Laryngology Flashcards
What is the only laryngeal aBductor?
Posterior cricoiarytenoid (PCA)
What muscle makes up the vocal FOLD body (vocalis)
Thyroarytenoid - deep to vocal ligament!
Vocal cord layers from superficial to deep?
Squamous epithelium, superficial lamina propria, vocal ligament (intermediate and deep lamina propria), thyroarytenoid
Components of stroboscopy grading (7)?
Mucosal wave, vibration, vertical phase, phase symmetry, regularity, adynamic segments, closure.
What is jitter and shimmer?
Jitter: Cycle to cycle variation in pitch/frequency
Shimmer: Cycle to cycle variatoin in amplitude
What are the components of the GRBAS scale?
Grade (overall severity)), Roughness, Breathiness, Asthenia, Strain
What hormone reduces LES pressure?
Glucagon
What is released by chief cells in the stomach and can cause refractory GERD?
Pepsin
What are the principle aDductors of the vocal cords?
Lateral cricoarytenoids (adduct and internally rotate arytenoid cartilage) and thyroarytenoid
What muscle is this and what is it innervated by?
Cricoarytenoid - External branch of superior laryngeal nerve
Which laser is preferred for respiratory papillomatosis?
-CO2 laser is main stay (and consider intralesional Cidofovir or Bevacizumab)
-BUT consider KTP laser for recurrent cases (less thermal damage to surrounding tissues)
Features of relapsing polychondritis?
Autoantibodies against type II collagen
Often have laryngeal dysfunction (cricoarytenoid joint especially affected) –> Hoarse, pain, cough, obstruction
Other sites: ears, nose, joints
Diagnosis: Clinical
TX: Steroids, immunomodulators
Site of:
Zenker’s Diverticulum
Killian-Jameson Diverticulum
Laimer Diverticulum?
Zenker: Between inferior constrictor and cricopharyngeas (Killian’s triangle)
Killian-Jameson: Between Oblique and Transverse cricopharyngeas fibers
Laimer: Between Cricopharyngeus and superior esophageal wall circular muscles
Esophageal Achalasia Features?
Degeneration of Aurbach’s plexus, failure of LES to relax
Bird’s beak on esophagram
TX: Botox or myotomy, can consider CCBs or nitrates to decrease LES pressure too.
CREST Syndrome (+ esophagram features)
Calcinosis, Raynaud’s, esophgeal dismotility, sclerodactyly, telangiectasia
Esophagram: dilated DISTAL esophagus, normal UES and LES
TX: Reflux regimen, CCBs (for Reynaud’s), can consider steroids
Diffuse esophageal spasm features?
Hih pressure non paristaltic contractions
Corkscrew esophaagus
Manometry: disorganized contractions
TX: Nitrates, Ca Channel Blockers
What histopath changes occur to vocal cords as they age?
INCREASE in collagen I and III,
DECREASE in Elastin
(i.e. VC stiffen with age)
What is laser an acronym for?
Light Amplification by Stimulated Emission of Radiation
Action of the cricothyroid muscle?
Increases length and tension of the vocal cord. Innervated by external branch of SLN.
Failure of what pharyngeal arch leads to a non recurrent RLN?
Failure of 4th pharyngeal ARCH (leads to a retroesophageal subclavian artery) –> non recurrent RLN
Sarcoidosis - what does it affect, histopath and TX?
Supraglottic thickening (i.. e. epiglottis), histopath shows NON necrotizing granulomas (non caseating) –> intralesional steroids
Other SX: Bilateral hilar lymphadenopathy, anterior uveitis, facial rash
AA women age 20-40
Wegener’s - what does it affect, hisopath and TX?
Subglottis, Necrotizing granulomas, Steroids…
ABductor spasmodic dysphonia:
Which muscle is affected?
How to diagnose?
TX?
-Posterior cricoarytenoid (only aBductor)
-Count 60-69 or “Harry’s Happy Hat” –> Breathiness (with consonents)
-Botox to PCA
ADductor spasmodic dysphonia:
Which muscle is affected?
How to diagnose?
TX?
-Thyroarytenoid or lateral cricoarytenoid
-Count 80-89 or “We eat eggs every easter) –> strain and breaks with vowels
-Botox to thyroarytenoid
SX of Parkinsons, specifically laryngeal signs and TX?
Low tone, soft/weak monotone voice, slurred, vocal tremor
Other: Tremor, shuffled gate, bradykinesia (mask like face)
TX: Lee Silverman Voice TX (helps with soft/weak voice
What do the following L EMG findings indicate?
Fibrillation potentials w/decreased activity?
Polyphasic action potentials?
Fatiguing?
Decreased frequency?
Decreased amplitude?
Fibrillation potentials w/decreased activity - Denervation (Fibrillation = FAIL)
Polyphasic action potentials - Reinnervation
Fatiguing - Myasthenia Gravis
Decreased frequency - Neuropathy (nerve cant get signal over to muscle as frequently)
Decreased amplitude - Myopathy (muscle isn’t working as well)
Do 1-6 months after injury
Vocal Tremor Features and TX
-Tremoring persists even with whispering
-Often have other tremors (hands, feet)
-TX: Beta blocker (primidone is 1st line), Botox to thyroartenoid (not first line)
What provides sensory to the subglottis? Supraglottis and glottis?
Subglottis: RLN
Supraglottis and Glottis: SLN
What is characteristic on LEMG for vocal cord paresis?
Large-amplitude polyphasic MUPs (due to the differing latencies of normal versus injured neurons) with incomplete recruitment.
What drugs increase LES pressure? Decrease?
INCREASE: Gastrin, Vasopressin,
DECREASE: Nitrates, CCBs, Glucagon, alcohol, chocolate, sedatives, nicotine
What does Dual PH probe test?
Tests LES and UES, allow differentiation between GERD and LPR, can be combined with impedance testing (can determine direction of flow and if reflux is acidic or not)
DeMeester score > 14.7 = abnormal
Polymyositis and Dermatomyositis Features, DX, TX?
PM: Idiopathic inflammation of striated muscle
DM: Variant with rashes, higher risk of malignancy
Associated with hiatal hernia, malignancies, vasculitis
SX: Hip/shoulder weakness, aspiration, upper 1/3 esophagus dysmotility, periorbital heliotrop rash (DM).
DX: EMG, muscle biopsy, increased CPK, LDH, liver enzymes
TX: Anti reflux, steroids, immunosuppressives
Mallory Weiss Syndrome VS Boerhave Syndrome?
MW: Incomplete tear from emesis (alcoholics), usually self limiting
Boerhaave: Rupture of ALL 3 layers of esophagus, severe SX (tachycardia, ches pain, subq emphysema, crunchy over heart (Hamman)
What is the most common benign and malignant esophageal tumor (and risk factor)?
Benign: Leiomyoma from muscularis
Malignant: Adenocarcinoma, main risk = Barrett’s
How do vocal cords lengthening/shortening affect pitch?
Lengthen/tense = INCREASED pitch
Shorten/relax = DECREASED pitch
