3 - Neurologic Disease Of The Larynx

Question 1

Lucian Sulica

Answer 1

Cornell

Question 2

Conclusion - Neuro disorders are a disorder of laryngeal movement

Answer 2

Exam must be performed across a number of laryngeal tasks:
Sustained phonation
Connected speech
Repetitive motion
Dysdiadochokinesis
Singing, whistling, etc

Question 3

Conclusion - Disease is usually systemic

Answer 3

Requires infraclavicular health issues exam:
General activity level
Facial expression
Cranial nerves
Articulation
Mental Status
UE Strength, rigidity, tremor
Gait

Question 4

Conclusion - Diagnosis is clinical

Answer 4

No lab or radiologic marker for disease

Redoubles importance of examination - close observation of phenomenology

Question 5

Hypofunctional Disorders

Answer 5

Peripheral neuropathy - most vocal fold paresis and paralysis
Neuromuscular junction disorders - Gillian Barre, MG
Myopathies
Parkinson’s
ALS

Question 6

Hyperfunctional Disorders

Answer 6

Dystopia
Tremor
Tics, Guilles de la Tourette Syndrome
Myoclonus
Choreas

Question 7

Voiced onset’s (eighties)

Answer 7

hard for SD

Question 8

Dystonia

Answer 8

Involuntary muscle contractions, frequently causing abnormal movement or posture
Idiopathic
May be slow, rapid or sustained
Aggravated by voluntary movement
Task-specific
Focal, segmental or generalized
Aggravated by stress & anxiety

Question 9

Spasmodic Dysphonia

Answer 9

Focal laryngeal dystonia
Task specific to voicing
Patterned:
Adductor - Involuntary glottic closure (83%)
Abductor - Involuntary glottic opening (17%)

Question 10

Botox

Answer 10

Prevents ACh release into synaptic cleft by cleaving SNAP25, so vesicles can’t fuse with presynaptic membrane

Question 11

Patient has breathy dysphonia with no scope in

Patient has normal phonation with scope in

Answer 11

Dystonia. Proprioceptive environment is changed, getting dystonia to release