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ENT > INFLAM DIS OF LARYNX > Flashcards

INFLAM DIS OF LARYNX Flashcards

1
Q
  • Rapidly developing infection of the larynx with airway obstruction and stridor
  • Most common in children below 6 years old
  • Explosive onset; presents with restlessness, apprehension, stridor, retraction and cyanosis
  • Presents in 2 forms
A

CROUP

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2
Q
  • Area Involved: Laryngeal surface Epiglottis
  • Etiologic agent: H. Influenza type B
  • Peak age: 3-6 years
  • Signs and symptoms: Tends to sit up with mouth open and chin forward
  • Not hoarse
  • Cough not croupy
  • May have dysphagia
  • Course: Rapid can be fatal within a few hours without treatment
  • Recurrence: Rare
  • Laryngoscopy: Cherry-red, markedly swollen epiglottis
A

Acute Epiglottitis

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3
Q
  • Area Involved: Area just below vocal cords
  • Etiologic agent: Viral
  • Peak age: 6 months – 3 years
  • Signs and symptoms: Tends to lie down
  • Hoarse
  • Very croupy cough
  • No dysphagia
  • Course: Less rapid
  • Recurrence: More common
  • Laryngoscopy: Subglottic swelling seen through glottis
A

Acute Subglottic Laryngitis

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4
Q

Antibiotic therapy fro croup

A

Ampicillin

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5
Q
  • Due to vocal fold abuse, toxic fumes, infection
  • Infectious etiology, usually a paninfection (sinus, ear, larynx, bronchi)
  • Influenza virus, adenovirus, streptococci most common
  • Diphtheria less common; with pseudomembrane formation, low fever
A

ACUTE LARYNGITIS

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6
Q

Laryngoscopy result in ACUTE LARYNGITIS

A

diffuse erythema of the larynx

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7
Q
  • Can be caused by:
    > Cigarette smoking
    > Esophageal disorders causing reflux (e.g. Zenker diverticulum)
    > Systematic disorders – allergy, hypothyroidism, Addison’s disease
    > Anxiety, tension
  • Hoarseness, long-standing inflammatory changes in laryngeal mucosa
    – Vocal cord mobility unaffected since changes are primarily mucosal or submucosal
  • Treatment: eliminate offending cause
A

CHRONIC NONSPECIFIC LARYNGITIS

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8
Q

Caused by lesions involving the recurrent laryngeal nerve of Neurologic Disorders of the Larynx

A
  • Tumors
  • Aneurysms of thoracic aorta
  • Enlarged node
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9
Q
  • Paralysis of abductor and adductors, except cricothyroid
  • Initially, paralyzed cord assumes intermediate or “cadaveric” position
  • Cricothyroid still functions to lengthen paralyzed cord, causing slow, passive medial rotation of affected arytenoid
  • 6 weeks after onset - paramedian position
  • No airway obstruction
  • No intervention needed
  • Managed by thyroplasty
A

Unilateral Midline Paralysis

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9
Q
  • Initially both cords are intermediate
    > Breathy voice
  • After 6 weeks, both cords assume paramedian position
    > Voice returns to normal but life-threatening airway obstruction results
  • Tracheostomy
  • Arytenoidopexy / arytenoidectomy
A

Bilateral Midline Paralysis

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10
Q

Laryngeal Tumors

  • Types: Squamous cell or epidermoid carcinoma
  • Etiologic factor: Smoking – more than 1 pack / day
  • Sex predilection: Males
  • Signs: Hoarseness, Neck mass, cervical lymphadenopathy, bleeding
  • Management: Radical surgery, radiotherapy, chemotherapy, neck dissection
A

Malignant Neoplasm

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11
Q

Laryngeal Tumors

  • Types: Polyps, Neuromas Cysts, Lipomas Chondromas, Papillomas
  • Etiologic factor: Vocal abuse
  • Sex predilection: Females
  • Signs: Hoarseness, Sensation of discomfort, No bleeding, no cervical lymphadenopathy
  • Management: Surgery; remove only the tumor; preserve all normal tissues and laryngeal function
A

