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Laryngeal disorders ผศ.นพ.ยงยุทธ วศินวงศ์
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Laryngeal disorders ผศ.นพ.ยงยุทธ วศินวงศ์
ภาควิชาจักษุ โสต นาสิกลาริงซ์วิทยา คณะแพทยศาสตร์ มหาวิทยาลัยศรีนครินทรวิโรฒ
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Pretest T or F 1. Reurrent laryngeal nerve เป็น pure motor fiber
2. การทำงานของ larynx ไม่เกี่ยวข้องกับการกลืน 3. Acute laryngitis เกิดการการติดเชื้อไวรัสเป็นส่วนใหญ่ 4. การกดลิ้นใน epiglottitis ทำให้เกิด laryngospasm ได้ 5. Thumb’s sign พบในโรค croup 6. Vocal nodule มักเป็น unilateral mass 7. Vocal granuloma มักเกิดจากการ intubation 8. Laryngeal trauma ควร intubation ทุกราย 9. Most common symptom ของ true vocal carcinoma คือ neck node enlargement 10. การดื่มสุราเป็นปัจจัยกระตุ้นให้เกิด acid reflux
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Laryngeal disorders ผศ.นพ.ยงยุทธ วศินวงศ์
ภาควิชาจักษุ โสต นาสิกลาริงซ์วิทยา คณะแพทยศาสตร์ มหาวิทยาลัยศรีนครินทรวิโรฒ
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Objectives Anatomy Physiology Common disorders Treatment
Laryngeal disorders Objectives Anatomy Physiology Common disorders Treatment
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Framework Muscles – intrinsic - extrinsic Innervation Vessels
1. Anatomy Framework Muscles – intrinsic - extrinsic Innervation Vessels
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Framework
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Muscles Intrinsic – adductors ; thyroarytenoid (true vocal cord:TVC), cricoarytenoid, interarytenoid - abductor ; post cricoarytenoid Extrinsic - cricothyroid
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Innervation Inferior RLN motor - all muscles except..
sensory- below TVC Superior RLN motor – cricothyroid muscle sensory – above TVC
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Blood supply Arterial sup. laryngeal artery inf. Laryngeal artery
Venous sup. & inf. Thyroid veins
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Airway protection Swallowing Voice production Air passage
Physiology Airway protection Swallowing Voice production Air passage
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Protection inspiration phonation
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Laryngeal disorders 1. Inflammation - Acute & chronic laryngitis, croup, 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
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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)
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Acute laryngitis Pathogen - adenovirus, influenza
Morexella catarrharis Hemophilus influenza Streptococcus pneumoniae Symptoms - hoarseness cough, +/- fever, malaise Sign - TVC swelling
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Treatment - voice rest - mucolytic, anticold +/- antibiotic
Acute laryngitis Treatment - voice rest - mucolytic, anticold +/- antibiotic Symptoms > 2 week, recurrent DDx - chronic laryngitis
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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
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Croup (acute laryngotracheobronchitis)
Diagnosis - symptoms & signs - flexible scope - x-ray norrowing of subglottis “Pencil’s sign”
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Pencil’s sign Normal
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Croup (acute laryngotracheobronchitis)
Treatment - early detection - observe, admit - humidification, hydration, O2 - antibiotic (penicillin) severe - steroid - intubation
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Epiglottitis - infection of supraglottis >> epiglottis
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*
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Epiglottitis Signs - epiglottis > swelling, inflam
- ** laryngospasm เมื่อกดลิ้น - fiberoptic X-ray - “Thumb’s sign”
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Epiglottitis Treatment - admit, closed monitoring
- broad spectrum penicillin - hydration, humidification - +/- steriod - prepare for intubation
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- vocal abuse, over-used - children, adult - fibrous formation
Vocal cord nodule - vocal abuse, over-used - children, adult - fibrous formation Symptoms - hoarseness Sign - nodule TVC > bilateral > anterior 1/3
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Nodule Treatment - voice rest - speech therapy
- failed, recurrent > surgery
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- vocal abuse - Reinke edema > capsule surrounding (polyp)
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
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Reinke’s edema Vocal polyp Both polyp, nodule
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Vocal granuloma inflammation > ulcer > granuloma
etiology - intubation - gastroesophageal reflux - partial laryngectomy Symptoms - hoarseness 2-3 wk after extubation
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Vocal granuloma Sign - arytenoid, unilateral Treatment - surgery
- follow by speech therapy - Rx acid reflux
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Carcinoma Chronic irritation - smoking, alcohol,
pollution, acid reflux Pathology - epithelial hyperplasia > dysplasia > carcinoma insitu > carcinoma
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Carcinoma Symptoms > 2-3 weeks - glottis > hoarseness
- supraglottis > dysphagia - subglottis > airway problems others - referred otalgia, chronic cough, hemoptysis, lymphadenopathy, wt. loss
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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
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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
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Laryngeal trauma
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Laryngopharyngeal reflux (LPR)
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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 life-style ; eat late at night
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Laryngopharyngeal reflux (LPR)
Symptoms - feel lump in the throat, chronic cough, regurgitation, heartburn Signs - arytenoid edema, TVC sweling granuloma, ulcer >>> carcinoma
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Laryngopharyngeal reflux (LPR)
Treatment - Lifestyle modification diet, stress, avoid eating before bedtime - medication protonpump inhibitor, H2 antagonist, antacid + prokinetic - surgery
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