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Stridor + Hoarse Voice Flashcards

1
Q

Obstruction in which anatomical locations might cause stridor?

A

Supraglottic
Glottic
Subglottic
Tracheal

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2
Q

What is stertor?

A

Low pitched snoring sound caused by obstruction above the supraglottic level

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3
Q

What are some acute causes of stridor?

A 
Foreign body
Epiglottitis
Laryngotracheobronchitis (croup)
Laryngitis
Anaphylaxis
Neck space abscess
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4
Q

What are some causes of chronic stridor?

A 
Laryngomalacia
Subglottic stenosis
Vocal cord paralysis
Subglottic haemangioma
Respiratory papillomatosis
Macroglossia or micrognathia
Malignancy
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5
Q

What is the most common cause of subglottic stenosis?

A

Secondary to prolonged intubation

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6
Q

Which important signs must be assessed for in a patient with stridor?

A 
Torticollis or trismus
Inability to swallow + drooling
Absence of cough
Systemic signs of infection
Cyanosis
Decreasing volume of stridor sound (becoming tired, less air movement)
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7
Q

What is torticollis?

A

Asymmetrical head/neck position

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8
Q

What is trismus?

A

Lockjaw

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9
Q

In which situations should you not examine a patient with stridor?

A

Croup or epiglottitis

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10
Q

Which investigations should be done for a chronic (non-emergency) stridor?

A

Fiberoptic nasal endoscopy
Further imaging:
- CT for abscess or malignancy
- bronchoscopy for visualising below vocal cords

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11
Q

What is the acute management of stridor?

A

ABCDE –>

  • stabilise, high flow oxygen, alert ENT/anaesthetics
  • suction secretions, remove obvious foreign bodies
  • adrenaline or steroids if required
  • bloods +/- ABG, cultures
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12
Q

If initial management does not improve stridor, what should be considered?

A

Intubation or emergency cricothyroidotomy

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13
Q

What causes epiglottitis?

A

Usually H. influenza type B

–> reduced since vaccination

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14
Q

Which age group most commonly gets epiglottitis?

A

Age 2 - 7

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15
Q

What are the clinical features of epiglottitis?

A

Initially sore throat, fever + SOB
–> absence of cough
Late signs: drooling, dysphagia, inspiratory stridor

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16
Q

Which position might a child with epiglottitis be in?

A

Tripod position

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17
Q

How is epiglottitis managed?

A 
Urgent ENT/anaesthetic review in HDU/ICU
Do not examine, avoid upsetting child
--> adrenaline nebs + IV dexamethasone
EUA + intubation in theatre
Blood + throat cultures
IV ceftriaxone, analgesia + fluids
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18
Q

What needs to be done for close contacts of a patient with epiglottitis?

A

Antibiotic prophylaxis for any close contacts who haven’t been vaccinated

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19
Q

What causes croup?

A

Viral –> parainfluenza, influenza, RSV, rhinovirus

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20
Q

Which age group most commonly get croup?

A

6 months - 2 years

21
Q

What are the clinical features of croup?

A

URTI –> dyspnoea, barking cough + fever
Worse at night
Gets worse over 48 hours and then self limiting

22
Q

How is croup severity graded?

A

Barking cough + stridor + …

  • grade 1: expiratory stridor
  • grade 2: pulsus paradoxus
  • grade 3: cyanosis or reduced cognition
23
Q

How is croup managed initially?

A

Single dose oral dexamethasone

+ paracetamol + ibuprofen as required

24
Q

How is croup managed if admission is required?

A

Oxygen + IV fluids
+/- inhaled steroids + adrenaline nebs
Intubation if very severe

25
Pathology affecting which structures causes hoarseness?
True vocal cords | Recurrent + superior laryngeal nerves
26
What is the technical word for hoarseness?
Dysphonia (change in voice)
27
What is the technical word for complete loss of voice?
Aphonia
28
Which diagnosis needs to be ruled out/identified when investigating hoarseness?
Laryngeal cancer
29
Which examinations should be done in a patient with hoarseness?
Oral cavity: tongue, palate, tonsillar fossa Cervical lymph nodes Thyroid
30
What is the first line investigation fr hoarseness?
Flexible nasal endoscopy (FNE)
31
What are you looking at on flexible nasal endoscopy?
Check post nasal space --> nasopharynx --> pharynx --> larynx Base of tongue, epiglottis, vocal cords, pyriform fossa, posterior pharyngeal wall Look for masses, ulcers + asymmetry
32
How long should a patient have a hoarse voice for to be referred to ENT?
> 3 weeks
33
What are the infective causes of a hoarse voice?
Laryngitis Acute epiglottitis Candida
34
What are the features of laryngitis?
Inflammation of vocal cords, commonly after URTI Examination normal Inflamed larynx on FNE
35
What might cause candida infection leading to a hoarse voice?
Inhaled steroids
36
Which neurological pathology causes a hoarse voice?
Recurrent laryngeal nerve palsy
37
What might cause a recurrent laryngeal nerve palsy?
``` Thyroid cancer Lung cancer Aortic aneurysm MS Stroke ```
38
How should a recurrent laryngeal nerve palsy be investigated?
Neck and cranial nerve exam | CT skull base to diaphragm
39
Which benign laryngeal conditions may cause a hoarse voice?
``` Vocal cord nodules Muscle tension dysphonia Vocal cord polyps Laryngeal papillomas Reflux laryngitis Reinke's oedema ```
40
What are vocal cord nodules and what causes them?
Benign, often bilateral nodules at junction between anterior + middle third of vocal folds Secondary to phono trauma (vocal abuse)
41
How are vocal cord nodules managed?
SALT (speech and language therapy) | Surgery if severe/resistant
42
What is muscle tension dysphonia?
Hoarseness worse at the end of day or after prolonged use
43
How is muscle tension dysphonia diagnosed and managed?
Diagnosis --> stroboscopy (voice clinic for vocal cord dysfunction) Management --> SALT
44
How can you tell the different between vocal cord polyps and nodules?
Polyps are unilateral
45
How are vocal cord polyps managed?
Excise to exclude malignancy
46
What are laryngeal papillomas and how are they managed?
Benign lesions caused by HPV | Excision or debulking as can grow and obstruct airway
47
Which investigations should be done for reflux laryngitis?
FNE --> erythematous larynx | OGD
48
How is reflux laryngitis managed?
PPI + H. pylori eradication
49
What is Reinke's oedema and how is it managed?
Oedema of the vocal cords caused by smoking | --> smoking cessation + voice therapy

ENT (14 decks)

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