Larynx

Question 1

Conditions of the larynx

Answer 1

Inflammatory

1. Acute pharyngitis & laryngitis
2. Allergic pharyngolaryngeal edema - life threatening type I hypersensitivity reaction, assoc w facial edema & bronchospasm
3. Acute toxic laryngitis - death in fires, smoke inhalation
4. Chronic laryngitis - common in heavy smokers, chronic irritation of epithelium - squamous metaplasia - dysplasia - SCC

Benign Lesions

1. Singer’s nodules (vocal cord nodules)
2. Laryngeal papilloma/squamous papilloma

Carcinoma

Question 2

Clinical presentations of acute pharyngitis/laryngitis

Answer 2

• usually viral
• hoarseness
• if subglottic region/trachea affected - cough, tracheal soreness
• young children - airway is small & collapsible (cartilage not fully developed) - mucosal & submucosal edema - airway obstruction
• stridor - breathing sound due to obstruction of large airway, usually worse in inspiration
• children: cough + stridor = croup

Question 3

Features of singer’s nodules

Answer 3

• reactive nodular thickenings of the vocal cords
• in singeres, chronic smokers
• characteristically changes characer of the voice, often causes progressive hoarseness
• non-neoplastic

Question 4

Features of laryngeal papilloma/squamous papilloma

Answer 4

• benign tumour, may be single/multiple
• due to HPV infection
• usually solitary in adults
• children: juvenile laryngeal papillomatosis - multiple soft papillomas
• complications: obstruction, progression to SCC

Question 5

Features of carcinoma of the larynx

Answer 5

• smokers, >40y, 95% SCC
• can occur be supraglottic, glottic or subglottic - localisation impt for treatment/prognosis
• glottic tumours present early (hoarseness) - due to poor lymphatic supply - better prognosis
• may have polypoid/ulcerative growth patterns
• locally invasive, spreads first to regional lymph nodes

Question 6

Role of vaccination in URTI

Answer 6

1. C. diphtheriae infects upp airway mucosa, produces exotoxin causing necrosis of epithelium pseudomembrane may be aspirated causing airway obstruction
   - DtaP vaccine
2. Acute epiglottitis caused by H. influenzae infection - causing airway obstruction
   - Hib vaccine

Question 7

Complications of URTI

Answer 7

• in elderly, debilitated, unconscious
• poor cough reflex
• infected material may not be coughed up - pass into smaller airways & lung - pneumonia