Laryngeal Disorders

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Laryngeal Disorders

  1. 1. Laryngeal disorders DR MAHIPAL REDDY
  2. 2. Laryngeal disorders BY/DR K SUBHASH.,DR SRIDHAR,DR SREEKANTH AND ALL ENT SURGEONS OF IMA
  3. 4. Pretest T or F 1. Reurrent laryngeal nerve pure motor fiber larynx 3. Acute laryngitis 4. epiglottitis laryngospasm 5. Thumb’s sign croup 6. Vocal nodule unilateral mass 7. Vocal granuloma intubation 8. Laryngeal trauma intubation 9. Most common symptom ของ true vocal carcinoma neck node enlargement 10. acid reflux
  4. 5. Laryngeal disorders ผศ . นพ . ยงยุทธ วศินวงศ์ ภาควิชาจักษุ โสต นาสิกลาริงซ์วิทยา คณะแพทยศาสตร์ มหาวิทยาลัยศรีนครินทรวิโรฒ
  5. 6. Laryngeal disorders <ul><li>Objectives </li></ul><ul><li>Anatomy </li></ul><ul><li>Physiology </li></ul><ul><li>Common disorders </li></ul><ul><li>Treatment </li></ul>
  6. 7. 1. Anatomy Framework Muscles – intrinsic - extrinsic Innervation Vessels
  7. 8. Framework
  8. 11. Muscles Intrinsic – adductors ; thyroarytenoid (true vocal cord:TVC), cricoarytenoid, interarytenoid - abductor ; post cricoarytenoid Extrinsic - cricothyroid
  9. 14. Innervation Inferior RLN motor - all muscles except.. sensory- below TVC Superior RLN motor – cricothyroid muscle sensory – above TVC
  10. 15. Blood supply Arterial sup. laryngeal artery inf. Laryngeal artery Venous sup. & inf. Thyroid veins
  11. 16. Physiology <ul><li>Airway protection </li></ul><ul><li>Swallowing </li></ul><ul><li>Voice production </li></ul><ul><li>Air passage </li></ul>
  12. 17. Protection inspiration phonation
  13. 18. 1. Inflammation - Acute & chronic laryngitis , c roup, epiglottitis, ulcer, 2. Tumor - benign, nodule, polyp, granuloma - malignancy 3. Trauma - penetrating injury - blunt injury - iatrogenic 4. Congenital - cord paralysis, Laryngeal web, subglottic stenosis 5. Miscellaneous - laryngopharyngeal reflux (LPR) disease Laryngeal disorders
  14. 19. Common laryngeal disorders 1. Acute laryngitis 2. Croup 3. Epiglottitis 4. Vocal nodule 5. Vocal polyp 6. Vocal granuloma 7. Laryngeal carcinoma 8. Laryngeal trauma 9. Laryngopharyngeal reflux (LPR)
  15. 20. Acute laryngitis Pathogen - adenovirus, influenza Morexella catarrharis Hemophilus influenza Streptococcus pneumoniae Symptoms - hoarseness cough, +/- fever, malaise Sign - TVC swelling
  16. 22. Acute laryngitis Treatment - voice rest - mucolytic, anticold +/- antibiotic Symptoms > 2 week, recurrent DDx - chronic laryngitis
  17. 23. Croup (acute laryngotracheobronchitis) - Severe respiratory infection - 6 months-2 yrs. Pathogen - parainfluenza*influenza, adenovirus - follow by bacterial esp. H. influenza Symptoms - early URI symptoms - 2-3 days - barking cough, stridor - exhausted, lying down
  18. 24. Croup (acute laryngotracheobronchitis) Diagnosis - symptoms & signs - flexible scope - x-ray norrowing of subglottis “ Pencil’s sign”
  19. 25. Pencil’s sign Normal
  20. 26. Croup (acute laryngotracheobronchitis) Treatment - early detection - observe, admit - humidification, hydration, O2 - antibiotic (penicillin) severe - steroid - intubation
  21. 27. Epiglottitis - infection of supraglottis >> epiglottis - 2-10 yr., adult Pathogen - H. influenza type B Symptoms - early URI symptoms - children > change very fast 6-12 hr. - high fever, pain in throat - นั่ง โน้มตัวมาข้างหน้า *
  22. 28. Epiglottitis Signs - epiglottis > swelling, inflam - ** laryngospasm เมื่อกดลิ้น - fiberoptic X-ray - “Thumb’s sign”
  23. 29. Epiglottitis Treatment - admit, closed monitoring - broad spectrum penicillin - hydration, humidification - +/- steriod - prepare for intubation
  24. 30. Vocal cord nodule - vocal abuse, over-used - children, adult - fibrous formation Symptoms - hoarseness Sign - nodule TVC > bilateral > anterior 1/3
  25. 31. Nodule Treatment - voice rest - speech therapy - failed, recurrent > surgery
  26. 32. Vocal polyp - vocal abuse - Reinke edema > capsule surrounding (polyp) Symptoms - hoarseness > 2 wk Sign - ant 1/3 TVC, unilateral Treatment - surgery - follow by speech therapy
  27. 33. Reinke’s edema Vocal polyp Both polyp, nodule
  28. 34. Vocal granuloma inflammation > ulcer > granuloma etiology - intubation - gastroesophageal reflux - partial laryngectomy Symptoms - hoarseness 2-3 wk after extubation
  29. 35. Vocal granuloma Sign - arytenoid, unilateral Treatment - surgery - follow by speech therapy - Rx acid reflux
  30. 36. Carcinoma Chronic irritation - smoking, alcohol, pollution, acid reflux Pathology - epithelial hyperplasia > dysplasia > carcinoma insitu > carcinoma
  31. 37. Carcinoma Symptoms > 2-3 weeks - glottis > hoarseness - supraglottis > dysphagia - subglottis > airway problems others - referred otalgia, chronic cough, hemoptysis, lymphadenopathy, wt. loss
  32. 38. Carcinoma Diagnosis - biopsy ; indirect or direct laryngoscopy - extension ; CT, MRI - metastasis ; CXR, LFT Treatment - depends on staging TNM - early > surgery or RT alone - stage 3, 4 > combined surgery, RT, ChemoRx
  33. 39. Laryngeal trauma Most common -Car accident Others - athlete, penetrating, gun-short wound S&S >> location, severity - stridor, bleeding, emphysema, hemoptysis, dysphagia, crepitation - severe case > coma
  34. 40. Laryngeal trauma
  35. 41. Laryngopharyngeal reflux (LPR)
  36. 42. Laryngopharyngeal reflux (LPR) Stomach acid > reflux to esophagus + others = gastroesophageal reflux (GER) reflux up to larynx = LPR Etiology - relax sphincter, acid production food ; chocolate, spicy, cola, alcohol, drugs ; theophylin l ife-style ; eat late at night
  37. 43. Laryngopharyngeal reflux (LPR) Symptoms - feel lump in the throat, chronic cough, regurgitation, heartburn Signs - arytenoid edema, TVC sweling granuloma, ulcer >>> carcinoma
  38. 44. Laryngopharyngeal reflux (LPR) Treatment - Lifestyle modification diet, stress, avoid eating before bedtime - medication protonpump inhibitor, H2 antagonist, antacid + prokinetic - surgery

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