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ENT > hoarsneess > Flashcards

hoarsneess Flashcards

1
Q

what is hoarseness defined as ?

A

any change in the quality of human voice

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2
Q

what are the general causes associated with hoarseness ?

A

congenital
inflammatory
mucosal fold disorders
neoplastic
premalignant
neurological
miscellaneous
endocrine
aging

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3
Q

what are the congenital causes of hoarseness ?

A

laryngeal webs
vocal cord paralysis

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4
Q

what is the pathology in laryngeal webs ?

A

incomplete canalization of the laryngeal lumen

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5
Q

what is the clinical picture associated with laryngeal wbs ?

A

asymptomatic or weak hoarse cry
stridor if the web is large in size

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6
Q

what is the treatment for laryngeal webs ?

A

no treatment required if asymptomatic
microlaryngeal surgery
tracheostomy if the airway is compromised

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7
Q

what are the inflammatory causes of hoarseness ?

A

acute laryngitis
croup
chronic non specific laryngitis
chronic specific laryngitis
acute epiglottitis

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8
Q

which of the inflammatory causes of hoarseness is the commonest ?

A

acute laryngitis

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9
Q

what are the causes of acute laryngitis ?

A

post upper respiratory tract infection
viral causes include: parainfluenza, influenza, rhinovirus
bacterial causes : strep pneumonia

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10
Q

what is the clinical picture of acute laryngitis ?

A

general manifestation : fever, headache and malaise
hoarseness
discomfort and pain on phonation
dry cough
mucopurulent discharge
difficulty in breathing in severe cases

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11
Q

what is the treatment for acute laryngitis ?

A

humidification
rest
pain management
mucolytics
antibiotics

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12
Q

what is the presentation of acute epiglottitis ?

A

general manifestations - ill
muffled hot potato voice
rapid progressive stridor

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13
Q

what is the management for acute epiglottitis ?

A

as acute laryngitis
along with proper airway management

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14
Q

why is acute epiglottitis not commonly seen anymore ?

A

due to Hib vaccine

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15
Q

what is the presentation of croup ?

A

seal like barking cough

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16
Q

what is the causative organism in croup ?

A

parainfluenza virus

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17
Q

what is the presentation of chronic nonspecific laryngitis ?

A

GERD due to chronic irritation
heartburn
globus sensation
regurgitation
night breakthrough

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18
Q

what are the mucosal fold disorders causing hoarseness ?

A

vocal cord nodules or singers nodules
vocal cord polyps
vocal cord cysts
Reinke’s oedema

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19
Q

what is the gross picture of vocal cord nodules ?

A

sessile nodules
medial edge of vocal cord
at the junction of ant 1/3 and post 2/3
pinkish in early stage - white in late stage

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20
Q

what is the pathology behind vocal cord nodules ?

A

epithelial hyperplasia

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21
Q

what is the treatment for vocal cord nodules ?

A

excision by microlaryngeal surgery
along with voice therapy

22
Q

where are vocal cord polyps found ?

A

medial edge or undersurface of vocal cords
at the junction of ant 1/3 and post 2/3

23
Q

what is the pathology in vocal cord polyps ?

A

localized subepithelial oedema with vascular engorgement

24
Q

what is the treatment for vocal cord polyps ?

A

excision by microlaryngeal surgery
along with voice therapy

25
Q

what is reinke’s space ?

A

superficial lamina propria of the vocal ligament
a potential space

26
Q

how does reinke’s oedema happen ?

A

accumulation of fluid due to chronic irritation

27
Q

what is the main cause of reinke’s oedema ?

A

irreversible swelling of the vocal cords mainly due to chronic heavy smoking

28
Q

what are the benign neoplastic causes of hoarseness ?

A

Recurrent respiratory papillomatosis

29
Q

what is the causative organism of Recurrent Respiratory papillomatosis ?

A

Human papillomavirus

30
Q

what is the treatment of recurrent respiratory papillomatosis ?

A

CO2 ablation
high incidence of recurrence

31
Q

what are the premalignant causes of hoarseness ?

A

leukoplakia

32
Q

what is the pathology behind leukoplakia ?

A

epithelial hyperplasia and hyperkeratinization due to chronic irritation

33
Q

what is the presentation of leukoplakia ?

A

whitish patch with irregular surface
may occur as a single or multiple patches
unilateral or bilateral affection

34
Q

what is the treatment for leukoplakia ?

A

excision by microlaryngeal surgery
strict follow up

35
Q

what are the malignant causes of hoarseness ?

A

laryngeal carcinoma ( sq cell carcinoma )

36
Q

what aree the neurological causes of hoarsness ?

A

bilateral vocal cord paralysis

37
Q

what is the presentation of bilateral vocal cord paralysis ?

A

weak breathy voice

38
Q

what are the causes of bilateral vocal cord paralysis ?

A

thyroid surgery
trauma
mediastinal mass

39
Q

which nerves are more likely to be affected in thyroid surgery and in mediastinal masses ?

A

thyroid surgery : recurrent laryngeal surgery
Mediastinal mass : left vocal cord paralysis

40
Q

what is the diagnosis of a patient that complains of dysphonia without any obvious anatomical, neurological or other organic causes affecting the larynx ?

A

muscle tension dysphonia or functional dysphonia

41
Q

what are the types of functional dysphonia ?

A

hypofunctional dysphonia - incomplete closure of the vocal cords
hyperfunctional dysphonia - overuse of the laryngeal muscles and occasionally use of the false vocal cords

42
Q

what is the treatment of muscle tension dysphonia ?

A

voice therapy

43
Q

what are the endocrine causes of dysphonia ?

A

hypothyroidism
hormonal disturbances

44
Q

dysphonia due to aging ?

A

presbylaryngis or
presbyphonia

45
Q

what are the red flags that come with hoarseness ?

A

history of smoking or alcohol use
concomitant neck mass
unexplained weight loss
accompanying neurological symptoms
accompanying haemoptysis, dysphagia,odynophagia,otalgia
hoarseness that is persistent or worsening

46
Q

what investigations can be performed for a case of hoarseness ?

A

flexible nasoendoscopic examination of the larynx
appropriate blood tests
CT scan of the neck +/- mediastinal masses

47
Q

misuse of voice can lead to -

A

vocal cord polyps
nodules
or cysts

48
Q

excessive smoking can lead to ?

A

leukoplakia
Reinke’s oedema
laryngeal cancer

49
Q

what endocrinal disorder is associated with reinke’s oedema ?

A

hypothyroidism

50
Q

what does it mean when the vocal cord is in a paramedian position ?

A

recurrent laryngeal nerve paralysis

51
Q

what are the red flags associated with hoarseness that require urgent ENT referral ?

A

cachexia
hemoptysis , dysphagia
weight loss
persistent hoarseness for more than 3 weeks
accompanying neurological symptoms
neck mass

ENT (30 decks)

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