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Respiratory Block > Laryngotracheal disorders > Flashcards

Laryngotracheal disorders Flashcards

1
Q

What are functions of the larynx?

A

Voice production, protect the airway from aspiration/cough;assist in swallowing, airway/breathing, increase in intrabdominal pressure for valsalva, defecation

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2
Q

What is the power source for vocal production?

A

Lungs

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3
Q

What is the oscillator/affects tone and pitch in vocal production

A

larynx

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4
Q

What is the resonator/shapes, resonates, and articulate sounds in an individual voice?

A

Pharynx/sinuses

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5
Q

What are the components of the vocal ligament?

A

intermediate lamina propria and deep lamina propria

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6
Q

What are the components of the vibratory microanatomy?

A
  • Mucosa (epithelial cover-stratified squamous epithelium, spuerficial lamina propria-layer of surgical interest for benign pathologies)
  • Intermediate and deep lamina propria
  • Thyroarytenoid muscle
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7
Q

ABduction for the larynx is necessary for

A

breathing

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8
Q

ADduction of the larynx is necessary for

A

sound production, and during swallowing

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9
Q

What are some common causes of voice hoarseness

A
  • Neurological injury (recurrent laryngeal nerve injury)

- Alterations of vocal fold lining

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10
Q

What are possible causes in non lesion alterations of vocal fold lining seen in voice hoarseness

A
  • GERD/LPR
  • Sinus disease/allergic rhinitis
  • Dehydration
  • General health and wellness
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11
Q

What are some possible causes for neurological injury that causes voice hoarseness?

A
  • iatrogenic injury (MOST COMMON)
  • Neoplasm
  • Viral neuropathy
  • Idiopathic Injury
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12
Q

What are some symptoms of unilateral vocal fold paralysis?

A
  • Breathy
  • Weak dysphonia
  • Poor cough
  • Dysphagia
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13
Q

The majority of laryngeal lesions that coase voice hoarseness involve which layers of the vocal cords?

A

The superficial layers of the vocal fold: Superficial lamina propria and epithelial cover

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14
Q

What are some types of benign vocal fold lesions?

A
  • Nodules
  • Polyps
  • Cysts
  • Hemorrhage
  • Carcinoma
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15
Q

What is the most common cause of benign vocal fold lesions?

A

Phonotrauma (screaming)

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16
Q

What is the most common benign neoplasm of the larynx seen in children?

A

Recurrent respiratory papillomatosis

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17
Q

What is recurrent respiratory papillomatosis?

A

Exophytic airway lesions that may involve the entire aerodigestive tract

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18
Q

Does recurrent respiratory papillomatosis affect juveniles or children?

A

Both, but juvenile form is more aggressive

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19
Q

What is the etiology of recurrent respiratory papillomatosis?

A

Associated with Human Papilloma virus (HPV) types 6 and 11.

Childhood disease is linked to mom’s with genital HPV. While adult onset is possibly associated with oral-genital contact. Malignant transformation occurs in 1-7% of those for HPV11

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20
Q

Gardasil-9 protects against which HPVs?

A

6, 11, 16, 18, 31, 33, 45, 52, 58

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21
Q

Quadrivalent gardasil protects against which HPVs?

A

6, 11, 16, 18

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22
Q

Bivalent cervarix protects against which HPVs?

A

16 and 18

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23
Q

Treatment of vocal fold lesions includes what therapies?

A

A combination of medical treatment, speech therapy, and surgical therapy

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24
Q

The majority of larygneal carcinoma is what type of cancer?

A

> 90% are squamous cell carcinoma. The tumor typically arises from stratified epithelium or from respiratory epithelium that has undergone squamous metaplasia

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25
Q

What is the largest risk factor for laryngeal carcinoma?

A

Smoking is the largest risk factor, while alcohol use has synergistic effect

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26
Q

Is larygneal carcinoma curable?

A

Yes, it has excellent cure rates for early stage disease

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27
Q

Discuss the epidemiology regarding laryngeal cancer

A
  • Common head and neck cancer mutations
  • Prevalent over 40 years of age
  • 4:1 male predilection
  • More prevalent among lower socioeconomic class, in which it is diagnosed at more advanced stages
  • 1/3 will die of their disease
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28
Q

What are the different types of laryngeal carcinomas?

A
  1. Supraglottic (above vocal folds)
  2. Glottic (In vocal cords): MOST COMMON
  3. Subglottic (below vocal folds): most rare
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29
Q

What is the most common symptom for layrgneal carcinomas. What are other symptoms?

