Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SPC- ENT > SPC- Hoarsenss (Dysphonia) > Flashcards

SPC- Hoarsenss (Dysphonia) Flashcards

Be able to recall the definition of hoarseness Describe some of the causes of hoarseness

1
Q

What is hoarseness?

A

Difficulty producing sounds, with change in voice pitch or quality (scratchy, breathy, husky)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the majority of cases of hoarse voice caused by?

A 
Upper respiratory tract infections that are self limiting
Voice overuse (singing and shouting) is also a common cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If present, what factors would suggest further investigation for the cause of hoarseness?

A

Hoarseness lasting> 3 weeks (Especially in smokers- as it is the main and often only presentation of laryngeal carcinoma )
Neck lump
Any red flags for malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

If patient presents with hoarseness what other things should you ask them about?

A 
Smoking history
Family history of cancer
GORD
Dysphagia- Suggesting neck lump?
Stress
Singing
Shouting
Viral Illness features (most are caused by URTI)
Coughing up any blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If further investigation is required, what test would be requested?

A

Laryngoscopy
Assessment of cord mobility, inspect the mucosa and exclude local causes
A flexible laryngoscope can be used- entering through the nasal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the differential diagnoses for hoarse voice?

A 
Laryngeal cancer
Vocal cord/Laryngeal Nerve palsy
Laryngitis (Most common)
Reflux Laryngitis (Ask about GORD)
Reinke's Oedema
Vocal Cord Nodules (Caused by vocal abuse)
Spasmodic Dysphonia
Muscle Tension Dysphonia
Children with functional speech disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common cause of acute laryngitis?

A

Viral URTI that is usually self limiting-
e.g. Rhinovirus, coronavirus, influenza virus, respiratory syncytial virus (RSV)
There may be secondary infection with Strep or Staph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What other factors can cause laryngitis?

A

Reflux laryngitis due to GORD

Auto-immune disease (e.g. RA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the symptoms of laryngitis?

A

Pain
Felt Hypopharyngeal- last part of the pharynx where the larynx and the oesophagus meet
Dysphagia
Pain on phonation
Hoarse voice- oedema of vocal cords causes this
Preceding features of viral illness- Fever, fatigue, headache, nausea…
If malignant cause consider red flags for this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the treatment for acute laryngitis?

A

Often self limiting
Supportive treatment if viral infection suspected- simple analgesia, fluids, steam inhalations
Bacterial cause- Abx (Phenoxymethylpenicillin 500mg/6h PO for 1 week)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is chronic laryngitis?

A

Long term inflammation of the vocal cords leading to chronic changes
Associated with smoking and pollution/occupation exposure
(Creating chronic inflammation of the larynx- associated with oedema and vocal cord polyps)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the treatment for chronic laryngitis?

A 
Drainage of oedema if present
Excision of any nodules
Voice rest
Speech therapy
Avoidance of pollutants
Smoking cessation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is reflux laryngitis?

A

Reflux of gastric contents causes irritation of the vocal cords- this can lead to chronic laryngitis
History of GORD- Retrosternal burning pain, unpleasant taste in mouth, bad breath
~15% of all visits to ENT clinics are due to reflux laryngitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is reflux laryngitis treated?

A

PPIs- e.g. Omeprazole, lansoprazole
Diet/Lifestyle Modification
Weight loss
Surgical Fundoplication- if above fail, top of stomach wrapped around LOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Reinke’s Oedema?

A

Swelling of the vocal cords due to fluid collecting within Reinke’s Space (this is a gelatinous layer of the vocal cords underneath the other cells)
Vocal cords have a sac like appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What causes Reinke’s Oedema?

A

Chronic laryngitis- chord irritation from smoking/chronic vocal cord abuse
Symptoms are therefore similar to laryngitis
Described as a deep gruff voice- women often say they sound like a man

17
Q

What patients is Reinke’s Oedema almost exclusively seen in?

A

Smoking (Main cause)
Women
Hypothyroids
Elderly

18
Q

What is the treatment for Reinke’s Oedema?

