Voice Disorders Flashcards by Emmy Beever

What are the functions of the larynx (3)

Sphincter against contamination of food/liquid/secretions
Allows effective cough
Produces voice

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What does the superior laryngeal nerve innervate? (Sensory/motor)

Sensory - supraglottis

Motor - cricothyroid muscle

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What is the function of the cricothyroid muscle

Adjust the tension of the vocal cords allowing alterations in pitch

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What does the recurrent laryngeal nerve innervate ? (Sensory/motor)

Sensory - subglottis

Motor - all other laryngeal muscles

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Which muscle is described as the most important muscle in the body? (Except heart lol) - and why?

Posterior crico-arytenoid

Pulls cords apart

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Where do the supraglottic and subglottic and regions’ lymphatic drain into?

Supraglottic - cervical nodes

Subglottic - paratracheal nodes

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What do the supra glottis / glottis / sub glottis each consist of

Supra = epiglottis, false cords, ventricles, aryepiglottic folds, arytenoids
Glottis = true vocal cords
Subglottis = b/wn vocal cords + trachea

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List some causes of voice hoarseness

Inflammation: acute / chronic laryngitis
Neoplastic: Benign - papilloma/haemangioma, Malig - SCC
Neurological: Central - CVA/MS, Periph - recurrent laryngeal palsy/ motor neurone disease
Mechanical: vocal nodules / cyst / polyps / muscular tension dysphonia
Non-organic: functional dysphonia

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List some other symps of laryngeal malignancy

= Sub/supraglottic:

cough, throat irritation, neck lump, referred otalgia

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What is the prognosis for glottis malignancy?

+ for supra/sub-glottic

Glottis = good, small lesion presents early + poor lymphatic drainage
Sub/supraglottic = airway/voice not compromised until late so poorer prognosis

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What is the treatment for a laryngeal malignancy

Radiotherapy + radical surgical excision (laryngectomy/tracheostomy)

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What signs would be seen O/E/scope in laryngeal malignancy (3)

Airway narrowing
Thickened irregular mass w. leukoplakia + redness
? Fixated vocal cords

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What are the 3 main causes of recurrent laryngeal nn palsy?

+ one less common cause

1/3rd idiopathic
1/3rd surgical
1/3rd neoplasia (bronchi)

Also crico-arytenoid joint fixation (severe RA/reflux)

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What are the symptoms of recurrent laryngeal nn palsy?

Hoarse/weak voice
?Diplophonia
?High pitched voice
?Weak bovine cough
?Fluid choking

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What Ix are done in recurrent laryngeal nn palsy to rule out malignancy? (4)

CXR (mandatory)
CT (if CXR normal)
Thyroid USS
Endoscopy of aerodigestive tract under GA

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What are some causes of muscular tension dysphonia (6)

Stress/Anxiety/Depression
Conversion disorders
Back/neck problems
Poor vocal hygiene
Lifestyle (abuse/insuff fluids/caffeine+fizzy)
Secondary/compensatory to other mechanical prob (voice producing defect / cord structural defect / poor reap func)

What symptoms are seen in muscular tension dysphonia (4)

Variable hoarseness
Unstable voice
Dryness/discomfort sensation in throat
Normal cough

What would be seen O/E/scope in muscular tension dysphonia

Vocal folds normal

False cords / antero-posterior constriction

How is muscular tension dysphonia treated?

Vocal hygiene
Lifestyle advice
Voice therapy
Address underlying cause

What are papillomata and who do they occur in?

V rare benign tumour from HPV

Children > adults

How are papillomata treated?

Laser removal (req several as regrow)
Laryngectomy/tracheostomy if occluding airway (rare)

How/where do vocal cord nodules form?

Vocal abuse
Small white bilateral thickenings
Initially soft then fibrosis + harden

At point of maximal glottic closure (junc of ant 1/3rd + post 2/3rd)

Whats the difference b/wn a vocal cyst + a vocal polyp?

Cyst = oedema under cord covering + remains contained
Polyp = more superficial oedema + prolapses into airway

What is the aetiology of vocal (Reinke’s) oedema / cysts / polyps

Reinkes oedema = from smoking/excessive talking
Cyst = from laryngeal inflamm
Polyp = shouting with URTI / reflux

How do Reinke's oedema / vocal polyps / cysts look different on scope

Reinke's oedema = bilateral grey/red swelling along length of cord (erythrematous) Polyp = grey/red swelling in middle (haemorrhagic) Cyst = unilateral nodular swelling

What are the major causes of reduced/absent vocal cord motility? (5)

I: Viral infection, Laryngitis T: Cancers (benign/malig) of cord/joint/nerve T: Damage from intubation / reflux Idio: Functional dysphonia

How does acute laryngitis occur? | What can forced vocalisation in acute laryngitis →?

Vocal strain + irritants (alc, smoke) → Haemorrhage into vocal folds / fibrosis / permanent vocal disorders

What are the symptoms of acute laryngitis? (3) | What would be seen on scope? (2)

Hoarseness Malaise / pyrexia (if infective) Pain on speaking/swallowing Vocal cords red/oedematous Restricted cord movement

How can acute laryngitis be treated? (5)

``` Conservative: Steam inhalation Gentle warmth Voice rest Simple analgesia Cough suppressants (if prominent feature) ```

In chronic laryngitis, what may cause inflammation persist? (7)

Even small amount oedema in Reinke's space slow to resolve (poor lymph drainage) ``` Can be due to: Vocal abuse Chronic bronchitis Sinusitis/Post-nasal drip Reflux Alcohol/smoking fumes Environmental pollutants TB/Syphilis/Fungal (rarely) ```

How is chronic laryngitis managed? (2)

Intensive speech therapy | Removal of causative factors

List some possible causes of functional dysphonia (4) How is it treated? (2)

Voice strain Stress/life event at time of onset Fam/friend recently develop serious throat condition Psychiatric problems Firm reassurance Speech therapy to relieve laryngeal tension

What may chronic laryngitis lead to?

Dysplasia + carcinoma in situ

``` How may Epiglottitis present? What symps (4) ```

Initial URTI but rapidly (hrs) → total airway obstruction Difficulty swallowing Drooling Change in voice/cry Sitting up/accessorys

What pathogen causes Croup? Which part of airway inflamed? How does it present ? How managed?(3)

H.Influenzae (longer course than Epiglottitis) Diffuse inflamm of airway (laryngotracheobronchitis) Low-grade URTI → Pyrexia + Stridor → Deterioration + child toxic IV Abx + neb Adrenaline + poss Ventilation (serious)

What part of the airway is inflamed in Diphtheria ? How does it present? (3) What is a complication? How is it managed? (2)

Oral cavity + pharynx swelling Hoarse voice + cough → Stridor → Total airway obstruction Toxin produced can → myocardial / peripheral nn damage Early Abx + Antitoxin