39. Larynx

Answer 1

layers of the vocal fold

Question 2

between the cricoid and cricotracheal ligament, or between tracheal rings

Answer 2

cricothyrotomy vs tracheostomy

Question 3

airway protection, speech, swallowing

Answer 3

function of the larynx

Question 4

appropriate vocal fold approximation, too loose leads to breathiness, too tight leads to strained voice, adequate expiratory force, control of length and tension, intact laye structure of lamina propria for mucosal mobility, adequate vocal fold bulk, vocalis muscle may become atrophic with aging, neuropathy, or disuse, resonance of the vocal tract

Answer 4

requirements for normal phonation

Question 5

quality of voice change as a change in sound, increased effort, or vocal fatigue, time course, contributing factors like trauma, intubation, systemic illness, GERD, allergy/rhinitis, neurological problems, medications like an inhaler, substance use like tobacco and alcohol, professional voice demands or vocal abuse

Answer 5

clinical evaluation of hoarseness

Question 6

cannot go down the esophagus, gets a view of the true vocal cords, trachea, vocal cords

Answer 6

flexible fiber optic aryncoscope

Question 7

sleeves, can be suspended,

Answer 7

direct laryngoscopy

Answer 8

videostrobe

Question 9

laryngitis, nodules, polyps, immobility/paralysis ***

Answer 9

benign disorders of the larynx

Question 10

etiologies often infectious due to laryngeal inflammation, typically indirect like coughing, noxious chemicals, angioedema, vocal trauma, allergy, irritants, treated with voice rest, hydration, cough suppressants, decongestatins for nasal obstruction, mucolytics, reflux medications, steroids

Answer 10

acute laryngitis

Question 11

globus, dysphona, dysphagia, chronic cough, throat clearing, mucous, diagnosis by resolution of symptoms with medication and lifestyle adjustments, flexible laryngoscopy findings, 24 hour pH probe, upper esophagoscopy, barium esophagogram, treatment with diet and behavioral modifications, H2 blockers and PPIs, and surgical management with fundoplication, posterior commisue hypertrophy, puffy with edema,

Answer 11

laryngopharyngeal reflux

Question 12

due to vocal abuse,phonating too loudly too much, severe coughing, raspy reduced vocal range, opposing polypoid massess middle portion of membranous vocal folds, typically conservative management with voice therapy, optimize irritants, and surgery

Answer 12

vocal cord nodules

Answer 13

vocla cord polyp

Question 14

unilateral or bilateral, almost always smoking related, treatment usually surgical, recurrence rate is high with continued smoking

Answer 14

reinke’s edema

Question 15

warty tumor, HPV, benign which can have malignant transformation, juvenile onset due to maternal transmission, adult onset is most likely from sexual transmission, treatment with surgery, opften repeat debridements due to nature as a recurrent disease

Answer 15

recurrent respiratory papillomatosis

Answer 16

leukoplakia

Question 17

most common symptom with dysphonia and vocal fatigue, treatment is observation, voice therapy, and augmentation

Answer 17

laryngeal paresis

Question 18

most often breathy voice and vocal fatigue, swallowing and aspiration, etiologies inlcude cancer, surgery like thyroidectomy or cardiothoracic surgery, central nervous system disease like stroke or multiple sclerosis, idiopathic, treatment is to imptove glottic closure

Answer 18

unilateral laryngeal paralysis

Question 19

respiratory distress with minimal impact on the voice, gold standard treatment is tracheostomy, posterior cordotomy, arytenoidectomy, reinnervation, etiologies are surgical, CNS, cancer, inflammatory like sarcoid, lyme, syphillis, mechanical fixation with posterior scarring and prolonged intubation

Answer 19

bilateral laryngeal paralysis

Question 20

intermittent involuntary spasms, unknown etiology, adductor is the most frequent, strained strangled voice with frequent voice breaks, often occurs with onset of words starting with vowels, abductor form has whispering or breathy voice, treatment is speech therapy or botox injection to thyroaryenoid muscle

Answer 20

spasmodic dysphonia

Question 21

episodic, inappropriate vocal cord adduction during inspiration, treatment is with speech therapy

Answer 21

paradoxical vocal cord dysfunction