Laryngology Flashcards
Approximately what percent of patients with bilateral vocal cord paralysis never require tracheostomy?
50%.
In what percent of patients with bilateral vocal cord paralysis is decannulation possible after one of these procedures?
70%.
When is medialization thyroplasty appropriate for the treatment of vocal cord paralysis?
Any stable, definitive paralysis in a patient without surgical contraindications.
What substances can be used for temporary vocal cord medialization?
Autologous fat, Gelfoam, collagen, and micronized Alloderm.
What are the advantages of performing this procedure under local?
Desired voice quality can be precisely obtained and airway can be continually evaluated.
What are the indications for endolaryngeal stenting after open repair of laryngeal injuries?
Disruption of the anterior commissure; multiple displaced cartilage fractures; and multiple, severe lacerations.
What symptom, other than hoarseness, is most likely to be improved by medialization thyroplasty and arytenoid adduction?
Dysphagia.
What are the two primary techniques of laryngeal reinnervation?
End-to-end anastomosis of the recurrent laryngeal nerve to the ansa hypoglossi or nerve-muscle pedicle flap to the thyroarytenoid muscle (using the ansa and a small piece of strap muscle).
What is the most likely cause of prolonged dysphonia and vocal fold stiffness after surgery for Reinke’s edema?
Excessive suctioning of the superficial lamina propria.
True/False: Previous Teflon injection is a contraindication to medialization thyroplasty.
False.
True/False: When injecting Teflon in the vocal fold, it should be placed as far medially as possible.
False: It should be placed as far laterally as possible.
What is the most common immediate complication after repair of laryngeal injuries?
Granulation tissue.
What is the most common complication after insertion of a Blom-Singer indwelling voice prosthesis?
Granulation tissue.
What is the primary disadvantage of the indwelling voice prosthesis compared with the nonindwelling prosthesis?
Higher rate of fungal colonization.
Which laryngoscopes are best for visualizing the anterior commissure or the subglottis?
Holinger and Benjamin.
A 69-year-old man with terminal lung cancer has severe hoarseness secondary to left vocal cord paralysis. What would be the best treatment option?
Left vocal cord medialization with Teflon paste.
What are the four main categories of procedures for unilateral vocal cord paralysis?
Medialization thyroplasty, arytenoid adduction, intracordal injection, and laryngeal reinnervation.
What would be the best treatment for a 6o-year-old woman who experiences severe dysphagia and aspiration after removal of a high right vagal schwannoma?
Right medialization thyroplasty, arytenoid adduction.
What is the optimal treatment for presbylaryngeus?
Speech therapy for 1year; if that fails, then bilateral medialization thyroplasty.
Into which plane is the implant placed during medialization thyroplasty?
Subperichondrial.
What is the aim of laryngeal reinnervation?
To prevent atrophy of the thyroarytenoid muscle.
What is the aim of arytenoid adduction?
To pull the muscular process of the arytenoid laterally, resulting in adduction and lowering of the vocal process.
What are five ways to restore the airway in patients with bilateral vocal fold paralysis?
Tracheostomy, stitch lateralization of the arytenoid(s), laser arytenoidectomy, unilateral or bilateral laser cordectomy.
True/False: Arytenoid adduction is contraindicated for the treatment of presbylaryngeus.
True: Arytenoid adduction is contraindicated in any patient with mobile vocal folds.
Surgical disruption of which layer of the vocal cord is most likely to lead to vocal fold scarring?
Vocal ligament (highest amount of collagen and fibroblasts).
Under what anatomic conditions is medialization laryngoplasty most efficacious in the treatment of vocal fold scarring?
When arytenoids are mobile, glottic gap is >1.5 mm, and soft tissue deficiency is confined to the anterior 1/3 of the vocal fold.
In what % of patients with bilateral vocal cord paralysis is decannulation possible after one of these procedures
90%
What is the incidence of mediastinitis after diverticulectomy
What is the normal size (height) of the saccule
15 mm in 8°/o.
What % of patients with long-term tracheostomies are colonized with Pseudomonas
>60%.
What % of patients with esophageal stricture will develop esophageal cancer
1 -4%.
