Laryngeal Disorders Flashcards
A primary symptom of laryngeal disease
Hoarseness and Stridor
Any person with hoarseness for what duration must be evaluated by
indirect laryngoscopy?
> 2 weeks
The abnormal air flow past cords results in what?
hoarseness
In inspiratory stridor, where is the lesion in relation to the vocal cords?
lesions above cords
In expiratory stridor, where is the lesion in relation to the vocal cords?
lesions below cords
Anyone with what presenting symptom should have immediate evaluation of the airway and may require emergent tracheostomy?
stridor
Tracheotomy Indications
Airway obstruction at or above larynx
Respiratory failure requiring prolonged ventilation
Cricothyrotomy Indications
Emergent airway but not long standing
Fewer initial complications
“seal bark”
Worse at night
Acute inflammatory disease of the larynx
Croup
What is the most common cause of Croup?
viral
What is the most common group of viruses responsible for croup?
parainfluenza virus serotypes
Why are breathing treatments ineffective in croup?
Acute inflammatory disease of the larynx
What clinical presentation is described below?
Prodrome of URI symptoms followed by barking cough and stridor
May have labored breathing signs
+/- fever
Stridor (harsh, crowing noise made during inspiration)
Croup
If you suspect croup, what else needs to be ruled out first?
Make sure to consider FBO or epiglottitis in differential
Even though routine imaging is not done in croup, what finding would you expect to see on Xray?
Soft tissue neck radiograph shows “steeple sign” (Supraglottic narrowing secondary to edema and a normal epiglottis)
If croup is severe, what are some medications to consider?
Glucocorticosteroids (dexamethasone) or Nebulized racemic epinephrine if severe
What are some complications of croup?
Respiratory distress
Respiratory arrest
epiglottitis
Bacterial tracheitis
Atelectasis
dehydration
Infection of supraglottis
Severe, life threatening (medical emergency)
Viral or bacterial (almost always bacterial)
Epiglottitis/Supraglottitis
What is the most common organism responsible for epiglottitis/supraglottitis?
Haemophilis influenzae B
What clinical presentation of this disease is described below?
Presents as a rapidly developing sore throat and sudden onset high fever
Odynophagia out of proportion to findings
Drooling can be a sign of impending airway compromise
Muffled voice (hot potato)
Severe dysphagia – why you’ll see drooling
Sitting upright with neck extended 🡪 tripoding
Epiglottitis/Supraglottitis
What are the two most important things to remember on a physical exam of a patient with epiglottitis/supraglottitis?
Remember, their throat will be NORMAL looking – cannot see the epiglottis from inspecting the mouth (DO NOT assume malingering!)
Rule – nothing goes in the mouth (Don’t want to irritate the glottis and make it swell anymore)
Why is epiglottitis/supraglottitis rare nowadays?
Less common now due to vaccinations (specifically Hib vaccination)
Lateral neck soft tissue xray finding in epiglottitis/supraglottitis
“Thumb sign”
If you see a “Thumb sign” on xray, what should you suspect?
epiglottitis/supraglottitis
If you see a “steeple sign” on xray, what should you suspect?
croup
What diagnostic method can you use in adults with epiglottitis/supraglottitis that you cannot use in children?
Indirect laryngoscopy in adults (safe)
Warty-like lesions
Junction of ciliated and squamous epithelia
More common in children
Can cause airway obstruction if get too large
Laryngeal Papillomas
Most common cause of hoarseness
Loss of voice associated with URI/cough
May persist for a week after URI symptoms cleared
Acute Laryngitis
What is the etiology of acute laryngitis?
Viral – 90%
Bacterial – 10%
In bacterial causes of acute laryngitis, what are the most common organisms responsible?
M. catarrhalis
H. influenzae
What is the main treatment for acute laryngitis and why?
Complete – no whispering!
Persistent use can lead to formation of traumatic vocal cord hemorrhage, polyps, and cysts
List some red flags in a patient with hoarseness
Hoarseness that lasts for more than two weeks and that is not
associated with URI symptoms
Hoarseness with a history of tobacco or alcohol use
Hoarseness with concomitant discovery of a neck mass
Hoarseness with unexplained weight loss
Hoarseness associated with hemoptysis, dysphagia, odynophagia, otalgia, or airway compromise, etc
Reflux into the larynx
Causes chronic inflammation and hoarseness
Laryngopharyngeal Reflux
What are some symptoms you’d expect to see in laryngopharyngeal reflux?
Globus sensation (fullness in throat)
PND sensation
Esophageal spasm
Can also be associated with: GERD, Asthma, Throat clearing, Chronic cough, Heartburn and regurgitation
Seen in overachievers, anxiety
See in elite athletes
Can be confused with exercise induced asthma
Use albuterol inhaler – if it doesn’t help, then consider this in your DDX
Vocal Cord Dysfunction
Common cause of hoarseness
Secondary to vocal cord abuse
Smooth paired lesions
Vocal Cord Nodules
Leukoplakia of the vocal cords
Most commonly arises in smokers
presents with hoarseness
Direct laryngoscopy is a must to rule out cancer
Laryngeal Leukoplakia
Laryngeal Leukoplakia can further develop into what?
SCC
Laryngeal leukoplakia is commonly seen with what risk factor?
Smokers
What is the most common cancer in the larynx?
SCC
What are two risk factors associated with the development of SCC of the larynx?
EtOH use
tobacco use
In cases of vocal cord paralysis, what nerve is affected?
Vagus nerve (Recurrent laryngeal nerve)
What is paramount in cases of vocal cord paralysis?
Cord lateralization and airway assurance
List some unilateral causes of vocal cord paralysis
Thyroid surgeries
Apical lung cancer
Other neck surgeries
List some bilatera causes of vocal cord paralysis
Esophageal cancer
Thyroid surgery
Ventricular shunt malfunction
What type of foreign body is considered an emergency?
battery
