Chapter 20: Benign Laryngeal Disorders Flashcards Preview

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Flashcards in Chapter 20: Benign Laryngeal Disorders Deck (106):
1

Normal infant larynx

1. Situated higher in the neck than that of the adult
2. Softer, less rigid and more compressible by airway pressures
3. At the level C2-C4. (Adult: C4-C6)
4. 7 mm in the anteroposterior length and opens approximately 4mm in a lateral direction

2

1. Exaggeration of the soft, flabby state that is normal for newborns
2. As the infant inhales, the soft larynx falls together, narrowing the inlet and stridor results
3. Swallowing is unaffected

Laryngomalacia

3

Direct examination of laryngmalacia

1. Larynx fall together with inhalation
2. Subglottic area is normal
3. Stridor ceases if the larynx is held open with laryngoscope

4

Most infants cease to have the stridor by the 12th to 15th month

Laryngomalacia

5

Can be associated with a 2nd upper airway abnormality

Laryngomalacia

6

Disorder of the trachea due to lack of rigidity of the tracheal cartilages

Tracheomalacia

7

1. Subglottic diameter less than 4 mm
2. Presents with stridor shortly after birth or recurrent episodes of laryngotracheitis
3. Mild cases: observation, most cases require tracheotomy
4. Growth tends to resolve the relative stenosis, but laser excision or reconstructive surgery may be necessary

Congenital subglottic stenosis

8

Congenital webs

1. Glottic (75%)
2. Subglottic (12%)/Supraglottic (12%)

9

Both the airway and the cry or voice are affected, with the symptoms beginning at birth

Congenital webs

10

Congenital webs treatment

1. Laser or surgical excision
2. Repeated dilatation
3. Tracheotomy

11

1. May have airway obstruction or simply do not grow
2. Voice and swallowing and normal
3. Arise from the base of the tongue, aryepiglottic folds or false cords
4. If its possible: excision
5. Not possible: aspiration or marsupialization

Congenital cysts

12

1. Occurs primarily in infants under 6 months of age
2. Presence of external hemagioma plus stridor
3. Tends to regress, usually by the age of 12 months
4. Lateral xray: mass in the airway
5. Endoscopic: smooth, compressible mass often on the posterior or lateral wall
6. Tx: tracheotomy and allowing time for regression, laser excision

Hemagioma

13

1. Special type of congenital cyst that develops as s residual from a small appendix or saccus of the laryngeal ventricle
2. Present at any age but its origin is congenital

Laryngocele

14

1. As the cyst begins, it first causes a bulging of the false vocal cord on that side
2. With enlargement, the cyst dissects along the superior laryngeal nerve and vessels to present as mass in the neck
3. As they enlarge, they encroach on the airway and may cause stridor and airway obstruction

Laryngocele

15

Treatment for laryngocele

Dissection of the cyst using an external approach accompanied by a temporary tracheostomy

16

Result of a failure of fusion of the dorsal portions of the cricoid cartilages

Laryngotracheoesophageal cleft

17

There is an associated failure of closure of the tracheoesophaheal septum, thus creating a groove in the region of the cricoid cartilage

Laryngotracheoesophageal cleft

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1. Infant may have cyanosis, respiratory distress and recurrent episodes of pneumonia
2. Associated changes in the cry as well as inspiratory stridor
3. Direct laryngoscopy: normal larynx

Laryngotracheoesophageal cleft

19

Causes of vocal cord paralysis in infants

1. Birth canal trauma
2. Meningocele or mediatinal mass
3. Increase ICP

20

Unilateral vocal cord paralysis is more common on the...

Cleft

21

Children with bilateral vocal cord paralysis can have a...

Normal cry

22

Recovery of vocal cord paralysis

6-9 months but may take up to 14 months

23

1. Manifested by internal hematomas and occasionally by dislocation of the arytenoid cartilage
2. Caused by some blunt object striking an extended neck
3. Direct laryngoscopy: reduces the dislocated arytenoid cartilage

Mild contusions of the larynx

24

Don not cause airway obstruction, since the pharynx is very wide at this level

Hyoid fractures

25

The greater cornu of the hyoid does not normally unite to the body until...

