Salivary Gland and Laryngeal Disordes

Question 1

What is Sialadenitis?

Answer 1

salivary gland inflammation

Question 2

How does Sialadenitis occur?

Answer 2

decreased salivary flow or obstruction leads to stasis of fluid, which causes infection
can be viral (mumps, paramyxovirus) - often bilateral and dramatic
can be bacterial (staph aureus) - parotid and submandibular are most common

Question 3

What causes Sialadenitis?

Answer 3

Sjogen Syndrome
Dehydration (diuretics, anticholinergic medications) 
Chronic Illness
Smoking
Chronic Periodontal Disease
Sialolthiasis

Question 4

What are common symptoms of Bacterial Sialadenitis?

Answer 4

acute painful swelling of the gland
facial swelling
erythema
warmth
tenderness upon palpation
tenderness and erythema of the duct opening
pus
patient will not want you to touch it (very painful)
patient may report that it smells or tastes bad

Question 5

In what groups is Bacterial Sialadenitis more common, and in what group is Viral Sialadenitis more common?

Answer 5

bacterial is more common in adults
viral is more common in children; viral is less likely to have the purulent discharge, warmth and redness of bacterial sialadenitis

Question 6

How is Sialadenitis treated?

Answer 6

intravenous antibiotics (nafcillin)
hydration
warm compreses
sialagogues (lemon drops)
massage of gland

Question 7

What is Sialolithiasis?

Answer 7

Saliva stone process

Question 8

How does Sialolithiasis occur?

Answer 8

decreased salivary flow leads to stasis, leading to stone development
similar pathophysiology of sialadenitis, but different outcomes

Question 9

What causes Sialolithiasis?

Answer 9

Sjorgren Syndrome
Dehydration (diuretics, anticholinergic medications)
chronic illness
smoking
chronic peridontal disease

Question 10

Which salivary duct is affected more often by Sialolithiasis?

Answer 10

Wharton’s duct (submandibular) more often (80-90%) than Stensen’s duct (parotid)

Question 11

What are symptoms of Sialolithiasis?

Answer 11

acute painful swelling of the gland (can increase with meals)
often waxes and wanes
no pus but may be palpabel or sometimes visible stone on exam

Question 12

How is Sialolithiasis diagnosed?

Answer 12

diagnosed upon palpation of the stone

if stone cannot be palpated, imaging may be needed (CT over x-ray over MRI)

Question 13

How is Sialolithiasis treated?

Answer 13

increase salivary flow (hydration, warm compresses, sialogogues or lemon drops, massage of gland)
NSAIDs for pain
monitor for infectious symptoms

Question 14

When would you refer Sialolithiasis?

Answer 14

if stone is greater than 2 mm in diameter

if there is no resolution with conservative measures after 3-5 days

Question 15

Where do Salivary Gland Tumors most commonly occur, and are they more often benign or malignant?

Answer 15

Parotid tumors are more common and 80% are benign.

Submandibular and minor gland tumors are less common but more likely to be malignant (50-70%)

Question 16

What are signs and symptoms of Salivary Gland Tumors?

Answer 16

painless swelling
gradual onset (months to years)
possible facial nerve involvement (increases likelihood of malignancy)
on exam feels more firm rubbery/woody

Question 17

How are Salivary Gland Tumors diagnosed?

Answer 17

MRI

Question 18

How are Salivary Gland Tumors treated?

Answer 18

referral to an ENT for definitive treatment

likely excision

Question 19

Salivary gland pain indicates what?

Answer 19

Sialadenitis and Sialolithiasis are painful; salivary gland tumors are not

Question 20

If a salivary gland illness presents with pus, warmth, and redness, it is probably

Answer 20

Sialadenitis; not Sialolthiasis

Question 21

What is Laryngitis?

Answer 21

inflammation of the larynx

Question 22

How does Acute Laryngitis occur?

Answer 22

due to infection of primary vocal cords (rare) or from a secondary infection (common)
most commonly due to vocal cord overuse and abuse

Question 23

What are signs and symptoms of Acute Laryngitis?

Answer 23

hoarse voice that can persists up to a week to 10 days after other URI
acute onset
commonly after a URI
usually no pain or mild
resolving or absent URI symptoms
malaise
fatigue

Question 24

What is GERD?

Answer 24

lower esophageal problem due to dysfunction of lower esophageal sphincter

Question 25

What is Laryngopharyngeal Reflux?

Answer 25

upper esophogeal problem due to dysfunciotn of upper esophogeal sphincter take less gastric contents to make the effect as much due to laryngeal spasm and vagal response as to the presence of gastric conents worse while upright, as opposed to GERD which is worse while lying down

Question 26

How is Laryngopharyngeal relfux diagnosed?

Answer 26

should be a diagnosis of exclusion | refer to ENT for laryngoscopy to rule out cancer and other structural disorders

Question 27

How is Laryngopharyngeal reflux treated?

Answer 27

proton pump inhibitors (PPIs) can take 1-3 months for full resolution look for other causes if problem persists passed three months

Question 28

What is Epiglottits?

Answer 28

inflammation of the epiglottis

Question 29

What should you do if you suspect Epiglotitis?

Answer 29

refer emergently! | do not inspect; any irritation could cause closure and obstruct respiration

Question 30

How does Epiglotitis occur?

