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m4 ENT > Hoarseness > Flashcards

Hoarseness Flashcards

1
Q

Function of larynx

A
  1. Regulate flow of air into our lungs
  2. Protect airway from choking on material in the throat
  3. Cough reflex
  4. Voice production
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2
Q

Subsites of larynx

A

Supraglottis
Glottis
Subglottis

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3
Q

Recurrent laryngeal nerve innervation

A
  • Sensory innervation to glottis and subglottis
  • Motor innervation to all internal muscles of larynx, except cricothyroid muscle
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4
Q

Superior laryngeal nerve innervation

A
  • Internal branch provides sensory innervation to supraglottis
  • External branch provides motor innervation to cricothyroid muscle
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5
Q

Function of cricothyroid muscle

A

Tenses vocal folds producing high-pitched sounds
- Supplied by external branch of superior laryngeal nerve

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6
Q

Pathway of RLN

A

Loops around subclavian artery

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7
Q

Pathway of LLN

A

Loops around arch of aorta

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8
Q

Arterial supply to larynx

A

Superior laryngeal artery
- branch of superior thyroid artery (from ECA)

Inferior laryngeal artery
- branch of inferior thyroid artery (from thyrocervical trunk)

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9
Q

Venous drainage of larynx

A

Superior laryngeal vein
-> superior thyroid -> IJV

Inferior laryngeal vein
-> inferior thyroid -> left brachiocephalic vein

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10
Q

Common causes of hoarseness

A

Infection
- Infective Laryngitis (acute/chronic)
- Croup/acute laryngotracheobronchitis

Inflammatory
- Vocal cord nodules
- Vocal cord cysts
- Reinke’s edema

Neoplastic
Benign
- Vocal cord polyp
- Vocal cord papilloma

Malignant
- Larynx carcinoma

Others
- Vocal cord paralysis

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11
Q

Management for acute/chronic infective laryngitis

A

Symptomatic
- voice rest
- hydration
- cough suppressants

+/- abx

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12
Q

Causes of chronic infective laryngitis

A

Tuberculosis
Chronic sinusitis
Laryngopharyngeal reflux

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13
Q

Clinical features of croup/acute laryngotracheobronchitis

A

Hoarseness of voice
Inspiratory stridor
Barking cough

*Symptoms are worse at night

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14
Q

Vocal cord polyp

A
  • Unilateral, usually pedunculated
  • Smooth surfaces, regular edges, well-circumscribed
  • No necrosis or hemorrhage
  • Can be caused by overuse/ misuse of voice
  • Endolaryngeal microsurgery (ELMS)
  • Originates from stratified squamous non-keratinizing epithelium (first layer)
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15
Q

Vocal cord papilloma

A
  • HPV 6 and 11
  • Always biopsy first TRO SqCC
  • Advise patient that it’s recurrent, so observe only unless obstructing airway
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16
Q

Vocal cord nodule

A
  • Bilateral, symmetrical, smooth, well-circumscribed, hemispherical
  • Typical location is at junction of anterior 1/3 and posterior 2/3 of true vocal folds in superficial lamina propria
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17
Q

Causes of vocal cord nodules

A
  • Found in singers and teachers
  • A/w voice abuse/ chronic voice strain, heavy smoking
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18
Q

How does vocal cord nodules form?

A
  • Chronic friction of vocal cords on each other –> callus formation –> Vocal cord nodules
  • Early nodules are soft and 2° to submucosal hemorrhage while mature nodules are firm and due to fibrosis
  • Thickened epithelium over matrix of fibrin and collagen
19
Q

Management of vocal cord nodules

A

Voice rest
Hydration
Learn proper vocal hygiene
Speech therapy
Tx underlying causes (E.g., cough, reflux, stop smoking, shouting, prolonged conversations)

20
Q

Vocal cord cyst

A
  • In superficial lamina propria
  • ELMS
  • affects one layer deeper than vocal cord polyps
21
Q

Reinke’s edema

A

Fluid in Reinke’s space causing swelling of vocal cords
- Voice quality is rough and low pitch