What are the 3 stages of injury after caustic ingestion
- Necrosis, bacterial invasion, sloughing of the mucosa. 2. Granulation tissue and reepithelialization (day 5 - several weeks). 3. Scar formation and contraction.
What is the starting dose of botulinum toxin for treatment in a patient with harsh, strained voice with intermittent pitch breaks and glottal fry
1.0 - 2.5 MU into each thyroarytenoid muscle if administering bilaterally; 5 - 30 MU if administering unilaterally.
What % of cases of SO are familial
12%.
What % of laryngectomy patients who fail voice restoration following tracheoesophageal puncture (TEP) suffer from cricopharyngeal spasm
12%.
In what age groups is caustic ingestion most common
18 - 24 months, 20 - 30 years.
What is the incidence of tracheoinnominate fistula after tracheostomy
2%.
What is the tracheal wall mucosal capillary pressure
20 - 30 mm Hg.
What % of patients with glottic insufficiency will attain complete closure after voice therapy
20%.
When is the ideal time to perform endoscopy after ingestion
24 - 48 hours post-ingestion.
What does medical management of laryngeal injuries consist of?
24 hours or more of airway observation, voice rest, elevation of the head, humidified air, H2 blockers, steroids; antibiotics if lacerations are present.
What % of patients with tracheoinnominate fistulae survive
25%.
What is the lethal dose of botulinum toxin for humans
2500 to 3000 MU.
What is the starting dose of botulinum toxin for treatment in a patient with a breathy, hypophonic voice with abnormal whispered segments of speech
3.75 MU into the most active posterior cricoarytenoid muscle.
What is the mortality from colon interposition
4- I 5%.
What % of patients with unilateral vocal cord paralysis require surgical treatment
40%.
After 3 months of voice therapy, what % of benign vocal cord lesions will reduce in size or resolve
46% will reduce in size and 11 °/o will completely resolve.
Approximately what % of patients with bilateral vocal cord paralysis never require tracheostomy
50%.
What % of all instances of tracheal bleeding developing 48 hours or longer after surgery are caused by tracheoinnominate fistulae
50%.
What % of children with esophageal burns will develop esophageal stricture
7 - 15%.
What % of patients experience improvement in voice after nerve-muscle implantation
76%.
What % of patients without oropharyngeal burn will have evidence of esophageal injury
8 - 20%.
How many serotypes of botulinum toxin exist? Which is the most useful clinically
8 serotypes (A through G) with type A being the most useful.
What is the incidence of complications after PEG
9-15%).
What % of patients are eventually able to swallow well after this procedure
92%.
Voiceless consonants is suggestive of what disorder
Abductor SO.
What is a laryngocele
Abnormal dilatation of the laryngeal saccule.
What % of patients develop a granuloma after Teflon injection
About 35°/o.
How does the injury differ after ingestion of acidic substances versus ingestion of basic substances
Acidic substances cause coagulation necrosis; the eschar limits the depth of injury. Basic substances cause liquefaction necrosis and are likely to cause deeper injury.
What are the two types of spasmodic dysphonia (SO)
Adductor and abductor.
Which is more common
Adductor SO.
Which of these is characterized by a harsh, strained voice with inappropriate pitch breaks, breathiness, and glottal fry
Adductor SO.
The inability to sustain vowels during speech is suggestive of what disorder
Adductor SO.
When should PEG be performed when done as part of an oncologic resection
After the primary resection to avoid inadvertent spread of tumor cells to the gastrostomy site.
What factors are associated with the highest success with esophageal dilatation for treatment of strictures secondary to caustic ingestion
Age
Which drugs potentiate the effect of botulinum toxin
Aminoglycoside antibiotics.
When is medialization thyroplasty appropriate for the treatment of vocal cord paralysis
Any stable, definitive paralysis in a patient without surgical contraindications.
Where are vocal nodules most commonly located
At the junction of the anterior I /3 and posterior 2/3 of the vocal fold.
What substances can be used for temporary vocal cord medialization
Autologous fat, Gelfoam, collagen, micronized alloderm.
What is the test of choice for diagnosis of Zenker’s diverticulum
Barium swallow.
