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
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
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
4
Q
Antibiotic therapy fro croup
A
Ampicillin
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
6
Q
Laryngoscopy result in ACUTE LARYNGITIS
A
diffuse erythema of the larynx
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
8
Q
Caused by lesions involving the recurrent laryngeal nerve of Neurologic Disorders of the Larynx
A
- Tumors
- Aneurysms of thoracic aorta
- Enlarged node
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
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
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
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
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
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)
14
Q
most common manifestation of GERD
A
Acid laryngitis
15
Q
- Dysphonia (hoarseness) – most common
- Dysphagia
- Chronic throat clearing and cough
- Excessive throat mucus
- Vocal fatigue
- heartburn
A
GERD
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
17
Q
LEVEL OF Treatment: Laryngeal GERD
- Antireflux surgery
- Nissen fundiplication
A
Level III
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
- Etiology:
> External/internal trauma or by infection
- Diagnosis:
> Indirect, fiberoptic or direct laryngoscopy
> Dyspnea seen on exertion
- Treatment:
> Resection of posterior web via thyrotomy
Posterior Glottic Stenosis
25
Complete Glottic Stenosis Tx
- Stent is left in position for
4 to 8 weeks
26
done when bilateral vocal cord paralysis accompanies complete glottic stenosis
Arytenoidectomy
27
- Clinical Features
> Dyspnea
> Wheezing
> Nonproductive cough
> Respiratory distress syndrome
> Stridor
> Diagnosis made by Laryngoscopy
- Etiology:
> Long term endotracheal intubation
> Trauma
> Neoplasm
> Irradiation
> Severe infection
Subglottic Stenosis
28
- 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
Congenital Web
29
- 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
Congenital Laryngeal Cyst
30
Vocal Cord Paralysis Etiology
- Trauma at birth
- Platybasia
- Arnold-Chiari syndrome
- Congenital cardiovascular lesion
31
- Associated with skin hemangioma
- Anterior subglottic area is most susceptible
- Treatment: tracheostomy, steroids, surgical excision with placement of intraluminal stent
Subglottic Hemangioma
32
- 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
Subglottic Cyst
33
- 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)
Laryngomalacia
34
- Larynx appears the same as laryngeal chondromalacia
- Other accompanying features are severe mental retardation, hypertelorism, microcephaly, strabismus
Cri-du-chat Syndrome
35
- 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
Laryngeal Atresia
36
- 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
Acute Laryngeal Trauma
37
All techniques such as ___ is discouraged unless the airway obstruction is unrelieved by the patient’s reflex
Heimlich maneuver, finger probing and pounding at the back
38
Most common postoperative problem ____ which may be treated with humidification and systemic steroids
subglottic laryngeal edema
39
– 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
Medial
Intermediate
40
Unilateral midline paralysis is the most frequent, with the
left more than the right
41
- Most common form of bilateral motor paralysis
- Caused by extensive thyroid surgery
- Treatment:
> Endolaryngeal arytenoidectomy
> Extralaryngeal arytenoidectomy
> Transverse cordotomy
> Nerve-muscle transposition
Bilateral Paralysis
42
- 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
Superior Laryngeal Nerve Paralysis
43
- refers to chronic hoarseness due to structural malformation of the larynx
- maybe due to vocal cord abuse or polyps leading to dysphonia
- Dysplastic dysphonia
- Habitual dysphonia
44
- Due to loss of protective laryngeal function as seen in severe cranial nerve loss
- Nasogastric tube feeding provides for temporary solution for obtaining nutrition
Intractable Aspiration
