Upper Airway and Voice Disorders

Question 1

Look at anatomy

upper airway
vocal cord
larynx
neck muscles and triangles

Answer 1

.

Question 2

What are examples of infective ulcers?

Answer 2

Herpes Simplex - ulcers a re painful usually accompanied by pyrexia/malaise
Herpes Zoster - can affect oral cavity in immunocompromised

Question 3

What type of cancer can present in the oral cavity?

Answer 3

SCC - any ulcer that fails to heal within 2 weeks should be biopsied

Question 4

What can white patches in the mouth be a sign of?

3 things

Answer 4

Candida - immunocompromised or asthmatics due to steroid deposition

Leukoplakia - associated with local irritation (dentures, smoking)
3% malignancy so biopsy

Lichen Planus - purple plaques with white lace like appearance

Question 5

What is torus palatines?

Answer 5

Benign osteoma of hard palette

excise only if problematic

Question 6

What is a mucus retention cyst ?

Answer 6

smooth pale round swelling

excise only if symptomatic

Question 7

What is a ranula?

Answer 7

retention cysts on floor of the mouth, under the tongue

develops from submandibular or sublingual ducts

marsupialization (stitching open) cyst is effective tx

Question 8

How does squamous cell carcinoma present?

Answer 8

sore throat 
pain 
referred otalgia 
bleeding 
dysphagia
can spread to lymph nodes so palpate

Question 9

How is SCC treated?

Answer 9

Deep biopsy under GA diagnoses and assess biopsy spread

pan-endoscopy of whole upper aerodigestive tract to look for secondary tumours

radical removal and reconstruction of all tumours or radiotherapy +/- chemotherapy

Question 10

What is stridor and what does it indicate?

Answer 10

laryngeal stridor is high pitched and musical, produced on inspiration

laryngeal obstruction

Question 11

What is starter and what does it indicate?

Answer 11

snoring

naso-oropharynx obstruction

Question 12

What are congenital causes of upper airway obstruction?

Answer 12

laryngomalacia
vocal cord palsy
subglottic stenosis

Question 13

What are acquired causes of upper airway obstruction?

Answer 13

trauma 
foreign body 
angioedema 
epiglottis 
croup 
carcinoma 
external compression

Question 14

How would you assess the severity of an upper airway obstruction?

Answer 14

Present on exertion?
Present on deep inspiration?
Has to talk in short phrases?
Unable to talk?
Use of accessory muscles?
Cyanosed?
Resp arrest?

Question 15

How does tonsillitis present?

Answer 15

systemically unwell
sore throat
dysphagia
hallitosis

Question 16

What causes tonsillitis?

Answer 16

usually viral (AV, RSV, CMV) or bacterial (strep, pneumonia, h.influenza)

Question 17

What is seen on examining a tonsillitis pt?

Answer 17

lymphadenitis
enlarged tonsils
slough on tonsil surface

In glandular fever tonsils are covered in white exudate

Question 18

Treatment of tonsillitis?

Answer 18

hydration
analgesia
fluids

if severe penicillin or erythromycin

Question 19

When is a tonsillectomy considered?

Answer 19

if recurrent (>4-5/year) 
or in a child with multiple febrile convulsions

Question 20

What is the main complication of tonsillitis?

How does is present?

Answer 20

Peritonsilar abscess (quincy)

tonsil pushed medially
uvular displaced away from affected size

drooling and truisms (pain on opening mouth) is common

DRAIN

This is life threatening!!

Question 21

What are nodules and polyps of the vocal cords caused by?

Answer 21

Voice abuse

Question 22

How do nodules and polyps of the vocal cords present?

Answer 22

Husky voice

Worsens with use

Question 23

What do nodules and polyps of the vocal cords look like on examination?

Answer 23

Bilateral swellings in vocal fold

Question 24

How are nodules and polyps of the vocal cords managed?

Answer 24

Voice therapy
surgical excision
histology

Question 25

What is Rinke's Oedema caused by?

Answer 25

smoking increased voice usage reflux

Question 26

How does Rinke's Oedema present?

Answer 26

deep pitched gravely voice | can cause choking episodes

Question 27

What does Rinke's Oedema look like on examination?

Answer 27

Bilateral swellings on vocal cords

Question 28

How is Rinke's Oedema managed?

Answer 28

stop smoking reflux treatment voice therapy

Question 29

How do cysts on the vocal cords present?

Answer 29

husky loss of range increased effort unilateral nodule on vocal fold

Question 30

How are cysts on the vocal cords treated?

Answer 30

Voice therapy | Surgery

Question 31

What is laryngeal papillomatosis?

