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Laryngeal Disorders
1.
Laryngeal disorders DR
MAHIPAL REDDY
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
5.
Laryngeal disorders ผศ
. นพ . ยงยุทธ วศินวงศ์ ภาควิชาจักษุ โสต นาสิกลาริงซ์วิทยา คณะแพทยศาสตร์ มหาวิทยาลัยศรีนครินทรวิโรฒ
6.
7.
1. Anatomy Framework
Muscles – intrinsic - extrinsic Innervation Vessels
8.
Framework
9.
10.
11.
Muscles Intrinsic
– adductors ; thyroarytenoid (true vocal cord:TVC), cricoarytenoid, interarytenoid - abductor ; post cricoarytenoid Extrinsic - cricothyroid
12.
13.
14.
Innervation Inferior RLN
motor - all muscles except.. sensory- below TVC Superior RLN motor – cricothyroid muscle sensory – above TVC
15.
Blood supply Arterial
sup. laryngeal artery inf. Laryngeal artery Venous sup. & inf. Thyroid veins
16.
17.
Protection inspiration phonation
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
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)
20.
Acute laryngitis Pathogen
- adenovirus, influenza Morexella catarrharis Hemophilus influenza Streptococcus pneumoniae Symptoms - hoarseness cough, +/- fever, malaise Sign - TVC swelling
21.
22.
Acute laryngitis Treatment
- voice rest - mucolytic, anticold +/- antibiotic Symptoms > 2 week, recurrent DDx - chronic laryngitis
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
24.
Croup (acute
laryngotracheobronchitis) Diagnosis - symptoms & signs - flexible scope - x-ray norrowing of subglottis “ Pencil’s sign”
25.
Pencil’s sign Normal
26.
Croup (acute
laryngotracheobronchitis) Treatment - early detection - observe, admit - humidification, hydration, O2 - antibiotic (penicillin) severe - steroid - intubation
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 *
28.
Epiglottitis Signs -
epiglottis > swelling, inflam - ** laryngospasm เมื่อกดลิ้น - fiberoptic X-ray - “Thumb’s sign”
29.
Epiglottitis Treatment -
admit, closed monitoring - broad spectrum penicillin - hydration, humidification - +/- steriod - prepare for intubation
30.
Vocal cord nodule
- vocal abuse, over-used - children, adult - fibrous formation Symptoms - hoarseness Sign - nodule TVC > bilateral > anterior 1/3
31.
Nodule Treatment -
voice rest - speech therapy - failed, recurrent > surgery
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
33.
Reinke’s edema Vocal
polyp Both polyp, nodule
34.
Vocal granuloma inflammation
> ulcer > granuloma etiology - intubation - gastroesophageal reflux - partial laryngectomy Symptoms - hoarseness 2-3 wk after extubation
35.
Vocal granuloma Sign
- arytenoid, unilateral Treatment - surgery - follow by speech therapy - Rx acid reflux
36.
Carcinoma Chronic irritation
- smoking, alcohol, pollution, acid reflux Pathology - epithelial hyperplasia > dysplasia > carcinoma insitu > carcinoma
37.
Carcinoma Symptoms >
2-3 weeks - glottis > hoarseness - supraglottis > dysphagia - subglottis > airway problems others - referred otalgia, chronic cough, hemoptysis, lymphadenopathy, wt. loss
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
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
40.
Laryngeal trauma
41.
Laryngopharyngeal reflux (LPR)
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
43.
Laryngopharyngeal reflux (LPR)
Symptoms - feel lump in the throat, chronic cough, regurgitation, heartburn Signs - arytenoid edema, TVC sweling granuloma, ulcer >>> carcinoma
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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