The cookie is used to store the user consent for the cookies in the category "Analytics". This cookie is set by GDPR Cookie Consent plugin. These cookies ensure basic functionalities and security features of the website, anonymously. Necessary cookies are absolutely essential for the website to function properly. Figure 7 - Flexible nasal endoscopy view of laryngitis Figure 5 - Microlaryngoscopy view of a vocal cord polyp Management is mainly voice therapy from the SALT team, however in severe or resistant cases, surgical intervention may be warranted 3), occurring at the junction between the anterior and middle third of the vocal folds due to strain. They are benign lesions that are frequently bilateral (Fig. Vocal cord nodules are commonly secondary to chronic phonotrauma (vocal abuse). Functional causes should be seen as a diagnosis of exclusion when no obvious cause can be found, however it is a common cause for hoarseness. Regardless, all cases of new onset hoarseness need investigation and management depends on the underlying cause. There are a multiple causes of hoarseness, ranging from simple benign conditions to serious malignant or neurological causes. Swallowing assessments such as Flexible Endoscopic Evaluation of Swallowing (FEES) or Video Fluoroscopy (VF) to be done by Speech and Language Therapists (SALT) if there were any concurrent concerns regarding a safe swallow. It involves the use of synchronised flashing lights to make vocal fold movements appear slower, allowing for complete assessment of their movement. Video-stroboscopy is used in specialist voice clinics and can be a useful diagnostic test in vocal cord dysfunction. These can include CT neck and chest (to assess for any lesion along the path of recurrent laryngeal nerve) or laryngeal electromyography (EMG, to distinguish between palsy from fixation, i.e. If patients are suspected of having a vocal cord palsy, additional investigations are often required. Figure 2 - Microlaryngoscopy view of the vocal cords (anterior is top of the image) Most cases would warrant CT imaging from skull base to diaphragm, to assess for any pathology affecting the recurrent laryngeal nerve route. Investigation and management options are further discussed here.Ī recurrent laryngeal nerve palsy can be caused by a wide range of causes, including thyroid cancer, lung cancer, thoracic aortic aneurysm, multiple sclerosis (MS), or stroke.Įxtensive examinations are key to further delineating the underlying diagnosis, including neck examination and cranial nerve examination. Patients present with a hoarse voice, alongside potential other red flag signs such as a neck lump, dysphagia, weight loss or referred otalgia. It can be further classified into supraglottic, glottic or subglottic in origin. Laryngeal cancers are usually squamous cell carcinomas (SCC), associated with human papilloma virus (HPV) infection. These are usually treated with antibiotics and should result in complete recovery.Īcute epiglottitis is infection of the epiglottis, further discussed here. FNE findings may show oedematous arytenoids and mildly inflamed epiglottis. Supraglottitis is inflammation of the supraglottic structures, commonly after respiratory tract infections. Phoni, CC BY-SA 3.0, via Wikimedia Commonsįigure 7 – Flexible nasal endoscopy view of laryngitis Smoking cessation and voice therapy are the mainstay of treatment. It is strongly linked to smoking and is more common females, but can also be seen with laryngopharyngeal reflux. Reinke’s oedema is oedema of the vocal folds (Fig. Further investigation may require an gastroscopy and treatment will be with proton pump inhibitor (PPI) therapy ± H. Whilst clinical examination will often be unremarkable, but FNE will reveal interarytenoid oedema, oedematous vocal cords, or granulations of the vocal cord process. Laryngopharyngeal reflux (LPR) is a caused by acid reflux resulting in inflammation of the larynx. It is not uncommon for patients to need r epeat procedures as papillomas can recur. If left untreated, papillomas can grow to cause airway obstruction and hence need surgical excision or debulking. Laryngeal papillomas are benign lesions in the larynx, commonly caused by HPV infection. Welleschik, CC BY-SA 3.0, via Wikimedia Commonsįigure 5 – Microlaryngoscopy view of a vocal cord polyp
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