CONGENITAL LARYNGEAL DISEASE AND VOICE DISORDERS Yard Doc

CONGENITAL LARYNGEAL DISEASE AND VOICE DISORDERS Yard. Doc. Dr. Müzeyyen Doğan

Learning goal and objectives of the lesson Learning goal of the lesson: The learner should know the main clinical features and investigation of the congenital laryngeal and voice disorders with their treatments Learning objectives of the lesson the learner will be able to: n identify the glottic pathology that may be responsible for hoarseness n describe basic phonosurgical principals n describe basic voice and speech therapy principals n know how to manage benign laryngeal disorders medically or surgically. Skill objectives of the lesson the learner will be able to take a directed history and perform a physical exam on a hoarse patient

Disease of the larynx n Congenital abnormalities of the larynx : n Laryngomalacia most common cause of stridor in neonate and infants Laryngeal finding : n Inward collapse of aryepiglottic fold (short) into laryngeal inlet during inspiration. n Epiglottis collapses into laryngeal inlet. n n n SSX: n n DX: n n RX: n n n intermittent inspiratory stridor that improve in prone position. HX and endoscopy observation Epiglottoplasty Tracheostomy

Subglottic stenosis : n n types: n n n n n membranouse Cartilaginous mixed Grades: n n Incomplete recanalization, small cricoid ring I <70% II 70 -90% III 91 -99% IV complete obstruction SSX : biphasic stridor , failure to thrive. DX: chest and neck X-ray , flexible endoscope RX: tracheotomy n grade I - II ; n Grade III –IV: n n endoscope (CO 2 or excision with dilation ) open procedures: n Ant cricoid split n LTR OR CTR

Subglottic stenosis

n Laryngeal web: n n Types: n n n Supraglottic Glottis Subglottic SSX: n n incomplete decanalization weak cry at birth , variable degrees of respiratory obstruction DX: flexible endoscope Rx : n no treatment laser excision open procedure+ tracheostomy

Subglottic haemangioma n Most common in subglottic space n n Types: n n n 50% of subglottic hemangiomas associated with cutaneous involvement capillary (typically resolve) Cavernous SSX: biphasic stridor DX : endoscope RX: n n n observation Crticosteroid CO 2 LASER

Traumatic conditions of the larynx n n n Direct injuries (blows) Penetration (open) Burns (inhalation , corrosive fluids) Inhalation foreign bodies Intubations injuries : n n Prolonged intubation Blind intubation too large tube pathology : n n n Abrasion ► granulomatous formation …. subglottic stenosis SSX; hoarsness , dyspnoea RX: n n n voice rest endoscopic removal prevention

Vocal fold lesions secondary to vocal abuse and trauma n Vocal nodules (singer’s nodules) n At junction of ant 1/3 and mid 1/3 n RX : voice therapy n surgical excision n

n Vocal fold polyp : n Middle and ant 1/3 , free edge , unilateral n Mucoid , hemorrhagic n RX : n surgical excision

n Vocal fold cyst ; n congenital dermoid cyst mucus retention cyst n RX: n n surgical excision

n Reinke’s edema n RX: voice rest , stop smoking n surgical excision n

Laryngocele Air filled dilation of the appendix of the ventricle , communicates with laryngeal lumen n congenital or acquired n n types : External : through thyrohyoid membrane n Internal : n Combined n n Rx : marsupialization

Vocal cord paralysis n Causes: n Adult n n n n n Neoplastic Iatrogenic : Idiopathic Trauma Neurological infectious systemic diseases Toxins children n n Arnold chiari malformation Birth trauma

SSX: Dysphonia Chocking Stridor

n Vocal cord position : n n Rx : n n Median , paramedian , cadaveric Self limiting or permanent paralysis For medialization : n Vocal cord injections n n n Gelfoam, fat, collagen, Teflon. Thyroplasty For lateralization: n n n cordotomy Thyroplasty tracheotomy

n Inflammation of the larynx Acute viral laryngitis: n n SSX: n n Rx: n n n Haemophilis influnzae B 2 -6 years fever , dysphagia , drooling , dyspnea, sniffing position , no cough, normal voice. DX : n n conservative Ssx: n n dysphonia , fever cough Acute epiglottis : n n Rhinovirus, parainfluenza Rx: n n x-ray (thumbprint sign) do not examine the child in ER Intubation in OR IV abx corticosteroid

n Croup (laryngotracheobronchitis ) n n SSX: n n biphasic stridor, fever , brasssy cough , hoarseness , no dysphagia DX: n n Primary involves the subglottic Parainfluenza 1 -3 1 -5 years x-ray , steeple sign RX: n humidified oxygen, racmic epinephrine , steroid

Diphtheritic laryngitis n Causes: n n Ssx: n n n Corynebacterium diphtheriae Cough , stridor , dysphonia , fever Greyish –white membrane Treatment: n n Antitoxin injection Systemic pencillin Oxygen tracheostomy

n Fungal laryngitis : Immunocompromised n candidiasis , aspergillosis n n Ssx: n n dysphonia , cough odynophagia RX: n antifungal regimen

n Recurrent respiratory papillomatosis: n n 2/3 before age 15 rarely malignant change HPV 6 -11 Risks: n n n younger first time mother (condyloma acuminata) Lesions: wart like (cluster of grapes ) Types : n n n SSX: n n juvenile Senile Hoarseness stridor RX; n n laser excision , microdebrider Adjunctive therapy: acyclovir , interferon …