Laryngology Flashcards
Match the bronchial arch with it’s laryngeal derivative:
A. Corniculate, arytenoid and cricoid cartilages; some laryngeal muscles;RLN
B. Upper body of hyoid bone and less cornu
C. Epiglottis, thyroid cartilage, cuneiform cartilages, pharyngeal constrictors, some laryngeal musculature, SLN
D. Lower body of hyoid and greater Cornu
A. V/VI
B. II
C. IV
D.III
Position of infant larynx related to cervical vertebrae vs adult
Infant: C1-C4
Adult: C4-C7 (by age 4)
Name intrinsic laryngeal muscles, function and innervation
- Cricothyroid: lengthens VF, external SLN
- Posterior cricoarytnoid: abducts, RLN
- Lateral cricoarytnoid: adducts, RLN
- Oblique arytenoid: adducts, RLN
- Transverse arytenoid: adducts
- Thyroarytnoid: relaxes, shortens and adducts; RLN
Describe sensation of the larynx
Internal branch of SLN above the glottis and RLN below glottis. Tip of epiglottis receives innervation from IX
Describe subtypes of laryngeal epithelium
- Supraglottis: pseudostratified columnar epithelium (respiratory epithelium)
- Glottis: stratified squamous epithelium
- Subglottis: pseudostratified columnar
- Lingual surface of epiglottis: stratified squamous
- Laryngeal surface of epiglottis: stratified squamous merging into pseudostratified columnar
Jitter
Cycle to cycle variation in frequency
Shimmer
Cycle to cycle variation in amplitude
GRABS scale
Grade Roughness Breathiness Asthenia (lack of power) Strain
0- no déficit, 1- mild, 2-moderate, 3- severe
Five aspects evaluated by stroboscopy
Symmetry - appearance of VFs, symmetry of motion of one VF compared to the other
Periodicity - regularity of glottic cycles
Amplitude- lateral excursion of mid membranous cord, should be ~1/3 width of true VF
Mucosal wave- movement of the SLP
Closure- VF coming together
Common side effects of PPIs
Abdominal pain, diarrhea, nausea, osteoporosis, elevated liver function tests, headache, candidiasis
Vocal fold nodules
Benign growth in the superficial layer of the anterior and middle third of the true vocal fold which can be either acute (edematous, erythematous, or vascular) or chronic (firm non-vascular secondary to scar deposition and fibrosis).
- Seen at midportion of membranous VF (where shearing and collisional forces are greatest)
- Bilateral
- Tx: speech therapy followed by surgical removal if continued poor voice and persist nodules after > 3months of therapy
Vocal fold Nodules versus polyps
Nodules: Always bilateral,
composed of inflammatory tissue, respond to voice rest, have a broad range of appearances
Polyps: Unilateral or bilateral, full of either gelatinous material or blood, typically do not respond to voice rest.
Treatment of choice for vocal fold hemorrhage
This is a laryngologic emergency and the treatment is 7 to 14 days of total voice rest with follow up to ensure resorption of blood and identify a varix that could be treated. If the blood has not resolved chordotomy and a evacuation of blood are indicated.
Vocal fold scar versus sulcus vocalis
Vocal fold scar: the lamina propria is replaced with abnormally fibrous and disorganized tissue.
Sulcus vocalis: the lamina propria has degenerated or disappeared leaving an epithelial lined depression down to the vocal ligament or deeper.
What benign lesion often occurs on the posterior vocal fold near the vocal process as either an ulcerative or nodular polypoid process?
Vocal fold granuloma
True or false the polypoid changes associated with Reinke Edema are permanent?
True however the degree of edema and turgidity may fluctuate with voice use and exacerbating factors
Intracortical vocal fold cysts
Usually arise within the superficial lamina propria (although can arise from the vocal ligament or epithelium). They may be open to the epithelium of the vocal fold and can be associated with a sulcus, they are also commonly associated with a contralateral nodule. Two types: mucous retention cysts (wax and wane) and epidermoid/Keratin cysts (fairly stable)
A cyst involving which branchial cleft may involve the larynx
Third branchial cleft
Laryngeal saccule
A blind sac between the false vocal fold and the thyroid cartilage, which opens into the anterior third of the laryngeal ventricle, is lined with ciliated respiratory epithelium and mucous glands. It is responsible for lubricating the vocal folds.
Anterior versus lateral saccular cysts
Anterior: Extend mediately into the laryngeal lumen between the true and false vocal folds
Lateral: Extends posteriorly and superiorly to involve the aryepiglottic fold
Laryngocele versus saccular cyst
Laryngocele: Air filled dilation of the saccule that communicates with the laryngeal lumen
Saccular cyst: Fluid filled dilation of the saccule that does not communicate with the laryngeal lumen
Internal versus external/combined laryngocele’s
Internal: Contained within the thyroid cartilage
External: Extends through the thyrohyoid membrane
Treatment of laryngeal saccular cyst vs laryngocele
Saccular cyst: marsupialization or complete Excision
Laryngocele: complete excision vía endoscopic or external approach.
-Marsupialization not recommended
What is a laryngopyocele and how is it managed?
A saccular cyst filled with purulent debris. Can be a surgical emergency. Secure and airway and drain and culture. Either at the time of drainage or after acute infection complete excision of cyst. Medical management of acute episode with IV antibiotics, antipyretics and steroids.