HEENT EXAM 1
Order by
46 terms
Terms | Definitions |
|---|---|
 Neuromuscular Laryngeal Dysfunction | Alterations in the form and function of the vocal cords present as changes in voice or speech patterns |
| Neuromuscular Laryngeal Dysfunction | the cause can be abnormalities of the intrinsic or extrinsic laryngeal musculature, neurologic dysfunction, aging |
| Vocal Cord Paralysis | Diseases that affect the vagus nerve or the laryngeal branches can result in vocal cord paralysis and impaired laryngeal sensation Unilateral cord paralysis is about 75% and the Left is more common b/c its longer and more circuitous |
| Vocal Cord Paralysis | CNS lesions and peripheral lesions (90%) involving the vagus nerve Peripheral: Neoplasm, postsurgical, idiopathic, medical/inflammatory, trauma CNS: Parkinson's Disease, Stroke, MS |
| Vocal Cord Paralysis | Hoarseness is most common, stridor, SOB, changes in vocal quality, cough, aspiration |
| Vocal Cord Paralysis | Testing: Flexible laryngoscopy can assess vocal cord function, position, sensation. CXR CT or MRI Direct laryngoscopy or bronchoscopy are useful. |
| vocal cord paralysis | Treatment: Speech therapy if minimal voice changes Surgical intervention may be needed in more severe cases |
| bilateral vocal cord paralysis | Uncommon Results in the inability to abduct the vocal cords |
| bilateral vocal cord paralysis | Causes: Probable postsurgical injury (after a total thyroidectomy)/ recurrent laryngeal nerve CNS abnormality, MS, CVA, ALS/ Vagal nerve |
| bilateral vocal cord paralysis | Presentation: Laryngeal nerve: stridor, possible respiratory distress, Voice intact because vocal cords are adducted Vagal nerve: weak voice, history of aspiration, short of breath on exertion, often other cranial nerves involved |
| bilateral vocal cord paralysis | Treatment: Endotracheal intubation to secure the airway or tracheotomy |
| presbyphonia | Can be a part of the normal aging process. Causes: Structural change with age, calcification of the laryngeal cartilage, loss of vocal cord elasticity, decrease in muscle bulk |
| presbyphonia | Presentation: Breathy, tremulous, weak voice with pitch alterations and early fatigability Exam shows a posterior glottic gap, bowing of the vocal cords and muscle atrophy |
| presbyphonia | Treatment: Eliminate vocal strain Speech Therapy Surgery can be considered |
| Parkinson's Disease | May develop vocal dysfunction secondary to bradykinesia and difficulty initiating voluntary muscle activity |
| Parkinson's Disease | Presentation: Breathy, hypophonic, tremulous, monotone Vocal cords are adynamic and bowed |
| Parkinson's Disease | Treatment: Voice training with SLP Medication: Dopamine for tremors can be helpful. |
| Myasthenia Gravis | Neuromuscular junction disorder with weakness and fatigue of the skeletal muscles. Affects all ages |
| Myasthenia Gravis | Cause: Acetylcholine deficiency causes an inability of the myoneural junction depolarization |
| Myasthenia Gravis | Presentation: Gradual onset Diplopia and ptosis of the eyelids. Facial weakness Voice alteration with weakness of the laryngeal muscles and difficulty speaking. Voice fatigue Dysphagia and Dyspnea |
| Myasthenia Gravis | Testing: Acetylcholinesterase testing and EMG |
| Myasthenia Gravis | Treatment: Voice improves after rest May need emergent airway Acetylcholinesterase: neostigmine Fluids Avoid fatigue Range of motion |
| ALS | Progressive degeneration of anterior horn cells in the spinal cord that causes wasting and weakness of the skeletal muscle |
| ALS | Presentation: Usually involves the hands, forearms, legs and progresses to the rest of the body the face, throat and respiratory system Raspy, monotone voice, difficulty speaking and difficulty swallowing Depressed gag reflex Pooling secretions in the larynx and hypopharynx |