A

Most common symptom is hoarseness.

Other symptoms: Dysphagia, hemoptysis, throat pain, ear pain, airway compromise, aspiration, neck mass

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30
Q

What is the treatment for early stage layryngeal carcinoma? (I or II)

A

single modality therapy: Surgery OR Radiation therapy (85-95% local control rate)

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31
Q

What is the treatment for advanced stage laryngeal carcinoma? (III or IV)

A

Combined-modality therapy

  • Primary surgery followed by radiation
  • Concurrent chemoradiation therapy
  • Primary CRT or RT with surgery for salvage
32
Q

What are some complications that can develop from radiation treatment?

A
  • Skin changes
  • Mucositis
  • Odynophagia
  • Laryngeal edema
  • Xerostomia
  • Stricture and fibrosis
  • Radionecrosis
  • Hyperthyroidism
33
Q

What are some of the types of surgical therapies for advanced laryngeal cancer?

A
  • Transoral laser microsurgery
  • Open partial laryngectomy
  • Total laryngectomy
34
Q

What is involved with a total larygnectomy?

A

Complete separation of the digestive and respiratory tracts. Tracheal stump attached to neck

35
Q

What types of options are available for an individual with no voice box?

A
  • Electrolarynx: Although has poor intelligiblity and is cumbersome in that it requires external device
  • Pure esophageal speech: Forces a bolus through the cricopharngeus. The air bolus is then regurgitated through the pharyngoesophageal segment, which vibrates to produce sound
  • Tracheoesophageal speech: Diversion of exhaled air into the pharynx by way of a permanent, surgically constructed tracheoesophageal fistula. The pharyngoesophageal segment above the fistula vibrates, producing a neovoice
36
Q

What are some signs of pediatric obstructive sleep apnea

A
  • Mouth breathing, snoring, snorting, gasping, apnea
  • Dysphagia and choking on solid foods indicate obstructing tonsils, whereas hyponasal speech suggests enlarged adenoid tissue
  • Poor sleep, enuresis, poor attention
37
Q

There is a greater risk of OSA in patients with __ and __.

A

Decreased neuromuscular tone and craniofacial anomalies

38
Q

How is OSA diagnosed?

A

Mostly clinical diagnosis is used, but definitive diagnosis by polysomnography. Routing use for diagnosis is not recommended in children

39
Q

What might be demonstrated on a polysomnography test in a patient with OSA?

A

episodic hypoxia, intermittent hypercapnia, and sleep fragmentation

40
Q

OSA occurs in __% of children, peaks in __ age, and is more prevalent in __ children.

A

2-3%, peaks in pre school age, more prevalent in obese children

41
Q

What are some morbidities/ complications of OSA?

A

Failure to thrive, poor growth, learning diabilities, behavioral problems, cardiopulmonary issues, ADHD

42
Q

What is the most common cause of upper airway obstruction in children?

A

Adenotonsillar hypertrophy

43
Q

What are forms of treatment for pediatric OSA?

A

Surgical: Adenotonsillectomy

Non-surgical: CPAP and/or weight loss

44
Q

What might be seen in a patient after having had their pediatric OSA surgically treated?

A

Improved height and weight and improved school performance

45
Q

What is stridor?

A

High pitch breathing from turbulent airflow through the larynx or trachea caused by narrowing or obstruction. It can be inspiratory, expiratory or biphasic

46
Q

What is stertor?

A

Used to described airway noise from nose, nasopharynx, and oropharynx. Low pitched, nonmusical, snoring

47
Q

What is wheezing?

A

High pitched sound, indicating LOWER AIRWAY DISEASE; more commonly end expiratory noise

48
Q

Where does inspiratory stridor generally come from?

A

From the supraglottis/glottis

49
Q

Where does biphasic stridor generally come from?

A

Subglottis

50
Q

Where does expiratory stridor generally come from?

A

From the trachea

51
Q

Snoring occurs from an obstruction in which of the following? (Nasopharynx, larynx, trachea/bronchi, small airways)

A

Nasopharyx, and possibly the larynx in small babies

52
Q

Stridor occurs from an obstruction in which of the following? (Nasopharynx, larynx, trachea/bronchi, small airways)

A

Nasopharynx, larynx, trachea/bronchi

53
Q

Wheezing occurs from an obstruction in which of the following?

A

Larynx (severe obstruction, trachea/bronchi, small airways

54
Q

Thumb sign is indicative of what condition? Is this an airway emergency?

