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Otorhinolaryngology > Voice disorders > Flashcards

Voice disorders Flashcards

1
Q

What are the main function of the larynx?

A

Acts as a sphincter to prevent things getting into the lungs.

Speech

Allows cough

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2
Q

What does the larynx connect to superiorly and inferiorly?

A

Superiorly it connects to the pharynx

Inferiorly the trachea

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3
Q

What does the larynx consist of?

A

Thyroid cartilage
Cricoid cartilage
The epiglottis
The arytenoid cartilages

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4
Q

What does the epiglottis attach to?

A

The thyroid cartilages

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5
Q

What are the arches called that food bolus falls down to enter the oseophagus?

A

pyriform fossa

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6
Q

What are the glottis?

A

It is another name for the vocal cords

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7
Q

What is the most common malignant tumour of the larynx?

A

a squamous cell carcinoma

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8
Q

What risk factor has the highest association for tumour of the larynx?

(which is the second)

A

as the most common malignant tumour is a squamous cell carcinoma, the commonest risk factor is unsurprisingly:

Smoking

(also heavy alcohol intake)

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9
Q

What is the primary symptoms of carcinoma of the vocal cords?

A

Hoarseness

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10
Q

What is the prognosis of carcinoma of the vocal cords and why?

A

95% 5-year survival

As a small lesion will cause symptoms early AND

the area has poor lymphatic drainage

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11
Q

How long should hoarseness persist for before you should suspect cancer?

A

6 weeks

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12
Q

How is the larynx split into the supraglottis and subglottis?

A

It is divided by the vocal cords

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13
Q

What is the prognosis of cancers in the supraglottis and subglottis?

A

not as good as for vocal cord tumours as they have less specific symptoms

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14
Q

What are the symptoms of cancers in the supraglottis and subglottis?

A

Throat irritation
Cough
Referred otalgia
Lump (Lymph node in the neck)

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15
Q

What are the signs of cancers of the larynx?

A

leukoplakia
narrowing of airway
Fixation of vocal cords

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16
Q

What are the treatment options for laryngeal malignancies?

A

endoscopic removal

radiotherapy

radical surgical excision (if radical enough tracheostomy will be required)

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17
Q

From what nerve does the recurrant laryngeal nerve come from?

A

The vagus nerve

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18
Q

What structures do the left and right recurrant laryngeal nerves loop under?

A

Left - runs under arch of aorta

Right - under the right subclavian artery

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19
Q

Explain the rule of thumb for vocal cord palsies.

A

1/3 due to surgery
1/3 idiopathic
1/3 neoplastic

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20
Q

To what degree to vocal cord palsies affect the left and right sides?

A

75% Left

15% Right

10% Bilaterally

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21
Q

What is the most common malignant cause of vocal cord palsies?

A

Cancer of the bronchus

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22
Q

What are the symptoms of a recurrant laryngeal nerve palsy?

A

Horseness which tires with talking

choking with fluids

diplophonia (the voice simultaneously produces two sounds of different pitch)

weak bovine cough

High pitched voice

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23
Q

What is the Ix strategy for vocal cord palsies?

A

Assume malignant until proven otherwise

X-ray is mandatory

CT if nothing seen on x-ray

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24
Q

Other than surgical trauma and neoplasia what can cause vocal cord palsy?

A

crico-arytenoid joint may become fixed due to

severe RA or

reflux

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25
Q

What is muscle tension dysphonia?

A

Normal hoarse voice

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26
Q

What are the causes of muscle tension dysphonia?

A

1ry causes: stress, axiety, vocal abuse, etc, etc

2ry causes: e.g.
excessive tension required to

overcome a deficiency in the voice producing mechanism

caused by e.g. cord structural defect

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27
Q

How does muscle tension dysphonia present?

A

variable hoarseness

can range from normal to no voice BUT worsens with use

dryness/uncomfortable sensation in the throat

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28
Q

What is the treatment for muscle tension dysphonia?

A

remove causative factor

general lifestyle advice

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29
Q

What are the types of vocal cord benign lesion?

A 
papillomata
nodules
polyps
cysts
Reinke’s oedema
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30
Q

What are the most common benign vocal cord lesion?

A

Papillomata of the larynx

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31
Q

In whom are papillomata of the larynx most commonly seen?

A

Children, but can manifest in adults

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32
Q

What causes papillomata of the larynx?

A

HPV

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33
Q

How severe is papillomata of the larynx?

A

It varies from very minor to affecting the whole respiratory tree.

