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ENT > Speech and Swallowing + Dysphonia + Larynx Cancer > Flashcards

Speech and Swallowing + Dysphonia + Larynx Cancer Flashcards

1
Q

What are three phases of swallowing

A

Oral phase
Pharyngeal phase
Oesophageal phase

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2
Q

What occurs in oral phase

A

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

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3
Q

What happens in pharyngeal phase

A

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

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4
Q

What happens in oesophageal phase

A

Bolus passes UOS which contracts

Bolus propelled down by peristaltic motion via myenteric plexus

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5
Q

What is respiration in relevance to voice production

A

Source of energy through airflow

Provides larynx with a column of air which vocal cords can vibrate with to create sound

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6
Q

How are words formed

A

Action of pharynx, tongue, lips and teeth

Any dysfunction = voice change

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7
Q

What is phonation

A

Flow of air through different vocal cord position, tension, vibration and length

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8
Q

What is resonation

A

Oral nasal speech balance

Depends on nasopharynx, nasal cavity and oral cavity

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9
Q

What is articulation

A

Production of speech

Determined by action of lips, tongue and jaw

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10
Q

What does change in voice require

A

REFERRAL ENT
- Can be change in quality, pitch, loudness or vocal effort

Investigation

  • Flexible nasoendoscopic exam
  • Blood test as appropriate e.g. thyroid
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11
Q

What should vocal cords be

A

Pearly white

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12
Q

What is important in the Hx of hoarseness

A 
How long
Persistent or intermittent
Any pain
Any cough / dysphagia
Voice use
PMH - asthma / reflux (GORD) / rhino sinusitis 
Smoking history
Drug history
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13
Q

What causes hoarseness

A 
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
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14
Q

When do you investigate hoarseness and how

A

If >3 weeks

Laryngoscopy

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15
Q

What are symptoms of laryngeal nerve palsy and where does it run

A 
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
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16
Q

What causes

A

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

17
Q

How do you investigate and Rx

A 
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
18
Q

What are red flags in dysphonia

A 
Smoking / alcohol
Neck mass
Unexplained weight loss
Other neuro Sx
Haemoptysis / dysphagia / odynophagia / otalgia / 
Persistent and worsneing
Immunocompromsied
19
Q

What can larynx be divided into

A

Supraglottis
Glottis
Subglottis

20
Q

Where is laryngeal cancer most common

A

Glottis

21
Q

What type of cancer

A

SCC

22
Q

What are RF

A

Smoking

Alcohol

23
Q

What are symptoms

A 
Hoarsness = most common presentation 
Noisy breathing
Stridor
Cough
Haemoptysis
Odynophagia
Dysphagia
Neck LN
24
Q

How do you investigate

A

Flexible naso-endoscopy
Microlaryngoscopy for biopsy
CT neck and chest to stage

25
Q

How do you Rx

A

Chemo
RT
Surgery
Tracheostomy

26
Q

Role of SALT

A 
Disorders of speech and swallowing
Dysphagia - to reduce aspiration risk, use screening procedure
Dysarthria
Dysphasia
Dysphonia
Hearing impairment
Oral surgery

ENT (14 decks)

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