Larynx issues

Question 1

Functions of the larynx

Answer 1

Phonation
Positive thoracic pressure: inc. auto-positive end expiratory pressure
Respiration
Prevention of aspiration

Question 2

Laryngitis

Answer 2

Usually viral and self-limiting
Secondary bacterial infection may develop
Symptoms: pain hoarseness and fever
Redness and swelling of the vocal cords
Treat with Penicillin V if necessary

Question 3

Laryngeal Papilloma

Answer 3

Pedunculated vocal cord swellings caused by HPV
Present with hoarseness
Usually occur in children
Treat with laser removal

Question 4

Recurrent Laryngeal nerve palsy

Answer 4

Supplies all intrinsic muscles of the larynx except for cricothyroideus. Responsible for ab/adduction of vocal folds
Symptoms:
-Hoarseness
-“Breathy” voice with bovine cough
-Repeated coughing from aspiration (↓ supraglottic
sensation)
-Exertional dyspnoea (narrow glottis)

Question 5

Causes of recurrent laryngeal nerve palsy

Answer 5

-30% are cancers: larynx, thyroid, oesophagus,
hypopharynx, bronchus
-25% iatrogenic: para- / thyroidectomy, carotid
endarterectomy
-Other: aortic aneurysm, bulbar / pseudobulbar palsy

Question 6

Laryngeal squamous cell carcinoma

Answer 6

Incidence: 2000/yr in uk
Associations: smoking, EtOH
Presentation
  Male smoker
  Progressive hoarseness → stridor
  Dys/odono-phagia
  Weight loss

Question 7

Investigations for laryngeal SCC

Answer 7

Laryngoscopy + biopsy (inc. nodes)

MRI staging

Question 8

Management of laryngeal SCC

Answer 8

Radiotherapy

Laryngectomy

Question 9

Total laryngectomy

Answer 9

Permanent tracheostomy
  Speech valve
  Electrolarynx
  Oseophageal speech (swallowed air)
Regular follow up for recurrence