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ENT > Stridor + Hoarse Voice > Flashcards

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
Q

Pathology affecting which structures causes hoarseness?

A

True vocal cords

Recurrent + superior laryngeal nerves

26
Q

What is the technical word for hoarseness?

A

Dysphonia (change in voice)

27
Q

What is the technical word for complete loss of voice?

A

Aphonia

28
Q

Which diagnosis needs to be ruled out/identified when investigating hoarseness?

A

Laryngeal cancer

29
Q

Which examinations should be done in a patient with hoarseness?

A

Oral cavity: tongue, palate, tonsillar fossa
Cervical lymph nodes
Thyroid

30
Q

What is the first line investigation fr hoarseness?

A

Flexible nasal endoscopy (FNE)

31
Q

What are you looking at on flexible nasal endoscopy?

A

Check post nasal space –> nasopharynx –> pharynx –> larynx
Base of tongue, epiglottis, vocal cords, pyriform fossa, posterior pharyngeal wall
Look for masses, ulcers + asymmetry

32
Q

How long should a patient have a hoarse voice for to be referred to ENT?

A

> 3 weeks

33
Q

What are the infective causes of a hoarse voice?

A

Laryngitis
Acute epiglottitis
Candida

34
Q

What are the features of laryngitis?

A

Inflammation of vocal cords, commonly after URTI
Examination normal
Inflamed larynx on FNE

35
Q

What might cause candida infection leading to a hoarse voice?

A

Inhaled steroids

36
Q

Which neurological pathology causes a hoarse voice?

A

Recurrent laryngeal nerve palsy

37
Q

What might cause a recurrent laryngeal nerve palsy?

A 
Thyroid cancer
Lung cancer
Aortic aneurysm
MS
Stroke
38
Q

How should a recurrent laryngeal nerve palsy be investigated?

A

Neck and cranial nerve exam

CT skull base to diaphragm

39
Q

Which benign laryngeal conditions may cause a hoarse voice?

A 
Vocal cord nodules
Muscle tension dysphonia
Vocal cord polyps
Laryngeal papillomas
Reflux laryngitis
Reinke's oedema
40
Q

What are vocal cord nodules and what causes them?

A

Benign, often bilateral nodules at junction between anterior + middle third of vocal folds
Secondary to phono trauma (vocal abuse)

41
Q

How are vocal cord nodules managed?

A

SALT (speech and language therapy)

Surgery if severe/resistant

42
Q

What is muscle tension dysphonia?

A

Hoarseness worse at the end of day or after prolonged use

43
Q

How is muscle tension dysphonia diagnosed and managed?

A

Diagnosis –> stroboscopy (voice clinic for vocal cord dysfunction)
Management –> SALT

44
Q

How can you tell the different between vocal cord polyps and nodules?

A

Polyps are unilateral

45
Q

How are vocal cord polyps managed?

A

Excise to exclude malignancy

46
Q

What are laryngeal papillomas and how are they managed?

A

Benign lesions caused by HPV

Excision or debulking as can grow and obstruct airway

47
Q

Which investigations should be done for reflux laryngitis?

A

FNE –> erythematous larynx

OGD

48
Q

How is reflux laryngitis managed?

A

PPI + H. pylori eradication

49
Q

What is Reinke’s oedema and how is it managed?

A

Oedema of the vocal cords caused by smoking

–> smoking cessation + voice therapy

ENT (14 decks)

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