Age 35

26

Treatment of hyoid bone fractures

Expectant

27

Signs of laryngeal fracture

1. Hoarseness
2. Inspiratory or expiratory stridor
3. Hemoptysis
4. Subcutaneous emphysema

28

When laryngotracheal separation occurs, the trachea will retract into the lower neck

Emergency tracheostomy is required

29

Most likely fracture runs in a...

Vertical plane from the bottom of the thyroid notch to the lower border of the cartilage

30

Avulsion of the thyroid cartilage from the cricoid and trachea...

1. Facial pain
2. Aphonia
3. Subcutaneous emphysema

31

Required in anyone with a laryngeal fracture

1. Cervical spine films
2. Neurologic exam

32

Causes of laryngeal stenosis

1. Blunt or perforating trauma
2. High tracheostomy
3. Caustic ingestion
4. Gunshot wound
5. Irritation from an endotracheal tube cuff

33

Used to delineate laryngeal and subglottic stenosis

Ct scan

34

Treatment of chronic laryngeal stenosis is very complicated and must be individualized

1. Dilatation
2. Excision
3. Direct re-anastomosis
4. Skin grafting over a mo
5. Partial or total laryngectomy

35

1. Endotracheal tube abrades the vocal process of the arytenoid cartilage
2. Perichondritis develops and the healing process produces a raised polypoid lesion in the posterior portion of thr glottic chink (rima glottidis)
3. Not very hoarse but the voice is changed
4. Bilateral

Intubation granuloma

36

Treatment of intubation granuloma

Endoscopic surgical removal, often using the CO2 laser

37

1. Resulting in stridor and airway obstruction
2. Develop at any age even in adults
3. Most common in children under 6 years of age

Croup

38

Contain loose areolar tissue that is prone to swell when inflamed

1. Laryngeal surface of the epiglottis
2. Area just below the vocal cords in the larynx

39

Croup can be divided into:

1. Acute supraglottis (epiglottis)
2. Acute subglottic laryngitis

40

Signs and symptoms of croup

1. Restlessness
2. Apprehension
3. Stridor
4. Retraction
5. Cyanosis

41

1. More explosive
2. Tends to sit up with mouth open and chin forward, is not hoarse
3. Tends not to have a croupy a cough, but is more likely to have dysphagia
4. Painful to swallow, child may drool
5. Dysphagia may be a sign of impending collapse (results from the spread of inflammation into the adjacent esophageal inlet and means that the inflammatory process has swollen the epiglottis markedly)

Acute supraglottis (epiglotitis)

42

Hoarse with very croupy cough and usually want to lie down

Acute subglottic laryngitis

43

Management of croup

1. Rapid treated without long delay in the radiology or ED
2. Must not be upset or agitated

44

Soft tissue lateral xray in croup

Narrowing of the subglottic area or an enlarged epiglottis

45

Should not be done unless one is equipped to pass a bronchoscope or endotracheal tube

Depressing the tongue to see the epiglottis (may force the swollen epiglottis into the larynx like a cork)

46

Treatment of croup

1. IV fluid therapy is started in order to prevent dehydration and drying of secretions
2. Antibiotic therapy to actual Hemophilus or Staphylococcus is initiated
3. Steroids are given in large doses
4. Patient must be carefully observed and consideration given to intubation or tracheostomy

47

Evaluation of croup

Monitor
1. Pulse
2. Respiratory rate
3. Degree of restlessness
4. Apprehension
5. Use of accessory muscles of respiration
6. Degree of cyanosis
7. Degree of retraction
8. Overall fatigue

48

Indicate the need to support (croup)

1. RR over 40
2. PR over 160
3. Increasing restlessness and retraction

49

Can occur in 30-40 year old adults

Acute epiglotitis

50

Most cases of croup resolve in...

