Summary Head + Neck conditions

HEAD AND NECK SUMMARIES




Microsoft Office User
[COMPANY NAME] [Company address]

,
, DYSPHAGIA (ASSESSMENT)



HISTORY AETIOLOGY
- Level of dysphagia – pharynx, upper, mid, Extraluminal – external pressure on pharynx and
lower oesophagus
- Solids, liquids, saliva - Neck mass (retrosternal goitre)
- Associated symptoms: hoarseness, - Vascular abnormalities (e.g. thoracic aortic
odynophagia, otalgia, regurgitation, GI aneurysm, double aortic arch)
bleeding, weight loss - Any time of mediastinal mass
- Time course of symptoms - Lung cancer
- Risk factors for cancer of oesophagus and
pharynx – smoking, alcohol excess Intramural – pharyngeal, oesophageal
- Motility problems
- MND/MS
INVESTIGATIONS - CVA
- Achalasia
- FBC - ? IDA
- Oesophageal spasm
- CXR
- Pharyngeal pouch
- CT/MRI – suspicion of malignancy
- Benign/malignant stricture
- Barium swallow
- Candidiasis
- Panendoscopy – includes laryngoscopy and
upper oesophagoscopy Intraluminal – oesophageal
- Dynamic investigations – video fluoroscopy - Foreign body
- Oesophageal or pharyngeal cancer
- Candidiasis
- Oesophageal web/plummer-vinson syndrome



DYSPHONIA (ASSESSMENT)



INVESTIGATIONS AETIOLOGY
Flexible nasendoscopic examination of the larynx - Malignant e.g. SCC
Blood tests as appropriate - Benign
o Vocal cord nodules
Urgent referral to ENT for patients with dysphonia
o Papillomas
and red flag symptoms
o Cysts
- Neuromuscular – vocal cord palsy
- Trauma – surgery, intubation, excess use
RED FLAG SYMPTOMS - Endocrine – hypothyroidism
- Hx of smoking and alcohol use - Infective
- Concomitant neck mass o Laryngitis
- Unexplained weight loss o Corticosteroids (inhaled may predispose
- Accompanying neurological symptoms to this)
- Accompanying haemoptysis, dysphagia, - Iatrogenic
odynophagia, otalgia o Recurrent laryngeal nerve palsy
- Hoarseness that is persistent and worsening secondary to thyroid surgery
(rather than intermittent) - Functional - muscle tension dysphonia
- Hoarseness in immunocompromised patient