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ENT > Upper Airway and Voice Disorders > Flashcards

Upper Airway and Voice Disorders Flashcards

1
Q

Look at anatomy

upper airway
vocal cord
larynx
neck muscles and triangles

A

.

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2
Q

What are examples of infective ulcers?

A

Herpes Simplex - ulcers a re painful usually accompanied by pyrexia/malaise
Herpes Zoster - can affect oral cavity in immunocompromised

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3
Q

What type of cancer can present in the oral cavity?

A

SCC - any ulcer that fails to heal within 2 weeks should be biopsied

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4
Q

What can white patches in the mouth be a sign of?

3 things

A

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

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5
Q

What is torus palatines?

A

Benign osteoma of hard palette

excise only if problematic

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6
Q

What is a mucus retention cyst ?

A

smooth pale round swelling

excise only if symptomatic

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7
Q

What is a ranula?

A

retention cysts on floor of the mouth, under the tongue

develops from submandibular or sublingual ducts

marsupialization (stitching open) cyst is effective tx

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8
Q

How does squamous cell carcinoma present?

A 
sore throat 
pain 
referred otalgia 
bleeding 
dysphagia
can spread to lymph nodes so palpate
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9
Q

How is SCC treated?

A

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

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10
Q

What is stridor and what does it indicate?

A

laryngeal stridor is high pitched and musical, produced on inspiration

laryngeal obstruction

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11
Q

What is starter and what does it indicate?

A

snoring

naso-oropharynx obstruction

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12
Q

What are congenital causes of upper airway obstruction?

A

laryngomalacia
vocal cord palsy
subglottic stenosis

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13
Q

What are acquired causes of upper airway obstruction?

A 
trauma 
foreign body 
angioedema 
epiglottis 
croup 
carcinoma 
external compression
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14
Q

How would you assess the severity of an upper airway obstruction?

A 
Present on exertion?
Present on deep inspiration?
Has to talk in short phrases?
Unable to talk?
Use of accessory muscles?
Cyanosed?
Resp arrest?
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15
Q

How does tonsillitis present?

A

systemically unwell
sore throat
dysphagia
hallitosis

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16
Q

What causes tonsillitis?

A

usually viral (AV, RSV, CMV) or bacterial (strep, pneumonia, h.influenza)

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17
Q

What is seen on examining a tonsillitis pt?

A

lymphadenitis
enlarged tonsils
slough on tonsil surface

In glandular fever tonsils are covered in white exudate

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18
Q

Treatment of tonsillitis?

A

hydration
analgesia
fluids

if severe penicillin or erythromycin

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19
Q

When is a tonsillectomy considered?

A 
if recurrent (>4-5/year) 
or in a child with multiple febrile convulsions
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20
Q

What is the main complication of tonsillitis?

How does is present?

A

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!!

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21
Q

What are nodules and polyps of the vocal cords caused by?

A

Voice abuse

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22
Q

How do nodules and polyps of the vocal cords present?

A

Husky voice

Worsens with use

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23
Q

What do nodules and polyps of the vocal cords look like on examination?

A

Bilateral swellings in vocal fold

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24
Q

How are nodules and polyps of the vocal cords managed?

A

Voice therapy
surgical excision
histology

25
Q

What is Rinke’s Oedema caused by?

A

smoking
increased voice usage
reflux

26
Q

How does Rinke’s Oedema present?

A

deep pitched gravely voice

can cause choking episodes

27
Q

What does Rinke’s Oedema look like on examination?

A

Bilateral swellings on vocal cords

28
Q

How is Rinke’s Oedema managed?

A

stop smoking
reflux treatment
voice therapy

29
Q

How do cysts on the vocal cords present?

A

husky
loss of range
increased effort

unilateral nodule on vocal fold

30
Q

How are cysts on the vocal cords treated?

A

Voice therapy

Surgery

31
Q

What is laryngeal papillomatosis?

A

seen in juveniles

due to HPV infection in weakened immune system

32
Q

How is laryngeal papillomatosis treated?

A

laser removal of papillomata. although can spontaneously regress at any time

in adults there is change of malignancy so histology is needed after removal

33
Q

How does laryngeal carcinoma present?

