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ENT > Laryngeal Disorders > Flashcards

Laryngeal Disorders Flashcards

1
Q

A primary symptom of laryngeal disease

A

Hoarseness and Stridor

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2
Q

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

A

> 2 weeks

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3
Q

The abnormal air flow past cords results in what?

A

hoarseness

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4
Q

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

A

lesions above cords

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5
Q

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

A

lesions below cords

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6
Q

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

A

stridor

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7
Q

Tracheotomy Indications

A

Airway obstruction at or above larynx

Respiratory failure requiring prolonged ventilation

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8
Q

Cricothyrotomy Indications

A

Emergent airway but not long standing

Fewer initial complications

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9
Q

“seal bark”

Worse at night

Acute inflammatory disease of the larynx

A

Croup

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10
Q

What is the most common cause of Croup?

A

viral

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11
Q

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

A

parainfluenza virus serotypes

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12
Q

Why are breathing treatments ineffective in croup?

A

Acute inflammatory disease of the larynx

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13
Q

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)

A

Croup

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14
Q

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

A

Make sure to consider FBO or epiglottitis in differential

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15
Q

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

A

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

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16
Q

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

A

Glucocorticosteroids (dexamethasone) or Nebulized racemic epinephrine if severe

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17
Q

What are some complications of croup?

A

Respiratory distress
Respiratory arrest
epiglottitis
Bacterial tracheitis
Atelectasis
dehydration

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18
Q

Infection of supraglottis

Severe, life threatening (medical emergency)

Viral or bacterial (almost always bacterial)

A

Epiglottitis/Supraglottitis

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19
Q

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

A

Haemophilis influenzae B

20
Q

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

A

Epiglottitis/Supraglottitis

21
Q

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

A

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)

22
Q

Why is epiglottitis/supraglottitis rare nowadays?

A

Less common now due to vaccinations (specifically Hib vaccination)

23
Q

Lateral neck soft tissue xray finding in epiglottitis/supraglottitis

A

“Thumb sign”

24
Q

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

A

epiglottitis/supraglottitis

25
Q

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

A

croup

26
Q

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

A

Indirect laryngoscopy in adults (safe)

27
Q

Warty-like lesions

Junction of ciliated and squamous epithelia

More common in children

Can cause airway obstruction if get too large

A

Laryngeal Papillomas

28
Q

Most common cause of hoarseness

Loss of voice associated with URI/cough

May persist for a week after URI symptoms cleared

A

Acute Laryngitis

29
Q

What is the etiology of acute laryngitis?

A

Viral – 90%

Bacterial – 10%

30
Q

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

A

M. catarrhalis

H. influenzae

31
Q

What is the main treatment for acute laryngitis and why?

A

Complete – no whispering!

Persistent use can lead to formation of traumatic vocal cord hemorrhage, polyps, and cysts

32
Q

List some red flags in a patient with hoarseness

A

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

33
Q

Reflux into the larynx

Causes chronic inflammation and hoarseness

A

Laryngopharyngeal Reflux

34
Q

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

A

Globus sensation (fullness in throat)
PND sensation
Esophageal spasm

Can also be associated with: GERD, Asthma, Throat clearing, Chronic cough, Heartburn and regurgitation

35
Q

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

A

Vocal Cord Dysfunction

36
Q

Common cause of hoarseness

Secondary to vocal cord abuse

Smooth paired lesions

A

Vocal Cord Nodules

37
Q

Leukoplakia of the vocal cords

Most commonly arises in smokers

presents with hoarseness

Direct laryngoscopy is a must to rule out cancer

A

Laryngeal Leukoplakia

38
Q

Laryngeal Leukoplakia can further develop into what?

A

SCC

39
Q

Laryngeal leukoplakia is commonly seen with what risk factor?

A

Smokers

40
Q

What is the most common cancer in the larynx?

A

SCC

41
Q

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

A

EtOH use
tobacco use

42
Q

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

A

Vagus nerve (Recurrent laryngeal nerve)

43
Q

What is paramount in cases of vocal cord paralysis?

A

Cord lateralization and airway assurance

44
Q

List some unilateral causes of vocal cord paralysis

A

Thyroid surgeries
Apical lung cancer
Other neck surgeries

45
Q

List some bilatera causes of vocal cord paralysis

A

Esophageal cancer
Thyroid surgery
Ventricular shunt malfunction

46
Q

What type of foreign body is considered an emergency?

A

battery

ENT (13 decks)

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