A

Reduce the risk factors- stop smoking, GORD management, prevent over use of vocal cords
SALT therapy
If conservative treatment fails surgical treatment can be considered- microlaryngoscopy to treat oedema. CO2 laser can be used to make the small incisions (laser therapy)

19
Q

What are vocal cord nodules?

A

Nodules that develop due to trauma/chronic inflammation of the vocal cords
Fibrous tissue can develop causing the affected area to be stiffer and the vocal cords cannot vibrate effectively
Appear in pairs due to trauma occurring to the vocal cords when coming into contact
Note- Form at the junction of the anterior 1/3 and posterior 2/3 of the cord. This is the middle of the membranous vocal fold as the posterior 1/3 is cartilage

20
Q

What kind of people might vocal cord nodules be seen in?

A 
Teachers
Singers
Presenters
Angry people
Football fans
Think of vocal cord overuse
21
Q

What voice change is seen with vocal cord nodules?

A

Cause hoarse voice as the cords cannot come into contact as usual
Variable husky voice

22
Q

What is the treatment for vocal cord nodules?

A

Speech therapy- prevent further injury and allow for tissue repair. Encourages good vocal habits, warn-ups, hydration, rest time
Failure of this surgical excision may be considered

23
Q

What is muscle tension dysphonia?

A

Functional disorder due to abnormal laryngeal muscle tension
Excessive effort is used to produce voice
Patients complain of a husky hoarse voice that tires easily
Voice is often best in the mornings and deteriorates with use

24
Q

What is muscle tension dysphonia associated with?

A

Previous episode of laryngitis- particularly in patients who have had to carry on with heavy voice use despite dysphonia
Professional voice users
Voice overuse
Psychological stress

25
Q

What is the management for muscle tension dysphonia?

A

Vocal cord rest
Speech therapy
Reassurance and explanation

26
Q

What is vocal cord palsy?

A

Paralysis of the vocal cords

27
Q

Describe the route of the recurrent laryngeal nerves?

A

Recurrent laryngeal nerves branch from the vagus nerve
Vagus nerve exits the brain from the jugular foramen and travels within the carotid sheath
The left recurrent laryngeal nerve branches off at the aortic arch (passes infront, around and then ascends behind the arch)
The right recurrent laryngeal nerve branches off at the right subclavian artery
Right and left recurrent laryngeal nerves ascend in a grove between the trachea and the oesophagus
They pass behind the thyroid gland and enter the larynx underneath the inferior constrictor muscle

28
Q

Which nerves supplies the intrinsic muslces of the larnyx, except for the cricothyroid muscle (innervated by superior laryngeal branch of the vagus nerve)?

A

Recurrent Laryngeal Nerves

Right and left

29
Q

What are the symptoms of vocal cord palsy?

A

Weak breathy voice- hoarse voice
Repeated coughing/aspiration
Exertional dyspnoea- narrow glottis reduces airflow, normally when breathing heavily the vocal cords open to accommodate increased airflow. This is especially a problem if bilateral

30
Q

What are the causes of vocal cord palsy?

A

30% are due to cancers- larynx, thyroid, oesophagus, hypopharynx, bronchus, lung, mediastinal mets) (Consider red flags)
25% are iatrogenic- e.g after (para)thyroidectomy, oesophageal or pharyngeal pouch surgery (causing damage to the nerve)
Others- CNS Disease, TB, Aortic aneurysm (of arch), External trauma to the neck

31
Q

How should the cause of vocal cord palsy be investigated?

A

If no history of recent surgery request a CXR. If normal proceed to CT (skull to diaphragm), USS thyroid, OGD

32
Q

How might non-malignant causes of vocal cord palsy be treated?

A

Unilateral palsies can be compensated for by movement of the contralateral cord
Re-innervation techniques
If bilateral medialisation (bringing paralysed cord to the midline) is contra-indicated due to reduced airway. May require a tracheostomy to secure adequate airway

SPC- ENT (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions