Upper Airway and Voice Disorders Flashcards
Look at anatomy
upper airway
vocal cord
larynx
neck muscles and triangles
.
What are examples of infective ulcers?
Herpes Simplex - ulcers a re painful usually accompanied by pyrexia/malaise
Herpes Zoster - can affect oral cavity in immunocompromised
What type of cancer can present in the oral cavity?
SCC - any ulcer that fails to heal within 2 weeks should be biopsied
What can white patches in the mouth be a sign of?
3 things
Candida - immunocompromised or asthmatics due to steroid deposition
Leukoplakia - associated with local irritation (dentures, smoking)
3% malignancy so biopsy
Lichen Planus - purple plaques with white lace like appearance
What is torus palatines?
Benign osteoma of hard palette
excise only if problematic
What is a mucus retention cyst ?
smooth pale round swelling
excise only if symptomatic
What is a ranula?
retention cysts on floor of the mouth, under the tongue
develops from submandibular or sublingual ducts
marsupialization (stitching open) cyst is effective tx
How does squamous cell carcinoma present?
sore throat pain referred otalgia bleeding dysphagia can spread to lymph nodes so palpate
How is SCC treated?
Deep biopsy under GA diagnoses and assess biopsy spread
pan-endoscopy of whole upper aerodigestive tract to look for secondary tumours
radical removal and reconstruction of all tumours or radiotherapy +/- chemotherapy
What is stridor and what does it indicate?
laryngeal stridor is high pitched and musical, produced on inspiration
laryngeal obstruction
What is starter and what does it indicate?
snoring
naso-oropharynx obstruction
What are congenital causes of upper airway obstruction?
laryngomalacia
vocal cord palsy
subglottic stenosis
What are acquired causes of upper airway obstruction?
trauma foreign body angioedema epiglottis croup carcinoma external compression
How would you assess the severity of an upper airway obstruction?
Present on exertion? Present on deep inspiration? Has to talk in short phrases? Unable to talk? Use of accessory muscles? Cyanosed? Resp arrest?
How does tonsillitis present?
systemically unwell
sore throat
dysphagia
hallitosis
What causes tonsillitis?
usually viral (AV, RSV, CMV) or bacterial (strep, pneumonia, h.influenza)
What is seen on examining a tonsillitis pt?
lymphadenitis
enlarged tonsils
slough on tonsil surface
In glandular fever tonsils are covered in white exudate
Treatment of tonsillitis?
hydration
analgesia
fluids
if severe penicillin or erythromycin
When is a tonsillectomy considered?
if recurrent (>4-5/year) or in a child with multiple febrile convulsions
What is the main complication of tonsillitis?
How does is present?
Peritonsilar abscess (quincy)
tonsil pushed medially
uvular displaced away from affected size
drooling and truisms (pain on opening mouth) is common
DRAIN
This is life threatening!!
What are nodules and polyps of the vocal cords caused by?
Voice abuse
How do nodules and polyps of the vocal cords present?
Husky voice
Worsens with use
What do nodules and polyps of the vocal cords look like on examination?
Bilateral swellings in vocal fold
How are nodules and polyps of the vocal cords managed?
Voice therapy
surgical excision
histology
What is Rinke’s Oedema caused by?
smoking
increased voice usage
reflux
How does Rinke’s Oedema present?
deep pitched gravely voice
can cause choking episodes
What does Rinke’s Oedema look like on examination?
Bilateral swellings on vocal cords
How is Rinke’s Oedema managed?
stop smoking
reflux treatment
voice therapy
How do cysts on the vocal cords present?
husky
loss of range
increased effort
unilateral nodule on vocal fold
How are cysts on the vocal cords treated?
Voice therapy
Surgery
What is laryngeal papillomatosis?
seen in juveniles
due to HPV infection in weakened immune system
How is laryngeal papillomatosis treated?
laser removal of papillomata. although can spontaneously regress at any time
in adults there is change of malignancy so histology is needed after removal
How does laryngeal carcinoma present?
progressive hoarseness
stridor
otalgia
dysphagia
mass, cervical lymphadenopathy
How is laryngeal carcinoma managed?
Radiotherapy
Excision
Mention MDT!!
speech therapy, maxfax, physio, dietician etc
Which device is essential to compensate for loss of filtration, warming and humidifaction in nasal breathing after laryngectomy?
Heat and Moisture Exchange device? HME
How is speech achieved after laryngectomy?
oesophageal speech
trachea-oesophageal fistula - with one way value
artificial larynx - gives robotic speech
What is acute laryngitis caused by?
can be infective or due to vocal cord abuse/irritants
How does acute laryngitis present?
Hoarse voice or aphonia
odynophagia - pain when swallowing
if infective - malaise/pyrexia
vocal cords appear red and oedematous
What is the treatment of acute laryngitis?
voice rest
analgesia
steam inhalations
don’t whisper - talk at conversation voice
What is epiglottitis?
acute life threatening condition
caused by Hib
How does epiglottitis present?
dysphagia
drooling
voice change/chnage in childs cry
toxic patient
How should epiglottitis be treated?
allow patient to sit comfortable
do not distress or examine
IV Abx
Intubate and ventilate until recovered
Presentation of laryngitis?
Hoarse voice Aphonia Pain on talking Irritant paroxysmal cough URTI symptoms
erythematous vocal folds
raised lesions in larynx
leukoplakia
Causes of laryngitis?
Commonly viral - HPV
Fungal - secondary to INH steroids
Treatment of laryngitis?
self limiting analgesia fluids steam inhalation only abc if severe and persistent
What is extra-oesophageal reflux?
hoarseness associated with: chronic throat clearing cough excessive mucus choking episodes globus sensation occasionally dysphagia
only 40% have heart burn
What is seen on examination with extra oesophageal reflux
erythema and oedema in larynx
What is the treatment for extra oesophageal reflux?
Lifestyle changes - increased water, decreased caffeine
alginates - gaviscone on post food and PPIs bd
What causes recurrent laryngeal nerve palsy?
1/3 idiopathic
1/3 malignancy
1/3 iatrogenic
neurological
How does recurrent laryngeal palsy present?
weak voice
tires quickly
laryngeal discomfort
dysphagia
immobilised vocal cord seen
How is recurrent laryngeal palsy investigated and treated?
CXR - mediastinal mass
CT neck - nerve lesion
Treatment
- voice therapy to encourage compensation
- vocal cord medicalization - injection of polymer or thyroplasty
What are the other causes of immobilised vocal cords?
Crico-arytenoid joint fixture - e.g. RA
acid reflux
Bronchial cancer
What is the voice disorder, muscle tendon imbalance?
excessive tension on laryngeal muscles
related to stress, neck and back problems, poor vocal hygiene and lifestyle
How does muscle tendon imbalance present?
Huskiness
abnormal pitch
throat discomfort
vocal cords are normal in appearance
How is muscle tendon imbalance treated?
vocal hygiene
lifestyle changes
voice therapy
What are the congenital causes of stridor?
laryngomalacia
vocal cord palsy
subglottic stenosis
What are the acute causes of stridor?
Trauma Foreign body Angioneurotic oedema - allergic reaction Epiglottis Croup Vocal cord palsy
What are the chronic causes of stridor?
vocal cord palsy carcinoma subglottic stenosis papillomata polyp/cyst external compression - thyroid mass
When should a tonsillectomy be considered ?
sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections)
the person has five or more episodes of sore throat per year
symptoms have been occurring for at least a year
the episodes of sore throat are disabling and prevent normal functioning
