EN4.40-44 | Larynx Voice and Airway — Glossary

Life-threatening cellulitis of the supraglottic structures (mainly the epiglottis) caused by Haemophilus influenzae type b (in children) or streptococcus/staphylococcus (in adults); presents with drooling, toxic appearance, hot-potato voice, and the 'thumb sign' on lateral neck X-ray; the MOST important management rule is to secure the airway before any oral examination.

Acute viral inflammation of the vocal cords causing hoarseness, usually following an upper respiratory tract infection; almost always self-limiting in 7–14 days; managed with voice rest and symptomatic measures; antibiotics are not indicated.

Congenital hindbrain herniation in which the cerebellar tonsils and brainstem herniate through the foramen magnum, potentially compressing the vagal nuclei and causing bilateral vocal cord palsy in neonates; must be excluded by MRI brain in any neonate with unexplained bilateral VCP.

Stridor present on both inspiration and expiration, indicating obstruction at the subglottic or tracheal level — the rigid cricoid ring produces symmetric narrowing that creates turbulence in both respiratory phases; seen in croup, subglottic haemangioma, subglottic stenosis, and bilateral vocal cord palsy.

A benign laryngeal lesion arising from the posterior vocal process of the arytenoid (not the free cord edge), caused by laryngopharyngeal reflux, vocal abuse or post-intubation trauma; primary treatment is anti-reflux therapy; surgical excision has a high recurrence rate.

Inability of a vocal cord to abduct on laryngoscopy, indicating invasion of the cricoarytenoid joint or the thyroarytenoid/paraglottic musculature; the defining criterion for T3 classification in glottic carcinoma; a critical prognostic upstaging finding.

A grading system for subglottic stenosis based on percentage of airway obstruction: Grade I (<50%), Grade II (51-70%), Grade III (71-99%), Grade IV (complete obstruction); guides treatment selection between endoscopic and open surgical approaches.

The fibromuscular membrane between the lower border of the thyroid cartilage and the upper border of the cricoid cartilage; the site of emergency cricothyroidotomy; the cricothyroid arteries run across its superior third — incision should be in the inferior two-thirds.

Emergency surgical airway procedure performed through the cricothyroid membrane in the 'can't intubate, can't oxygenate' scenario; provides a temporising airway access; must be converted to a formal tracheostomy within 24-48 hours to prevent subglottic stenosis from cuff pressure at the cricoid level.

Viral subglottic oedema caused primarily by parainfluenza virus type 1; affects children 6 months–5 years; presents with barking cough and inspiratory stridor; the 'steeple sign' (subglottic narrowing) is seen on AP neck X-ray; treated with dexamethasone and nebulised adrenaline for moderate-severe disease.

A tracheostomy tube with an inflatable cuff around its outer tube that seals against the tracheal wall; used for positive pressure ventilation and to reduce aspiration; cuff pressure must be maintained at 20-25 mmHg (15-20 cmH2O) to balance effective sealing against tracheal mucosal ischaemia.

Removal of the tracheostomy tube once the original indication has resolved and the patient has demonstrated the ability to breathe safely and adequately through the upper airway during progressive capping trials; the stoma closes spontaneously within 1-2 weeks in most patients.

Potentially fatal upper airway infection caused by Corynebacterium diphtheriae; the exotoxin causes tissue necrosis and grey-white pseudomembrane formation in the pharynx and larynx; the membrane bleeds when forcibly removed; treated with antitoxin (given empirically on clinical suspicion) plus penicillin or erythromycin.

Equine-derived antitoxin that neutralises unbound circulating diphtheria exotoxin; must be administered immediately on clinical suspicion without waiting for culture results, as the toxin irreversibly binds to cardiac and neural tissue; given intramuscularly or intravenously depending on severity.

Prophylactic removal of the regional lymph node groups at risk of occult metastasis in a clinically N0 neck; recommended for N0 supraglottic carcinoma (20-30% occult nodal disease rate) but not for N0 early glottic carcinoma (low lymphatic supply).

A tracheostomy tube with a window (fenestration) in the posterior wall of the outer tube; when the inner tube is removed and the stoma is capped, exhaled air can pass through the fenestration and upward through the larynx and upper airway, allowing phonation; used during weaning.

Flexible endoscopic examination of the larynx via the nasal cavity under topical anaesthesia; provides a dynamic real-time view of cord movement and is superior to IDL for assessing vocal cord mobility and subtle mucosal changes.

Squamous cell carcinoma arising from the true vocal cord; presents early with hoarseness (the cord's vibration is immediately disrupted); has an excellent prognosis at T1 due to the sparse lymphatic supply at the glottis.

A perceptible change in voice quality — roughness, breathiness, strain or pitch alteration — resulting from abnormal vibration of the vocal folds due to any structural, inflammatory, neurological or functional cause.

Squamous cell carcinoma arising in the hypopharynx (piriform sinus, posterior pharyngeal wall, or postcricoid region); presents late with progressive dysphagia and neck mass; carries a poor overall prognosis (~25-35% five-year survival) due to late diagnosis and rich lymphatic spread.