Where are internal laryngoceles located
Beneath the mucosa of the false vocal cord and aryepiglottic folds.
What is the best way to successfully restore the airway in a one-stage procedure in patients with bilateral vocal fold paralysis (other than tracheostomy)
Bilateral laser cordotomy.
What problems are seen in patients with vocal cord paralysis due to a brainstem disorder
Breathiness; pitch changes; chronic aspiration; VPI.
What are the typical features of abductor SO
Breathy, effortful hypnotic voice with abnormal whispered segments of speech.
When do most laryngoceles present
Can present at any time, but most commonly arise in the sixth decade of life.
What is the most significant early complication of this procedure
Cervical anastomotic leak (50%).
What is the most significant late complication of this procedure
Cervical anastomotic stricture ( 44% ).
What is the preferred method of treatment for SD
Chemical denervation with botulinum toxin.
Which patients are at a higher risk of pneumothorax after tracheostomy
Children.
What is the most common esophageal bypass procedure
Colon interposition.
What are the indications for esophageal bypass
Complete esophageal stenosis and failure to establish a lumen with dilatation. Irregularity and diverticuli of the esophagus. Mediastinitis secondary to dilatation. Fistula formation. Inability to maintain a lumen of 40 Fr or greater with dilatation. Patient intolerance of frequent procedures.
What is the best test to differentiate between cricopharyngeal spasm and stricture in patients who fail voice restoration following TEP
Contrast video fluoroscopy.
What are the signs of a tracheoesophageal fistula after tracheostomy
Copious secretions, food aspiration, and air leak around the cuff ‘with abdominal distension.
What test should be done if the history and physical exam do not explain the etiology of vocal cord paralysis
CT scan from skull base to A-P window.
Which complication is most likely to be avoided with endoscopic diverticulectomy versus open diverticulectomy
Damage to the recurrent laryngeal nerve.
How does the pattern of the EMG wave appear in the presence of a myopathy
Decreased amplitude, normal frequency.
How does the pattern of the EMG wave appear in the presence of a neuropathy
Decreased frequency with normal amplitude.
What effect does damage to the superior laryngeal nerve have on voice
Decreased range of pitch.
What accounts for vocal fold bowing observed with vocal fold paralysis
Denervation atrophy of the thyroarytenoid muscle.
What are the advantages of performing this procedure under local
Desired voice quality can be precisely obtained and airway can be continually evaluated.
What are the indications for endolaryngeal stenting after open repair of laryngeal injuries
Disruption of the anterior commissure, multiple displaced cartilage fractures, and multiple, severe lacerations.
After caustic ingestion, what sign is most likely to signal the development of a complication
Drooling.
What are the potential adverse effects of botulinum toxin injections into these muscles for treatment of blepharospasm
Due to diffusion of the toxin, ptosis, diplopia, epiphora, lagophthalmos.
What symptom, other than hoarseness, is most likely to be improved by medialization thyroplasty and arytenoid adduction
Dysphagia.
What are the most common manifestations of laryngopharyngeal reflux (LPR)
Dysphonia (71°/o), chronic cough (51°/o), globus (47%), chronic throat clearing (42%), dysphagia (35%).
Which types of laryngeal injuries are best managed medically
Edema; small hematoma with intact mucosa; small glottic or supraglottic lacerations not involving the free margin of the vocal cords or the anterior commissure and without cartilage exposure; single nondisplaced thyroid cartilage fractures.
How is the cricopharyngeus muscle identified with EMG
Electrical activity occurs at rest and diminishes or stops with swallowing.
What is the test of choice in the evaluation of caustic ingestion
Endoscopy.
What are the 2 primary techniques of laryngeal reinnervation
End-to-end anastomosis of the recurrent laryngeal nerve to the ansa hypoglossi or nerve-muscle pedicle flap to the thyroarytenoid muscle (using the ansa and a small piece of strap muscle).
What is the management of patients with evidence of grade 2 or 3 injury (transmucosal or transmural) on endoscopic exam
Esophageal rest (NPO), reflux precautions, +/steroids, +/antibiotics, +/- lathyrogens, +/subcutaneous heparin, +/- NGT, +/ prophylactic bougienage.
