Unit 3 Day 11 (Tue 5/5) Flashcards
5 Layers Covering Vocal Folds
– Epithelium – Superficial Lamina Propria – Intermediate Lamina Propria – Deep Lamina propria – Vocalis muscle (medial thyroarytenoid)
Components of Voice Production
- source: pulmonary/infraglottic- diaphragm, intercostals
- vibratory production: laryngeal- extrinsic and intrinsic muscles
- resonance: supraglottic and oral phase
Stridor
-the major symptom that indicates disorders of the upper airway and larynx
- Inspiratory – supraglottic, extrathoracic
- Expiratory – tracheal, large bronchi intrathoracic
- biphasic – laryngeal, immediate subglottis, croup
Hoarseness Causes
- viral laryngitis- acute
- reflux -chronic
- vocal abuse
- allergies, PND
- chronic cough
- nodules
- polyps
- trauma
- age
- neurological disorders
- smoking without malignancy
- malignancy
Hoarseness- When to See Doctor
- if hoarseness lasts longer tan 2-3 weeks
2. if hoarseness is associated with: – Pain, note ear radiation possible – Coughing up blood – Difficulty swallowing – A lump in the neck – Complete loss or severe change in voice lasting longer than a few days
Laryngopharyngeal Reflux (LPR)
LPR = escape of stomach acids from the stomach into the esophagus through the LES. May reach the larynx, oral cavity and lungs.
-signs: hoarseness, chronic cough, foreign body sensation, tracheal stenosis
- sx:
- bad breath or bitter taste in a.m.
- a.m. hoarseness or after meals
- sensation of a lump in the throat (globus)
- sensation of post-nasal drip but no nasal issues
- heartburn not always present
4 Phases of Cough
- inspiratory phase
- compressive phase
- expiratory phase
- relaxation
Consequences of Impaired Cough
- aspiration of stomach contents
- acute airway obstruction
- pneumonia
- lung abscess
- respiratory failure/ARDS
- bronchiectasis
- pulmonary fibrosis
Acute Cough Time Frame
-cough lasting less than 3 weeks
Acute Cough: Life Threatening Causes
- Congestive heart failure
- Pneumonia
- Asthma Exac!
- COPD Exac.
- Pulmonary Embolism
Acute Cougg: Non-Life Threatening Causes
- upper respiraory tract infrction (the common cold)
- lower respiratory tract infection (acute bronchitis)
- exacerbation of pre-existing condition
Sub-Acute Cough Time Frame
-cough lasting 3 to 8 weeks
Sub-Acute Cough Causes
-PNA
Chronic Cough Time Frame
-cough lasting longer than 8 weeks
Chronic Cough Causes
– Upper airway cough syndrome! – Asthma – Gastroesophageal reflux disease! – Non-asthmatic eosinophilic bronchitis – Neuropathic cough • Cough may have more than one cause-- a diagnostic challenge!
Upper Airway Cough Syndrome (UACS)
- Classic symptoms: “tickle” in throat; throat clearing, hoarseness, nasal congestion
- Cough may be the only symptom in ~ 20%
- Signs (may be absent): inflamed nasal mucosa, secretions in posterior oropharynx
- Diagnostic/Therapeutic trial: 1st generation anti-histamine/decongestant combination medication for 2 weeks
Asthma
- Classic symptoms: intermittent wheeze
- Cough may be the only symptom in 7-57% patients (depends on study)– “Cough-variant asthma”
- Signs (often absent): expiratory wheezing on chest exam
- Diagnostic/! Therapeutic trial: inhaled corticosteroid + bronchodilator for! ≥ 8 weeks
Gastroesophageal Reflux Disease (GERD)
- Classic symptoms: heartburn, sour taste in mouth
- Cough may be only symptom in ≤ 75% patients with chronic cough
- Diagnostic/Therapeutic trial: gastric acid suppression with proton pump inhibitor (e.g. omeprazole) for ≥ 2 months, combined with diet and lifestyle modification
Non-Asthmatic Eosinophilic Bronchitis (NAEB)
- Eosinophilic airway inflammation WITHOUT variable airflow obstruction or airway hyperresponsiveness
- Diagnostic/Therapeutic trial: inhaled corticosteroid for ≥ 4 weeks
Cough in Children
- Most common cause is viral URTI, but this cough should resolve in 1-3 weeks
- Chronic cough in kids is defined as cough for > 4 weeks
- Asthma, sinus disease, GERD can cause chronic cough in kids, too
- Chronic tobacco smoke exposure can cause chronic cough; counsel parents
