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ENT > Voice Disorders > Flashcards

Voice Disorders Flashcards

1
Q

Where do the false vocal cords lie

A

between the corniculate/arytenoid cartilage posteriorly, and the thyroid cartilage anteriorly

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2
Q

where do the true vocal cords lie

A

between the muscular processes of the arytenoid cartilage and the thyroid cartilage

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3
Q

what does the arytenoid cartilage do

A

provides posterior attachment for both vocal cords and move to allow speech

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4
Q

what does the piriform fossa do

A

channels food either side of the larynx into the oesophagus

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5
Q

what is the supraglottis innervated by

A

internal branch of the superior laryngeal nerve

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6
Q

what innervates the cricothyroid muscles

A

external branch of the superior laryngeal nerve

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7
Q

what innervates the subglottic region

A

recurrent branch of the superior laryngeal nerve

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8
Q

what muscle abducts the vocal cords

A

posterior cricoarytenoid muscle

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9
Q

what lymph nodes does the larynx drain to

A

supraglottis - neck lymph (cervical)

subglottis - paratracheal lymph

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10
Q

whats the most common type of laryngeal malignancy

A

SCC

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11
Q

whats the most important risk factor for laryngeal malignancy

A

smoking

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12
Q

whats the most common symptom of laryngeal malignancy (glottic tumours)

A

hoarsenses >6 weeks

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13
Q

whats the general prognosis of laryngeal malignancy

A

generally good as small lesions cause symptoms early and the region has poor lymphatic drainage

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14
Q

whats the 5 year survival of laryngeal malignancy

A

95%

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15
Q

why do supraglottic/subglottic tumours have a worse prognosis than glottic tumours

A

symptoms are much more vague and voice symptoms do not appear until much later on so they tend to be caught much later

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16
Q

whats the primary treatment for laryngeal tumours

A

endoscopic removal
radiotherapy
radical surgical excision (laryngectomy)

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17
Q

why is the recurrent laryngeal nerve at risk for damage

A

it has a long course into the torso (around the aorta)

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18
Q

what’s the rule of 1/3s for laryngeal nerve palsy

A

1/3 idiopathic
1/3 surgery - e.g. thyroidectomy
1/3 neoplasia

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19
Q

what is a common cause of death for recurrent laryngeal nerve palsy

A

aspiration pneumonia as there is a lack of airway protection

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20
Q

what are signs and symptoms of recurrent laryngeal nerve palsy

A 
weak voice
parilaryngeal discomfort
choking on fluids
tires on prolonged talking 
higher pitched voice 
diplophonia 
weak, bovine cough
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21
Q

what side do vocal cord palsies tend to affect

A

75% left, 15% right, 10% both

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22
Q

what should you assume a vocal cord palsy to be unless proven otherwise

A

malignant

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23
Q

whats the mandatory investigations for a suspected vocal cord palsy

A

chest x ray
CT head + chest
USS thyroid (if CXR clean)
Rigid endoscopy (if CXR clean)

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24
Q

.

A

.

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25
Q

whats the management of vocal cord palsy

A

await recovery
voice therapy
vocal cord medialisation

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26
Q

how long may vocal cord palsy recovery take

A

up to 1 year

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27
Q

whats the most common cause of voice disorders seen in secondary care

A

muscular tension dysphoria

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28
Q

what is muscular tension dysphoria

A

imbalance in pull of the vocal cords leading to an asymmetry and increased tension in the paired laryngeal muscles

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29
Q

what is the aetiology of muscular tension dysphoria

A 
stress
anxiety
depression 
conversion disorders 
neck/back problems
lifestyle - vocal abuse, too much coffee/tea, eating late at night
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30
Q

how does muscular tension dysphoria present

A

variable hoarseness that worsens with use
dry/uncomfortable throat
voice is usually unstable
normal cough

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31
Q

what would you find on examination for muscular tension dysphoria

A

vocal cords appear normal and move normally, false cords may be constricted (antero-posterior closure or extreme closure obscuring true cords)

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32
Q

whats the treatment for muscular tension dysphoria

A

vocal hygeine
lifestyle advice
voice therapy
addressing underlying causative factors

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33
Q

what are examples of benign vocal cord lesions

A

Nodules
Polyps
Reinkes Odema
Cysts

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34
Q

what are causes of vocal cord nodules

A

voice abuse
shouting
reflux

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35
Q

whats the general demographic for vocal cord nodules

A

young adulrs (<40) F>M

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36
Q

what are symptoms of vocal cord nodules

A

husky voice worse with use
loss of higher range of voice
perilaryngeal discomfort

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37
Q

what would you see on examination for vocal cord nodules

A

bilateral swellings of midmembranous portion of vocal fold giving hourglass appearance

38
Q

what’s the treatment of vocal cord nodules

A

voice therapy

surgical excision if unresponsive

39
Q

what are causes of vocal polyps

A

shouting when with cold or when having gastroosophageal reflux

40
Q

whats the general demographic for vocal cord polyps

A

M>F, 30-50

41
Q

what are symptoms for vocal cord polyps

A

husky voice worse with use

voice cuts out if speaking

42
Q

what would you see on examination for vocal cord polyps

A

unilateral swellings arising from mid-membranous ortions of vocal folds

43
Q

how do you treat vocal cord polyps

A

surgical excision
medical treatment
voice therapy

44
Q

what is the most common causes of reinkes odema

A

smoking - most common
talking
extra-osophageal reflux

45
Q

whats the presentation of reinkes odema

A

deep pitched, gravelly voice

if severe may cause choking

46
Q

what would you see on examination for reinkes odema

A

bilateral gray/erythamtous swellings along the whole length of membranous portion of the vocal fold

