Laryngology Flashcards
Management OSA
Medical [3]
Surgical [2]
Rx to reduce REM Respiratory stimulants CPAP ventilation Surgery Children - adenotonsillectomy Adults - resection of soft palate or lateral pharyngeal bands
Salivary gland disease Sialolithiasis Stone composition [2] Presentation [2] Associated with [1] Ix [1] Mx [2]
Stone composition: calcium phosphate or calcium carbonate
Colicky pain, post-prandial swelling of gland
Most often occurs with chronic sialdenitis
Ix: sialography, CT/x-ray
Mx:
- Gland excision (for other stones and chronic inflammation)
- Conservative: sialogogues
Salivary gland disease Sialadenitis Causative organism [1] Presentation [2] Sequelae [1] Management [4]
Staph aureus infection Pain and swollen gland Pyrexia + systemic upset Sequelae: submandibular abscess Mx: high-dose antibiotics, rehydration, oral hygiene Citrus mouthwash
Hoarseness
Benign causes [5]
Neurological causes [2]
Mechanical causes [3]
- Voice overuse
- Smoking
- Post viral
- Hypothyroidism
- GERD
Neurological causes: - Recurrent laryngeal nerve palsy - Vocal fold palsy Mechanical causes: - Vocal cord nodules - Vocal cord polyps and cysts
Recurrent laryngeal nerve palsy [1]
Due to this nerve’s great length, it is frequently damaged in diseases
Vocal fold palsy
Define [2]
Investigation
Vocal fold palsy - when hoarseness and unexplained immobile vocal cord
CXR - bronchial ca
CT scan brain - hilar neoplasms
US - thyroid gland
Vocal cord nodules
On examination what will you expect to see? [3]
Tx [2]
O/E: small white nodular thickenings of vocal folds bilaterally
Tx: speech therapy > surgical excision
Vocal cord polyps
Describe Reinke’s edema
Reinke’s edema - whole length of vocal cord is edematous, edema in Reinke’s space
Cyst forms when edema localists under coverings of cord
Polyp results from edema more superficially which then prolapses into airway
Vocal cord polyps
Investigation [2]
Mx [2]
Stroboscopic examination show altered mucosal wave
Ask patient to breath out to elicit any vocal polyps
Mx: remove and do histological examination
Stridor
Define [1]
Causes: congenital, acquired
Which cause is most common with a barking cough*
Noisy breathing Congenital causes - Laryngomalacia - Vocal cord web - Vocal cord palsy - Subglottic stenosis Acquired - Trauma, FB -Angioneurotic edema - Epiglottitis - Croup* - Vocal cord palsy, polyp, cyst - Carcinoma - External compression by thyroid mass
Neck lumps
Most common [1] and its cause [2]
Reactive lymphadenopathy
Post local infection or generalized viral illness
Neck lumps
Lymphoma clinical features [3]
Rubbery, painless lymphadneopathy
Alcohol pain (uncommon)
B- symptoms
Neck lumps
Thyroid swelling
Moves upward on swelling
Neck lumps Thyroglossal cyst Epidemiology [1] Site [1] Sign [2]
<20 yo
Midline between isthmus of thyroid and hyoid bone
Moves upwards with protrusion of tongue
May be painful if infected
Neck lumps Pharyngeal pouch Define [2] On examination [2] Symptoms [4]
A posteromedial herniation between thyropharyngeus, cricopharyngeus
Not seen but if large, midline lump in neck
Gurgling on palpation
Dysphagia
Regurgitation
Aspiration
Chronic cough, halitosis
Neck lumps
Cystic hygroma [3]
When is it commonly found
Congenital lymphatic lesion [1] typically found in neck [1] classically on the left [1]
Presentation: usually evident at birth up and as old as 2yo
Neck lumps Branchial cyst Define [2] Cause [1] Age at presentation [1]
Oval mobile cystic mass [1] that develops between SCM and pharynx [1].
Failure of obliteration of second branchial cleft.
Early adulthood presentation
Sore throat meets CENTOR criteria - what abx [2]
Phenoxymethylpenicillin
Erythromycin
Viral parotitis - mumps
Describe typical patient [6]
Young adult Parotid swelling painful Pancreatitis Orchitis Reduced hearing Meningoencephalitis
Centor criteria [4]
Clinical signficance [2]
- Presence of tonsillar exudate
- Tender anterior cervical lymphadenopathy
- History of fever
- Absence of cough
Score of 3, 4 indicates 30-50% chance isolating Streptocci
Stridor management (acute airway obstruction) [10]
Let patient sit/lie down in comfortable position Give oxygen Nebulised adrenaline IV access Dexamethasone/Hydrocortisone IV Call ENT reg, anesthetist Prep crash tracheostomy kit Obtain ABG ENT reg will do flexible nasendoscopy to visualise airway CXR, Neck XR
What is croup also known as?
Management croup [3]
Laryngotracheobronchitis
- Give antibiotics
- humidified O2, + nebulized adrenaline (5mL 1:1000, may buy time in severe disease needing ventilating)
- dexamethasone 150μg/kg PO stat or budesonide 2mg nebulized.
Acute epiglottitis
What differentiates in presentation? [2]
Mx [8]
NO COUGH, stridor + drooling = epiglottitis
Take to ITU; don’t examine throat (causes resp. arrest)
O2 by mask till anaesthe- tist and ENT doctor arrive
Give nebulized adrenaline,
IV dexamethasone
Visual diagnosis at naso- pharyngeal intubation
Blood/epiglottic culture
Find cricothyrotomy kit
IVI + penicillin G & ceftri- axone 2g/12h IV
Antipyretic, eg ibuprofen
Laryngeal paralysis mx
May need urgent airway intervention +/- surgery
