Larynx and Trachea Flashcards
History in evaluation of larynx nd trachea
symptoms such as hoarseness, change in the quality of the voice, dyspnoea, difficulty in breathing, stridor, cough, expectoration, haemoptysis, pain, dysphagia or choking
Stridor
used to describe noisy breathing
Inspiratory vs. expiratory stridor
Inspiratory stridor suggests obstruction of the larynx. Expiratory stridor implies tracheobronchial obstruction
Biphasic stridor suggests
a subglottic or glottic anomaly.
Laryngomalacia
Laryngomalacia (or congenital flaccid larynx) is the most frequent congenital anomaly of the larynx. It produces partial obstruction of the supraglottic airway
Clinical features of Laryngomalacia
The newborn typically will develop intermittent, inspiratory, low-pitched stridor within the first 2 weeks of life, which resolves slowly over several months. The symptom worsens during feeding
D iagnosis and treatement of Laryngomalacia
Laryngoscopy
t consists of careful observation and reassurance of the parents. A small number of these infants seen by a paediatric otolaryngologist will require surgical intervention
Character of stricor in Vocal fold paralysis
inspiratory or biphasic, with a high-pitched musical quality
Causes of Paralysis of the vocal folds in a newbor
idiopathic or can result from birth trauma,
central or peripheral neurologic diseases,
or thoracic diseases or procedures.
Approximately 70% of noniatrogenic unilateral vocal fold paralyses will resolve spontaneously, most within the first six months of lif
Subglottic stenosis
cricoid diameter of less than 3.5 mm
Congenital stenosis can present as
a membranous and cartilaginous type and is typically the result of malformation of the cricoid cartilage
The stridor of subglottic stenosis may be
inspiratory or biphasic and will worsen when the patient is agitated (increased airflow)
Subglottic stenosis diagnosis
Direct laryngoscopy and bronchoscopy are needed to fully evaluate subglottic narrowing
Tracheal stenosis may result from
complete tracheal rings or other cartilage deformities
Diagnosis of tracheal stenosis
Endoscopic evaluation with a rigid bronchoscope is clearly the most accurate means of diagnosing tracheal stenosis
Treatment. Tracheal stenoses can be managed
endoscopically, whereas longer stenoses are better corrected through an open approach
r segmental resection and reanastomosis for short-segment stenosis and use of slide tracheoplasty or augmentation of longsegment stenosis
Acute laryngitis
an inflammatory process of the larynx, which can affect mucosa
(superficial type) or deeper laryngeal structures (muscle, cartilage)
Main symptoms of acute laryngitis
Hoarseness, aphonia, pain in the larynx, and coughing attacks are the main symptoms of acute laryngitis
Acute laryngitis is usually due to
ascending or descending viral infections from other parts of the airway. The cause is viral or, rarely, bacterial infection
Diagnosis of . Acute laryngitis
Laryngoscopy reveals oedematous and eryhematous vocal folds. Depending on the underlying disease, the neighbouring pharyngeal or tracheal mucosa may also be inflamed
Treatment of Acute laryngitis
steam inhalation, analgesia, and sufficient oral intake of fluids. Steroids are indicated for marked oedema
Diphtheritic croup usually begins with
laryngeal membranes and obstruction
Diphtheritic laryngitis
greyish-white membranes, occurring as an isolated condition, is also rare
The term “pseudocroup” includes a group of
acute laryngotracheal diseases mainly affecting children.
Acute subglottic laryngitis (laryngotracheitis) in children
A dry, barking cough following an upper respiratory tract infection that rapidly becomes worse.
