17 Hypopharynx/Larynx Flashcards
A 45-year-old woman presents with dysphonia and on exam is found to have left vocal cord paralysis in the paramedian position. Complete history and physical exam are otherwise unremarkable. CT scan of the neck and chest and laboratory findings, including electrolytes, RPR, and thyroid function tests, are normal. What are the next steps?
MRI neck and chest followed by laryngoscopy/bronchoscopy if needed
A 78-year-old man presents with a weak, breathy voice and was recently treated for pneumonia. On exam, he was found to have left vocal paralysis in the intermediate position with a wide posterior gap that does not close with vocalization. What is the most appropriate test?
MRI brain/skull base (his H&P suggest nerve lesion above RLN)
What is the primary purpose of laryngeal EMG in pts with VF paralysis
To distinguish paralysis from mechanical fixation
Which laryngeal muscles are typically analyzed with EMG
Thyroarytenoid and cricothyroid muscles
An EMG wave pattern of decreased frequency w/ nl amplitude suggests what sort of d/o
neuropathy
An EMG wave pattern of decreased amplitude w/ nl frequency suggests what sort of d/o
myopathy
What is the significance of picket fence pattern on EMG
Indicates partial reinnervation (polyphasic action potentials)
What are the features of a denervation pattern on EMG
Sharp waves or fibrillation potentials, complex repetitive discharges, and little or no electrical activity during attempts at voluntary contraction
What is the significance of a denervation pattern 1 year after injury
spontaneous recovery is very unlikely
What dz does a fatiguing pattern on EMG suggest
Myasthenia gravis
How is the CP muscle identified with EMG
Electrical activity occurs at rest and diminishes or stops with swallow
Stridor that increases in intensity with crying, agitation, or straining is characteristic of what disorders?
laryngomalacia or subglottic hemangioma
M/c location of subglottic hemangioma
Left posterolateral subglottis
What are the indications for rigid bronch in kids with laryngomalacia
- Severe or atypical stridor
- Abnl high kilovolt cervical radiograph
- High degree of suspicion for a synchronous airway lesion
What is the only clinical sign that is strongly a/w a synchronous airway lesion
Cyanosis
How can one dx exercise-induced laryngomalacia
With exercise flow-volume spirometry
What is the typical appearance of a type I posterior laryngeal cleft
Soft tissue defect in the interarytenoid musculature w/o a defect in the cricoid cartilage
What is the typical presentation of a child with a laryngeal cleft type 2 or greater
H/o aspiration, PNA, choking, coughing during feeds, and sx of airway obstruction
What common cause of congenital airway obstruction is characterized by inspiratory stridor at birth that decreases when placed on the side of the lesion?
UVFP
What is the significance of VF fixation in pts with laryngeal carcinoma
Invasion of the vocalis muscle has occurred and LN mets is more likely
T/F: any laryngeal tumor with VF fixation is at least T3
True
What are the 3 m/c presenting sx of hypopharyngeal CA
dysphagia, neck mass, sore throat (in descending order of incidence)
How does one assess for involvement of the prevertebral fascia from a hypopharyngeal tumor
Intraoperative evaluation is most accurate. During endoscopy, one can attempt to mobilize the posterior pharyngeal wall to assess for involvement. Video esophagography and CT scan are also helpful.
What is Schaefer’s classification system of laryngeal injuries
Group I: Minor hematomas or lacerations, no fractures, and minimal airway compromise.
Group II: Moderate edema, lacerations, mucosal disruption without exposed cartilage, nondisplaced fractures, and varying degrees of airway compromise.
Group III: Massive edema, mucosal disruption, displaced fractures, cord immobility, and varying degrees of airway compromise.
Group IV: Same as group III but with two or more fracture lines and/or skeletal instability or significant anterior commissure trauma.
Which voice analysis gives a 3D representation of sound (time, intensity, frequency)
Spectogram
Which voice analysis test plots minimums and maximums of loudness at selected levels of fundamental freq and reflects pt’s vocal capacity
Phonetogram
Which voice analysis test graphs multiple vocal parameters at once and is very useful for showing changes over time
Multidimensional voice profile
A pt c/o total aphonia yet generates sound with coughing. What is likely dx?
Psychosomatic conversion dysphonia