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34
Q

What is the most common site of papillomata of the larynx? (and hence how does it present)

A

The vocal cords (presents with hoarse voice)

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35
Q

In severe cases how will papillomata of the larynx present?

A

with stidor

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36
Q

How is papillomata of the larynx treated?

A

laser. several session over several years if often require due to the rapidly recurring nature

Immune regulation with

steroids

or interferon can also be used

In adults histology to check for squamous cell carcinoma transformation

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37
Q

What are vocal cord nodules caused by (and hence what are other names used for it?)

A

Result from vocal abuse (singers or screamer’s nodules)

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38
Q

What symptoms do vocal cord nodules cause?

A

Hoarseness and

gruffness of the voice

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39
Q

What is the treatment for vocal cord nodules?

A

Nothing unless pt is not happy with voice

Speech therapy (fairly successful)

Surgical excision

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40
Q

What is the appearance of vocal cord nodules?

A

Small
White
Thickenings of the vocal cords BILATERALLY

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41
Q

How do vocal cord nodules form?

A

Small haemorrhage due to trauma (so are soft)

Eventually fibrose (are firm)

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42
Q

What is Reinke’s oedema?

A

Inflammation of the vocal cords

leads to odema along the whole length of

Reinke’s space

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43
Q

What causes vocal cord polyps and cysts?

A

When inflammation of the vocal cords along Reinke’s space (this is Reinke’s oedema) is localised to one area rather than the whole cord as in Reinke’s oedema.

The resulting oedema in Reinke’s space causes a polyp or cyst

44
Q

What specifically causes a vocal cord cyst?

A

When the localised oedema under the covering of the cord remains contained within it

45
Q

What specifically causes a vocal cord polyp?

A

results from oedema which is superficial within the cords prolapsing into the airway.

46
Q

What is the Ix for vocal cord cysts and polyps?

A

Removal for histology

47
Q

What is the main presenting compaint for vocal cord polyps and cysts?

A

Hoarse voice

48
Q

What are the main causes of vocal cord polyps?

A

Shouting when you have a cold

extraoesophageal reflux

49
Q

Who typically get vocal cord polyps?

A

Men

40y/o

50
Q

What are the main symptoms of vocal cord polyps?

A

Hoarse voice

Voice cutting out when speaking

51
Q

What does a vocal cord polyp look like?

A

unilateral

grey or haemorrhagic

swelling

arising in the middle of the cord

52
Q

What is the treatment for vocal cord polyps?

A

Medical:
i.e. treatment for extraoesophageal reflux or steroids

Surgical removal

Voice therapy

53
Q

What are the causes of Reinke’s oedema?

A

Smoking

Overtalking

Reflux

54
Q

What are the symptoms of Reinke’s oedema?

A

Deep gravelly voice

If severe: choking

55
Q

What does Reinke’s oedema look like?

A

bilateral

grey or erythematous

swelling

along the whole length

56
Q

What is the treatment for Reinke’s oedema?

A

Stop smoking

Surgical reduction

Medical treatment for: reflux and voice therapy

57
Q

Which gender does Reinke’s oedema occur more in?

A

M=F

58
Q

Which gender do vocal cord cysts occur more in?

A

M=F

59
Q

What are the causes of vocal cord cysts?

A

It is not known

60
Q

What are the symptoms of vocal cord cysts?

A

Hoarse voice

Pitch breaks

Loss of range of voice

Increased effort to speak

61
Q

What is the treatment for vocal cord cysts?

A

stop smoking

surgical reduction

medical treatment for reflux and voice therapy

62
Q

What are the causes of reduced/absent vocal cord mobility?

A

laryngitis

cancers (benign or malignant) of the cord/joint or a tumour of the nerve

damage from intubation

laryngeal reflux

functional dysphonia

63
Q

What will be the result if the vocal cords cannot close fully?

A

The voice will be affected

The airway will not

64
Q

What will be the result if the vocal cords cannot open fully?

A

The voice will NOT be affected

The airway will be affected

65
Q

What is functional dysphonia?

A

Poor voice quality without any obvious
anatomical,
neurological
or other organic difficulties

affecting the larynx (aka voice box)

66
Q

What are some potential causes of functional dysphonia?

A

bereavement

Psychiatric causes

67
Q

Give some examples of treatment for functional dysphonia?

A

Reassurance it will resolve

Speech therapy can reduce tension

Psych referal

68
Q

What are the symptoms of functional dysphonia?

A

Hoarse voice

which is weak and tires easily

69
Q

What are potential causes of acute laryngitis?

