Disorders of the Larynx and Upper Trachea

Question 1

Dysphonia

Answer 1

any change in voice, most cases resolve with out tx w/in a month

Question 2

Hoarseness

Answer 2

difficulty making sounds when trying to speak. Vocal sounds may be weak, breathy, scratchy, or husky, and the pitch or quality of the voice may change.

Question 3

Stridor

Answer 3

noisy breathing caused by airflow through a narrow airway (implies airway obstruction)

Question 4

Congenital Disorders

Answer 4

laryngomalacia
tracheomalacia
subglottic stenosis

Question 5

Infectious Disorders

Answer 5

epiglottitis
laryngotracheobronchitis (croup)
membranous tracheitis
TB
syphilis
fungal infections

Question 6

Neoplastic Disorders

Answer 6

laryngeal carcinoma

recurrent respiratory papillomatosis

Question 7

Traumatic Disorders

Answer 7

can occur with or with out open neck injury

signs and symptoms:
dyspnea/stridor
dysphonia/aphonia
cough/hemoptysis
neck pain dysphagia/odynophagia
tenderness of larynx
subcutaneous emphysema

Question 8

What is the “thumbprint sign”?

Answer 8

acute epiglotitis

Question 9

What is the “steeple sign”?

Answer 9

croup

Question 10

What are the typical signs and symptoms of glottis cancer?

Answer 10

hoarseness and voice change
respiratory difficulty
throat pain
otalgia (ear pain)
cough, hemoptysis
dysphagea
weight loss

Question 11

Laryngeal Neoplasm:

Answer 11

males more common

> 90% SCCA

Question 12

Tx of a laryngeal neoplasm:

Answer 12

radiation- good for smaller cancer (>85% cure rate), maybe be used in combo with surgery

Question 13

GERD

Answer 13

acid from the stomach in the larynx or esophagus

symptoms:
dysphagia
dysphonia
chronic throat clearing
excessive throat mucus
voice fatigue
globus

Question 14

Tx of GERD:

Answer 14

modify diet and lifestyle
H2 blockers
proton pump inhibitor
anti reflux inhibitor

Question 15

Voice Abuse:

Answer 15

contact ulcer of larynx or nodules

symptoms:
hoarseness
neck pain on exertion

Question 16

Tx of voice abuse:

Answer 16

ENT referral

• voice therapy
• voice rest
• microlaryngoscopy
• rarely excision of lesion

Question 17

What are the types of stridor?

Answer 17

inspiratory- supraglottic
expiratory- trachea or distal airway (wheezing as in asthma)
biphasic- glottic or subglottic

Question 18

How do we dx GERD?

Answer 18

clinically with flexible laryngoscopy

gold standard is 24 hr double pH probe monitor

Question 19

How do we diagnose laryngeal trauma?

Answer 19

neck CT- look for fracture of laryngeal cartilages

Question 20

How do we tx laryngeal trauma?

Answer 20

if airway is unstable plan for tracheostomy

if no fx: voice rest, humidified O2, steroids
if fracture: consult

Question 21

Laryngomalacia

Answer 21

stridor- usually insiratory, occuring several weeks after birth
MOST COMMON CONGENITAL ANOMALY CAUSING AIRWAY OBSTRUCTION

immature laryngeal cartilage
spontaneous resolution, tracheotomy if not/laser surgery

Question 22

Tracheomalacia

Answer 22

Immature tracheal rings
trachea collapses on exhalation

young children with multiple bouts of pneumonia

Question 23

Tx for tracheomalacia:

Answer 23

observation
CPAP
possible tracheostomy

Question 24

Subglottic Stenosis:

Answer 24

congenital or acquired
prolonged intubation

prevention with proper sized endotracheal tube, avoid prolonged intubation, tracheotomy

Question 25

Acute epiglottitis:

Answer 25

rapidly progressing acute laryngitis etiology: H influenza B (less common with vaccine) MEDICAL EMERGENCY- fatal with in hours

Question 26

Signs and symptoms of epiglottitis:

Answer 26

sore throat with rapid progression to dysphagia, refusal of feeds, "hot potato" voice prefer to be upright slightly leaning forward ("flower sniffing position") DO NOT USE TONGUE BLADE

Question 27

Tx of epiglottitis:

Answer 27

ENT consult blood culture if adult OR for oral intubation, direct laryngoscopy, possible tracheostomy (if unable to intubate) broad spectrum abx (IV) if : h. influenza, staph, strep

Question 28

Acute Laryngotracheobronchitis:

Answer 28

CROUP infection of lower respiratory passage way viral in etiology, most likely para influenza

Question 29

Symptoms of Croup:

Answer 29

barking cough, fever

Question 30

Tx of Croup:

Answer 30

hospitalize and observe steroids, racemic epinephrine consider broad spectrum abx when in doubt intubate

Question 31

Membranous tracheitis

Answer 31

Atypical croup staph aureus, strep pneumo symptoms similar to croup but with a higher fever

Question 32

Tx of membranous tracheitis:

Answer 32

broad spectrum abx | pts do not respond to epinephrine

Question 33

Risk Factors for Laryngeal Carcinoma:

Answer 33

smoking and alcohol (HUGE FACTORS) AA/whites > asian/latino HPV GERD

Question 34

YOU CAN ONLY RADIATE AND AREA ONCE!

Answer 34

KNOW THAT

Question 35

What is the most common benign neoplasm of the larynx?

Answer 35

recurrent respiratory papillomatosis (a/w hpv 6 & 11)

Question 36

Tx of recurrent respiratory papillpmatosis?

Answer 36

excision w/ cold instruments or laser, intralesional cidofovir, intralesional bevacizumab (avastin)