Answer 30

severe inflammation; essentially cellulitis of the epiglottis and adjacent supraglottic structures can progress to life-threatening airway obstruction very rapidly

Question 31

What causes Epiglotitis?

Answer 31

Infections (bacterial are more common than viruses which are more common that fungal infection)

Question 32

What infectious agents are responsible for Epiglotitis in children?

Answer 32

Haemophilus influenzae type B (Hib) - has declined since immunizations H. influenzae types, streptococci, and staphylococcus aureus

Question 33

What infectious agents are responsible for Epiglotitis in adults?

Answer 33

broad range of bacteria and viruses (not as emergent as Epiglotitis in children)

Question 34

What infectious agents are responsible for Epiglotitis in immunocompromised patients?

Answer 34

Pseudomonas aeruginosa and Candida (fungus)

Question 35

In what group is Epiglotitis most common?

Answer 35

5 cases in 100,000 children under 5 years old | median age is 1-5 years old

Question 36

What are signs and symptoms of Epiglotitis?

Answer 36

drooling tripod formation red, swollen epiglottis rapid onset (within 24 hours) respiratory distress, stridor, tachypnea, anxiety refusal to lige down sore throat, dysphagia, drooling, anterior neck pain muffled hot potato voice marked reactions and labored breathing indicate impending respiratory failure verbal patients with pain out of proportion unimmunized patient

Question 37

How is Epiglotits treated?

Answer 37

``` do not attempt to visualize do not attempt other invasive procedures primary objective is to manage the airway and immediately involve airway specialists hospitalization IV antibiotics (ceftriaxone) IV corticosteroids (dexamethasone) ```

Question 38

If you are not able to maintain an airway in a patient with Epiglotitis, what should you do?

Answer 38

Attempt bag-valve mask ventilation; if you are unable to oxygenate, attempt intubation, but first be prepared to establish a surgical airway; if you are able to oxygenate, get endotracheal intubation by the most capable provider, preferably in the OR

Question 39

If you are able to maintain an airway in a patient with Epiglottitis, what should you do?

Answer 39

provide supplemental humidified oxygen and maintain the child in a position of comfort with their parent keep patient in setting where airway can be rapidly managed

Question 40

What are Vocal Cord Polyps?

Answer 40

mass arising form the superficial lamina propia of the vocal cord thought to form in area of resolved vocal cord hemorrhage unilateral typically within anterior half of cord result of vocal cord trauma

Question 41

What are symptoms of Vocal Cord Polyps?

Answer 41

subacute hoarseness of voice usually following vocal abuse or sever cough mild to no dicomfort

Question 42

How are Vocal Cord Polyps diagnosed?

Answer 42

typically requires ENT for laryngoscopy

Question 43

How are Vocal Cord Polyps Treated?

Answer 43

vocal rest occasionally corticosteroids resection for treatment-resistant polyps

Question 44

Vocal Cord Nodules

Answer 44

typically bilateral and symmetrical chronic vocal abuse often resolve with vocal modification, but may need surgery common in singers

Question 45

Polypoid Corditis

Answer 45

Reinke's edema - gelatinous collection of lamina propia resulting from breakdown of elastin fibers leads to big, floppy, bumpy, goopy, vocal cords caused by smoking leads to smoker's voice may resolve with cessation of smoking

Question 46

How is Unilateral Vocal Cord Paralysis usually caused?

Answer 46

latrogenic (from treatment) recurrent laryngeal nerve damage due to thyroid surgery, thyroid cancer, or other neck surgery lower cranial nerve and/ or Vagus Nerve damage due to skull base tumor layrngeal cancer cricoarytenoid arthritis due to severe advanced RA idiopathetic (must rule out masses and lesions)

Question 47

How is Bilateral Vocal Cord Paralysis caused?

Answer 47

Recurrent laryngeal nerve damage due to thyroid resection esopharyngeal cancer laryngeal cancer cricoarytenoid arthritis due to severe RA

Question 48

What are symptoms of Vocal Cord Paralysis?

Answer 48

unilateral - breathy dysphonia | bilateral - inspiratory stridor

Question 49

How is Vocal Cord Paralysis diagnosed?

Answer 49

laryngoscopy | CT form base of skull to top of lungs - search for underlying cause

Question 50

How is Vocal Cord Paralysis treated?

Answer 50

depends on underlying etiology often permanent possible surgical management

Question 51

What is the most common type of Laryngeal Cancer?

Answer 51

Squamous cell carcinoma - an epithelial cancer arising form the mucosal surface of the larynx

Question 52

What predisposes patients to Laryngeal Cancer?

Answer 52

nearly exclusively in smokers heavy alcohol use men more than women 50-70 years of age

Question 53

What are signs and symptoms of Laryngeal Cancer?

Answer 53

dysphonia is the most common presenting complaint any hoarseness lasting more than 2 weeks in a smoker should be evaluated more advanced: hemoptysis, dysphagia, throat or ear pain weight loss airway compromise may occur

Question 54

How is Laryngeal cancer diagnosed?

Answer 54

diagnosis is made by having a high index of suspicion laryngoscopy biopsy get head and neck CT for staging

Question 55

How is Laryngeal Cancer treated?

Answer 55

most cases are treatable, but early detection is key goals: cure, preservation of safe and effective swallowing and voice, avoidance of permanent tracheostoma radiation for acute surgical cures, chemo, radiation for T3 or T4 nodal involvement more towards surgery, but still chemo