Flashcards in Pharyngeal, larygneal and neck disorders Deck (52)
lifespan of taste receptor cells? How do we interpret flavor?
most impt factor in flavor?
- 10 days
- flavor: combo of smell, taste, irritaion, texture and tempurature
- smell or aroma of food most impt factor in flavor!
What is hypogeusia?
- diminished taste to 1 or more tastants
- absent taste fxn
- persistent sweet, sour, salty, bitter, or metallic taste
What is allegeusia?
- unpleasant taste of food or drink that is usually pleasant
What is phantogeusia?
- unpleasant taste produced indigenously due to gustatory hallucination
Etiology of taste disorders?
- gastric reflux
- xerostomia: diseases, radiation, infections, drugs (anticholinergics), toxins
Eval of pt with taste disorder?
- mouth exam
- can do whole mouth taste testing or referral for spatial testing
- smell pts breath 5-10 cm from their mouth, rate on scale from 0-5, 5 being unbearably strong
- next check air from nasal passages and score
- eval tongue odor, use spoon to scrap off exudate
- labs: ANA (autoimmune)
Tx of dysgeusia?
- diffiuclt to tx
- tx underlying problem when possible
- clonazepam (klonopin)
tx of burning mouth?
- TCAs (make mouth dry)
What questions should you ask pt presenting with halitosis?
- good oral hygiene?
- mouth breather or snores?
- excess nasal d/c or nasal obstruction?
- underlying medical problems? diabetes, immunosuppressed
- halitophobics - constantly afraid of having bad breath even though they don't
Etiology of halitosis?
oral cavity: 85-90%
- breakdown of aas producing sulfur and other gases
- poor oral hygiene
- accumulation and putrefaction of post nasal drip on back of tongue
- other: dental abscesses, gingivitis, unclean dentures (take dentures out to do thorough mouth exam)
nasal passages: 5-8%, from nasal infections, polyps
- in children with fbs in the nose
tonsilloliths form from bacteria in tonsillar crypts and can be foul smelling
Tx of halitosis?
- specific dx tx appropriately
- may need referral to dentist
- oral source:
proper dental care and hygiene, cleaning of post. tongue, rinsing and deep gargling with mouthwash, brief gum chewing, sufficient water intake
59 YO Female pt presents with mouth being sore for 4-5 days especially when eating, it feels dry and she has pain at corners of mouth
- she is type II DM, HTN
- oral candidiasis
- susceptible to this because she is a diabetic
- tx: diflucan (one pill), or liquid nystatin
What are some oral infections (stomatitis)?
- recurrent aphthous stomatitis (RAS) - most common cause of mouth ulcers in north america
- always rule out cancer for persistent or unusual lesions, esp if smokers, drink excessively, just older
Tx of aphthous ulcers?
- sx relief:
triamcinolone acetonide in orabase gel
topical analgesics (OTC):
- chemical cautery with silver nitrate or sulfuric acid
- severe: intralesional or oral cortisone
VZV presentation in oral cavity?
- grouped vesicles or erosions unilaterally on hard palate, can include buccal mucosa, tongue and gingiva
- wouldn't be limited to one side of mouth like VZV, could be vesicles on both sides
HIV infection in mouth?
- painful mucocutaneous ulceration one of most distinctive manifestations of primary HIV-1
- shallow, sharply demarcated ulcers can be found on oral mucosa
- there are many opportunistic infection that also cause oral lesions
- loss of lingual papillae, can migrate over time over tongue
Complications of xerostomia?
etiolgies of xerostomia?
- dental caries - severe
- gum disease
- salivary gland calculi
autoimmune, radiation, med side effects
tx: artificial saliva (use 6x a day with meals)
Ddx of odynophagia?
- severe stomatitis
- candida involving the esophagus
- other causes of stomatitis usually seein in immunosuppressed pts
- tx underlying cause
Indications for indirect laryngoscopy?
- hoarseness for longer than 2 weeks
- voice change
- fb sensation
-uncoop pt, or one with strong gag reflex
- compromised airway (croup or epiglottitis)
What do you need for indirect laryngoscopy?
- fiber optic nasopharyngoscopy becoming procedure of choice!
gauze to wrap pts tongue
topical anesthetic can be used to prevent gagging
Pt comes in complaining about voice being scratchy and coughing, has hoarse voice. Has nonproductive cough especially at night for past couple of weeks. No hemoptysis or night sweats or odynophagia, non-smoker, does take occasional tums for heart burn after he eats, has 3-5 drinks/week
- nothing is remarkable on exam - you want to see down the throat - larynx - get?
- then you see polyp on right vocal cord, what was most likely cause of this polyp?
- pt education?
- indirect laryngoscopy
- most likely has GERD
- acid is refluxing over vocal cords - forming polyps
- educate pt: tell him not to eat large meals within 3 hrs of betime, elevate head of bed, don't add pillows, no ETOH before bed, no acidic foods, use PPI
What history ?s should you ask about if a pt presents with hoarseness?
- duration and onset
- triggering factors
- what makes it better and or worse?
- other head and neck sxs or past surgery involving neck
- hx of smoking or ETOH abuse
- hx of reflux or sinonasal disease
- h/o trauma or endotracheal intubation
- occupation, hobbies and habits impacting voice use
Etiologies of hoarseness?
- acute laryngitis (URI or voice misuse)
- chronic laryngitis
- benign vocal fold lesions
- malignancy involving larynx
- neuro dysfxn (ALS, MS)
- non-organic (fxnl) issues: aging
- systemic conditions and rare causes
Tx of acute laryngitis?
- less then 3 weeks duration
- self-limited condition
- secondary to URI or acute vocal strain
cause and Tx of chronic laryngitis?
- chronic irritants that over time result in injury
- toxins, GERD, chronic sinusitis, postnasal drip, chronic ETOH use, chronic vocal strain, tobacco smoke
- tx underlying etiology like GERD - PPI, lifestyle changes
What is muscle tension dysphonia?
- not neuro or psychological
- imbalance of tension in muscles involved in voice production
- seen in aging with atrophy of some of the supporting structures of the vocal cords