Larygology

Question 1

What is stridor

Answer 1

Harsh noise produced by turbulent airflow through a partially obstructed airway

Question 2

What does an inspiratory stridor indicate

Answer 2

Obstructed larynx

Question 3

Stridor causes

Answer 3

Traumatic: foreign body
Autoimmune/allergic: anaphylaxis
Infective: laryngotracheobronchitis (coup), tescheitis, supraglottitis/epiglotitis, DSNI
Neoplastic
Congenital

Question 4

What is laryngomalacia

Answer 4

Prolapse of the supraglottis structures into the laryngeal inlet on inspiration.
Most common cause of stridor in infants
Majority managed conservatively (10% surgery)

Question 5

Laryngeal web (what and treatment)

Answer 5

Congenital condition that presents with an abnormal cry and stridor

Arises from failure of the recanalization of the larynx in the embryo

Tx - incision for thinner webs, thicker webs may require stenting

Question 6

Subglottic stenosis

Answer 6

Partial or complete narrowing of subglottic area

Congenital (cartilage)
Acquired (soft tissue - prolonged intubation)

Lateral neck xray shows stenosis

Tx - determined by age (range from observe to reconstruction)

Question 7

Tracheostomy

Answer 7

Operative technique that creates a surgical airway in the vertical trachea.

Formed by making an incision through the skin and trachea into the airway.

Question 8

Tracheostomy indications

Answer 8

Relieve upper airway obstruction
Prophylactically in head and neck surgery

Question 9

What is hoarseness/voice changes a symptom of

Answer 9

Primary laryngeal disease

Question 10

Common causes of dysphonia

Answer 10

Trauma - phonotrauma - voice abuse and misuse leaning to trauma of vocal cords
Neoplasm - vocal fold nodule, vocal fold polyp, vocal cord papilloma, laryngeal cyst, laryngeal SCC

Question 11

Treatment of vocal folds papilloma

Answer 11

Coblation

Question 12

DDx for dysphasia

Answer 12

Vascular - stroke
Inflammation- GORD
Trauma
Autoimmune/allergy - eosinophilia oesophagitis, scleroderma
Metabolic
Infective
Neoplastic
Congenital
Degenerative - achalasiz, Zenker diverticulum

Question 13

Chronic cough

Answer 13

Last more than 8 weeks

Aetiology - post nasal drip syndrome/Upper airway cough syndrome, asthma, GORD

Question 14

Why does upper airway cough syndrome cause chronic cough

Answer 14

Secretions containing inflammatory mediators stimulate pharyngeal and laryngeal sites

Question 15

How does GORD cause chronic cough

Answer 15

1. Distal oesophageal acid exposure that stimulates and oesophageal - bronchial cough reflex via CN X
2. Micro aspiration of acid to the larynx/trachea

Question 16

Tx for UACS

Answer 16

Treat underlying sinusitis

Question 17

Dx and Tx non-asthmatic eosinophilic bronchitis

Answer 17

Dx sputum
Tx inhaled corticosteroids

Question 18

What is globus

Answer 18

Persistent or intermittent painless sensation of lump or foreign body in the throat

Question 19

Aetiology of globus

Answer 19

1. GORD (25-50%)
2. Non- specific oesophageal motility disorders
3. Malignancy
4. Psychological/stress
5. Other

Question 20

Ix and management of globus

Answer 20

1. Full ENT exam
2. 3 month trial of PPI
3. Further Ix (24hr pH monitoring, endoscopy)
4. Psych input

Question 21

Zenker diverticulum

Answer 21

Herniation of the posterior pharyngeal/oesophageal mucosa and submucosa due to increased pressure pressure. Either due to lack of coordination of musculature or a hypertensive upper oesophageal sphincter.

Question 22

Zenker diverticulum management

Answer 22

Transoral endoscopic treatment with CO2 laser or electrocautry

Open neck approaches are also still preformed