What is the most likely cause of prolonged dysphonia and vocal fold stiffness after surgery for Reinke’s edema
Excessive suctioning of the superficial lamina propria.
What are mixed laryngoceles
External laryngoceles with a dilated internal component.
T/F: Previous Teflon injection is a contraindication to medialization thyroplasty
False
T/F: During medialization thyroplasty, the resected fragment of thyroid cartilage should be replaced in its original position after graft insertion
False.
T/F: Cricopharyngeal myotomy as an adjunctive procedure to diverticulectomy has been shown to significantly decrease the incidence of recurrence
False.
T/F: When injecting Teflon in the vocal fold, it should be placed as far medial as possible
False; it should be placed as far lateral as possible.
What is the greatest advantage of bronchoscopic visualization during percutaneous dilational tracheostomy
Fewer major complications occur.
What kind of dystonia is spasmodic dysphonia
Focal.
What factors are thought to account for diminished responses to botulinum toxin
Formation of antibodies, high cumulative dose, drug interactions.
What condition would cause a tense sounding voice, vocal fatigue, and a prolonged closed phase with reduced vibratory and mucosal wave amplitude during videostroboscopy
Glottic hyperabduction dysphonia.
What are the contraindications to steroid use
Grade 3 burns, esophageal or gastric perforation.
What is the most common complication after insertion of a Blom-Singer indwelling voice prosthesis
Granulation tissue.
What is the most common immediate complication after repair of laryngeal injuries
Granulation tissue.
What is Schaefer’s classification system of laryngeal injuries
Group I: minor hematomas or lacerations, no fractures, and minimal airway compromise. Group I I: moderate edema, lacerations, mucosal disruption without exposed cartilage, nondisplaced fractures, and varying degrees of airway compromise. Group Ill: massive edema, mucosal disruption, displaced fractures, cord immobility, and varying degrees of airway compromise. Group IV: same as Ill but with 2 or more fracture lines and/or skeletal instability or significant anterior commissure trauma.
Which drugs limit the effect of botulinum toxin
Guanidine and aminopyridines.
What is the disadvantage of the indwelling voice prosthesis compared to the non-indwelling prosthesis
Higher rate of fungal colonization.
What is a MU
I M U is the dose required to kill 50% of a batch of mice.
Which type of vocal cord granuloma has the worst prognosis
Idiopathic.
What are the indications for panendoscopy in patients with vocal cord paralysis
If history, physical exam, CT scan, electrolytes, RPR, TFT’s do not reveal etiology.
What should be done for the patient who has ingested a battery
If the battery is still in the esophagus (confirmed by radiographs), immediate esophagoscopy is indicated. If it has passed into the stomach, it can be allowed to pass.
Your patient has a unilateral vocal cord paralysis after thyroidectomy for goiter. What are the indications for surgical intervention
If the paralysis is well tolerated (e.g. no aspiration and voice quality acceptable to the patient), 12 months is allowed for spontaneous recovery before proceeding with surgery. If the symptoms are severe, early surgery, typically a reversible procedure, is indicated.
What are the contraindications to percutaneous endoscopic gastrostomy
Inability to perform upper endoscopy safely; inability to transilluminate the abdominal wall; presence of ascites, coagulopathy, or intra-abdominal infection.
What are the characteristics of focal dystonias
Inappropriate and excessive efferent activity of motor neurons in small areas.
What would be the histologic findings on muscle biopsies at the site of botulinum toxin injections
Increased unmyelinated axonal sprouts; no change in muscle fibers histologically.
What is the significance of a “picket fence” pattern on E:M G
Indicates partial reinnervation (polyphasic action potentials).
If the vocal cord is in the paramedian position, why is aspiration less likely
Indicates that the superior laryngeal nerve is intact, and hence, laryngeal sensation is intact.
What is the mechanism of action of botulinum toxin
Inhibition of acetylcholine release from cholinergic nerve endings.
What can be done if symptoms persist after complete paralysis of the posterior cricoarytenoid
Inject the contralateral posterior cricoarytenoid muscle with very small increments of toxin or inject the cricothyroid muscle.