Benign Neoplasm

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12
Q

– cordal tumors alter voice no matter how small because they interfere with proper vocal cord approximation
– large tumors may obstruct airway and alter voice even if extrachordal  dysphagia
– if pedunculated, may get caught in glottic aperture during phonation and alter voice

A
  • Site of tumor
  • Size
  • Nature
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13
Q
  • Localized traumatic laryngitis
  • Causes:
    > Vocal overuse
    > Predisposing factors: ectomorphic and athletic body type, vociferous & aggressive personalities
    > Precipitating factors: allergy, thyroid and emotional imbalance, upper respiratory infection, sinusitis
    > Aggravating factors: cigarette smoking and alcohol
  • 2 types:
    > Acute / fresh type
    > Chronic / mature type
  • Clinical features:
    > More often in women, children (boys), professional singers, lecturers
    Hoarseness
    > Most common site: junction of anterior and middle thirds, usually bilateral
A

VOCAL NODULES (Singer’s Nodules)

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14
Q

most common manifestation of GERD

A

Acid laryngitis

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15
Q
  • Dysphonia (hoarseness) – most common
  • Dysphagia
  • Chronic throat clearing and cough
  • Excessive throat mucus
  • Vocal fatigue
  • heartburn
A

GERD

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16
Q

Clinical manifestations:
- Posterior laryngitis w/ characteristic red arytenoids and piled-up interarytenoid mucosa
- Diffuse edema/ Reinke’s edema
- Diffuse erythema
- Mucosal swelling
- Granuloma of vocal process of the arytenoid

A

GERD

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17
Q

LEVEL OF Treatment: Laryngeal GERD

  • Antireflux surgery
  • Nissen fundiplication
A

Level III

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18
Q

LEVEL OF Treatment: Laryngeal GERD

  • H2 blocker (ranitidine, cimetidine, famotidine)
  • Prokinetic drugs (bethanol, metoclopromide, cisapride)
  • Cytoprotective agents (sucralfate)
  • Hydrogen pump blocker (omeprazole)
A

Level II: Antireflux medication

19
Q

LEVEL OF Treatment: Laryngeal GERD

  • Dietary modification
  • Lifestyle modification
  • Liquid antacid
A

LEVEL I

20
Q
  • Caused by injury to larynx
  • Types:
    > Supraglottic stenosis
    > Glottic stenosis
    > Anterior glottic stenosis
    > Posterior glottic stenosis
    > Complete glottic stenosis
    > Subglottic stenosis
A

Acquired stenosis of Larynx

21
Q
  • Etiology:
    > external crushing trauma
    > caustic ingestion
    > severe infection
  • Most common injury: rupture of thyroepiglottic ligament with superior retraction of epiglottis & herniation of soft tissue of preepiglottic space into the laryngeal lumen
  • Associated tear in posterior pharyngeal wall & arytenoids may be dislocated
  • Direct Laryngoscopy
  • Tracheotomy
A

Supraglottic Stenosis

22
Q

3 varieties:
- Anterior stenosis
> With laryngeal function
> With bilateral paralysis
- Posterior stenosis
Complete stenosis
> With laryngeal function
> With bilateral laryngeal paralysis

A

Glottic Stenosis

23
Q

2 types of Anterior Glottic Stenosis

A
  • Anterior web results from traumatic endoscopy, infections or foreign body
  • More extensive (thick) stenosis usually from external trauma
24
Q
  • Etiology:
    > External/internal trauma or by infection
  • Diagnosis:
    > Indirect, fiberoptic or direct laryngoscopy
    > Dyspnea seen on exertion
  • Treatment:
    > Resection of posterior web via thyrotomy
A

Posterior Glottic Stenosis

25
Q

Complete Glottic Stenosis Tx
- Stent is left in position for

A

4 to 8 weeks

26
Q

done when bilateral vocal cord paralysis accompanies complete glottic stenosis

A

Arytenoidectomy

27
Q
  • Clinical Features
    > Dyspnea
    > Wheezing
    > Nonproductive cough
    > Respiratory distress syndrome
    > Stridor
    > Diagnosis made by Laryngoscopy
  • Etiology:
    > Long term endotracheal intubation
    > Trauma
    > Neoplasm
    > Irradiation
    > Severe infection
A