Answer 31

seen in juveniles | due to HPV infection in weakened immune system

Question 32

How is laryngeal papillomatosis treated?

Answer 32

laser removal of papillomata. although can spontaneously regress at any time in adults there is change of malignancy so histology is needed after removal

Question 33

How does laryngeal carcinoma present?

Answer 33

progressive hoarseness stridor otalgia dysphagia mass, cervical lymphadenopathy

Question 34

How is laryngeal carcinoma managed?

Answer 34

Radiotherapy Excision Mention MDT!! speech therapy, maxfax, physio, dietician etc

Question 35

Which device is essential to compensate for loss of filtration, warming and humidifaction in nasal breathing after laryngectomy?

Answer 35

Heat and Moisture Exchange device? HME

Question 36

How is speech achieved after laryngectomy?

Answer 36

oesophageal speech trachea-oesophageal fistula - with one way value artificial larynx - gives robotic speech

Question 37

What is acute laryngitis caused by?

Answer 37

can be infective or due to vocal cord abuse/irritants

Question 38

How does acute laryngitis present?

Answer 38

Hoarse voice or aphonia odynophagia - pain when swallowing if infective - malaise/pyrexia vocal cords appear red and oedematous

Question 39

What is the treatment of acute laryngitis?

Answer 39

voice rest analgesia steam inhalations don't whisper - talk at conversation voice

Question 40

What is epiglottitis?

Answer 40

acute life threatening condition | caused by Hib

Question 41

How does epiglottitis present?

Answer 41

dysphagia drooling voice change/chnage in childs cry toxic patient

Question 42

How should epiglottitis be treated?

Answer 42

allow patient to sit comfortable do not distress or examine IV Abx Intubate and ventilate until recovered

Question 43

Presentation of laryngitis?

Answer 43

``` Hoarse voice Aphonia Pain on talking Irritant paroxysmal cough URTI symptoms ``` erythematous vocal folds raised lesions in larynx leukoplakia

Question 44

Causes of laryngitis?

Answer 44

Commonly viral - HPV | Fungal - secondary to INH steroids

Question 45

Treatment of laryngitis?

Answer 45

``` self limiting analgesia fluids steam inhalation only abc if severe and persistent ```

Question 46

What is extra-oesophageal reflux?

Answer 46

``` hoarseness associated with: chronic throat clearing cough excessive mucus choking episodes globus sensation occasionally dysphagia ``` only 40% have heart burn

Question 47

What is seen on examination with extra oesophageal reflux

Answer 47

erythema and oedema in larynx

Question 48

What is the treatment for extra oesophageal reflux?

Answer 48

Lifestyle changes - increased water, decreased caffeine alginates - gaviscone on post food and PPIs bd

Question 49

What causes recurrent laryngeal nerve palsy?

Answer 49

1/3 idiopathic 1/3 malignancy 1/3 iatrogenic neurological

Question 50

How does recurrent laryngeal palsy present?

Answer 50

weak voice tires quickly laryngeal discomfort dysphagia immobilised vocal cord seen

Question 51

How is recurrent laryngeal palsy investigated and treated?

Answer 51

CXR - mediastinal mass CT neck - nerve lesion Treatment - voice therapy to encourage compensation - vocal cord medicalization - injection of polymer or thyroplasty

Question 52

What are the other causes of immobilised vocal cords?

Answer 52

Crico-arytenoid joint fixture - e.g. RA acid reflux Bronchial cancer

Question 53

What is the voice disorder, muscle tendon imbalance?

Answer 53

excessive tension on laryngeal muscles related to stress, neck and back problems, poor vocal hygiene and lifestyle

Question 54

How does muscle tendon imbalance present?

Answer 54

Huskiness abnormal pitch throat discomfort vocal cords are normal in appearance

Question 55

How is muscle tendon imbalance treated?

Answer 55

vocal hygiene lifestyle changes voice therapy

Question 56

What are the congenital causes of stridor?

Answer 56

laryngomalacia vocal cord palsy subglottic stenosis

Question 57

What are the acute causes of stridor?

Answer 57

``` Trauma Foreign body Angioneurotic oedema - allergic reaction Epiglottis Croup Vocal cord palsy ```

Question 58

What are the chronic causes of stridor?

Answer 58

``` vocal cord palsy carcinoma subglottic stenosis papillomata polyp/cyst external compression - thyroid mass ```

Question 59

When should a tonsillectomy be considered ?

Answer 59

sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections) the person has five or more episodes of sore throat per year symptoms have been occurring for at least a year the episodes of sore throat are disabling and prevent normal functioning