A

progressive hoarseness
stridor
otalgia
dysphagia

mass, cervical lymphadenopathy

34
Q

How is laryngeal carcinoma managed?

A

Radiotherapy
Excision

Mention MDT!!
speech therapy, maxfax, physio, dietician etc

35
Q

Which device is essential to compensate for loss of filtration, warming and humidifaction in nasal breathing after laryngectomy?

A

Heat and Moisture Exchange device? HME

36
Q

How is speech achieved after laryngectomy?

A

oesophageal speech

trachea-oesophageal fistula - with one way value

artificial larynx - gives robotic speech

37
Q

What is acute laryngitis caused by?

A

can be infective or due to vocal cord abuse/irritants

38
Q

How does acute laryngitis present?

A

Hoarse voice or aphonia
odynophagia - pain when swallowing
if infective - malaise/pyrexia

vocal cords appear red and oedematous

39
Q

What is the treatment of acute laryngitis?

A

voice rest
analgesia
steam inhalations
don’t whisper - talk at conversation voice

40
Q

What is epiglottitis?

A

acute life threatening condition

caused by Hib

41
Q

How does epiglottitis present?

A

dysphagia
drooling
voice change/chnage in childs cry
toxic patient

42
Q

How should epiglottitis be treated?

A

allow patient to sit comfortable
do not distress or examine
IV Abx
Intubate and ventilate until recovered

43
Q

Presentation of laryngitis?

A 
Hoarse voice 
Aphonia 
Pain on talking 
Irritant paroxysmal cough 
URTI symptoms

erythematous vocal folds
raised lesions in larynx
leukoplakia

44
Q

Causes of laryngitis?

A

Commonly viral - HPV

Fungal - secondary to INH steroids

45
Q

Treatment of laryngitis?

A 
self limiting 
analgesia
fluids
steam inhalation 
only abc if severe and persistent
46
Q

What is extra-oesophageal reflux?

A 
hoarseness associated with: chronic throat clearing 
cough
excessive mucus 
choking episodes
globus sensation 
occasionally dysphagia

only 40% have heart burn

47
Q

What is seen on examination with extra oesophageal reflux

A

erythema and oedema in larynx

48
Q

What is the treatment for extra oesophageal reflux?

A

Lifestyle changes - increased water, decreased caffeine

alginates - gaviscone on post food and PPIs bd

49
Q

What causes recurrent laryngeal nerve palsy?

A

1/3 idiopathic
1/3 malignancy
1/3 iatrogenic
neurological

50
Q

How does recurrent laryngeal palsy present?

A

weak voice
tires quickly
laryngeal discomfort
dysphagia

immobilised vocal cord seen

51
Q

How is recurrent laryngeal palsy investigated and treated?

A

CXR - mediastinal mass
CT neck - nerve lesion

Treatment

  • voice therapy to encourage compensation
  • vocal cord medicalization - injection of polymer or thyroplasty
52
Q

What are the other causes of immobilised vocal cords?

A

Crico-arytenoid joint fixture - e.g. RA
acid reflux
Bronchial cancer

53
Q

What is the voice disorder, muscle tendon imbalance?

A

excessive tension on laryngeal muscles

related to stress, neck and back problems, poor vocal hygiene and lifestyle

54
Q

How does muscle tendon imbalance present?

A

Huskiness
abnormal pitch
throat discomfort

vocal cords are normal in appearance

55
Q

How is muscle tendon imbalance treated?

A

vocal hygiene
lifestyle changes
voice therapy

56
Q

What are the congenital causes of stridor?

A

laryngomalacia
vocal cord palsy
subglottic stenosis

57
Q

What are the acute causes of stridor?

A 
Trauma 
Foreign body 
Angioneurotic oedema - allergic reaction 
Epiglottis 
Croup 
Vocal cord palsy
58
Q

What are the chronic causes of stridor?

A 
vocal cord palsy 
carcinoma 
subglottic stenosis 
papillomata
polyp/cyst 
external compression - thyroid mass
59
Q

When should a tonsillectomy be considered ?

A

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

ENT (6 decks)

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