Chapter 58 : Neurologic Disorders of the Larynx

Question 1

Cerebellar lesions impaire coordination of motor activities, what is the specific laryngologic finding for cerebellar involvement?

Answer 1

Scanning Speech (also known as staccato or explosive speech)

Question 2

Dystonia is defined as sustained contraction of skeletal muscles often involving twisting and repetitive movements. In cases of childhood-onset idiopathic dystonia, family study show _______ (autosomal vs X-linked and dominant vs recessive?) pattern of inheritance and is commonly seen in chromosome ___ (a number)

Answer 2

Autosomal- Dominant ; Chromosome number 9

Question 3

_____ is defined as an idiopathic focal dystonia of the larynx

Answer 3

Spasmodic dysphonia

Question 4

Which is more common Adductor or Abductor spasmodic dysphonia? A combination of the two is called what? In terms of symptoms match the ff with the appropriate type of dysphonia Adductor spasmodic dysphonia Abductor spasmodic dysphonia Match with A) Strained or Strangled voice B) Breathy voice breaks or Whispering voice

Answer 4

Adductor dysphonia Mixed Laryngeal Dystonia Adductor spasmodic dysphonia: Strained or Strangled voice Abductor spasmodic dysphonia: Breathy voice breaks or Whispering voice

Question 5

Rare form of laryngeal dystonia which patients adduct their vocal cords while inspiring?

Answer 5

Adductor breathing dystonia The glottic adduction causes stridor and sypnea but this is typically self-limited, does not cause hypoxia and does not warrant surgical airway management.

Question 6

The most effective management for symptoms of spasmodic dysphonia is chemodenervation with ______?

Answer 6

Botulism Toxin

Question 7

______ Syndrome is a regional dystonia of the head and neck and evident in those with blepharospasm, oromandibular dystonia, torticollis, or spasmodic dysphonia

Answer 7

Meige syndrome

Question 8

Mechanism of action of Botulinum Toxin? What is the most commonly used type of Botulinum Toxin used?

Answer 8

Effect on neuromuscular junction by inhibiting the release of acetylcholine, causing flaccid paralysis Botulinum Toxin Type A is most used in the market Botulinum Toxin Type B is also present.

Question 9

Specific muscle injected for adductor spasmodic dysphonia? How about abductor spasmodic dysphonia?

Answer 9

Adductor spasmodic dysphonia: Thyroarytenoid or Thyroarytenoid Ð vocalis muscle complex 0.05 to 20 units of botox for adductor spasmodic dysphonia via EMG Guided percutaneous injection. Abductor spasmodic dysphonia: Posterior Cricoarytenoid muscle

Question 10

This disease entity results from bilateral lesions of the corticobulbar tract resulting to muscle spasticity and hyperreflexia of the pharynx, palate, lips, tongue and larynx. Patients with this disease have specific signs of hypernasality as well as slow, labored articulation? VS This disease entity consists of rhythmic contractions of the soft palate, pharynx, larynx at a rate of one or two contractions per second. Examination reveals slow rhythmic adduction and abduction of the VF as well as a choppy voice and intermittent nasality? Choices: Myoclonus OR Pseudobulbar Palsy

Answer 10

This disease entity results from bilateral lesions of the corticobulbar tract resulting to muscle spasticity and hyperreflexia of the pharynx, palate, lips, tongue and larynx. Patients with this disease have specific signs of hypernasality as well as slow, labored articulation? Pseudobulbar Palsy This disease entity consists of rhythmic contractions of the soft palate, pharynx, larynx at a rate of one or two contractions per second. Examination reveals slow rhythmic adduction and abduction of the VF as well as a choppy voice and intermittent nasality? Myoclonus

Question 11

This specific disease entity causes involuntary purposeless rhythmic movement of a part of the body specifically 6-8 hz of shaking hands?

Answer 11

Essential Tremor The most active muscles are the Sternohypod and Sternothyroid muscles which rhythmically elevating and loweing the larynx

Question 12

In essential tremor, this finding pertains to rhythmic alterations in pitch and loudness?

Answer 12

Vocal tremor also known as tremulous voice, wavy voice, tremulous quavering speech

Question 13

This disease entity is defied as hyperfunctional posturing of the vocal folds causing tightness and dysphonia with harness, breathiness, choppy vocal production.

Answer 13

Muscle Tension Dysphonia It is primarily behavioral in nature but can be a compensatory strategy for a genuine disorder

Question 14

Acute bulbar polio causes pharyngeal and laryngeal paresis but specifically spares this muscle.

Answer 14

Cricopharyngeus muscle

Question 15

Specific tongue PE finding for Amyotrophic lateral sclerosis?

Answer 15

“Bag of worms” appearance in the tongue due to fasciculations.