A

As part of a general infective process (post-URTI, HPV, candida -> poor inhaler technique)

In isolation it can be due to:

vocal abuse

irritants such as cigarette smoke

70
Q

What are the symptoms of acute laryngitis?

A

Hoarse voice (can lead to complete aphonia)

pain on speaking + swollowing

71
Q

How do the vocal cords appear in acute laryngitis?

A

Erythematous

Odematous

Including the whole larynx

72
Q

How is the vocal cord movement affected in acute laryngitis?

A

It is restricted

symmetrically

not completely paralysed

73
Q

How is acute laryngitis treated?

A

Mainly supportive:

Steam inhalation

Voice rest

Can also use:

cough suppressants

74
Q

What is the risk if you abuse your voice during acute laryngitis?

A

lead to hemorrhage within the larynx leading to

fibrosis

and thus permanent vocal disorders

75
Q

How dangerous is epiglottis?

A

Can be life threatening

76
Q

When should you always consider epiglottitis?

A

In children (as it is more common) with

pyrexia and

sore throat

77
Q

How may epiglottitis unfold in a child?

A

Signs of an URTI

leading to complete airway obstruction

78
Q

What should you avoid doing in a patient with epiglottitis?

A

Lying them down as this may collapse the airway

Doing intra-oral investigations without intubation or emergency tracheostomy

79
Q

What is the common responsible agent of epiglottitis?

A

H.influenzae

80
Q

What is the treatment for epiglottitis?

A

IV antibiotics (as the usual causative factor is H.influenzae)

81
Q

What is usually the cause of croup?

A

Viral infection

82
Q

What is croup also known as?

A

laryngotracheobronchitis

83
Q

How does croup compare to epiglottitis?

A

It can also be fatal

Croup has a slightly longer course

84
Q

How does croup present?

A

low grade URTI

then pyrexia

and stidor

There will be generalised deterioration of the child

85
Q

What is the treatment for croup?

A

IV antibiotics

nebulised adrenaline

Ventilation if severe

86
Q

What is the cause of chronic laryngitis?

A

Multifactorial cause but most important one is:

smoking

87
Q

What will be the classic Hx of chronic laryngitis?

A

a nasty URTI

and since this they have been hoarse

88
Q

Why does the inflammation in chronic laryngitis remain?

A

Due to multiple factors such as:

vocal abuse

sinusitis leading to post nasal drip

acid reflux

89
Q

What are the symptoms of chronic laryngitis?

A

hoarse voice

90
Q

What will examination of the vocal cords in chronic laryngitis show?

A

erythematous cords which may be

thickened and

oedematous

91
Q

What are the risks associated with chronic laryngitis?

A

The chronic inflammation can lead to:

dysplasia

and carcinoma in situ

92
Q

What is the Mx of chronic laryngitis? (mention when surgery is indicated)

A

intensive speech therapy

removal of causitive factors

(surgery is no longer used except for diagnostic purposes)

93
Q

What is dysphonia?

A

any impairment

in the voice or

difficulty speaking

94
Q

What is dysarthria?

A

Imperfect articulation of speech due to disturbances of muscular control or incoordination

95
Q

What is dysphasia? (which specific situations is this term used)

A

Impairment in the:

production

and

comprehension

of speech

(particularly when related to a brain injury)

96
Q

What is sensory dysphasia?

A

Impairment in the COMPREHENSION of speech

97
Q

What is expressive dysphasia?

A

Impairment in the PRODUCTION of speech

98
Q

How can listening to the voice help you determine the origin of a voice problem?

A

If rough then a problem with the way the cords are vibrating

if breathy then implies vocal cord palsy (i.e. they cannot be completely brought together)

99
Q

Name the potential causes of voice disorders?

A

Think C then LMNOP

CARCINOMA
cysts
cord palsy

Laryngitis
Muscle tension dysphonia
Nodules
Oedema (Reinke's)
Polyps
Papillomatosis
100
Q

How long do surgeons generally wait before operating on vocal cord issues?

A

6 months as function may return

101
Q

What is the common infective agent in tonsillitis?

A

Viral

102
Q

What are the symptoms of tonsillitis?

A

Malaise, pyrexia

sore throat

white/yellow slough on tonsils

103
Q

What is the treatment for tonsillitis?

A

Hydration and analgesia

Surgery if >4 cases per annum

104
Q

How do the size of adenoids change as you get older?

A

They regress with age

105
Q

Why would an adenoidectomy be performed?

A

Sleep apnoea/snoring

Recurrant glue ear (as the adenoids are a bacterial resevoir)

Otorhinolaryngology (7 decks)

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