H U C O M
5341
ENT lecture
2013-2014
By :
Dr \Mona Haj Ahmed Batowm
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Hoarseness
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Unpaired cartilage :
-thyroid, criciod , epiglottis.
Paired cartilages :
Arytenoids ,corniculates , cuneiforms.
Muscle of larynx:
Divided in to parts:
1-Intrinsic muscles that include :
-cricothyroids, posterior cricoarytenoids, lateral cricoarytenoids,
transverse arytenoids, oblique arytenoids, and thyroarytenoids.
All these muscle supplied by recurrent laryngeal nerve except
cricothyriod supplied by superior laryngeal nerve .
Extrinsic muscles:
Strap muscle that include:
Anatomy of larynx
N.B
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superior and inferior laryngeal artery
Innervations by :
-Vagus nerve.
-laryngeal nerve :internal and external branches that supply
cricothyroide muscle.
recurrent laryngeal nerve :anterior and posterior branch. -
. Galen,s nerve: anastmosis of the both above mentioned -
recurrent laryngeal nerve palsy mainly presents with voice changes.
the left recurrent laryngeal nerve has a long course which extends
down into the chest and loops under the arch of the aorta to return to
the larynx. But he right recurrent laryngeal nerve is shorter and loops
around the subclavian artery. so, the left nerve is more susceptible to
disease than the right.
breathing Passage. -
-Airway protection.
-aid in the clearance of secretion.
-Vocalization.
Blood supply of larynx
Laryngeal Function
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symptoms of Laryngeal Anomalies and diseases:
Airway obstruction - dyspnea
Feeding difficulties dysphagia and odynophagia
Abnormalities of Phonation dysphonia and aphonia
Airway protection
First level- Epiglottis, aryepiglottic folds & arytenoids
Second level- False vocal folds
Third level- True vocal folds
Anomalies of any of this structures lead to aspiration and swallowing
dysfunction.
Anomalies of any of this structures lead to aspiration and swallowing
dysfunction .
Symptoms coughing, choking and gagging episodes, stasis of secretion,
and recurrent pneumonia.
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Symptoms of Airway Obstruction
Stridor
Increase work of breathing with retraction, nasal flaring & tachypnea
apnea episodes, cyanosis & sudden death.
Inspiratory stridor (Supraglottic & glottic). -
Collapse during negative inspiratory pressure. -
Biphasic stridor (Subglottic). -
Expiratory stridor (lower tracheobronchial tree).
Congenital anomalies
Most common congenital laryngeal anomaly (50-75%).
Most frequent cause of stridor in children.
Male predominance 2:1.
Flaccidity of supraglottic laryngeal tissues.
Characterized by inward collapse of supraglottic structures during
inspiration.
Laryngomalacia:
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Etiopathogenesis of
Congenital laryngeal stridor (laryngomalacia):
Cartilage immaturity
Anatomic abnormality
Neuromuscular immaturity
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Clinical presentation:
Stridor is the hallmark of congenital LM. -
-High pitched, inspiratory, worsens with agitation, crying, feeding or in
the supine position.
Feeding symptoms. -
-Choking, coughing, prolonged feeding time, recurrent emesis,
dysphagia, weight loss GERD symptoms.
Complications of LM:
10-20% of patients present with complications. -
Life threatening airway obstruction. -
Failure to thrive. -
Cyanosis. -
Sleep apnea. -
Pulmonary hypertension, developmental delay and cardiac failure.
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Abnormal dilatation of the saccule (appendix of the ventricle)
containing air and maintaining an open communication with laryngeal
lumen.
Men >women.
Bilateral - 25%.
Hoarseness, lateral neck mass, dyspnea, dysphagia, laryngopyocele
Laryngocele
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Acquired: increased intralaryngeal pressure (glassblowers, musicians,
weight lifters)
Congenital
SCC in 15% of cases
Laryngocele: Types
Internal: laryngocele confined to the intrinsic larynx
External: dilated sac projects upward and laterally
Combined
Acute or Chronic -
Viral Bacterial Fungal -
-laryngitis presents with hoarseness and generalized hyperemia of the
laryngeal mucous membrane.
Acute laryngitis commonly follows an upper respiratory tract infection,
or is traumatic following vocal abuse.
Voice rest is the most effective treatment.
Chronic laryngitis may be associated with infection in the upper or
lower respiratory tract, but is commonly irritative due to occupation
and environment, vocal abuse, or tobacco.
Laryngitis
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The unusual laryngitis of myxoedema must not be forgotten.
Acute laryngitisadults
more common in winter months
usually caused by acute coryza (common cold) or influenza.
heavy smoker with a cold, shouting abuse in winter
CLINICAL FEATURES
include aphonia (the voice reduced to a whisper) or dysphonia (a
painful croak) and pain around the larynx, especially on coughing.
stringy mucus and dry, with the larynx to be red laryngoscopy shows
between the cords.
TREATMENT
Absolute voice rest.
inhalation.
smoking.
Antibiotics + Antihistamincs + Antitussive + Corticoid.laryngitis
epiglotitis
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Haemophylus influenzae type B -
Reddened, markedly edematous supraglottic structures -
-Edema with marked infiltrate of neutrophyls with or without
microabscess formation.
stenosing laryngotracheitis (croup)
Location: Subglottic -
Peak occurrence: Age 1-3years -
-Pathogen; Viruses (often parainfluenza viruses) with possible bacterial
superinfection
Incidence: Approximately 90% -
-Onset: Often follows an infection, with dyspnea increasing over a
period of hours
-Stridor: Inspiratory; indpendent of body position
Voice: Harsh, hoarse, to aphonic -
Cough: Barking, dry -
-Degulitition: Normal, with no excessive salivation
Local findings: Redness of the vocal folds and subglottic swelling -
Acute Epiglottitis
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General condition: Satisfactory -
Fever: < 39 C -
acute epiglottitis
Location: Supraglottic -
Peak occurrence: Age 2-7years -
-Pathogen; Usually Heamophilus influenzae (group B)
Incidence: Approximately 10% -
-Onset: Fulminating very severe dyspnea, often develops within 1-
2hours
-Stridor: Inspiratory (if present); often storous: expiratory rattle,
gurgle, exacerbated by recumbent position
Voice: Clear soft, muffled, slurred, not hoarse -
Cough: Often absent -
Degulitition: Painful dysphagia, with excessive salivation -
-Local findings: Massive swelling of the epiglottis, larynx cannot be
visualized
-General condition: Severe systemic toxicity
Fever: >39 C
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- Glottic Cancer: 59% -
Supraglottic Cancer: 40%. -
Subglottic Cancer: 1%. -
Most subglottic masses are extension from glottic carcinomas. -
85-95% of laryngeal tumors are squamous cell carcinoma.
N:B
Main symptoms of laryngitis is hoarseness.
Reinke`s edema :is diffuse edema of vocal cord common in smoker.
Laryngeal
tumors
