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Voice disorders Flashcards

(105 cards)

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1
Q

What are the main function of the larynx?

A

Acts as a sphincter to prevent things getting into the lungs.

Speech

Allows cough

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2
Q

What does the larynx connect to superiorly and inferiorly?

A

Superiorly it connects to the pharynx

Inferiorly the trachea

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3
Q

What does the larynx consist of?

A

Thyroid cartilage
Cricoid cartilage
The epiglottis
The arytenoid cartilages

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4
Q

What does the epiglottis attach to?

A

The thyroid cartilages

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5
Q

What are the arches called that food bolus falls down to enter the oseophagus?

A

pyriform fossa

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6
Q

What are the glottis?

A

It is another name for the vocal cords

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7
Q

What is the most common malignant tumour of the larynx?

A

a squamous cell carcinoma

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8
Q

What risk factor has the highest association for tumour of the larynx?

(which is the second)

A

as the most common malignant tumour is a squamous cell carcinoma, the commonest risk factor is unsurprisingly:

Smoking

(also heavy alcohol intake)

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9
Q

What is the primary symptoms of carcinoma of the vocal cords?

A

Hoarseness

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10
Q

What is the prognosis of carcinoma of the vocal cords and why?

A

95% 5-year survival

As a small lesion will cause symptoms early AND

the area has poor lymphatic drainage

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11
Q

How long should hoarseness persist for before you should suspect cancer?

A

6 weeks

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12
Q

How is the larynx split into the supraglottis and subglottis?

A

It is divided by the vocal cords

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13
Q

What is the prognosis of cancers in the supraglottis and subglottis?

A

not as good as for vocal cord tumours as they have less specific symptoms

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14
Q

What are the symptoms of cancers in the supraglottis and subglottis?

A

Throat irritation
Cough
Referred otalgia
Lump (Lymph node in the neck)

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15
Q

What are the signs of cancers of the larynx?

A

leukoplakia
narrowing of airway
Fixation of vocal cords

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16
Q

What are the treatment options for laryngeal malignancies?

A

endoscopic removal

radiotherapy

radical surgical excision (if radical enough tracheostomy will be required)

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17
Q

From what nerve does the recurrant laryngeal nerve come from?

A

The vagus nerve

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18
Q

What structures do the left and right recurrant laryngeal nerves loop under?

A

Left - runs under arch of aorta

Right - under the right subclavian artery

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19
Q

Explain the rule of thumb for vocal cord palsies.

A

1/3 due to surgery
1/3 idiopathic
1/3 neoplastic

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20
Q

To what degree to vocal cord palsies affect the left and right sides?

A

75% Left

15% Right

10% Bilaterally

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21
Q

What is the most common malignant cause of vocal cord palsies?

A

Cancer of the bronchus

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22
Q

What are the symptoms of a recurrant laryngeal nerve palsy?

A

Horseness which tires with talking

choking with fluids

diplophonia (the voice simultaneously produces two sounds of different pitch)

weak bovine cough

High pitched voice

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23
Q

What is the Ix strategy for vocal cord palsies?

A

Assume malignant until proven otherwise

X-ray is mandatory

CT if nothing seen on x-ray

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24
Q

Other than surgical trauma and neoplasia what can cause vocal cord palsy?