Compared to men, women have a significantly higher incidence of vocal cord granulomas caused by what
Intubation.
Which types of laryngeal injuries require open exploration and repair
Lacerations involving the free margin of the vocal cord or anterior commissure; large mucosal lacerations with exposed cartilage; multiple displaced cartilage fractures; avulsed or dislocated arytenoids; vocal cord immobility.
What are the contraindications to percutaneous dilatational tracheostomy
Large thyroid goiter or other neck mass, marked obesity, coagulopathy, previous neck surgery, neck trauma including bums, and inadequate access to the trachea.
What is the most common congenital anomaly of the larynx
Laryngomalacia.
What position will the vocal cord be in if the nerve is damaged at or above the nodose ganglion
Lateral.
In patients with unilateral vocal cord paralysis, which side is most commonly involved
Left.
What are the physical findings of type 2 sulcus vocalis or “sulcus vergeture”
Linear sulcus along the medial edge of the fold separating the superior and inferior lips of the membranous vocal fold by a rigid contracted band.
What are the operative and pathologic findings of patients with pathologic sulcus vocalis
Loss of superficial lamina propria and fixation of a thinned epithelium to underlying vocal ligament.
What muscles are injected when using botulinum toxin to treat oromandibular dystonia
Masseter, temporalis, medial and lateral pterygoid muscles.
What are the available treatments for cricopharyngeal dysphagia
Mechanical dilation, pharyngeal plexus neurectomy, cricopharyngeal myotomy, or botulinum toxin.
What are the 4 main categories of procedures for unilateral vocal cord paralysis
Medialization thyroplasty, arytenoid adduction, intracordal injection, and laryngeal reinnervation.
What syndrome is associated with blepharospasm
Meige’s syndrome.
What is the most useful stroboscopic parameter in differentiating a vocal fold cyst from a polyp
Mucosal wave.
What condition is characterized by generalized tension in all laryngeal muscles
Muscular tension dysphonia.
Breathiness that progressively worsens as the day wears on is classic for which autoimmune disease
Myasthenia gravis.
What disease does a fatiguing pattern on EMG suggest
Myasthenia gravis.
What precaution should be taken for a patient with a tracheostomy undergoing general anesthesia
Nitrous oxide should be avoided as it diffuses into the cuff and can increase the pressure by up to 40mm Hg. If it used during induction, the cuff should be deflated temporarily.
What is the management of patients with evidence of grade 1 injury (superficial) on endoscopic exam
No intervention; schedule for esophagogram in 3 weeks.
What is the most likely consequence of ingesting hair relaxer
No long-term sequelae.
What is the difference in impedance values and stimulus response thresholds between intramuscular needle electrodes and endotracheal tube-mounted surface wire electrodes for recording laryngeal muscle activity
No significant difference.
What effect does adductor laryngeal breathing dystonia have on the voice
None.
In which part of the world is Zenker’s diverticulum most common
Northern Europe.
Where are post-intubation granulomas typically located
On the vocal process of the arytenoid.
When is CT scan indicated in the evaluation of these patients
Only for group I and II patients where there is questionable fracture.
When is Teflon paste used
Only in patients who are terminally ill with a permanent vocal cord paralysis.
What are the onset, peak, and duration of effects of botulinum toxin
Onset 24 to 72 hours, peak effect at I 0 - 14 days, duration 3 - 6 months.
Which muscles are involved in blepharospasm
Orbicularis oculi, procerus, and corrugator supercilii.
What is adductor laryngeal breathing dystonia
Paradoxical adduction of the vocal folds during inspiration, causing inspiratory stridor that worsens with exertion and disappears during sleep.
What are the 4 etiologies of vocal cord immobility
Paralysis, synkinesis, cricoarytenoid joint fixation, and interarytenoid scar.
What position will the vocal cord be in if the nerve is damaged below the nodose ganglion
Paramedian, due to innervation from the superior laryngeal nerve.
What effect does tracheostomy have on the incidence of pneumonia
Patients on a ventilator are at a higher risk of pneumonia after tracheostomy and also tend to develop more serious pneumonias (Pseudomonas) secondary to antibiotic resistance.
