symptoms of sinusitis?
discharge from nose
blocked nose
sinus headache
how would you treat sinusitis?
painkillers
decongestants
if persistent GP will prescribe antibiotics/corticosteroid spray
what are some worrying nasal symptoms?
if any kind of symptom is only unilateral
bleeding
visual symptoms
cheek swelling
what is epistaxis?
nosebleeding
what causes epistaxis?
trauma
irritation (picking yir nose ya weirdo)
spontaneous
if your’e on blood thinners/anticoagulants that cause you to bleed more easily
how do you stop epistaxis?
pinch top of the nose, put pressure on it in order to help the blood clot
what are the symptoms in nasal polyps?
blocked nose
runny nose
reduced olfaction
obstructive sleep apnoea OSA
what causes nasal polyps?
inflammation of the nasal lining
asthma can be a trigger
how would you diagnose nasal polyps?
endoscopy
how would you treat nasal polyps?
corticosteroid spray/tablets
surgery if persistent
what is a deviated nasal septum?
septum displaced to one side making one nasal passage smaller
what causes a deviated septum?
congenital
injury to the nose
how would a deviated septum be treated?
medical management (decongestants) until surgery = septoplasty
what are adenoids?
part of the immune system in a child, they disappear in adults
why would adenoids be removed?
if they are swollen and causing breathing and sleeping difficulties
also if there is persistent otitis media
what will be done to treat infected/swollen adenoids?
adenoidectomy surgery
discuss allergic rhinitis
commonly known as having allergies
these are inhaled substances that cause hypersensitivity
symptoms include congestion and sneezing
it is treated with antihistamines or steroids
what happens physiologically in cleft palate?
the maxillary bone does not properly fuse which results in the cleft of bone and mucosa
what does cleft palate pose a problem to?
- feeding
- hearing
- speech
- respiration
what is a pharyngeal pouch?
a diverticulum (abnormal sac) of the inferior pharyngeal constrictors
what are the symptoms of a pharyngeal pouch?
dysphagia
regurgitation
halitosis