48-72 hours and the patient can be extubated

51

3-6 years
Onset hours
Voice clear
Dysphagia
Sitting up
Rarely recurs
Rapid course
Lateral xray: supraglottic edema
Hemophilus influenzae most common
Streptococcus or viral etiology less common

Supraglottitis

52

Under 3 years
Onset days
Hoarse
No dysphagia
No drooling
Recumbent
May recur
Days to weeks
Normal neck films
Viral etiology

Laryngotracheobronchitis (infraglottitis)

53

8-15 years
1-2 week period of respiratory infection with rapid deterioration
Barking cough
Inspiratory stridor
Recumbent
Intubation needed to remove secretions or pseudomembranes
Tracheal xray: irregular margins
Most typical: S. aureus
Less common: Streptococcus or H. influenzae

Bacterial tracheitis

54

1-5 years
Rapid onset, usually evening
No associated infection
Exposure to humidity or cold relieves
May be non inflammatory edema of subglottic area

Spasmodic croup

55

Produce acute laryngitis

1. Vocal abuse
2. Toxic fume inhalation
3. Infection

56

Most common causative organisms in acute laryngitis

1. Influenza virus
2. Adenovirus
3. Streptococci

57

Treatment of acute laryngitis

1. Voice rest
2. Antibiotics
3. Increased humidity
4. Cough suppressants

58

Advised in patient with acute laryngitis

1. Singers and voice professionals must be advised to let the inflammatory process subside before resuming their careers
2. Attempting to sing during the infection may result in hemorrhage in the larynx and the subsequent development of vocal cord nodules

59

1. Pain radiating to the ear
2. Dysphagia
3. Hoarseness
4. Arytenoid is edematous, erythematous and immobile
Vocal cord paralysis: joint should move passively
Arthritis: fixed

Acute cricoarytenoid arthritis

60

Early symptom of hypothyroidism due to deposition of mucopolysaccharides submucosally

Hoarseness

61

1. Supraglottic larynx is primarily involved as true cords ate spared
2. Present with hoarseness and dysphagia
3. Diffuse edema without ulceration of the supraglottic larynx
4. Noncaseating granulomas with giant cells
5. Tx: systemic steroids or direct intralesional injection of steroids
Obstructing: tracheostomy

Sarcoidosis

62

Cause simultaneous mucosal ulceration in the larynx and otal cavity

Histoplasmosis

63

Treatment of laryngeal pemphigus
Cicatricial stenosis can result

Dapsone
Steroid

64

More often involved in TB of larynx

Posterior aspect of the cords

65

Chronic granulomatous infections

TB
Syphilis
Leprosy

66

1. Variety of conditions that are all characterized by hoarseness
2. Repeated attacks of acute laryngitis
3. Exposed to irritating dust or smoke or may use their voices improperly in a neuromuscular sense

Chronic nonspecific laryngitis

67

Treatment of chronic nonspecific laryngitis

1. Removing the offending cause
2. Correcting treatable related disorders
3. Reeducating vocal habits through speech therapy

68

1. May be unilateral
2. Results from prolonged or improper use of the vocal cords
3. Soft, loosely edematous tumor to a firm, fibrous growth or a vascular lesion with many small vessels
4. Respond to vocal restraint and re education

Vocal nodules

69

1. Associated with prolonged vocal use, smoking and persistent inflammation
2. Surgical removal must be done on one side at a time to prevent the development of synechiae in the anterior commisure

Diffuse vocal cord polyposis

70

1. More likely to occur in male
2. Men forcefully bring the arytenoid cartilages together-->irritation forms a granuloma
3. Complaints of pain and notices only a slight vocal change
4. Heals slowly, over 2-3 months
5. Tx: speech therapy

Contact ulcer

71

1. Most common tumor of the larynx in children
2. Occurs in children between 18 months and 7 years of age, and involution often occurs at puberty
3.

