Investigation & Tx of URT noise Flashcards
Refresh your anatomy of larynx?
typical history?
poor performance & noise at exercise
What might e see on PE?
- Palpable CAD muscle atrophy?
- Narrow inter-mandibular space
- Slap test (contra-lat arytenoid twitch)
What is the most common cause of laryngeal neuropathy?
IDIOPATHIC laryngeal neuropathy
but can also see:
- Recurrent laryngeal trade
- Fourth branchial arch defect
- Liver dx (ragort posioning)
What will out diagnostic approach include?
- Exercise test
- Resting endoscopy
- Exercise endoscopy
Detail the exercise test
- Ridden exercise including canter in both directions
- Inspiratory noise? (link to stride pattern)
detail resting endoscopy?
- Laryngeal symmetry?
- Synchrony?
- Slap test
What is a conventional approach to investigation URT noise?
What are the MAIN and the less common causes of URT noise?
MAIN:
1. Left laryngeal neuropathy
2. Dorsal displacement of the soft palate
More Rare:
3. Axial deviation of aryepiglottic folds
4. Epiglottic entrapment
Summary of exercise endoscopy?
What is the surgical tx for Idiopathic Laryngeal Neuropathy?
Ventirculectomy -> removal of laryngeal ventricle
- Clean contaminated
- Incision heals by 2nd intention
How else can we do a ventriculectomy?
LASER - standing surgery
- Ablation of laryngeal saccule -> scar tissue forms within saccule
- Rapid return to exercise
hat si Tieback surgery?
- Prosthesis to replace the pull of CAD muscle - leads to arytenoid abduction
Compare & contrast Ventriculectomy vs Tieback sx?
Prognosis for ventriculectomy?
- Minimal risk of post-op complication
- Good noise reduction (often not total)
- 60% owners report improved performance!
Prognosis for tieback sx?
- Significant complication rate
- Good prognosis for improved performance
Which tx option is best?
- OWNER EXPECTATIONS CRITICAL
- Noise reduction vs. improved airflow
- Owner’s attitude to risk
- Exercise endoscopy offers functional
assessment - Laser surgery options available
Describe dorsal displacement of soft palate?
- Racehorse problem
- ‘Gurgling’ at end of race/when fatigued
- Conservative tx: tongue-tie
What is the Tie-forward sx for dorsaldisplacement?
- Technique described in past 15 yrs
- Suture to advance larynx relative to hyoid apparatus
- Some evidence for improved performance in racehorses
- Longevity of prosthesis?
hat else can be done for dorsal displacement of soft palate?
- Cautery of the caudal part of
the soft palate (can use
laser) - Repeated application at 2-
4mm intervals - Total of 1000J
- Not evidence-based!
Describe axial deviation of aryE folds as indication for laser surgery
- Excision of tissue collapsing into the
airway during exercise - Triangular portion of aryepiglottic fold
removed