47
Q

whats the treatment for reinkes odema

A

smoking cessation
surgery
medicinal treatment of reflux
voice therapy

48
Q

what are the 2 types of vocal cord cysts

A

mucus retention cysts

epidermoid

49
Q

what are the symptoms of vocal cord cysts

A

husky voice
increased effort to speak
voice breaks
decreased range of voice

50
Q

what would you see on examination for vocal cord cysts

A

unilateral nodular swelling/bulging

51
Q

how do you treat vocal cord cysts

A

voice therapy

surgical excision

52
Q

what causes decreased or absent vocal cord mobility

A 
viral infection
cancers
damage from intubation
laryngeal reflux
functional dysphonia 
laryngitis
53
Q

what would a lateral resting vocal cord sound like

A

poor voice but good airway

54
Q

what would a medial resting vocal cord sound like

A

poor airway but good voice

55
Q

what is functional dysphonia

A

wide variety of functional voice issues

56
Q

whats the presentation of functional dysphonia

A

weak/hoarse voice that tires easily and is abnormally pitched

57
Q

what is functional dysphonia usually associated with

A

vocal train
stress
psychiatric issues
a stressful period in life

58
Q

what is the treatment of functional dysphonia

A

reassurance
speech therapy
if required psychiatric referral

59
Q

what is acute laryngitis

A

pure laryngeal inflammation

60
Q

what causes acute laryngitis

A

vocal abuse
cigarettes
alcohol

61
Q

what are symptoms of acute laryngitis

A 
hoarse voice most commonly
aphonia 
pain on speaking 
allodynia 
malaise (if infective) 
pyrexia  (if infective)
62
Q

what would you find on examination for acute laryngitis

A

vocal cord red and odematous
arytenoids/false cord swelling
movement of cords restricted but symmetrically without paralysis

63
Q

how do you treat acute laryngitis

A 
supportive 
steam inhalation 
voice rest
analgesia
warmth to anterior neck 
cough suppressants if required
64
Q

what may forced vocalisation lead to in acute laryngitis

A

haemorrhage into the vocal folds which may fibrose and cause permanent vocal cord damage

65
Q

what is epiglottitis

A

acute life-threatening bacterial infection o the epiglottis

66
Q

what causes epiglottitis

A

H.influenzae

67
Q

what are the features of epiglottitis

A 
difficulty swallowing 
drooling
change in voice
change in cry 
high grade pyrexia
inspiratory stridor
68
Q

what should you avoid doing in a patient with epiglottiits

A

avoid upsetting them - throat may close if they cry

avoid lying down and worsenes breathing

69
Q

whats the treatment for epiglottitis

A

rapid IV antibiotics - ceftriaxone

70
Q

what is croup

A

a viral infection causing diffuse airway inflammation

71
Q

what organisms cause croup

A

parainfluenza (mainly)
RSV
adenovirus

72
Q

what is the presentation for croup

A

low grade URTI

increased in pyrexia + inspiratory stridor

73
Q

whats the treatment for croup

A

nebulised adrenaline
oral dexamethosone
if serious - ventilatory support

74
Q

what is are the symptoms of laryngeal diptheria

A

hoarse voice
stridor
cough

75
Q

what are complications of laryngeal diptheria

A

myocardium + peripheral nerve damage may occur from toxin release

76
Q

what causes chronic laryngitis

A

initial period of inflammation which is then sustained by another infection on top/vocal abus/acid reflux/alcohol fumes

77
Q

what are some rare causes of chronic laryngitis

A

syphilis/TB/Fungal infection

78
Q

what are signs and symptoms of chronic laryngitis

A

hoarse voice
erythematous cords
thickened/odematous cords

79
Q

what do you need to watch out for with chronic layngitis

A

chronic inflammation may lead to cancer formation so important to keep an eye on

80
Q

whats the treatment for chronic laryngitis

A

removal of causative factors

intensive speech therapy

81
Q

what does a rough voice indicate

A

problems in vocal cord vibration

82
Q

what does a breathy voice indicate

A

vocal cords brought together (e.g. palsy)

83
Q

why do surgeons tend to like to delay surgery for voice problems

A

because voice can recover in 6 months with approproate treatment so waiting tends to be the better approach

84
Q

what is a thyroplasty

A

window cut in thyroid membrane and a silastic shim (type of implant) placed to manually reposition vocal cords

85
Q

what are the options for vocal cord surgery

A

fluid based shift

thyroplasty

86
Q

what is the most common form of laryngitis

A

HPV

87
Q

what is fungal laryngitis usually secondary to

A

steroid inhalation

immunosuppression

88
Q

what are signs of a viral/bacterial laryngeal infection

A

erythematous vocal cords

89
Q

what is a sign of a fungal laryngeal infection

A

leukoplakia

90
Q

what should be suspected if a child has a rapidly progressing URTI

A

diptheria
corup
epiglottitis

91
Q

what is the most common non-infectious cause of voice disorders

A

extra-osophageal reflux

92
Q

how do you treat extra-osophageal reflux

A

dietary advice/vocal hygeine
PPI BD before meals for 2 months
+/- alginates + H2 antagonists

ENT (8 decks)

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