Laryngotrachael Disorders Flashcards
vocal production generator
result
- lungs
- power source
vocal production oscillator
result
- larynx
- tone and pitch
vocal production resonator
result
- pharynx/sinuses
- shape, resonate, and articulate sound into individual voice
epithelial cover of the mucosa
- stratified squamous epithelium
superficial layer of the mucosa
- lamina propria
what comprises the vocal ligament
- intermediate lamina propria
- deep lamina propria
what motion of the larynx allows for breathing
- abduction
what motion of the larynx allows for sound production and swallowing
- adduction
what produces the sounds of speaking or singing
- edges of larynx vibrating together
indications for referral to an ENT in regard to hoarseness
- hoarseness for 2 weeks
- with ear pain, trouble swallowing, or difficulty breathing
hoarseness for greater than 2 weeks suggests
- another diagnosis than acute viral laryngitis
common causes of hoarseness
- neurological injury
- alterations of vocal cord folding
what nerve is injured to cause hoarseness
- recurrent laryngeal nerve injury
most common injury to the recurrent laryngeal nerve that causes hoarseness
other causes
- iatrogenic (injury during a medical procedure)
- neoplasm
- viral neuropathy
- idiopathic
alterations of vocal fold lining caused by
- non-lesion
- lesion
non-lesion causes of alterations of vocal fold lining
- GERD
- sinus disease/allergic rhinitis
- dehydration
symptoms of unilateral vocal fold paralysis
- breathy, weak hoarseness
- poor cough
- trouble swallowing
the vast majority of laryngeal lesions that cause hoarseness involve
- superficial layers of the vocal fold
what are the superficial layers of the vocal fold
- superficial lamina propria
- epithelial cover
the most common cause of benign vocal fold lesions is
- phonotrauma (yelling)
what is the most common benign neoplasm of the larynx in children
- recurrent respiratory papillomatosis
etiology of recurrent respiratory papillomatosis
- HPV types 6 and 11
recurrent respiratory papillomatosis childhood disease linked to
- mom’s with genital HPV
adult onset of recurrent respiratory papillomatosis associated with
- oral-genital contact
best HPV vaccine
- gardasil-9
treatment of vocal fold lesions
- medical treatment
- speech therapy
- surgery
most common cause of unilateral vocal fold paralysis
- iatrogenic
90% of laryngeal carcinoma is
- squamous cell carcinoma
largest risk factor for laryngeal carcinoma
- smoking
effect of EtOH use on laryngeal carcinoma
- synergistic effect
tumor in laryngeal carcinoma arises from
- stratified squamous epithelium
- respiratory epithelium that has undergone metaplasia
laryngeal tumors more prevalent at which age
- over 40
laryngeal tumors more prevalent in which gender
- males
laryngeal tumor more prevalent along which class
- lower SES
most common subtype of laryngeal cancer
- glottic - vocal folds
most common symptom of laryngeal tumors
- hoarseness
- neck mass
important physical exam maneuver for laryngeal tumors
- good neck exam looking for lymphadenopathy
neck mass in an adult is _____ until proven otherwise
- cancer
lab workup for laryngeal tumors suspicion
- CT neck and chest
- PET/CT
- laryngoscopy, bronchoscopy, esophagoscopy
treatment of early laryngeal tumors
- single modality
- surgery
- or radiational therapy
treatment of advanced stage laryngeal tumors
- surgery with radiation
how long do we use radiation for laryngeal tumors
- 6-7 weeks daily
surgical therapy for advanced laryngeal cancer
- transoral laser microsurgery
- open partial laryngectomy
- total laryngectomy
what is a total laryngectomy
- complete separation of digestive and respiratory tracts
- tracheal stump attached to the neck
can patients without a larynx or voice box speak?
- yes
how tracheoesophageal speech works
- divert exhaled air into pharynx by creation of tracheoesophageal fistula
- pharyngoesophageal segment above the fistula will vibrate and produce a voice
can we give patients without a voice box a breathing tube through the mouth?
- no
some symptoms of pediatric obstructive sleep apnea
- poor sleep
- kid wetting the bed
- poor attention
pediatric obstructive sleep apnea - dysphagia and choking on solid foods indicates
- obstructing tonsils
pediatric obstructive sleep apnea - hypo nasal speech suggests
- enlarged adenoid tissue
greater risk of pediatric obstructive sleep apnea in patients with
- decreased neuromuscular tone
- craniofacial anomalies
definitive diagnosis for pediatric obstructive sleep apnea
- polysomnography
- routine use for diagnosis NOT recommended
pediatric obstructive sleep apnea peaks at what age
- preschool age
pediatric obstructive sleep apnea higher in which children
- obese children
most common cause of upper airway obstruction in children with pediatric obstructive sleep apnea
- adenotonsillar hypertrophy
treatment of pediatric obstructive sleep apnea
- adenotonsillectomy
nonsurgical treatment of pediatric obstructive sleep apnea
- CPAP
- weight loss
which is high pitch breathing from turbulent airflow through the LARYNX OR TRACHEA that is caused by narrowing or obstruction outside of chest cavity
it can be inspiratory, expiratory, or bisphasic
mostly high pitched
- stridor
what is used to describe airway noise from the nose, NASOPHARYNX and oropharynx
is low pitched, nonmusical, snoring
- stertor
which is a high pitched sound that indicates LOWER AIRWAY DISEASE
more commonly end expiratory noise
- wheezing
inspiratory stridor from
- supraglottis/glottis
biphasic stridor from
- subglottis
expiratory stridor from
- trachea
what is a big sign on Xray for epiglottitis
- thumb sign
typical bacterial for epiglottitis/supraglottitis
affects what age
- H. flu type b
- 2-6
result of epiglottitis/supraglottitis
- airway emergency
treatment of epiglottitis/supraglottitis
- secure airway
- IV antibiotics
- steroids
laryngotracheobronchitis also known as
- croup
laryngotracheobronchitis most commonly caused by
which ones
- viral
- parainfluenza
laryngotracheobronchitis result
- swelling from inflammation leads to airway narrowing
laryngotracheobronchitis affects what age group
- under 3
laryngotracheobronchitis symptoms
- barking cough
- stridor
- hoarseness
- difficulty breathing
X ray sign of laryngotracheobronchitis
- steeple sign
treatment of laryngotracheobronchitis
- steroids
- nebulizer epi (bronchodilates)
- cool mist
voice in epiglottitis
- muffled
voice in croup
- hoarse
most common cause of stridor in children
- laryngomalacia
laryngomalacia definition
- congenital abnormality of laryngeal cartilage
laryngomalacia presents around which age
- < 2 months
- resolves by 18 months
laryngomalacia - floppy cartilage leads to
- collapse
- inspiratory stridor
laryngomalacia worse when
- supine
- feeding
- exertion
most common treatment of laryngomalacia
- observation
- sometimes supraglottoplasty
one thing you must avoid doing in a patient with epiglottiis/supraglottitis
- avoid agitating the patient
