L19: conditions of the larynx & applications to airway management

Question 1

List conditions affecting the larynx

Answer 1

Laryngitis 
Laryngeal nodules 
Laryngeal cancer 
Laryngeal oedema (allergic reaction or swallowed foreign body)
Epiglottitis 
Croup

Question 2

Describe laryngitis

Answer 2

Inflammation of the larynx, often involving the true VCs
Hoarse/weak voice & sore throat
History of URTI
Infectious (viral typically) and non-infectious aetiology
Usually self-limiting (2-3 weeks)

Question 3

Describe laryngeal nodules

Answer 3

Acute trauma/chronic irritation
Hoarseness of voice (> 3 weeks)
Requires visualisation of cords +/- biopsy

Question 4

Describe epiglottitis

Answer 4

Inflammation causing swelling of the epiglottis and supraglottic tissues
Typically affects 2-6 years old -> can deteriorate very quickly due to obstruction of airways
Presentation: difficulties breathing, difficulties swallowing – pooling & drooling of saliva

Question 5

Describe what you should do in a patient with suspected epiglottitis

Answer 5

Do not exam throat – can cause significant deterioration (child completely closes off airway as child gets upset)
Urgent treatment – intubation or tracheostomy
Underlying cause is usually haemophilus influenza B = treated with course of abx (vaccine has been very effective preventing infants from contracting the disease, but unvaccinated can still get it)

Question 6

Describe croup

Answer 6

Commonly seen in children between 6 months and 3 years
Typically caused by the parainfluenza virus – affects larynx and trachea
Doesn’t require a hospital admission & can be safely treated by the GP sitting them upright & giving a single dose of corticosteroids

Question 7

List simple airway manoeuvres

Answer 7

Head tilt

Chin tilt

Question 8

Describe airway adjuncts

Answer 8

Only use if patient can breathe spontaneously – patent upper airway
1) Oropharyngeal airway (contradicted if minimal depression of consciousness)
2) Nasopharyngeal airway
Allow for spontaneous ventilation if patient is able to breathe spontaneously -> offers no protection of lower respiratory tract from vomit/secretions

Question 9

Describe a supraglottic airway

Answer 9

Eg. iGel
Maintains airway and affords some protection
Minimal technical skills required to insert, often first line in cardiac arrest
Not for long-term ventilation

Question 10

Describe a definitive airway

Answer 10

Intubation = endotracheal tube
Technical skill required – requires use of laryngoscope to visualise vocal cords
Secures and protects (from secretions/vomit) lower respiratory tract
Patient, if possible, anaesthetised prior to insertion