“2 bags of water”

22
Q

Causes of Reinke’s edema

A

Smoking
LPR
Hypothyroidism (Due to myxedema)

23
Q

Suspect vocal cord paralysis in patients presenting with

A

Hoarseness &
Cough whenever eating/drinking ie aspiration risk

24
Q

Causes of unilateral vocal cord paralysis

A

Iatrogenic
- Thyroidectomy
- CABG
- C-spine Sx
- Esophageal Sx
- Intubation causing traction and stretching

Neoplastic
- Lung CA (Pancoast tumour)
- Thyroid CA (Commoner)
- Esophageal CA

Trauma
- Blunt injury
- Deep neck lacerations

Neurological
- Posterior circulation stroke
- Multiple sclerosis

Neuromuscular
- GBS
- Myasthenia gravis

Idiopathic

25
Q

Most pertinent investigation to send for vocal cord paralysis

A

CT scan from base of skull to thorax TRO malignancy

26
Q

Management of vocal cord paralysis

A
  1. Type 1 thyroplasty: implant
  2. Injection medialisation of vocal cords
    *paralyzed vocal fold (vocal cord) is pushed to the middle so that the functioning vocal fold can close properly
27
Q

What do the positions of the paralysed vocal cords indicate?

A

Lateral: Poor voice but good airway
Medial: Good voice but poor airway

28
Q

Laryngeal carcinoma is mostly what type of carcinoma?

A

Squamous cell carcinoma

29
Q

Risk factors for laryngeal Ca

A
  1. smoke
  2. alcohol
  3. reflux
  4. paint
  5. hpv
30
Q

Hoarseness >3 weeks in duration

A

Refer ENT TRO malignancy

31
Q

Symptoms of laryngeal ca

A
  1. Chronic hoarseness
  2. Cough
  3. Neck lump
  4. Globus feeling
  5. Throat irritation
  6. Blood stained sputum
32
Q

Treatment of laryngeal Ca

A

Histological confirmation via biopsy
Stage: CT larynx & thorax

Surgical:
- Trans-oral laser resection
- Open surgery
-> Partial laryngectomy
-> Total laryngectomy

Non Surgical
- Radiation
- Chemo-radiation

33
Q

Speech rehabilitation options post-larynectomy/for laryngeal speech

A

Esophageal speech
Electrolarynx
Transesophageal puncture and voice prosthesis

34
Q

What scale is used to assess hoarseness?

A

GRBAS
Subjective grading from 0-3
Roughness (Irregularity of vibration)
Breathiness (Air leakage)
Asthenia (Weakness)
Strain (Muscle tension)

35
Q

Gold standard examination for hoarseness

A

Strobovideolaryngoscopy

36
Q

What is VHI 10?

A

Video handicap index
- Self-rating questionnaire that determines impact of perceived vocal abnormality on day to day life of patient
- 10 items
- Grade 0-4
- VHI score >11 is considered abnormal

37
Q

Extrinsic muscle of larynx

A

Cricothyroid

38
Q

Intrinsic muscle of larynx

A

Adductors:
Thyroarytenoid: Adductor Portion
Lateral Cricoarytenoid
Interarytenoid
Transverse Arytenoid

Abductor:
Posterior cricoarytenoid

39
Q

Causative organism of croup

A

Viral infection (most commonly parainfluenza virus)

40
Q

Age of incidence for croup

A

6 months - 3 years old

41
Q

Symptoms of croup are worse when?

A

At night

42
Q

Secondary bacterial superinfection in croup can be caused by

A

Staph Aureus (give abx)

43
Q

What sign can be observed in anterior neck xray for croup?

A

Steeple sign
(Subglottic tracheal narrowing mimics shape of church steeple)

44
Q

Management of croup

A
  • Anti-pyretics
  • Mist Tx
  • Avoid smoking at home
    -Humidified air, oxygen

If severe
- IV fluids
- Oral dexamethasone to reduce airway swelling (IV too)
- Nebulized adrenaline
- Intubation

m4 ENT (25 decks)

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