17 Hypopharynx/Larynx

Question 1

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?

Answer 1

MRI neck and chest followed by laryngoscopy/bronchoscopy if needed

Question 2

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?

Answer 2

MRI brain/skull base (his H&P suggest nerve lesion above RLN)

Question 3

What is the primary purpose of laryngeal EMG in pts with VF paralysis

Answer 3

To distinguish paralysis from mechanical fixation

Question 4

Which laryngeal muscles are typically analyzed with EMG

Answer 4

Thyroarytenoid and cricothyroid muscles

Question 5

An EMG wave pattern of decreased frequency w/ nl amplitude suggests what sort of d/o

Answer 5

neuropathy

Question 6

An EMG wave pattern of decreased amplitude w/ nl frequency suggests what sort of d/o

Answer 6

myopathy

Question 7

What is the significance of picket fence pattern on EMG

Answer 7

Indicates partial reinnervation (polyphasic action potentials)

Question 8

What are the features of a denervation pattern on EMG

Answer 8

Sharp waves or fibrillation potentials, complex repetitive discharges, and little or no electrical activity during attempts at voluntary contraction

Question 9

What is the significance of a denervation pattern 1 year after injury

Answer 9

spontaneous recovery is very unlikely

Question 10

What dz does a fatiguing pattern on EMG suggest

Answer 10

Myasthenia gravis

Question 11

How is the CP muscle identified with EMG

Answer 11

Electrical activity occurs at rest and diminishes or stops with swallow

Question 12

Stridor that increases in intensity with crying, agitation, or straining is characteristic of what disorders?

Answer 12

laryngomalacia or subglottic hemangioma

Question 13

M/c location of subglottic hemangioma

Answer 13

Left posterolateral subglottis

Question 14

What are the indications for rigid bronch in kids with laryngomalacia

Answer 14

• Severe or atypical stridor
• Abnl high kilovolt cervical radiograph
• High degree of suspicion for a synchronous airway lesion

Question 15

What is the only clinical sign that is strongly a/w a synchronous airway lesion

Answer 15

Cyanosis

Question 16

How can one dx exercise-induced laryngomalacia

Answer 16

With exercise flow-volume spirometry

Question 17

What is the typical appearance of a type I posterior laryngeal cleft

Answer 17

Soft tissue defect in the interarytenoid musculature w/o a defect in the cricoid cartilage

Question 18

What is the typical presentation of a child with a laryngeal cleft type 2 or greater

Answer 18

H/o aspiration, PNA, choking, coughing during feeds, and sx of airway obstruction

Question 19

What common cause of congenital airway obstruction is characterized by inspiratory stridor at birth that decreases when placed on the side of the lesion?

Answer 19

UVFP

Question 20

What is the significance of VF fixation in pts with laryngeal carcinoma

Answer 20

Invasion of the vocalis muscle has occurred and LN mets is more likely

Question 21

T/F: any laryngeal tumor with VF fixation is at least T3

Answer 21

True

Question 22

What are the 3 m/c presenting sx of hypopharyngeal CA

Answer 22

dysphagia, neck mass, sore throat (in descending order of incidence)

Question 23

How does one assess for involvement of the prevertebral fascia from a hypopharyngeal tumor

Answer 23

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.

Question 24

What is Schaefer’s classification system of laryngeal injuries

Answer 24

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.

Question 25

Which voice analysis gives a 3D representation of sound (time, intensity, frequency)

Answer 25

Spectogram

Question 26

Which voice analysis test plots minimums and maximums of loudness at selected levels of fundamental freq and reflects pt’s vocal capacity

Answer 26

Phonetogram

Question 27

Which voice analysis test graphs multiple vocal parameters at once and is very useful for showing changes over time

Answer 27

Multidimensional voice profile

Question 28

A pt c/o total aphonia yet generates sound with coughing. What is likely dx?

Answer 28

Psychosomatic conversion dysphonia