Laryngeal Disorders

Question 1

A primary symptom of laryngeal disease

Answer 1

Hoarseness and Stridor

Question 2

Any person with hoarseness for what duration must be evaluated by
indirect laryngoscopy?

Answer 2

> 2 weeks

Question 3

The abnormal air flow past cords results in what?

Answer 3

hoarseness

Question 4

In inspiratory stridor, where is the lesion in relation to the vocal cords?

Answer 4

lesions above cords

Question 5

In expiratory stridor, where is the lesion in relation to the vocal cords?

Answer 5

lesions below cords

Question 6

Anyone with what presenting symptom should have immediate evaluation of the airway and may require emergent tracheostomy?

Answer 6

stridor

Question 7

Tracheotomy Indications

Answer 7

Airway obstruction at or above larynx

Respiratory failure requiring prolonged ventilation

Question 8

Cricothyrotomy Indications

Answer 8

Emergent airway but not long standing

Fewer initial complications

Question 9

“seal bark”

Worse at night

Acute inflammatory disease of the larynx

Answer 9

Croup

Question 10

What is the most common cause of Croup?

Answer 10

viral

Question 11

What is the most common group of viruses responsible for croup?

Answer 11

parainfluenza virus serotypes

Question 12

Why are breathing treatments ineffective in croup?

Answer 12

Acute inflammatory disease of the larynx

Question 13

What clinical presentation is described below?

Prodrome of URI symptoms followed by barking cough and stridor

May have labored breathing signs

+/- fever

Stridor (harsh, crowing noise made during inspiration)

Answer 13

Croup

Question 14

If you suspect croup, what else needs to be ruled out first?

Answer 14

Make sure to consider FBO or epiglottitis in differential

Question 15

Even though routine imaging is not done in croup, what finding would you expect to see on Xray?

Answer 15

Soft tissue neck radiograph shows “steeple sign” (Supraglottic narrowing secondary to edema and a normal epiglottis)

Question 16

If croup is severe, what are some medications to consider?

Answer 16

Glucocorticosteroids (dexamethasone) or Nebulized racemic epinephrine if severe

Question 17

What are some complications of croup?

Answer 17

Respiratory distress
Respiratory arrest
epiglottitis
Bacterial tracheitis
Atelectasis
dehydration

Question 18

Infection of supraglottis

Severe, life threatening (medical emergency)

Viral or bacterial (almost always bacterial)

Answer 18

Epiglottitis/Supraglottitis

Question 19

What is the most common organism responsible for epiglottitis/supraglottitis?

Answer 19

Haemophilis influenzae B

Question 20

What clinical presentation of this disease is described below?

Presents as a rapidly developing sore throat and sudden onset high fever

Odynophagia out of proportion to findings

Drooling can be a sign of impending airway compromise

Muffled voice (hot potato)

Severe dysphagia – why you’ll see drooling

Sitting upright with neck extended 🡪 tripoding

Answer 20

Epiglottitis/Supraglottitis

Question 21

What are the two most important things to remember on a physical exam of a patient with epiglottitis/supraglottitis?

Answer 21

Remember, their throat will be NORMAL looking – cannot see the epiglottis from inspecting the mouth (DO NOT assume malingering!)

Rule – nothing goes in the mouth (Don’t want to irritate the glottis and make it swell anymore)

Question 22

Why is epiglottitis/supraglottitis rare nowadays?

Answer 22

Less common now due to vaccinations (specifically Hib vaccination)

Question 23

Lateral neck soft tissue xray finding in epiglottitis/supraglottitis

Answer 23

“Thumb sign”

Question 24

If you see a “Thumb sign” on xray, what should you suspect?

Answer 24

epiglottitis/supraglottitis

Question 25

If you see a “steeple sign” on xray, what should you suspect?

Answer 25

croup

Question 26

What diagnostic method can you use in adults with epiglottitis/supraglottitis that you cannot use in children?

Answer 26

Indirect laryngoscopy in adults (safe)

Question 27

Warty-like lesions Junction of ciliated and squamous epithelia More common in children Can cause airway obstruction if get too large

Answer 27

Laryngeal Papillomas

Question 28

Most common cause of hoarseness Loss of voice associated with URI/cough May persist for a week after URI symptoms cleared

Answer 28

Acute Laryngitis

Question 29

What is the etiology of acute laryngitis?

Answer 29

Viral – 90% Bacterial – 10%

Question 30

In bacterial causes of acute laryngitis, what are the most common organisms responsible?

Answer 30

M. catarrhalis H. influenzae

Question 31

What is the main treatment for acute laryngitis and why?

Answer 31

Complete – no whispering! Persistent use can lead to formation of traumatic vocal cord hemorrhage, polyps, and cysts

Question 32

List some red flags in a patient with hoarseness

Answer 32

Hoarseness that lasts for more than two weeks and that is not associated with URI symptoms Hoarseness with a history of tobacco or alcohol use Hoarseness with concomitant discovery of a neck mass Hoarseness with unexplained weight loss Hoarseness associated with hemoptysis, dysphagia, odynophagia, otalgia, or airway compromise, etc

Question 33

Reflux into the larynx Causes chronic inflammation and hoarseness

Answer 33

Laryngopharyngeal Reflux

Question 34

What are some symptoms you'd expect to see in laryngopharyngeal reflux?

Answer 34

Globus sensation (fullness in throat) PND sensation Esophageal spasm Can also be associated with: GERD, Asthma, Throat clearing, Chronic cough, Heartburn and regurgitation

Question 35

Seen in overachievers, anxiety See in elite athletes Can be confused with exercise induced asthma Use albuterol inhaler – if it doesn’t help, then consider this in your DDX

Answer 35

Vocal Cord Dysfunction

Question 36

Common cause of hoarseness Secondary to vocal cord abuse Smooth paired lesions

Answer 36

Vocal Cord Nodules

Question 37

Leukoplakia of the vocal cords Most commonly arises in smokers presents with hoarseness Direct laryngoscopy is a must to rule out cancer

Answer 37

Laryngeal Leukoplakia

Question 38

Laryngeal Leukoplakia can further develop into what?

Answer 38

SCC

Question 39

Laryngeal leukoplakia is commonly seen with what risk factor?

Answer 39

Smokers

Question 40

What is the most common cancer in the larynx?

Answer 40

SCC

Question 41

What are two risk factors associated with the development of SCC of the larynx?

Answer 41

EtOH use tobacco use

Question 42

In cases of vocal cord paralysis, what nerve is affected?

Answer 42

Vagus nerve (Recurrent laryngeal nerve)

Question 43

What is paramount in cases of vocal cord paralysis?

Answer 43

Cord lateralization and airway assurance

Question 44

List some unilateral causes of vocal cord paralysis

Answer 44

Thyroid surgeries Apical lung cancer Other neck surgeries

Question 45

List some bilatera causes of vocal cord paralysis

Answer 45

Esophageal cancer Thyroid surgery Ventricular shunt malfunction

Question 46

What type of foreign body is considered an emergency?

Answer 46

battery