Subglottic Stenosis

28
Q
  • Develops as a band that extends over part or all of the glottis
  • Anterior 2/3 of the glottis is the most susceptible site
  • Treatment: bronchoscope or tracheostomy tube for atresia
A

Congenital Web

29
Q
  • Occurs most commonly in the supraglottic area (lateral wall of the supraglottis or on the epiglottis)
  • Maybe associated with a laryngocele
  • Treatment: aspiration, endoscopic excision
A

Congenital Laryngeal Cyst

30
Q

Vocal Cord Paralysis Etiology

A
  • Trauma at birth
  • Platybasia
  • Arnold-Chiari syndrome
  • Congenital cardiovascular lesion
31
Q
  • Associated with skin hemangioma
  • Anterior subglottic area is most susceptible
  • Treatment: tracheostomy, steroids, surgical excision with placement of intraluminal stent
A

Subglottic Hemangioma

32
Q
  • Acquired in newborns after long-term intubation
  • Usually in the posterior subglottic larynx
  • Cyst maybe submucosal within a soft tissue subglottic stenosis
  • Treatment: endoscopic excision, cupped forceps, laser
A

Subglottic Cyst

33
Q
  • Most common laryngeal abnormality of the newborn
  • Due to unusual flaccidity of the laryngeal tissues, especially the epiglottis
  • Treatment: generally observation (stridor usually disappears by 12 to 16 months of age)
A

Laryngomalacia

34
Q
  • Larynx appears the same as laryngeal chondromalacia
  • Other accompanying features are severe mental retardation, hypertelorism, microcephaly, strabismus
A

Cri-du-chat Syndrome

35
Q
  • Results from failure of the developing larnyx to recanalize after the normal epithelial fusion takes place toward the end of the 3rd month of gestation
  • May be supraglottic, glottic, subglottic
  • Treatment: tracheostomy, resection, cartilage implant
A

Laryngeal Atresia

36
Q
  • Severe laryngeal injury may occur without open neck injuries
  • 3 poor prognostic features in acute blunt laryngeal injuries include:
  • Early airway obstruction requiring tracheostomy, presence of bare cartilage in the laryngeal lumen, fracture and collapse of the cricoid
  • Distinctive clinical signs indicative of laryngeal injuries are the following:
    > Deformities of the neck, subcutaneous emphysema, laryngeal tenderness, crepitus over the laryngeal framework
A

Acute Laryngeal Trauma

37
Q

All techniques such as ___ is discouraged unless the airway obstruction is unrelieved by the patient’s reflex

A

Heimlich maneuver, finger probing and pounding at the back

38
Q

Most common postoperative problem ____ which may be treated with humidification and systemic steroids

A

subglottic laryngeal edema

39
Q

– paralyzed cord remains in the midline as the abductor muscles are weaker and more vulnerable than the adductor fibers
– also known as cadaveric, is midway between the midline position and complete abduction

A

Medial
Intermediate

40
Q

Unilateral midline paralysis is the most frequent, with the

A

left more than the right

41
Q
  • Most common form of bilateral motor paralysis
  • Caused by extensive thyroid surgery
  • Treatment:
    > Endolaryngeal arytenoidectomy
    > Extralaryngeal arytenoidectomy
    > Transverse cordotomy
    > Nerve-muscle transposition
A

Bilateral Paralysis

42
Q
  • Usually secondary to thyroidectomy or supraglottic laryngectomy
  • Guttman’s test can be done by applying frontal pressure to the thyroid on normal subject lowers the voice while lateral pressure raises the voice. The opposite is true for SLN paralysis
A

Superior Laryngeal Nerve Paralysis

43
Q
  • refers to chronic hoarseness due to structural malformation of the larynx
  • maybe due to vocal cord abuse or polyps leading to dysphonia
A
  • Dysplastic dysphonia
  • Habitual dysphonia
44
Q
  • Due to loss of protective laryngeal function as seen in severe cranial nerve loss
  • Nasogastric tube feeding provides for temporary solution for obtaining nutrition
A

Intractable Aspiration

ENT (9 decks)

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