How do laryngoceles become external
Penetrate the thyrohyoid membrane at the site of entry of the superior laryngeal artery and nerve.
What are some examples of lathyrogens
Penicillamine, beta aminopropionitrile, N-acetylceptine.
How is injection into the cricothyroid muscle accomplished, and how is proper placement confirmed
Peroral route; confirm by having the patient sing an ascending scale and observing an increase in EMG activity as the pitch increases.
What are the risk factors for innominate artery rupture after tracheostomy
Placement of trach below the 3rd ring; aberrant course of the innominate artery; use of a long, curved tube; overhyperextension of the neck during the procedure; prolonged pressure by inflated cuff; and tracheal infection.
What is the most common cause of mortality in pediatric patients who undergo tracheostomy
Plugging or accidental decannulation in children
What pathologic changes occur in the larynx as a result of G ERD
Polypoid corditis (Reinke’s edema), posterior glottic and arytenoid edema/erythema.
Which muscle is responsible for abductor SD
Posterior cricoarytenoid muscle.
Which of these is most common
Posterior glottic edema.
What distinguishes type 1 or physiologic sulcus from pathologic sulcus
Preservation of vocal cord vibratory activity on videostroboscopy, signifying intact superficial lamina propria (Type I).
Once the ABC’s have been stabilized, what is the acute management of caustic ingestion injury
Prevent ongoing injury with irrigation of eyes, skin, and mouth, +/flushing of the esophagus and stomach with water or milk
What are the clinical criteria for pediatric decannulation
Recovery from the original indication for tracheotomy, cessation of mechanical ventilation for at least 3 months, minimal present oxygen requirement, and an absence of frequent pulmonary infections or severe swallowing dysfunction.
What is felt to be the safest way to address severe esophageal strictures with dilatation
Retrograde technique using Tucker dilators over a guide string.
What would be the best treatment for a 60-year-old woman who experiences severe dysphagia and aspiration after removal of a high right vagal schwannoma
Right medialization thyroplasty, arytenoid adduction.
Why should all patients with history of caustic ingestion be followed for life with repeated esophagograms and endoscopy
Risk of SCC A of the esophagus is 1 000 times that of the general population.
What are the features of type 3 sulcus vocalis
Severe dysphonia, vocal fold stiffness, and a medial pit-shaped sulcus.
What are the features of a denervation pattern on EMG
Sharp waves or fibrillation potentials, complex repetitive discharges, and little or no electrical activity during attempts at voluntary contraction.
What are the primary advantages of endoscopic versus open resection for Zenker’s diverticulum
Shorter operative time with no significant difference in complication rate: absence of skin incision; minimal postoperative pain; quicker resumption of oral feeding; shorter hospital stay.
What factor is most important regarding the risk of surgical complications in patients undergoing Zenker’s diverticulectomy
Size of the diverticulum.
What are the primary limitations to endoscopic diverticulectomy
Size of the sac; difficult to perform in very small or large sacs ( 10 cm); limitations in access due to anatomic factors (ie, inability to extend the neck or limited jaw excursion).
Which types of laryngeal injuries are more common in children than adults
Soft tissue injury with edema, arytenoid dislocation, and recurrent laryngeal nerve injury; telescoping injuries where the cricoid becomes displaced under the thyroid.
What is the optimal treatment for presbylaryngeus
Speech therapy for I year; if that fails, then bilateral medialization thyroplasty.
What is the significance of a denervation pattern 1 year after injury
Spontaneous recovery is very unlikely.
Where is the most likely site of injury after ingestion of an acidic caustic agent
Stomach.
What are the adverse effects of posterior cricoarytenoid injections
Stridor (particularly with exertion), airway compromise, dysphagia and aspiration.
What injuries are more commonly associated with laryngotracheal separation than with other laryngeal injuries
Subglottic stenosis and bilateral recurrent laryngeal nerve injury.
Which area of the larynx is involved in Wegener’s granulomatosis
Subglottis.
Into which plane is the implant placed during medialization thyroplasty
Subperichondrial.
What are lathyrogens
Substances that interfere with the cross-linking of collagen.