A

Epiglottisi; it is an airway emergency

55
Q

Epiglottitis or supraglottitis is more commonly seen in children or adults?

A

Seen in both, but is more common in children

56
Q

What is the typical bacteria associated with epiglottitis or supraglottitis?

A

Haemophilus influenzae type b and streptococcus species

57
Q

What is the treatment for epiglottitis or supraglottitis?

A
  • Secure the airway
  • FLexible fiberoptic nasotracheal intubation
  • tracheotomy
  • Cricothyrotomy
  • ENT and anesthesia available
  • IV abx and steroids
58
Q

What is Croup?

A

Laryngotracheobronchitis; a common primarily pediatric viral respiratory illness

59
Q

Croup affects __% of children 6 months-6years old

A

15%

60
Q

With croup, there is a __ and __ lasting for 12 to 72 hours

A

prodromal period coryza and low grade fever

61
Q

What are the common viruses seen in croup?

A

parainfluenzae, influenza, measles, adenovirus, RSV.

But can have bacterial superinfection

62
Q

What are some symptoms of croup?

A

Barking cough, stridor, hoarseness, difficulty breathing. Swelling from inflammation leads to airway narrowing

63
Q

What is a common sign on x-ray seen in croup?

A

Steeple sign

64
Q

How serious is croup?

A

Not very? The majority recover with no sequelae. Mostly managed as outpatients, while small % require hospitalization

65
Q

What is the treatment for croup?

A
  • Steroids
  • Nebulized racemic epinephrine (constricts arterioles, fluid resorption, and bronchodilation)
  • Cool mist- moistens airway, decreases viscosity, and soothes inflamed mucosa
66
Q

Compare and contrast epiglottis vs croup

A

Epiglottitis: Haemophilus influenzae B, 2-6 yrs old, rapid, no cough, severe dysphagia, inspiratory stridor, fever/drooling, tripod, muffled voice, thumbprint sign

Croup: Parainfluenza virus, <3 years old, slow, barking cough, no dysphagia, biphasic stridor, fever, lying back, hoarse voice, steeple sign

67
Q

What is the most common cause of stridor in infants? Other causes of stridor in infants>?

A

Most common: Laryngomalacia
Other causes: Bilateral vocal fold paralysis, laryngeal web, laryngeal atresia, subglottic stenosis, subglottic hemangioma, recurrent respiratory papillomatosis

68
Q

What is laryngomalacia?

A

Congenital abnormality of laryngeal cartilage; usually presents<2 months of life and resolves by 18 months

The floppy cartilage leads to collapse and inspiratory stridor. Worse when supine, feeding, and with exertion

69
Q

What is the treatment for laryngomalacia?

A
  • Mostly self limiting; observation

- In 10%, surgery (supraglottoplasty) may be indicated. Severe stridor, apnea, failure to thrive, pulmonary hypertension

70
Q

What are some causes of laryngotracheal stenosis?

A
  • Congenital
  • Idiopathic
  • Trauma (external, blunt, penetrating, thermal, or chemical burn. Intubation/tracheotomy. Radiation)
  • Chronic inflammatory disease (Bacterial, fungal, TB, leprosy, sarcoidosis, RA. GERD)
  • Benign neoplasms/malignant neoplasms
  • Collagen vascular diseases (Granulomatosis with polyangitis, relapsing polycondritis)
71
Q

What are some contributing factors for laryngotracheal stenosis?

A

Endotracheal tubes: Not typically recommended use >7-10 days. Or size of tube too large (7-8 mm ID for adult males, 6-7mm females)

72
Q

How does laryngotracheal stenosis occur from endotracheal tubes?

A

Edema, ulceration, secondary infection, perichondritis, granulation tissue

73
Q

Who are at increased risk for laryngotracheal stenosis from endotracheal tubes?

A

GERD, Chronic illness, Immunocompromised, Radiation, Diabetes

74
Q

What are some symptoms of laryngotracheal stenosis?

A
  • Shortness of breath with exertion
  • High pitched inspiratory breathing or stridor
  • No aid with use of inhalers
  • Tightness in throat
75
Q

What are some indications for tracheotomy?

A
  • Bypass upper airway obstruction
  • Prolonged intubation to avoid long term complications
  • Cure for obstructive sleep apnea/hypercarbic hypobentilation syndrome
  • Patients who need a ventilator long term
76
Q

Rules for tracheotomy?

A
  • Know the size
  • Cuff or no cuff
  • Keep clean and open airflow

Respiratory Block (2 decks)

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