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ENT > Voice Disorders > Flashcards

Voice Disorders Flashcards

1
Q

What are the functions of the larynx (3)

A

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

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2
Q

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

A

Sensory - supraglottis

Motor - cricothyroid muscle

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3
Q

What is the function of the cricothyroid muscle

A

Adjust the tension of the vocal cords allowing alterations in pitch

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4
Q

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

A

Sensory - subglottis

Motor - all other laryngeal muscles

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5
Q

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

A

Posterior crico-arytenoid

Pulls cords apart

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6
Q

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

A

Supraglottic - cervical nodes

Subglottic - paratracheal nodes

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7
Q

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

A 
Supra = epiglottis, false cords, ventricles, aryepiglottic folds, arytenoids
Glottis = true vocal cords
Subglottis = b/wn vocal cords + trachea
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8
Q

List some causes of voice hoarseness

A

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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9
Q

List some other symps of laryngeal malignancy

A

= Sub/supraglottic:

cough, throat irritation, neck lump, referred otalgia

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10
Q

What is the prognosis for glottis malignancy?

+ for supra/sub-glottic

A 
Glottis = good, small lesion presents early + poor lymphatic drainage
Sub/supraglottic = airway/voice not compromised until late so poorer prognosis
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11
Q

What is the treatment for a laryngeal malignancy

A

Radiotherapy + radical surgical excision (laryngectomy/tracheostomy)

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12
Q

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

A

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

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13
Q

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

+ one less common cause

A

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

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

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14
Q

What are the symptoms of recurrent laryngeal nn palsy?

A 
Hoarse/weak voice
?Diplophonia
?High pitched voice
?Weak bovine cough
?Fluid choking
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15
Q

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

A

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

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16
Q

What are some causes of muscular tension dysphonia (6)

A

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)

17
Q

What symptoms are seen in muscular tension dysphonia (4)

A

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

18
Q

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

A

Vocal folds normal

False cords / antero-posterior constriction

19
Q

How is muscular tension dysphonia treated?

A

Vocal hygiene
Lifestyle advice
Voice therapy
Address underlying cause

20
Q

What are papillomata and who do they occur in?

A

V rare benign tumour from HPV

Children > adults

21
Q

How are papillomata treated?

A 
Laser removal (req several as regrow)
Laryngectomy/tracheostomy if occluding airway (rare)
22
Q

How/where do vocal cord nodules form?

A

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)

23
Q

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

A 
Cyst = oedema under cord covering + remains contained
Polyp = more superficial oedema + prolapses into airway
24
Q

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

A

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

25
Q

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

A

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

26
Q

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

A

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

27
Q

How does acute laryngitis occur?

What can forced vocalisation in acute laryngitis →?

A

Vocal strain + irritants (alc, smoke)

→ Haemorrhage into vocal folds / fibrosis / permanent vocal disorders

28
Q

What are the symptoms of acute laryngitis? (3)

What would be seen on scope? (2)

A

Hoarseness
Malaise / pyrexia (if infective)
Pain on speaking/swallowing

Vocal cords red/oedematous
Restricted cord movement

29
Q

How can acute laryngitis be treated? (5)

A 
Conservative:
Steam inhalation
Gentle warmth
Voice rest
Simple analgesia
Cough suppressants (if prominent feature)
30
Q

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

A

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)
31
Q

How is chronic laryngitis managed? (2)

A

Intensive speech therapy

Removal of causative factors

32
Q

List some possible causes of functional dysphonia (4)

How is it treated? (2)

A

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

33
Q

What may chronic laryngitis lead to?

A

Dysplasia + carcinoma in situ

34
Q 
How may Epiglottitis present?
What symps (4)
A

Initial URTI but rapidly (hrs) → total airway obstruction

Difficulty swallowing
Drooling
Change in voice/cry
Sitting up/accessorys

35
Q

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

A

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)

36
Q

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

A

Oral cavity + pharynx swelling

Hoarse voice + cough → Stridor → Total airway obstruction

Toxin produced can → myocardial / peripheral nn damage

Early Abx + Antitoxin

ENT (6 decks)

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