Examination of the larynx using a warmed laryngeal mirror placed in the oropharynx to reflect the image of the vocal cords; the primary clinical technique for laryngeal visualisation in the outpatient setting.

The removable cannula that fits within the outer tracheostomy tube and can be extracted for cleaning without disturbing the outer tube or the stoma; the key safety design feature of a tracheostomy tube; cleaned every 4-8 hours to prevent secretion build-up.

The commonest benign laryngeal tumour, caused by HPV types 6 and 11; presents as exophytic, frond-like masses on the vocal cord; juvenile form is aggressive and recurrent; adult form more often curable; treated by CO2 laser or microdebrider excision.

The commonest cause of stridor in infants; caused by abnormally floppy supraglottic structures (omega-shaped epiglottis, short aryepiglottic folds) that are sucked inward during inspiration; presents from the first weeks of life; self-resolves in >90% by 18-24 months; diagnosed by flexible nasolaryngoscopy.

A white patch on the vocal fold representing hyperkeratosis; may represent dysplasia or early carcinoma in a smoker; requires biopsy under microlaryngoscopy for histological grading.

The maximum duration in seconds that a patient can sustain a vowel sound on a single breath; normal is ≥15 seconds for men and ≥12 seconds for women; a MPT below 8 seconds indicates significant glottic incompetence from cord palsy or a large glottic lesion.

Endoscopic examination of the larynx under general anaesthesia using a rigid laryngoscope (Kleinsasser or similar) and an operating microscope; used for tissue biopsy, polypectomy, papilloma excision, granuloma excision, and assessment of lesions not adequately seen on indirect laryngoscopy.

The undulating wave-like vibration of the vocal fold cover (epithelium + Reinke's space) propagating from the inferior to superior surface during phonation, visible on laryngostroboscopy; its loss indicates stiffness or scarring.

Inhaled 1:1000 epinephrine (0.5 mL/kg, maximum 5 mL) used in moderate-severe croup; acts by vasoconstriction to reduce subglottic mucosal oedema; produces rapid but temporary relief (2–3 hours) — patients must be observed for rebound swelling; always used with systemic corticosteroids.

The smooth, rounded solid introducer that fills the lumen of a tracheostomy tube during insertion, allowing smooth passage through the tracheal opening without snagging the mucosa; MUST be removed immediately after tube insertion as it completely occludes the lumen.

Treatment of T3 laryngeal carcinoma with concurrent cisplatin-based chemotherapy and radiotherapy (70 Gy in 35 fractions), with the aim of preserving laryngeal function; established by RTOG trials; salvage total laryngectomy is used if the tumour fails to respond.

Combined endoscopic assessment comprising direct laryngoscopy, rigid oesophagoscopy, and bronchoscopy, performed under general anaesthesia; used to assess the full extent of hypopharyngeal or laryngeal carcinoma, obtain biopsy, and exclude synchronous second primaries in the oesophagus or bronchus.

A one-way valve fitted to the outer tracheostomy tube that opens during inspiration and closes during expiration, forcing exhaled air upward through the larynx to allow phonation and improve swallowing coordination; the tracheostomy tube cuff MUST be completely deflated when the valve is in use.

Microsurgical procedures on the vocal fold performed under general anaesthesia with an operating microscope; used for polyp excision, Reinke's oedema drainage, and papilloma removal; preserves the mucosal cover and Reinke's space to maintain post-operative vocal fold vibration.

The commonest type of hypopharyngeal carcinoma (~60-65%); arises in the pear-shaped recess lateral to the aryepiglottic fold; presents with unilateral dysphagia, referred otalgia, and cervical lymphadenopathy; often at advanced stage at diagnosis.

A triad of iron-deficiency anaemia, dysphagia from a post-cricoid mucosal web, and koilonychia (spoon-shaped nails); occurs predominantly in middle-aged women; the postcricoid web is a pre-malignant lesion; the syndrome is a recognised risk factor for postcricoid carcinoma.

Fibrosis at the level of the cricoid cartilage following prolonged or traumatic endotracheal intubation, causing progressive inspiratory or biphasic stridor months after extubation; classified by Cotton-Myer grading (Grade I: <50% obstruction to Grade IV: complete); managed by endoscopic dilatation (Grade I-II) or laryngotracheal reconstruction (Grade III-IV).

The only abductor of the vocal cords; arises from the posterior cricoid lamina, inserts on the muscular process of the arytenoid, and rotates the arytenoid laterally to open the glottis; innervated by the recurrent laryngeal nerve.

A fatty tissue space between the epiglottis anteriorly and the thyrohyoid membrane and hyoid bone anteriorly; invasion of this space by supraglottic tumours allows spread toward the base of tongue and is a staging upstaging feature on CT/MRI.

A branch of the vagus nerve (CN X) that supplies all intrinsic laryngeal muscles except the cricothyroid; the left RLN loops under the aortic arch (longer intrathoracic course) and the right RLN loops under the right subclavian artery.

Aggressive, recurrent HPV 6/11-induced papillomatosis of the larynx affecting young children; acquired by vertical HPV transmission from mother at birth; requires multiple CO2 laser excision procedures throughout childhood; rare malignant transformation with HPV 11.

