laryngeal disorders
TRANSCRIPT
Laryngeal Laryngeal disordersdisordersDR MAHIPAL DR MAHIPAL
REDDYREDDY
Laryngeal disordersLaryngeal disorders
BY/DR K BY/DR K SUBHASH.,DR SUBHASH.,DR SRIDHAR,DR SRIDHAR,DR SREEKANTH AND SREEKANTH AND ALL ENT SURGEONS ALL ENT SURGEONS OF IMAOF IMA
Pretest T or F Pretest T or F 1. Reurrent laryngeal nerve 1. Reurrent laryngeal nerve pure motor fiberpure motor fiber
larynx larynx
3. Acute laryngitis 3. Acute laryngitis
4.4. epiglottitis laryngospasmepiglottitis laryngospasm
5. Thumb’s sign 5. Thumb’s sign croupcroup
6. Vocal nodule 6. Vocal nodule unilateral massunilateral mass
7. Vocal granuloma 7. Vocal granuloma intubationintubation
8. Laryngeal trauma 8. Laryngeal trauma intubationintubation
9. Most common symptom 9. Most common symptom ของ ของ true vocal true vocal carcinoma carcinoma
neck node enlargementneck node enlargement
10. 10. acid refluxacid reflux
Laryngeal disordersLaryngeal disorders
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Laryngeal disordersLaryngeal disorders
ObjectivesObjectives
1.1. AnatomyAnatomy
2.2. PhysiologyPhysiology
3.3. Common disordersCommon disorders
4.4. TreatmentTreatment
1. Anatomy1. Anatomy
FrameworkFramework
Muscles – intrinsicMuscles – intrinsic
- extrinsic- extrinsic
Innervation Innervation
VesselsVessels
FrameworkFramework
MusclesMuscles
Intrinsic Intrinsic – adductors ; – adductors ; thyroarytenoid thyroarytenoid (true (true vocal cord:TVC), vocal cord:TVC), cricoarytenoid, cricoarytenoid, interarytenoidinterarytenoid
- abductor ; - abductor ; post cricoarytenoidpost cricoarytenoid
ExtrinsicExtrinsic - - cricothyroidcricothyroid
InnervationInnervationInferior RLN Inferior RLN
motor - all muscles except..motor - all muscles except..
sensory- below TVCsensory- below TVC
Superior RLN Superior RLN
motor – cricothyroid musclemotor – cricothyroid muscle
sensory – above TVCsensory – above TVC
Blood supplyBlood supply
Arterial Arterial
sup. laryngeal arterysup. laryngeal artery
inf. Laryngeal arteryinf. Laryngeal artery
VenousVenous
sup. & inf. Thyroid veinssup. & inf. Thyroid veins
PhysiologyPhysiology
1.1. Airway protectionAirway protection2.2. Swallowing Swallowing
3.3. Voice productionVoice production
4.4. Air passageAir passage
ProtectionProtection
inspirationinspiration
phonationphonation
1. Inflammation- Acut e & chr oni c l ar yngi t i s, c roup, epiglottitis, ulcer,
2 . Tumor - benign, nodule, polyp, granuloma
- mal i gnancy 3 . Trauma - penetrating injury
- blunt injury- i at r ogeni c
4 . Congenital - cord paralysis, Laryngeal web, subglottic stenosis
5 . Miscellaneous- laryngopharyngeal reflux (LPR)
di sease
Laryngeal disordersLaryngeal disorders
Common laryngeal Common laryngeal disordersdisorders
1. Acute laryngitis1. Acute laryngitis
2. Croup2. Croup
3. Epiglottitis3. Epiglottitis
4. Vocal nodule4. Vocal nodule
5. Vocal polyp5. Vocal polyp
6. Vocal granuloma6. Vocal granuloma
7. Laryngeal carcinoma7. Laryngeal carcinoma
8. Laryngeal trauma8. Laryngeal trauma
9. Laryngopharyngeal reflux 9. Laryngopharyngeal reflux (LPR)(LPR)
Acute laryngitisAcute laryngitisPathogen - adenovirus, influenzaPathogen - adenovirus, influenza
Morexella catarrharisMorexella catarrharis
Hemophilus influenzaHemophilus influenza
Streptococcus pneumoniaeStreptococcus pneumoniae
Symptoms - hoarseness cough, +/- fever, malaise
Sign - TVC swelling
Acute laryngitisAcute laryngitisTreatment Treatment - voice rest- voice rest
- mucolytic, anticold- mucolytic, anticold
+/- antibiotic+/- antibiotic
Symptoms > 2 week, recurrent
DDx - chronic laryngitis
Croup Croup (acute (acute laryngotracheobronchitis)laryngotracheobronchitis)
- Severe respiratory infection- Severe respiratory infection
- - 6 months-2 yrs. Pathogen - parainfluenza*influenza, adenovirus
- follow by bacterial esp. H. influenzaSymptoms - early URI symptoms
- 2-3 days - barking cough, stridor- exhausted, lying down
Croup Croup (acute (acute laryngotracheobronchitis)laryngotracheobronchitis)
Diagnosis - symptoms & signs- flexible scope- x-ray
norrowing of subglottis
“Pencil’s sign”
Pencil’s sign
NormalNormal
Croup Croup (acute (acute laryngotracheobronchitis)laryngotracheobronchitis)
Treatment - early detection- observe, admit- humidification, hydration, O2- antibiotic (penicillin)severe - steroid
