Page 1014 - TNFlipTest

OT28 Otolaryngology
If hoarseness present for >2 wk in a smoker, laryngoscopy must be done to rule out malignancy
Vocal Cord Paralysis
Unilateral: Affected cord lies in the paramedian position, inadequate glottic closure during phonationweak, breathy voice. Usually medializes with time, whereby phonation and aspiration improve. Treatment options include voice therapy, injection laryngoplasty (Radiesse), medialization using silastic block
Bilateral: Cords rest in midline, therefore voice remains good but respiratory function is compromised and may present as stridor. If no respiratory issues, may monitor closely and wait for improvement. If respiratory issues, intubate and will likely require vocal cord lateralization, arytenoidectomy, posterior
costal cartilage graft, or tracheotomy
Hoarseness Toronto Notes 2019 Hoarseness
Definitions
• hoarseness:changeinvoicequality,rangingfromvoiceharshnesstovoiceweakness;reflects abnormalities anywhere along the vocal tract from oral cavity to lungs
• dysphonia: a general alteration in voice quality • aphonia:nosoundemanatesfromvocalfolds
Acute Laryngitis
Definition
• <2wkinflammatorychangesinlaryngealmucosa
Etiology
• viral: influenza, adenovirus, HSV
• bacterial:GroupAStreptococcus
• mechanical:acutevoicestrain→submucosalhemorrhage→vocalcordedema→hoarseness • environmental:toxicfumeinhalation
Clinical Features
• URTIsymptoms,hoarseness,aphonia,coughattacks,±dyspnea
• truevocalcordserythematous/edematouswithvascularinjectionandnormalmobility
Treatment
• usuallyself-limited,resolveswithin~1wk • voicerest
• humidification
• hydration
• avoidirritants(e.g.smoking)
• treatwithantibioticsifthereisevidenceofcoexistentbacterialpharyngitis
Chronic Laryngitis
Definition
• >2wkinflammatorychangesinlaryngealmucosa
Etiology
• repeatedattacksofacutelaryngitis
• chronicirritants(dust,smoke,chemicalfumes)
• chronicvoicestrain
• chronicrhinosinusitiswithpostnasaldrip
• chronicEtOHuse
• esophagealdisorders:GERD,Zenker’sdiverticulum,hiatushernia • systemic:allergy,hypothyroidism,Addison’sdisease
Clinical Features
• chronicdysphonia:ruleoutmalignancy
• cough,globussensation,frequentthroatclearing2°toGERD
• laryngoscopy:cordserythematousandthickened,withulceration/granulomaformationandnormal
mobility
Treatment
• removeoffendingirritants
• treatrelateddisorders(e.g.antisecretorytherapyforGERD) • speechtherapywithvoicerest
• ±antibiotics±steroidstodecreaseinflammation
• laryngoscopytoruleoutmalignancy
Vocal Cord Polyps
Definition
• structuralmanifestationofvocalcordirritation
• acutely,polypforms2°tocapillarydamageinthesubepithelialspaceduringextremevoiceexertion
Etiology
• mostcommonbenigntumourofvocalcords • voicestrain(muscletensiondysphonia)
• laryngealirritants(GERD,allergies,tobacco)