Laryngology

Question 1

Most common pathogen in viral laryngitis

Answer 1

Rhinovirus

Can also see parainfluenza, RSV, adenovirus, flu, pertussis

Question 2

What are the clinical tools used to assess for LPR?

Answer 2

Reflux Symptom Index (RSI)

Reflux Finding Score (RFS)

Question 3

Where is tuberculous laryngitis typically located?

Answer 3

Posterior glottis (interarytenoids)

Question 4

Forms of chronic infectious laryngitis

Answer 4

Tuberculous laryngitis
Syphilitic laryngitis
Rhinoscleroma of larynx
Leprosy

Question 5

What can cause laryngeal chondritis?

Answer 5

Relapsing polychondritis (50% of RP pts)
Radiation
Infectious (TB, syphilis, septic laryngitis)

Question 6

What is the most commonly involved laryngeal cartilage involved in laryngeal chondritis?

Answer 6

Thyroid cartilage

Question 7

How do the various fungal laryngitis bugs look?

Answer 7

Candida: White plaques
Histo/Blasto: Ulceration
Coccidio: Nodule

Question 8

What are the benign laryngeal tumors?

Answer 8

Chondroma
Granular cell tumor
Recurrent respiratory papillomatosis

Question 9

Most common site in the larynx for a chondroma

Answer 9

Posterior cricoid cartilage (hyaline)

Question 10

Where do laryngeal granular cell tumors arise from?

Answer 10

Schwann cells in the posterior true vocal fold or arytenoids

Question 11

What is seen on histology of laryngeal granular cell tumors?

Answer 11

Pseudoepitheliomatous hyperplasia
(often confused for SCCa)

Question 12

Presentation of laryngeal sarcoid

Answer 12

Supraglottic submucosal mass

epiglottis most common

Question 13

Presentation of laryngeal GPA

Answer 13

Mucosal ulcerations

Subglottic mass/stenosis

Question 14

Presentation of laryngeal amyloidosis

Answer 14

Supraglottic mass covered by mucosa

Question 15

Which laryngeal joint is most commonly affected by RA?

Answer 15

Cricoarytenoid

Question 16

What laryngeal sites are involved in wegener’s, sarcoid, and amyloid?

Answer 16

Sarcoid: Supraglottis
Amyloid: Supraglottis
Wegener’s: Subglottis

Question 17

What should you have patients say if you believe them to have ADductor spasmodic dysphonia?
ABductor?

Answer 17

ADductor: 80-89
ABductor: 60-69

Question 18

Treatment for ADductor spasmodic dysphonia

Answer 18

Botox injection into the thyroarytenoid muscle

Question 19

How does a person’s voice change in response to hearing loss?

Answer 19

SNHL: Louder
CHL: Louder or sometimes quieter

Question 20

What causes diplophonia?

Answer 20

Recruitment of false cords or asymmetric mass

Question 21

What is seen on laryngoscopy in VCD?

Answer 21

Posterior glottic chink

Question 22

What type of stridor is heard with supraglottic obstruction?

Answer 22

Inspiratory

Question 23

What type of stridor is heard with glottic obstruction?

Answer 23

Inspiratory or biphasic

Question 24

What type of stridor is heard with subglottic obstruction?

Answer 24

Biphasic

Question 25

What type of stridor is heard with intrathoracic obstruction?

Answer 25

Expiratory

Question 26

What is the maximum trach tube cuff pressure?

Answer 26

25 mmHg Any higher will exceed capillary hydrostatic pressure.

Question 27

What is the most common pathogen in laryngitis?

Answer 27

Rhinovirus

Question 28

What is seen on FFL in tuberculous laryngitis?

Answer 28

Granulation and ulcerative tissue in posterior glottis. Typically interarytenoid.

Question 29

What non-classical infectious pathogens can infect the larynx?

Answer 29

``` H. flu (epiglottitis) Syphilis TB Leprosy Klebsiella rhinoscleromatis Candida, Aspergillus, endemic fungi ```

Question 30

What is the most commonly involved cartilage in laryngeal chondritis?

Answer 30

Thyroid cartilage

Question 31

What is seen on endoscopy in laryngeal chondritis?

Answer 31

Pale laryngeal mucosa

Question 32

What are the benign neoplasms of the larynx?

Answer 32

Chondroma Granular cell tumor RRP Vascular tumors (hemangioma, paraganglioma)

Question 33

Where is the most common site of laryngeal chondroma?

Answer 33

Posterior cricoid cartilage

Question 34

Where do laryngeal granular cell tumors arise?

Answer 34

Posterior portion of true cords; arytenoids

Question 35

From what do laryngeal granular cell tumors arise?

Answer 35

Schwann cells

Question 36

What is the risk of malignant degeneration in laryngeal granular cell tumor?

Answer 36

3%

Question 37

Why are laryngeal granular cell tumors sometimes confused with SCC?

Answer 37

They can induce pseudoepitheliomatous hyperplasia around their borders

Question 38

Where in the larynx can amyloidosis deposit?

Answer 38

Glottis & subglottis

Question 39

What causes hereditary angioedema?

Answer 39

C1 esterase inhibitor deficiency

Question 40

Acute treatment of hereditary angioedema

Answer 40

FFP C1 or kallikrein inhibitors Bradykinin receptor antagonist

Question 41

What are the causes of Reinke's edema?

Answer 41

``` LPR Smoking Hypothyroidism Vocal abuse Cough/throat clearing ```

Question 42

Where are laryngeal mucus retention cysts found?

Answer 42

Supraglottis

Question 43

What can cause a subglottic cyst?

Answer 43

ETT can obstruct a mucus gland Consider if stridulous after short, non-traumatic intubation

Question 44

What is seen on FFL in presbylaryngis?

Answer 44

VC bowing

Question 45

Where do vocal fold granulomas form?

Answer 45

Medial arytenoid near the vocal process Caused by vocal abuse

Question 46

Where do vocal fold nodules form?

Answer 46

Anterior-middle junction of TVF | Bilateral by definition

Question 47

What are the types of vocal fold polyps?

Answer 47

Mucoid | Angiomatous

Question 48

What should be suspected if voice worse than FFL suggests in a vocal abuser?

Answer 48

Sulcus vocalis

Question 49

What is the PPP rule?

Answer 49

In unilateral SLN injury, the Posterior commisure Points to the Paralyzed side

Question 50

On laryngeal EMG, what indicates good potential for recovery?

Answer 50

Polyphasic potentials

Question 51

On laryngeal EMG, what indicates poor potential for recovery?

Answer 51

Fibrillation potentials

Question 52

What is seen on FFL with SLN paralysis?

Answer 52

Bowing deformity | Cricothyroid responsible for VF tension

Question 53

What is seen on FFL with RLN paralysis?

Answer 53

Paramedian VF

Question 54

What infectious processes can cause VF immobility?

Answer 54

``` Lyme disease Syphilis EBV TB Viral ```

Question 55

How long does gelfoam last after injection medialization?

Answer 55

4-6w Must do 30% overcorrection for saline resorption

Question 56

How long does fat last after injection medialization?

Answer 56

6mo-1y

Question 57

How long does collagen last after injection medialization?

Answer 57

4-9mo

Question 58

How long does calcium hydroxyapatite (Radiesses voice) last after injection medialization?

Answer 58

Permanently

Question 59

How long does Radiesses voice gel last after injection medialization?

Answer 59

1-2mo Carrier only, no hydroxyapatite

Question 60

How long does Hyaluronic acid last after injection medialization?

Answer 60

6mo

Question 61

How long does micronized alloderm last after injection medialization?

Answer 61

6mo