- - intubation
EpiglottitisEpiglottitis
- infection of supraglottis >> epiglottis- infection of supraglottis >> epiglottis
- - 2-10 yr., adultPathogen - H. influenza type B
Symptoms - early URI symptoms- children > change very fast 6-12 hr.- high fever, pain in throat- น�&ง โน'มต�วมาข'างหน'า*
EpiglottitisEpiglottitis
Signs - epiglottis > swelling, inflam- ** laryngospasm เม)&อกดล�+น- fiberoptic
X-ray - “Thumb’s sign”
EpiglottitisEpiglottitis
Treatment- admit, closed monitoring- broad spectrum penicillin- hydration, humidification- +/- steriod- prepare for intubation
Vocal cord noduleVocal cord nodule
- vocal abuse, over-used- children, adult- fibrous formation
Symptoms - hoarsenessSign - nodule TVC> bilateral
> anterior 1/3
NoduleNodule
Treatment - voice rest- speech therapy- failed, recurrent > surgery
Vocal polypVocal polyp
- vocal abuse- vocal abuse
- - Reinke edema > capsule surrounding (polyp)
Symptoms - hoarseness > 2 wkSign - ant 1/3 TVC, unilateralTreatment - surgery
- follow by speech therapy
Reinke’s edema Reinke’s edema
Vocal polypVocal polyp
Both polyp, noduleBoth polyp, nodule
Vocal granulomaVocal granuloma
inflammation > ulcer > granulomainflammation > ulcer > granulomaetiology - intubation
- gastroesophageal reflux- partial laryngectomy
Symptoms - hoarseness 2-3 wk after extubation
Vocal granulomaVocal granuloma
Sign - arytenoid, unilateralTreatment - surgery
- follow by speech therapy- Rx acid reflux
CarcinomaCarcinomaChronic irritation Chronic irritation - smoking, alcohol,
pollution, acid reflux
Pathology - epithelial hyperplasia > dysplasia >
carcinoma insitu >carcinoma
CarcinomaCarcinoma
Symptoms > 2-3 weeks- glottis > hoarseness- supraglottis > dysphagia- subglottis > airway problems
others - referred otalgia, chronic cough, hemoptysis, lymphadenopathy, wt. loss
CarcinomaCarcinoma
DiagnosisDiagnosis - biopsy ; indirect or direct - biopsy ; indirect or direct
laryngoscopy laryngoscopy
- extension ; CT, MRI- extension ; CT, MRI
- metastasis ; CXR, LFT- metastasis ; CXR, LFT
TreatmentTreatment - depends on staging - depends on staging TNMTNM
- early > surgery or RT alone- early > surgery or RT alone
- stage 3, 4 > combined - stage 3, 4 > combined
surgery, RT, ChemoRxsurgery, RT, ChemoRx
Laryngeal traumaLaryngeal trauma
Most common -Car accidentMost common -Car accident
OthersOthers - athlete, penetrating, gun-- athlete, penetrating, gun-short short wound wound
S&SS&S >> location, severity>> location, severity
- stridor, bleeding, emphysema, - stridor, bleeding, emphysema, hemoptysis, dysphagia, hemoptysis, dysphagia,
crepitationcrepitation
- severe case > coma- severe case > coma
Laryngeal traumaLaryngeal trauma
ชนิ�ด การรกษาMinor- ม#hematoma, emphysema, - explore , แผล remove tureign body tear of cartilage - วางdrain
- reconstruction of frame work+ intubation
Major- multiple cartilage fracture - need intubation or tracheostomy- laryngo tracheal subluxation - exploration & reconstruction
+ intraluminal stent
Laryngopharyngeal reflux Laryngopharyngeal reflux (LPR)(LPR)
Laryngopharyngeal reflux Laryngopharyngeal reflux (LPR)(LPR)
Stomach acid > reflux to esophagus + Stomach acid > reflux to esophagus + others others
= gastroesophageal reflux (GER)= gastroesophageal reflux (GER)
reflux up to larynx = LPRreflux up to larynx = LPR
Etiology Etiology- relax sphincter, acid production- relax sphincter, acid production
food ; food ; chocolate, spicy, cola, alcohol, chocolate, spicy, cola, alcohol,
drugs ; drugs ; t heophyl i nt heophyl i n
ll - ife style- ife style ; ; eat late at nighteat late at night
Laryngopharyngeal reflux Laryngopharyngeal reflux (LPR)(LPR)
Symptoms Symptoms - feel lump in the throat,- feel lump in the throat,
chronic cough, chronic cough,
regurgitation, heartburnregurgitation, heartburn
SignsSigns - - arytenoid edema, TVC swelingarytenoid edema, TVC sweling
granuloma, ulcergranuloma, ulcer
>>> carcinoma>>> carcinoma
Laryngopharyngeal reflux Laryngopharyngeal reflux (LPR)(LPR)
Treatment Treatment - Lifestyle modification- Lifestyle modificationdiet, stress, avoid eating diet, stress, avoid eating
before bedtimebefore bedtime
- medication- medicationprotonpump inhibitor, protonpump inhibitor, H2 antagonist, antacid H2 antagonist, antacid+ prokinetic+ prokinetic
- surgery- surgery