Bilateral subepithelial oedema affecting the entire length of both vocal folds, producing large translucent swellings in Reinke's space; strongly associated with chronic smoking; produces a markedly low-pitched voice.

The superficial layer of the lamina propria of the vocal fold — a loose areolar potential space between the epithelium and vocal ligament; flooded by oedema in Reinke's oedema (polypoid degeneration) from smoking and hypothyroidism.

Absence of audible stridor in a child with obvious respiratory distress and intercostal/subcostal retractions, indicating that airflow through the critically narrowed airway is too slow to generate turbulence; a pre-arrest sign requiring immediate airway intervention — NOT a sign of improvement.

The pathognomonic radiological appearance of croup on an AP neck/chest X-ray — loss of the normal lateral shouldering of the subglottis, with the air column tapering to a narrow pencil-like column, resembling a church steeple.

A lower-pitched snoring sound produced by soft tissue vibration at the nasopharyngeal or oropharyngeal level; distinct from stridor; caused by adenotonsillar hypertrophy, macroglossia, or other causes of pharyngeal narrowing.

A high-pitched, musical or harsh respiratory sound produced by turbulent airflow through a partially obstructed extrathoracic airway; the phase (inspiratory/biphasic/expiratory) localises the level of obstruction.

An infantile vascular tumour of the subglottic region presenting between 6 weeks and 6 months of age with progressive biphasic stridor; associated with cutaneous facial haemangioma in 50%; diagnosed by microlaryngoscopy and bronchoscopy; treated with oral propranolol (drug of choice).

Squamous cell carcinoma arising from the supraglottic larynx (epiglottis, aryepiglottic folds, false cords); presents late with hoarseness when the true cord is eventually involved; metastasises early to bilateral cervical lymph nodes due to the rich supraglottic lymphatics.

Surgical procedure for severe laryngomalacia consisting of division of the shortened aryepiglottic folds and trimming of the redundant arytenoid mucosa; performed under microlaryngoscopy; reserved for laryngomalacia with failure to thrive, obstructive apnoea, aspiration, or cor pulmonale.

Laryngeal carcinoma that has invaded through the thyroid cartilage or extended beyond the larynx to involve the trachea, soft tissues of the neck, strap muscles, or thyroid gland; classified as 'resectable' T4; managed with total laryngectomy plus post-operative radiotherapy.

The pathognomonic radiological appearance of acute epiglottitis on a lateral neck X-ray — the swollen, rounded epiglottis silhouetted against the air column of the oropharynx, resembling a thumb projecting into the airway.

The bridge of thyroid tissue connecting the two thyroid lobes, crossing the anterior trachea at the level of the 2nd-4th tracheal rings; during surgical tracheostomy, it must be divided between ligatures or retracted superiorly to expose the correct tracheal level.

Surgical removal of the entire larynx, with creation of a permanent end-tracheostomy; the patient breathes permanently through the neck stoma; voice rehabilitation is achieved by tracheo-oesophageal puncture (TEP) with a prosthesis, electrolarynx, or oesophageal speech.

A rare but potentially fatal late complication of tracheostomy caused by erosion of the tracheostomy tube cuff or tip through the posterior wall of the innominate (brachiocephalic) artery; presents with a sentinel bleed followed by catastrophic haemorrhage; emergency management = compress the artery through the stoma; treated by urgent surgical repair.

A surgically created fistula between the posterior tracheal wall and the anterior oesophageal wall at the time of total laryngectomy, into which a one-way voice prosthesis is placed; allows exhaled air to be diverted through the oesophagus for voice production; the preferred method of voice rehabilitation after total laryngectomy.

Surgical creation of an opening in the anterior tracheal wall at the level of the 2nd-3rd tracheal ring, performed electively or semi-electively for airway obstruction, prolonged ventilation, pulmonary toilet, or prophylaxis before major head and neck surgery.

A surgical procedure for unilateral vocal cord palsy in which a silicone or Gore-Tex implant is inserted through a window in the thyroid cartilage to push the paralysed vocal fold toward the midline, closing the glottic gap and improving voice and swallowing; classified by Isshiki.

Bilateral, symmetrical, fibrous thickenings at the junction of the anterior one-third and posterior two-thirds of both vocal cords caused by repetitive phonatory trauma; commonest in professional voice users; respond to voice therapy.

Paralysis or paresis of one or both vocal cords resulting from dysfunction of the recurrent laryngeal nerve or vagus nerve; unilateral VCP produces a breathy voice and aspiration; bilateral VCP produces stridor and airway compromise.

Unilateral, sessile or pedunculated benign lesion at the anterior one-third/posterior two-thirds junction of the vocal cord; may be haemorrhagic (red) or oedematous (translucent); treated by microlaryngoscopic excision.

The paired fibromuscular structure at the level of the glottis, composed of the vocalis muscle, vocal ligament, and the multilayered lamina propria covered by squamous epithelium; responsible for phonation and airway protection.

A validated clinical severity score for croup comprising five components: stridor, retractions, air entry, cyanosis, and level of consciousness; total score 0-17; scores 0-2 = mild; 3-5 = moderate; ≥6 = severe; guides treatment intensity.