Where is Reinke’s edema located
Superficial layer of the lamina propria.
Which area of the larynx is involved in sarcoidosis
Supraglottis.
What are the 2 most common causes of vocal cord paralysis in adults
Surgical trauma (#I ), and lung cancer (#2).
Subcutaneous emphysema may prelude what condition after tracheostomy
Tension pneumomediastinum.
What is the premise behind pursuing long-term dilatation therapy
The native esophagus is the best esophagus.
What is the difference in using the right versus left colon
The right colon is interposed in an isoperistaltic fashion whereas the left colon is interposed in an antiperistaltic fashion.
Why are they commonly located there
This is the point of maximum velocity of the vocal cords during forceful adduction.
Which laryngeal muscles are typically analyzed with EMG
Thyroarytenoid and cricothyroid muscles.
Which muscles are responsible for adductor SD
Thyroarytenoid and lateral cricoarytenoid muscles.
What structure is most likely to be fractured after blunt trauma to the anterior neck
Thyroid cartilage.
What is the primary purpose of laryngeal EMG in patients with vocal cord paralysis
To distinguish paralysis from mechanical fixation.
What is the aim of laryngeal reinnervation
To prevent atrophy of the thyroarytenoid muscle.
What is the aim of arytenoid adduction
To pull the muscular process of the arytenoid laterally, resulting in adduction and lowering of the vocal process.
What should be done if the posterior tracheal wall is disrupted during tracheostomy
Tracheostomy tube should be replaced with an endotracheal tube.
What are some of the surgical options for treatment of bilateral vocal cord paralysis
Tracheostomy, horizontal cordotomy, arytenoidectomy, lateral cordotomy.
What are two ways to deliver botulinum toxin to the posterior cricoarytenoid muscle
Transcricoid and retrograde (rotating the larynx away from the side of injection).
T/F: Greater duration of symptom control has been demonstrated with unilateral versus bilateral injections
True.
T/F: Inducing emesis and activated charcoal are contraindicated in the management of caustic ingestion
True.
T/F: Arytenoid adduction is contraindicated for the treatment of presbylaryngeus
True; arytenoid adduction is contraindicated in any patient with mobile vocal folds.
What is the best treatment for patients with type 2 sulcus
Undermining and segmental slicing (Pontes and Behlau).
In which patients is this most commonly seen
Untrained occupational and professional voice users.
How can one confirm placement of the needle in the posterior cricoarytenoid muscle
Using EMG guidance, have the patient snif.f.
What are the typical features of esophageal cancer occurring after esophageal stricture from burn injury
Usually SCCA, with onset 25 - 70 years post-injury, occurring within the scar tissue, with a lower incidence of distant metastases and higher chance of cure with surgical resection.
How is recovery of function accomplished
Via sprouting of new nerve terminals and an increase in the number of postjunctional receptors.
What are the risk factors for developing a vocal fold granuloma
Vocal abuse, GERD, prolonged intubation, trauma, surgery.
What are the physical findings in patients with muscular tension dysphonia
Vocal cord nodules, posterior glottic chink.
What are the clinical findings associated with pathologic sulcus vocalis
Vocal fold stiffness, fullness, edema, and bowing; capillary ectasia; and vibratory disturbances.
Surgical disruption of which layer of the vocal cord is most likely to lead to vocal fold scarring
Vocal ligament (highest amount of collagen and fibroblasts).
In which situations is medialization laryngoplasty most efficacious in the treatment of vocal fold scarring
When arytenoids are mobile, glottic gap is > 1.5 mm, and soft tissue deficiency is confined to the anterior I /3 of the vocal fold.
When is polysomnography indicated to determine readiness for decannulation in children
When the tracheotomy was performed due to a dynamic airway disorder (OSA, craniofacial anomalies, pharyngeal hypotonia).
When should open exploration be performed after injury
Within 24 hours.
How soon will deep mucosal ulcerations and exposure of tracheal cartilage occur when cuff-to-tracheal wall tension exceeds mucosal capillary tension
Within I week.
What muscles are injected when using botulinum toxin to treat hemifacial spasm
Zygomaticus major and minor, levator anguli oris, and risorius.
