Page 1015 - TNFlipTest

Toronto Notes 2019
Hoarseness
Otolaryngology OT29
Epidemiology
• 30-50yrofage • M>F
Clinical Features
• hoarseness,aphonia,coughattacks±dyspnea
• pedicledorsessilepolyponfreeedgeofvocalcord • typically,polypisasymmetrical,soft,andsmooth
• morecommonontheanterior1/3ofthevocalcord • intermittentrespiratorydistresswithlargepolyps
Treatment
• avoidirritants
• endoscopiclaryngealmicrosurgicalremovalifpersistentorifhighriskofmalignancy
Vocal Cord Nodules
Definition
• vocalcordcallus
• i.e.“screamer’s”or“singer’s”nodules
Etiology
• earlynodulesoccur2°tosubmucosalhemorrhage
• maturenodulesresultfromhyalinization,whichoccurswithlong-termvoiceabuse • chronicvoicestrain
• frequentURTI,smoking,EtOHconsumption
Epidemiology
• frequentlyinsingers,children,bartenders,andschoolteachers • F>M
Clinical Features
• hoarsenessworstatendofday • onlaryngoscopy
■ oftenbilateral
■ atthejunctionoftheanterior1/3andposterior2/3ofthevocalcords–pointofmaximalcordvibration • chronicnodulesmaybecomefibrotic,hard,andwhite
Treatment
• voicerest
• hydration
• speechtherapy
• avoidirritants
• surgeryrarelyindicatedforrefractorynodules
Benign Laryngeal Papillomas
Etiology
• HPVtypes6,11
• possiblehormonalinfluence,possiblyacquiredduringdelivery
Epidemiology
• biphasicdistribution:1)birthtopuberty(mostcommonlaryngealtumour)and2)adulthood
Clinical Features
• hoarsenessandairwayobstruction
• canseedintotracheobronchialtree
• highlyresistanttocompleteremoval
• somejuvenilepapillomasresolvespontaneouslyatpuberty
• mayundergomalignanttransformation
• laryngoscopyshowswart-likelesionsinsupraglotticlarynxandtrachea
Treatment
• microdebridement or CO2 laser
• adjuvantsunderinvestigation:interferon,cidofovir,acyclovir
• HPVvaccinemayprevent/decreasetheincidence,butmoreresearchisneeded
Laryngeal Carcinoma
Vocal Cords: Polyps vs. Nodules
Polyps
Unilateral, asymmetric
Acute onset
May resolve spontaneously
Subepithelial capillary breakage
Soft, smooth, fusiform, pedunculated mass
Proton pump inhibitor
Surgicalexcision if persistent or in the presence of risk factors for laryngeal cancer
Nodule
Bilateral
Gradual onset
Often follow a chronic course
Acute: submucosal hemorrhage or edema Chronic: hyalinization within submucosal lesion
Acute: small, discrete nodules
Chronic: hard, white, thickened fibrosed nodules
Voice rest but no whispering, hydration, speech therapy if refractory to therapy
Surgicalexcisionaslast resort
• seeNeoplasmsoftheHeadandNeck,OT34