| ALS | Treatment: Discussion of future treatment and advance directive Consideration of mechanical ventilation |
| ALS | Death is often due to respiratory insufficiency or aspiration pneumonia |
| Laryngeal Neoplasia | There are benign, premalignant, and malignant neoplastic lesions |
| Laryngeal Neoplasia | Presentation can include hoarseness, dysphagia, odynophagia, and aspiration |
| Benign | : Vocal cord nodules, polyps, granulomas |
| Laryngeal Neoplasia | Benign to premalignant: Recurrent respiratory papillomatosis |
| Laryngeal Neoplasia | Leukoplakia Laryngeal cancer |
| RRP | Most common benign neoplastic process of larynx Cause: Infection HPV (human papilloma virus). Usually type 6 and 11 |
| RRP | Presentation: Juvenile onset Usually age 2-4 years. Otherwise in the 30's. Rare after age 40 Recurrent growth of exophytic warty lesions Presents with hoarseness, stridor, cough More aggressive in children and recurrent |
| RRP | Treatment: CO2 laser resection, cold steel dissection. Intralaryngeal cidofovir (Vistide) off-label use. Neither are curative. HPV DNA remains present. |
| Leukoplakia | Denotes white patch or plaque on mucous membrane Cause: Most common inciting agent is cigarette smoking |
| Leukoplakia | Presentation: May be asymptomatic, hoarseness, voice changes May be Isolated to vocal cords or larynx diffusely Keratinization of the mucosa occurs. It may involve dysplastic epithelial changes Painless white patch on the tongue, inside cheek, lower lip, floor of the mouth and it CANNOT be scraped off |
| Leukoplakia | Considered a premalignant lesion Carcinoma develops in less than 5% of cases to 30% Erythroplakia has a 60% rate of changing to malignancy |
| Leukoplakia | Diagnosis and Treatment: Excisional biopsy both diagnostic and therapeutic, especially in those with a history of alcohol and tobacco use |
| Leukoplakia | Follow up: Laryngoscopy to observe for recurrence or progression |
| Laryngeal Cancer | In U.S. incidence 11,100 new cases per year with 4300 deaths Most common type is squamous cell ~ 90% |
| Laryngeal Cancer | Male/female ratio 4:1 |
| Laryngeal Cancer | Causes: Major risk factors tobacco and ETOH use Ionizing radiation, occupational exposure RPR in types 16 &18. Leukoplakia |
| Laryngeal Cancer | Glottic malignancy outnumbers supraglottic in the US but not worldwide. Supraglottic have a richer lymphatic drainage. More often diagnosed with nodal metastasis Malignancy from the subglottis is rare |
| Laryngeal Cancer | Hoarseness, stridor, dysphagia, odynophagia, hemoptysis, weight loss, mass is neck, referred otalgia Airway compromise, aspiration Cancer of the true vocal cords, hoarseness occurs early. Hoarseness longer than two weeks deserves careful inspection The supraglottic cancer is often asymptomatic until the cancer is larger. (advanced stage): Muffled voice |
| Laryngeal Cancer | Glottic cancer is found earlier. Earlier change in voice Head and neck examination, lymph node exam. Back of mouth and tongue. Laryngoscopy in the office Patient should undergo general anesthesia for bronchoscopy, esophagoscopy, and direct laryngoscopy with biopsy. Done in OR setting and all 3 done. (SCC metastasizes to lung, mediastinum, liver then elsewhere) Cervical lymph nodes then lungs. CXR. May need CT or MRI, PET scan |
| Laryngeal Cancer | Treatment Depends upon staging Surgery, radiation, chemotherapy alone or in combo Early recognition and treatment (especially of the true vocal cords, b/c it is more easily recognized) has a good prognosis Voice preserving laryngectomy, total laryngectomy |
First Time Here?
Welcome to Quizlet, a fun, free place to study. Try these flashcards, find others to study, or make your own.