A

crico-arytenoid joint may become fixed due to

severe RA or

reflux

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25
What is muscle tension dysphonia?
Normal hoarse voice
26
What are the causes of muscle tension dysphonia?
1ry causes: stress, axiety, vocal abuse, etc, etc 2ry causes: e.g. excessive tension required to overcome a deficiency in the voice producing mechanism caused by e.g. cord structural defect
27
How does muscle tension dysphonia present?
variable hoarseness can range from normal to no voice BUT worsens with use dryness/uncomfortable sensation in the throat
28
What is the treatment for muscle tension dysphonia?
remove causative factor general lifestyle advice
29
What are the types of vocal cord benign lesion?
``` papillomata nodules polyps cysts Reinke’s oedema ```
30
What are the most common benign vocal cord lesion?
Papillomata of the larynx
31
In whom are papillomata of the larynx most commonly seen?
Children, but can manifest in adults
32
What causes papillomata of the larynx?
HPV
33
How severe is papillomata of the larynx?
It varies from very minor to affecting the whole respiratory tree.
34
What is the most common site of papillomata of the larynx? (and hence how does it present)
The vocal cords (presents with hoarse voice)
35
In severe cases how will papillomata of the larynx present?
with stidor
36
How is papillomata of the larynx treated?
laser. several session over several years if often require due to the rapidly recurring nature Immune regulation with steroids or interferon can also be used In adults histology to check for squamous cell carcinoma transformation
37
What are vocal cord nodules caused by (and hence what are other names used for it?)
Result from vocal abuse (singers or screamer’s nodules)
38
What symptoms do vocal cord nodules cause?
Hoarseness and | gruffness of the voice
39
What is the treatment for vocal cord nodules?
Nothing unless pt is not happy with voice Speech therapy (fairly successful) Surgical excision
40
What is the appearance of vocal cord nodules?
Small White Thickenings of the vocal cords BILATERALLY
41
How do vocal cord nodules form?
Small haemorrhage due to trauma (so are soft) Eventually fibrose (are firm)
42
What is Reinke’s oedema?
Inflammation of the vocal cords leads to odema along the whole length of Reinke's space
43
What causes vocal cord polyps and cysts?
When inflammation of the vocal cords along Reinke's space (this is Reinke’s oedema) is localised to one area rather than the whole cord as in Reinke’s oedema. The resulting oedema in Reinke’s space causes a polyp or cyst
44
What specifically causes a vocal cord cyst?
When the localised oedema under the covering of the cord remains contained within it
45
What specifically causes a vocal cord polyp?
results from oedema which is superficial within the cords prolapsing into the airway.
46
What is the Ix for vocal cord cysts and polyps?
Removal for histology
47
What is the main presenting compaint for vocal cord polyps and cysts?
Hoarse voice
48
What are the main causes of vocal cord polyps?
Shouting when you have a cold extraoesophageal reflux
49
Who typically get vocal cord polyps?
Men 40y/o
50
What are the main symptoms of vocal cord polyps?
Hoarse voice Voice cutting out when speaking
51
What does a vocal cord polyp look like?
unilateral grey or haemorrhagic swelling arising in the middle of the cord
52
What is the treatment for vocal cord polyps?
Medical: i.e. treatment for extraoesophageal reflux or steroids Surgical removal Voice therapy
53
What are the causes of Reinke’s oedema?
Smoking Overtalking Reflux
54
What are the symptoms of Reinke’s oedema?
Deep gravelly voice If severe: choking
55
What does Reinke’s oedema look like?
bilateral grey or erythematous swelling along the whole length
56
What is the treatment for Reinke’s oedema?
Stop smoking Surgical reduction Medical treatment for: reflux and voice therapy
57
Which gender does Reinke’s oedema occur more in?
M=F
58
Which gender do vocal cord cysts occur more in?
M=F
59
What are the causes of vocal cord cysts?
It is not known
60
What are the symptoms of vocal cord cysts?
Hoarse voice Pitch breaks Loss of range of voice Increased effort to speak
61
What is the treatment for vocal cord cysts?
stop smoking surgical reduction medical treatment for reflux and voice therapy
62
What are the causes of reduced/absent vocal cord mobility?
laryngitis cancers (benign or malignant) of the cord/joint or a tumour of the nerve damage from intubation laryngeal reflux functional dysphonia
63
What will be the result if the vocal cords cannot close fully?
The voice will be affected The airway will not
64
What will be the result if the vocal cords cannot open fully?
The voice will NOT be affected The airway will be affected
65
What is functional dysphonia?
