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