Juvenile papilloma

72

Initial symptoms of juvenile papilloma

Hoarseness and abnormal cry

73

1. Croup is suspected, no response to treatment
2. Enlarged to cause airway obstruction and present as an emergency requiring tracheostomy
3. Can be hormone-dependent, regressing with pregnancy and puberty
4. Viral etiology

Juvenile papilloma

74

Treatment for juvenile papilloma

1. Surgical removal, using microscope with a CO2 laser
2. Tetracycline
3. Steroids
4. Smallpox vaccine
5. Autologous vaccine
6. Alpha N1 interferon

75

Repeated surgical excision of juvenile papilloma can lead to

Laryngeal scarring or webbing

76

1. Tend to occur in tongue and larynx
2. Main symptom is hoarseness
3. Mucosa over may show pseudoepithelial hyperplasia

Granular cell myoblastoma

77

1. Slow-growing tumors of hyaline cartilage arising from the cricoid, thyroid, arytenoid or epiglottic cartilages
2. Main symptoms are hoarseness and dyspnea
3. Tx: surgical

Chondroma

78

1. Persistent irritation of the larynx, particularly by smoking may lead to the development of whitish area or may appear reddened
2. Biopsy: hyperkeratosis, carcinoma in situ or frank carcinoma
3. Tx: total endoscopic removal

Leukoplakia or Erythroplakia

79

Five positions of the vocal cord

1. Median
2. Paramedian
3. Intermediate
4. Slight abduction
5. Full abduction

80

Positions are designated by observing the size of the glottic chink

Paralysis is bilateral

81

Observer must 1st estimate the true midline midline position and then relate the cordal position to that

Paralysis is unilateral

82

Any lesion along the course of the recurrent laryngeal nerve can cause...

Laryngeal paralysis

83

Vocal cord opening of median position

Both cords in midline

84

Vocal cord opening in median position

Both cords in midline

85

Vocal cord opening in paramedian position

3-5 mm

86

Vocal cord opening in intermediate postion

7 mm

87

Vocal cord opening in slight abduction position

14 mm

88

Vocal cord opening in full abduction position

18-19 mm

89

Paralysis of cricothyroid muscle; sensory loss in half of larynx

Superior laryngeal paralysis

90

Effect of superior laryngeal paralysis

Loss of pitch; aspiration

91

Anterior commissure looks tilted to side of lesion; arytenoid on that side tilts in

Superior laryngeal paralysis

92

Paralysis of all intrinsic muscles in that side

Unilateral recurrent nerve paralysis

93

Effect of unilateral recurrent nerve paralysis

Hoarse; good airway except in small children; breathy voice; poor cough

94

Cord in paramedian position; no lateral motion

Unilateral recurrent nerve paralysis

95

Paralysis of all intrinsic muscles

Bilateral recurrent nerve paralysis

96

Effect of bilateral recurrent nerve paralysis

Good voice; poor airway, especially on exertion

97

Vocal cords do not move laterally; some patients adapt and exists with decreased exercise tolerance

Bilateral recurrent nerve paralysis

98

Vagus nerve lesion above the superior laryngeal nerve; may be unilateral or bilateral

Complete paralysis

99

Effect of complete paralysis

Similar to corresponding lesions of recurrent paralysis; more likely to aspirate

100

Cords are immobile but in intermediate position due to loss of adduction by cricothyroid muscle

Complete paralysis

101

Strained, hoarse voice, often staccato-like, due to hyperadduction of the true and false cords

Spastic dysphonia

102

This tension larynx usually starts in young adults, who become very self-conscious and may change occupation to avoid speech

Spastic dysphonia

103

Best therapy for spastic dysphonia

Surgical section of the right recurrent laryngeal nerve

104

Patient may complain of a total inability to talk

Psychogenic aphonia

105

1. Phonation with the false cords vibrating instead of the true vocal cords produces a husky voice
2. Larynx appears normal, but the false cords seem to overhang or cover the true cords

Dysphonia plicae ventricularis

106

1. Complain of vocal weakness
2. Voice lacks its usual tone and vigor
3. The voice breaks or drops in pitch
4. Examination: vocal cords appear slightly bowed

Vocal weakness