Poor voice quality without any obvious anatomical, neurological or other organic difficulties affecting the larynx (aka voice box)
66
What are some potential causes of functional dysphonia?
bereavement Psychiatric causes
67
Give some examples of treatment for functional dysphonia?
Reassurance it will resolve Speech therapy can reduce tension Psych referal
68
What are the symptoms of functional dysphonia?
Hoarse voice which is weak and tires easily
69
What are potential causes of acute laryngitis?
As part of a general infective process (post-URTI, HPV, candida -> poor inhaler technique) In isolation it can be due to: vocal abuse irritants such as cigarette smoke
70
What are the symptoms of acute laryngitis?
Hoarse voice (can lead to complete aphonia) pain on speaking + swollowing
71
How do the vocal cords appear in acute laryngitis?
Erythematous Odematous Including the whole larynx
72
How is the vocal cord movement affected in acute laryngitis?
It is restricted symmetrically not completely paralysed
73
How is acute laryngitis treated?
Mainly supportive: Steam inhalation Voice rest Can also use: cough suppressants
74
What is the risk if you abuse your voice during acute laryngitis?
lead to hemorrhage within the larynx leading to fibrosis and thus permanent vocal disorders
75
How dangerous is epiglottis?
Can be life threatening
76
When should you always consider epiglottitis?
In children (as it is more common) with pyrexia and sore throat
77
How may epiglottitis unfold in a child?
Signs of an URTI leading to complete airway obstruction
78
What should you avoid doing in a patient with epiglottitis?
Lying them down as this may collapse the airway Doing intra-oral investigations without intubation or emergency tracheostomy
79
What is the common responsible agent of epiglottitis?
H.influenzae
80
What is the treatment for epiglottitis?
IV antibiotics (as the usual causative factor is H.influenzae)
81
What is usually the cause of croup?
Viral infection
82
What is croup also known as?
laryngotracheobronchitis
83
How does croup compare to epiglottitis?
It can also be fatal Croup has a slightly longer course
84
How does croup present?
low grade URTI then pyrexia and stidor There will be generalised deterioration of the child
85
What is the treatment for croup?
IV antibiotics nebulised adrenaline Ventilation if severe
86
What is the cause of chronic laryngitis?
Multifactorial cause but most important one is: smoking
87
What will be the classic Hx of chronic laryngitis?
a nasty URTI and since this they have been hoarse
88
Why does the inflammation in chronic laryngitis remain?
Due to multiple factors such as: vocal abuse sinusitis leading to post nasal drip acid reflux
89
What are the symptoms of chronic laryngitis?
hoarse voice
90
What will examination of the vocal cords in chronic laryngitis show?
erythematous cords which may be thickened and oedematous
91
What are the risks associated with chronic laryngitis?
The chronic inflammation can lead to: dysplasia and carcinoma in situ
92
What is the Mx of chronic laryngitis? (mention when surgery is indicated)
intensive speech therapy removal of causitive factors (surgery is no longer used except for diagnostic purposes)
93
What is dysphonia?
any impairment in the voice or difficulty speaking
94
What is dysarthria?
Imperfect articulation of speech due to disturbances of muscular control or incoordination
95
What is dysphasia? (which specific situations is this term used)
Impairment in the: production and comprehension of speech (particularly when related to a brain injury)
96
What is sensory dysphasia?
Impairment in the COMPREHENSION of speech
97
What is expressive dysphasia?
Impairment in the PRODUCTION of speech
98
How can listening to the voice help you determine the origin of a voice problem?
If rough then a problem with the way the cords are vibrating if breathy then implies vocal cord palsy (i.e. they cannot be completely brought together)
99
Name the potential causes of voice disorders?
Think C then LMNOP CARCINOMA cysts cord palsy ``` Laryngitis Muscle tension dysphonia Nodules Oedema (Reinke's) Polyps Papillomatosis ```
100
How long do surgeons generally wait before operating on vocal cord issues?
6 months as function may return
101
What is the common infective agent in tonsillitis?
Viral
102
What are the symptoms of tonsillitis?
Malaise, pyrexia sore throat white/yellow slough on tonsils
103
What is the treatment for tonsillitis?
Hydration and analgesia Surgery if >4 cases per annum
104
How do the size of adenoids change as you get older?
They regress with age
105
Why would an adenoidectomy be performed?
Sleep apnoea/snoring Recurrant glue ear (as the adenoids are a bacterial resevoir)

Otorhinolaryngology (7 decks)

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