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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
whats the management of vocal cord palsy
await recovery voice therapy vocal cord medialisation
26
how long may vocal cord palsy recovery take
up to 1 year
27
whats the most common cause of voice disorders seen in secondary care
muscular tension dysphoria
28
what is muscular tension dysphoria
imbalance in pull of the vocal cords leading to an asymmetry and increased tension in the paired laryngeal muscles
29
what is the aetiology of muscular tension dysphoria
``` stress anxiety depression conversion disorders neck/back problems lifestyle - vocal abuse, too much coffee/tea, eating late at night ```
30
how does muscular tension dysphoria present
variable hoarseness that worsens with use dry/uncomfortable throat voice is usually unstable normal cough
31
what would you find on examination for muscular tension dysphoria
vocal cords appear normal and move normally, false cords may be constricted (antero-posterior closure or extreme closure obscuring true cords)
32
whats the treatment for muscular tension dysphoria
vocal hygeine lifestyle advice voice therapy addressing underlying causative factors
33
what are examples of benign vocal cord lesions
Nodules Polyps Reinkes Odema Cysts
34
what are causes of vocal cord nodules
voice abuse shouting reflux
35
whats the general demographic for vocal cord nodules
young adulrs (<40) F>M
36
what are symptoms of vocal cord nodules
husky voice worse with use loss of higher range of voice perilaryngeal discomfort
37
what would you see on examination for vocal cord nodules
bilateral swellings of midmembranous portion of vocal fold giving hourglass appearance
38
what's the treatment of vocal cord nodules
voice therapy surgical excision if unresponsive
39
what are causes of vocal polyps
shouting when with cold or when having gastroosophageal reflux
40
whats the general demographic for vocal cord polyps
M>F, 30-50
41
what are symptoms for vocal cord polyps
husky voice worse with use | voice cuts out if speaking
42
what would you see on examination for vocal cord polyps
unilateral swellings arising from mid-membranous ortions of vocal folds
43
how do you treat vocal cord polyps
surgical excision medical treatment voice therapy
44
what is the most common causes of reinkes odema
smoking - most common talking extra-osophageal reflux
45
whats the presentation of reinkes odema
deep pitched, gravelly voice | if severe may cause choking
46
what would you see on examination for reinkes odema
bilateral gray/erythamtous swellings along the whole length of membranous portion of the vocal fold
47
whats the treatment for reinkes odema
smoking cessation surgery medicinal treatment of reflux voice therapy
48
what are the 2 types of vocal cord cysts
mucus retention cysts | epidermoid
49
what are the symptoms of vocal cord cysts
husky voice increased effort to speak voice breaks decreased range of voice
50
what would you see on examination for vocal cord cysts
unilateral nodular swelling/bulging
51
how do you treat vocal cord cysts
voice therapy | surgical excision
52
what causes decreased or absent vocal cord mobility
``` viral infection cancers damage from intubation laryngeal reflux functional dysphonia laryngitis ```
53
what would a lateral resting vocal cord sound like
poor voice but good airway
54
what would a medial resting vocal cord sound like
poor airway but good voice
55
what is functional dysphonia
wide variety of functional voice issues
56
whats the presentation of functional dysphonia
weak/hoarse voice that tires easily and is abnormally pitched
57
what is functional dysphonia usually associated with
vocal train stress psychiatric issues a stressful period in life
58
what is the treatment of functional dysphonia
reassurance speech therapy if required psychiatric referral
59
what is acute laryngitis
pure laryngeal inflammation
60
what causes acute laryngitis
vocal abuse cigarettes alcohol
61
what are symptoms of acute laryngitis
``` hoarse voice most commonly aphonia pain on speaking allodynia malaise (if infective) pyrexia (if infective) ```
62
what would you find on examination for acute laryngitis
vocal cord red and odematous arytenoids/false cord swelling movement of cords restricted but symmetrically without paralysis
63
how do you treat acute laryngitis
``` supportive steam inhalation voice rest analgesia warmth to anterior neck cough suppressants if required ```
64
what may forced vocalisation lead to in acute laryngitis
haemorrhage into the vocal folds which may fibrose and cause permanent vocal cord damage
65
what is epiglottitis
acute life-threatening bacterial infection o the epiglottis
66
what causes epiglottitis
H.influenzae
67
what are the features of epiglottitis
``` difficulty swallowing drooling change in voice change in cry high grade pyrexia inspiratory stridor ```
68
what should you avoid doing in a patient with epiglottiits
avoid upsetting them - throat may close if they cry avoid lying down and worsenes breathing
69
whats the treatment for epiglottitis
rapid IV antibiotics - ceftriaxone
70
what is croup
a viral infection causing diffuse airway inflammation
71
what organisms cause croup
parainfluenza (mainly) RSV adenovirus
72
what is the presentation for croup
low grade URTI | increased in pyrexia + inspiratory stridor
73
whats the treatment for croup
nebulised adrenaline oral dexamethosone if serious - ventilatory support
74
what is are the symptoms of laryngeal diptheria
hoarse voice stridor cough
75
what are complications of laryngeal diptheria
myocardium + peripheral nerve damage may occur from toxin release
76
what causes chronic laryngitis
initial period of inflammation which is then sustained by another infection on top/vocal abus/acid reflux/alcohol fumes
77
what are some rare causes of chronic laryngitis
syphilis/TB/Fungal infection
78
what are signs and symptoms of chronic laryngitis
hoarse voice erythematous cords thickened/odematous cords
79
what do you need to watch out for with chronic layngitis
chronic inflammation may lead to cancer formation so important to keep an eye on
80
whats the treatment for chronic laryngitis
removal of causative factors | intensive speech therapy
81
what does a rough voice indicate
problems in vocal cord vibration
82
what does a breathy voice indicate
vocal cords brought together (e.g. palsy)
83
why do surgeons tend to like to delay surgery for voice problems
because voice can recover in 6 months with approproate treatment so waiting tends to be the better approach
84
what is a thyroplasty
window cut in thyroid membrane and a silastic shim (type of implant) placed to manually reposition vocal cords
85
what are the options for vocal cord surgery
fluid based shift | thyroplasty
86
what is the most common form of laryngitis
HPV
87
what is fungal laryngitis usually secondary to
steroid inhalation | immunosuppression
88
what are signs of a viral/bacterial laryngeal infection
erythematous vocal cords
89
what is a sign of a fungal laryngeal infection
leukoplakia
90
what should be suspected if a child has a rapidly progressing URTI
diptheria corup epiglottitis
91
what is the most common non-infectious cause of voice disorders
extra-osophageal reflux
92
how do you treat extra-osophageal reflux
dietary advice/vocal hygeine PPI BD before meals for 2 months +/- alginates + H2 antagonists

ENT (8 decks)

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