Thomas Allen Flashcards
What are the pathological causes of a hoarse voice?
o Vocal cord nodules- benign lesions on vocal cords- usually bilateral
o Muscle tension dysphonia
o Vocal cord polyps- usually unilateral
o Laryngeal papillomas- benign- usually caused by HPV
o Reflux laryngitis- reflux causing inflammation
o Reinke’s oedema- usually caused by smoking, common in women
o Laryngitis
o Acute epiglottitis
o Recurrent laryngeal nerve palsy
o Inhaled steroids
o ACEi
How is smoking related to hoarse voice?
Causes swelling and inflammation of the vocal cords
What are the different types of throat cancer that can lead to a hoarse voice?
o Squamous cell carcinoma
o Adenocarcinoma- starts at glandular cells of throat
o Sarcoma- develops in muscle fibers of neck
o Pharyngeal carcinoma
5 causes of stridor in adults
o Airway obstruction o Airway trauma o Being intubated o Vocal cord paralysis o Bronchitis o Tracheal stenosis o Tumours o Blunt trauma to neck o Infection- H. influenza bacterium
Emergency intervention for airway obstruction
o Stabilize patient o High flow o2 o Page anesthetist and ENT- tracheostomy o Try and remove blockage if can o Steroids/ adrenaline inhaled o Bloods- ABG, infection cultures
difference between stridor and stertor
o Stridor- high pitched, caused by narrowing of upper airway
o Stertor- sounds like a snore, result of stenosis of the nasopharynx and supraglottic region-only on inspiration
What investigations are needed to find out where a blockage in the airways is located?
o X-ray o Bronchoscopy o Laryngoscopy o CT o Nasendoscopy fibre optic or normal o Panendoscopy
How do you calculate pack years?
no. years smoked x avg packs smoked per day
20cig=1pack
what is tracheal tug
the downward pull of the thyroid cartilage towards sternum- usually seen in AAA, extra force needed to breathe, so trachea is pulled down
What is intercostal recession?
the inward pull of the intercostal muscles. Partial blockage, air can’t move freely change in pressure
Treatment for the different TNM staging
T1/2- radiotherapy (4-6 weeks)
T3/4- combined chemo and radiotherapy
T4- total excision
3 main ways of cancer spread
- Tissue- invasion of nearby tissues
- Lymph system- travels through the lymphatic system to other areas of the body first lymph nodes likely to be affected are the jugular chain then to the subclavicular nodes
- Blood- supraglottic via superior laryngeal a. and infraglottic via inferior thyroid artery
Risk factors for laryngeal cancer
- Age- usually older people are more susceptible
- Smoking
- Alcohol
- Diet- low fruit and veg is an indicator for laryngeal cancer
- HPV type 16 infection
- Family history
- Immunosuppression
- Exposure to some substances- wood, coal or soot dust, paint fumes, formaldehyde, nickel, diesel fumes, asbestos.
- GORD
- Hx of head and neck cancer
- Men
causes of vocal cord palsy
- Iatrogenic
- Neck or chest injury
- Stroke
- Tumour
- Infection- Lyme disease, EBV, herpes
- Neurological conditions e.g. Parkinson’s or MS.
- Blunt trauma
3 methods to allow speech after laryngectomy
voice prosthesis- trache valve
electrolarynx
oesophageal and tracheoesophageal speech
