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13 ENT > Hoarseness > Flashcards

Hoarseness Flashcards

1
Q

largest cartilage in the larynx

A

thyroid cartilage: provides support and protection for the vocal folds

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2
Q

vocal ligaments are attached to the __ of the thyroid cartilage

A

anterior inner surface

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3
Q

chief moving parts of the larynx

A

arytenoid cartilage

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4
Q

arytenoid cartilage connects to the cricoid or thyroid via __

A

intrinsic laryngeal muscles (thyroarytenoid, lateral cricoarytenoid, interarytenoid, posterior cricoarytenoid)

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5
Q

the only complete rigid ring within the airway

A

cricoid cartilage

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6
Q

adductor muscles

A 
thyroarytenoid
lateral cricoarytenoid (major)
interarytenoid
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7
Q

only abductor in the larynx

A

posterior cricoarytenoid

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8
Q

muscle with no direct action on arytenoid motion

A

cricothyroid myscle

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9
Q

major action of thyroarytenoid muscles

A

shorten or tense vocal fold and increase cross sectional area

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10
Q

histology of vocal folds

A

read

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11
Q

nerve supply

A

superior laryngeal nerves

  • internal: sensory
  • external: motor

recurrent laryngeal nerves
- supplies other intrinsic laryngeal muscles

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12
Q

mechanisms to close glottis

A
  • elastic recoil of soft tissues (myoelastic)

- negative pressure sucks the folds together (aerodynamic)

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13
Q

disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life

A

hoarseness

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14
Q

most frequent cause of hoarseness

A

inflammatory diseases (viral infection)

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15
Q

vocal fold nodules vs reflux laryngitis

A

vocal fold nodules: voice better in the morning, worsens during day

reflux pharyngitis: worse in the morning, gets better during day

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16
Q

t/f allergic attacks can trigger vocal fold swelling

A

true

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17
Q

breathy voice finding meanas

A

inadequate apposition of vocal fold edges (vocal fold paralysis, old age, mass lesions)

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18
Q

general rule in larynx visualization

A

should be visualized or referred to clinician who can if hoarseness persists for more than 2 weeks with any of the ff:

  • history of alcohol/tobacco abuse
  • concomitant discovery of neck mass
  • after trauma
  • assoc hemoptysis, dysphasia, or dyspnea
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19
Q

easiest and least expensive method to visualize larynx

A

indirect laryngoscopy (mirror)

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20
Q

t/f indirect laryngoscopy is more detailed than laryngeal endoscopy

A

false, LE is more detailed

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21
Q

indications for direct laryngoscopy

A

concomitant procedure (needs sedation)

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22
Q

gold standard laryngoscopy

A

largneal videostroboscopy (LVES)

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23
Q

etiology of vocal fold nodules

A

due to vocal abuse or misuse

  • talkativeness index score
  • professions with high vocal commitment
24
Q

suspect vocal fold nodules in _

A
  • pt who report voice fatigue assoc with voice use
  • pt voice worsens at end of day or week
  • pt chronically hoarse
25
Q

clinical presentation of vocal fold nodules

A
  • recurrent eventually chronic hoarseness worse at the end of the work day or week
  • harsh, breathy, loss of range, vocal fatigue
  • L: smooth bumps at junction of anterior and middle thirds of VFs, bilateral!!, symmetrical
26
Q

treatment for vocal fold nodule

A

voice therapy 6-12 wks, surgical excision

27
Q

etiology of vocal fold hemorrhage

A

abrupt onset during extreme vocal effort (men in noisy place)

28
Q

presentation of vocal fold hemorrhage

A
  • rough, husky, easy vocal fatigue, loss of high register

- laryngoscopy: superficial bruise with no vf edge convexity

29
Q

treatment for vocal fold hemorrhage

A

voice rest, short voice therapy, laser ablation

30
Q

etiology of vocal fold polyp

A

intermittent, severe voice abuse (m>w)

31
Q

presentation of vocal fold polyp

A
  • hoarseness like vf hemorrhage but worse and longer

- L: unilateral, broad-based or pedunculated mass, prominent vessels

32
Q

treatment for polyp

A

voice therapy, steroid use, surgical excision

33
Q

etiology of vocal fold cyst

A

congenital: epidermal inclusion cyst
acquired: blocked mucous gland cyst

vocal abuse/misuse

34
Q

presentation of vocal fold cyst

A
  • chronic or recurrent hoarseness
  • rough, breathy, loss of range, fatigue
  • L: found on superficial!! layer, unilateral!!
35
Q

types of vocal fold cyst

A

mucous retention cyst: mucus, fluid filled

epidermal inclusion cyst: caseous material, pearl like

36
Q

treatment for vocal fold cyst

A

trial voice therapy, surgery

37
Q

etiology of vocal fold granulomas

A

acid reflux, hoarseness when severe

38
Q

presentation of vf granuloma

A
  • low gravelly or husky voice

- L: granulomatous, unilateral, mass at posterior portion of vocal fold

39
Q

treatment for vf granulomas

A

conservative: reflux control, voice therapy

biopsy and surgery if fails

40
Q

etiology of reinke’s edema / bilateral diffuse polyposis or polypoid corditis

A
  • chronic irritation or inflammation
  • classic: female, smoker, avid talker
  • irritation = vascular congestion and venous stasis = edema
41
Q

presentation of reinke’s edema

A
  • low, coarse and gruff voice

- L: floppy vfs, elephant ear appearance, watery bags attached to vf

42
Q

treatment for reinke’s edema

A
  • smoking cessation, voice therapy, voice hygiene

- surgery

43
Q

etiology of laryngeal papilloma

A

hpv 6 and 11

44
Q

presentation of laryngeal papilloma

A
  • rough breathy voice

- dyspnea due to obstructive, bulky lesions

45
Q

treatment of laryngeal papilloma

A
  • serial surgical excision (recurrent)
  • intralesional injection with cidofovir (delays growth)
  • prevention: immunization, safe sex
46
Q

etiology of laryngeal cancer

A
  • most common site is vocal fold

- risk factors: smoking and alcohol

47
Q

presentation of laryngeal cancer

A
  • progressive hoarseness

- L: exophytic or infiltrating, friable irregular mass, can extend outside vf

48
Q

treatment of laryngeal cancer

A

surgery, chemoradiation

49
Q

etiology of vf paralysis

A

most common is iatrogenic

50
Q

presentation of vf paralysis

A
  • hoarseness from immobility
  • variable presentation

treatment: voice therapy, sugery

51
Q

etiology of laryngitis

A

most common: viral infection, bacterial is rare

52
Q

presentation of laryngitis

A
  • rough voice with aphonia
  • associated symptoms
  • L: boggy, edematous, erythematous
53
Q

treatment for laryngitis

A

non-specific, voice rest, control coughing and throat clearing, hydration, control post nasal drip, nsaid

54
Q

presentation of laryngopharyngeal reflux

A
  • globus
  • frequent throat clearing and irritation
  • intermittent cough
  • L: post cricoid and arytenoid edema or thickening, vf edema, thick mucus
55
Q

treatment for laryngoesophageal reflux

A

long term antacids, dietary restriction, lifestyle modfication

56
Q

presentation of presbylaryngeus

A
  • loss of tone and deconditioning
  • weak, breathy voice, vocal fatigue
  • L: vocal fold bowing

treatment: voice therapy, surgery

57
Q

t/f cold drinks can worsen hoarseness, and ginger gargles helps hoarseness

A

false

13 ENT (18 decks)

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