Throat Flashcards
UPPER AIRWAY ANATOMY
Outline the structures of the upper airway/throat. What is the function of the larynx and common symptoms related. Name some anomalies that can affect the larynx, trachea & bronchial tree
Larynx: breathing passage, valve to protect lungs Abnormalities can lead to airway obstruction, poor feeding and abnormal phonation
- Pharyngeal obstruction (nasal, tonsils, adenoids, tongue base, syndromic midface hypoplasia) = OSA/when asleep
- Laryngeal, tracheal or bronchial = worse when awake/with exercise
- Intrathoracic = expiratory wheeze/stridor
- Extrathoracic = inspiratory stridor
NOISY BREATHING
Outline from nose to trachea the causes of noisy breathing- consider structural/congenital, inflammatory, neoplastic
- *Nose / nasopharynx**
- Pyriform aperture stenosis
- Choanal atresia
- Midline nasal masses
- Turbinate hypertrophy
- Tonsillar/adenoid hypertrophy
Larynx
(Congenital)
- Laryngomalacia
- Vocal cord palsy
- Vascular ring
- Web/cyst
- Subglottic stenosis/haemangioma
(Inflammatory)
- Croup
- Epiglottitis
- Granulomas (TB, Wegner’s)
(Neoplastic)
- haemangioma, chondroma, papilloma
- lymphoma, SCC
LARYNGOMALACIA
Define, outline epidemiology, presentation, natural history, differential diagnosis, investigations and treatment
Laryngomalacia ‘floppy larynx’
Decreased laryngeal tone leading to supraglottic collapse during inspiration
Epidemiology
Most common cause of stridor in children 60% of cases
- 20% have additional airway abnormalities (i.e tracheomalacia)
- Can be associated with other syndromes (T21, 22q11)
- *Clinical features**
- Inspiratory stridor, exacerbated by exertion
- Mild- intermittent, feeding unaffected
- Severe: increased WOB, FTT , oxygen requirement
- *Natural history**
- Most symptoms appear first 2-6 weeks of life
- Increasing severity up to 6 months
- Resolves by 12-18 mo
- Can be worsened by GERD/neurological disease
DDx
Subglottic stenosis
VC palsy
Ring/cyst/web
Tracheomalacia
- *Investigations**
- Flexible nasendoscopy
- CXR/bronchoscopy if other airway abnormalities suspected
- Barium swallow/VFSS if feeding difficulties/aspiration
- Consider speech pathology involvement
- *Treatment**
- Expectant if mild
- Manage reflux- PPI, thickener
- Speech therapy for suck/swallow co-ordination (can impair laryngeal sensation)
- Supraglottoplasty 15-20% of cases, more severe
CONGENITAL SUBGLOTTIC STENOSIS
Define, outline epidemiology, presentation, natural history, differential diagnosis, investigations and treatment
Subglottic stenosis
Subglottis: space extending from cords (glottis) to cricoid cartillage
- Second most common cause of stridor
Causes
- Abnormally shaped cricoid cartillage (trapped tracheal ring)
- Soft tissue- cysts, mucosal gland hyperplasia, fibrosis
Presentation
- Inspiratory or biphasic stridor
- Can worsen with URTI, presentation of recurrent croup
- >50% stenosis often symptomatic/requires treatment
Natural history
- Improves with growth
- 50% require tracheostomy
Investigations
- Laryngoscope
- CXR (neck XR)- steeple sign
Treatment
- Dilatation (rarely effective as most cartillaginous)
- Laryngo-tracheal reconstruction
- Tracheostomy (reversible)
VOCAL CORD PALSIES
Define, outline epidemiology, presentation, natural history, differential diagnosis, investigations and treatment
Vocal cord palsies
- Third most common cause of stridor
- Recurrent laryngeal nerve supplies
Causes
- Bilateral: CNS- Chiari malformation, meningomyelocoele, hydrocephalus
- Unilateral: cardiac/thyroid surgery, TOF fistula, viral infection/autoimmune, instrumentation during delivery, intrathoracic lesions
Presentations
Unilateral:
- Aspiration, choking, coughing
- Weak breathy cry (babies)/ decreased volume or hoarseness (kids)
- Less common stridor
Bilateral:
- VCs midline, can have normal cry
- High pitched inspiratory stridor/cry
OTHER LARYNGEAL ABNORMALITIES
