investigation for hoarseness and stridor
TRANSCRIPT
Investigation for Hoarseness and StridorMohd Khairil Anwar bin Ramli 071303047 Batch 21
Stridor - history Time of Onset Congenital / acquired
Mode of Onset Sudden foreign body, oedema Gradual & progressive laryngomalacia, subglottic
haemangioma, juvenile papillomas Duration Short foreign body, oedema, infections Long laryngomalacia, laryngeal stenosis, subglottic
hemangioma, anomalies of tongue and jaw
Stridor - history Relation to feeding Aspiration laryngeal paralysis, esophageal atresia,
laryngeal cleft, vascular ring, foreign bode esophagus Cyanotic Spells Need for airway emergency
Aspiration or ingestion of a foreign body Laryngeal trauma Blunt injuries to layrnx Intubation laryngoscopy
Stridor physical examination Signs of respiratory distress Probable site of destruction inspiratory,
expiratory, biphasic Associated characteristic
Snoring or snorting sound nasal or nasopharynx Gurgling sound & muffled voice - pharynx Hoarse cry or voice - Larynx Expiratory wheeze branchial obstruction
Associated fever
Disappear on prone position larngomalacia,
micrognathia, macroglossia, inonimate artery compression
Stridor - InvestigationRADIOGRAPHY X-ray of chest and soft tissue neck Anteroposteral and lateral view
Fluroscopy To see chest movement
Tomography of chest For mediastinal mass
Esophagogram with lipoidal For atresia of esophagus, trachebranchial fistula or
aberrant vessels
Stridor - InvestigationRADIOGRAPHY Angiography In case of suspected aberrent vessels
Xeroradiography To show soft tissue lesion obsolete
CT scan/ MRI
Stridor - InvestigationDIRECT LARYNGOSCOPY WITHOUT ANAESTHESIA Can be done in infants and small children Rescuscitative measure and tracheostomy tray should be made available Gives opportunity to see if intubation will be possible or tracheostomy will be required for further examination
Stridor - InvestigationGA Bronchoscopy, Laryngoscopy, Esophagoscopy Bronchoscopy is done after slow induction Obstruction in air passage subglottis to bronchi Removal of obstruction Obtain aspirate or biopsy
If 3.5mm bronchosopy can be passed, intubation
is possible Child intubated detailed exam. Of larynx and esophagus Exclude laryngeal paralysis after anaesthesia has worn out, tube removed
Hoarseness- Investigation Done as per dictates of the causes suspected Acute Complete blood count Sedimentation Rate Nose and throat culture Sputum culture
Hoarseness- Investigation Chronic Laryngoscopic examination Chest X-ray-if vocal cord paralysis is found CT scan of the mediastinum-if vocal cord paralysis is
found C-1 esterase inhibitor level- to rule out angioneurotic edema CT scan / MRI if neurological abnormalities present Others Speech assessment, phonetogram, stroboscopy Direct laryngoscopy and microlaryngoscopy help in
detailed examination Bronchoscopy and esophagoscopy paralytic lesion of cord to exclude malignancy
Hoarseness- Investigation Phonetogram
displays the dynamic range of the human voice in
terms of both fundamental frequency (pitch) and intensity (loudness). Speech pathologists, laryngologists, voice
teachers, singing teachers and singers find this display to be useful in identifying the limits of vocal function.
Hoarseness- Investigation Phonetogram
Hoarseness- Investigation Stroboscopy Stroboscopy is direct examination of the vocal cords
and surrounding structures with the use of a stroboscope
Laryngomalacia
Bronchoscopy
Omega shaped
epiglottis
Congenital laryngeal web Membrane spanning between
the true vocal cords.
Cleft larynx U-shaped indentation of
cricoid lamina. Or complete form.
Laryngeal papillomatosis Bunches of wart like
excrescences Pinkish white Sessile/pedunculated Usu multiple
Laryngeal tumors
Squamous cell carcinoma of the larynx
LaryngoceleMRI
CT scan
Saccular cyst in Infant
CT scan
rigid laryngoscope
Foreign body
Foreign body
Acute epiglotitis (Supraglotitis) Laryngoscope Bright red epiglottis Edematous Later edema spread to
aryepiglottic folds and arytenoids
LaryngitisInitially supraglottic edema in arytenoids Then aryepiglottic folds and the false cord Interestingly..
Laryngotracheobronchitis
Pharynx congested Larynx congested with subglottic
inflammotory edema Mucosa of the trachea and bronchi also congested & covered with viscous secretion which later on dry up and form crust.
Vocal nodule Direct laryngoscopy: Usu bilateral Small nodules Greyish white
At junction of ant 3rd and post
2 3rd
VOCAL POLYPS
Soft, smooth,
pedunculated Same position as vocal nodule Complains of double voiceBilateral sessile laryngeal polyps
Vocal cord palsy
Left unilateral paralysis
Bilateral
Different lesion of the vocal cord
Investigation for Hoarseness and StridorThank You