Clinical features of Acute subglottic laryngitis (laryngotracheitis) in children
Hoarseness, inspiratory, expiratory or mixed stridor, retraction of the suprasternal notch and of the intercostal spaces during inspiration, and cyanosis. The severity of respiratory obstruction depends on the degree of mucosal swelling in the subglottis. Worsening symptoms in children lead to concern due to potential airway obstruction
pathogenesis. of (laryngotracheitis) in children
inflammatory mucosal swelling of the elastic cone in the subglottic space
Diagnosis of (laryngotracheitis) in children
The clinical picture is usually very typical. Laryngoscopy reveals glottal mucosal oedema and redness, potentially with crust formation
antibiotic and steroid treatment
If treatment fails and dyspnoea increases oxygen therapy and standby for an endotracheal intubation
Tracheostomy is carried out when there is severe obstruction and progressive formation of the crust
Acute epiglottitis is essentially
laryngeal supraglottitis
clinical triad of Acute epiglottitis
drooling, dysphagia, and distress
Severe pain of acute epiglottitis during swallowing and refusal of food and liquid intake may lead to
dehydration and potential circulatory collapse
Clinical features of Acute epiglottitis
Inspiratory stridor usually forces the patient to sit upright in bed with the nose pointing upwards in a “sniffing the morning air position”.
Speech is muffled (“hot potato speech”) and temperature is elevated
Causative pathogen and aetiology of Acute epiglottitis
The main cause is infection with haemophilus influenzae. The disease can also be caused by mucosal damage resulting from swallowing sharp-edged food, allowing pathogenic organisms to enter
Diagnosis in Acute epiglottitis
thick, swollen, red epiglottic rim
Treatment Acute epiglottitis
hospital if a diagnosis of epiglottitis is suspected. If respiratory arrest occurs, the airway is secured by intubation but tracheostosmy might be required
Bacterial tracheitis in children
(bacterial laryngotracheobronchitis, pseudomembranous croup, or membranous laryngotracheobronchitis) is a rare acute infection of the upper airway that does not involve the epiglottis but can cause life-threatening sudden airway obstruction, particularly in children
The infectious inflammatory process in Bacterial tracheitis in children involves the
subglottis and trachea with marked edema in the subglottis as in those with viral croup
Clinical features Bacterial tracheitis in children
brassy cough, high fever, worsening inspiratory stridor.
Diagnosis in Bacterial tracheitis in children
confirmed by endoscopic examination
The most commonly isolated pathogens Bacterial tracheitis in children
Staphylococcus aureus, Moraxella catarrhalis and H. influenzae
Chronic nonspecific laryngitis
This is laryngitis caused by a recurrent irritation, or following acute laryngitis
Symptoms of Chronic nonspecific laryngitis
hoarseness, a deeper voice, and sometimes a dry cough. The voice is less robust and there is a globus sensation in the larynx and a feeling of needing to clear the throat, but little or no pain
Chronic nonspecific laryngitis pathogenesis
mainly due to exogenous toxins such as cigarette smoking, occupational air pollution, and climatic influences.
Another cause is vocal overuse in bartenders, construction workers, call centre agents, and other professional speakers. Nasal obstruction may also be a factor in the pathogenesis.
An importan cause of chronic laryngitis is also
untreated laryngopharyngeal reflux
Vocal fold polyp Definition. Polyps are
fluid-filled collections that form on the edge of a vocal cord
Clinical features. Polyps
hoarseness, dys/aphonia, and attacks of coughing. If the polyp has a pedicle and is floating between the folds, the voice may return to normal for short intervals
Reinke’s oedema is a
pathologic condition of the vocal fold that involves an accumulation of a gelatinous type of fluid throughout the superficial aspect of the lamina propria
Clinicl feataures of Reinke’s oedema
hoarseness and deepening of the voice. Stridor may occur, particularly on exertion, if the oedema is marked
Recurrent respiratory papillomatosis
benign disease presenting with wart-like growths in upper airway which is caused by the human papillomavirus (HPV)
Clinical features of Recurrent respiratory papillomatosis
Hoarseness, often severe, and respiratory obstruction, depending on the site and extent of the lesions.
Carcinoma of the larynx accounts for approximately
40% of carcinomas of the head and neck
Carcinoma of the larynx t is most common between the ages of
45 and 75 years
Carcinoma of the larynx Clinical features
Hoarseness
foreign-body sensation
clearing the throat,
pain in the throat or
referred to the ears
dyspnoea,
dysphagia,
cough,
and haemoptysis.
Metastases to regional lymph nodes may also occur
Invasive carcinoma may develop from
epithelial dysplasia, particularly carcinoma in situ.
The clinical diagnosis of Carcinoma of the larynx
indirect laryngoscopy, video laryngoscopy, and stroboscopy
