Speech and Swallowing + Dysphonia + Larynx Cancer Flashcards
What are three phases of swallowing
Oral phase
Pharyngeal phase
Oesophageal phase
What occurs in oral phase
Bolus held in oral cavity
Closed posteriorly by soft palate and tongue to prevent leakage into pharynx
Tongue propels food to back of oral cavity into pharynx
Triggers swallowing reflexx
Afferent - CN 5,9,10
Go to swallowing centre in medulla
Efferent - 7,10,12
What happens in pharyngeal phase
Soft palate pulled upwards and closes of nasa-pharynx
Epiglottis covers larynx which moves up to prevent aspiration
UOS relaxes
Respiration inhibited to prevent food going into bronchi
What happens in oesophageal phase
Bolus passes UOS which contracts
Bolus propelled down by peristaltic motion via myenteric plexus
What is respiration in relevance to voice production
Source of energy through airflow
Provides larynx with a column of air which vocal cords can vibrate with to create sound
How are words formed
Action of pharynx, tongue, lips and teeth
Any dysfunction = voice change
What is phonation
Flow of air through different vocal cord position, tension, vibration and length
What is resonation
Oral nasal speech balance
Depends on nasopharynx, nasal cavity and oral cavity
What is articulation
Production of speech
Determined by action of lips, tongue and jaw
What does change in voice require
REFERRAL ENT
- Can be change in quality, pitch, loudness or vocal effort
Investigation
- Flexible nasoendoscopic exam
- Blood test as appropriate e.g. thyroid
What should vocal cords be
Pearly white
What is important in the Hx of hoarseness
How long Persistent or intermittent Any pain Any cough / dysphagia Voice use PMH - asthma / reflux (GORD) / rhino sinusitis Smoking history Drug history
What causes hoarseness
Voice overuse Vocal cord nodules / cyst Neuromuscular - vocal cord palsy Laryngitis Viral illness Hypothyroid Smoking Reflux laryngitis Trauma - surgery / intubation / laryngeal nerve palsy after thyroid surgery Laryngeal cancer - SCC Lung cancer - do CXR
When do you investigate hoarseness and how
If >3 weeks
Laryngoscopy
What are symptoms of laryngeal nerve palsy and where does it run
Weak breathy voice Hoarse voice Repeated coughing Exertional dysnopea Dysphagia
Path
- Comes from vagis
- Loops around aorta on L and subclavian on R
- Run in trachea-oesophageal groove before inserting into larynx
- Innervates all instrisinc muscle Except cricothyroid
What causes
30% due to cancer - skull base, thyroid, lung, oesophagus
25% iatrogenic after parathyroidectomy / carried endarectomy / mediastinum surgery
Infection
Trauma - endotracheal tube
CNS disease
RA / sarcoid / Wegner
Idiopathic
How do you investigate and Rx
Scope - Look at vocal cords - When you breath in they are apart - When you talk they come together to block of gap - If bilateral palsy = close so stridor CXR - tumour / mass CT from skull base to mediastinum
If idiopathic
- Voice rehab
- Consider surgery at 6 months to allow things to settle
What are red flags in dysphonia
Smoking / alcohol Neck mass Unexplained weight loss Other neuro Sx Haemoptysis / dysphagia / odynophagia / otalgia / Persistent and worsneing Immunocompromsied
What can larynx be divided into
Supraglottis
Glottis
Subglottis
Where is laryngeal cancer most common
Glottis
What type of cancer
SCC
What are RF
Smoking
Alcohol
What are symptoms
Hoarsness = most common presentation Noisy breathing Stridor Cough Haemoptysis Odynophagia Dysphagia Neck LN
How do you investigate
Flexible naso-endoscopy
Microlaryngoscopy for biopsy
CT neck and chest to stage
How do you Rx
Chemo
RT
Surgery
Tracheostomy
Role of SALT
Disorders of speech and swallowing Dysphagia - to reduce aspiration risk, use screening procedure Dysarthria Dysphasia Dysphonia Hearing impairment Oral surgery
