Laryngology systemic diseases

Question 1

What is the most common subsite affected by laryngeal sarcoidosis?

Answer 1

Epiglottis

Question 2

True or False. Laryngeal sarcoidosis can occur in
isolation without evidence of disease elsewhere in
the body.

Answer 2

True (1 to 5%)

Question 3

What is the pathognomonic finding of laryngeal

sarcoidosis during laryngoscopy?

Answer 3

Diffuse pale, edematous enlargement of the supraglottis

Question 4

True or False: An ACE (angiotensin-converting
enzyme) level is the test of choice for diagnosing
sarcoidosis.

Answer 4

False. An ACE level is useful for monitoring disease in
patients with sarcoidosis but is not recommended as a
diagnostic test due to low sensitivity (60%).

Question 5

What percentage of patients with granulomatosis
and polyangitis (Wegener) will develop subglottic
stenosis?

Answer 5

10 to 20%

Question 6

What are the expected biopsy findings in a patient

with granulomatosis with polyangiitis (Wegener)?

Answer 6

Necrotizing granulomas and necrotizing vasculitis of small

arteries, arterioles, capillaries, and venules

Question 7

In a patient with symptomatic subglottic stenosis
secondary to granulomatosis with polyangiitis
(Wegener), what will be found on flow-volume
loops during pulmonary function testing?

Answer 7

Flattening of both inspiratory and expiratory phases,

indicating a fixed airway obstruction

Question 8

What site within the larynx is most commonly

affected by amyloidosis?

Answer 8

The true and false cords and the ventricles

Question 9

What is the most common type of amyloid protein

deposit found in the larynx?

Answer 9

Amyloid light chain

Question 10

What autoimmune disorder results in episodic,
severe, and progressive inflammation of cartilage
most commonly within the ears, nose, and
laryngotracheobronchial tree?

Answer 10

Relapsing polychondritis

Question 11

What is the mechanism of respiratory distress in relapsing polychondritis?

Answer 11

Two mechanisms are possible: airway narrowing secondary
to fibrosis or airway collapse secondary to cartilage
destruction and fibrosis.

Question 12

What is the most common manifestation of airway

involvement in relapsing polychondritis?

Answer 12

Tracheobronchomalacia

Question 13

What percentage of patients with rheumatoid
arthritis develop cricoarytenoid joint involvement
(i.e., arthritis, ankylosis, etc)?

Answer 13

25 to 30%. May also see cricothyroid joint dysfunction or
rheumatoid nodules on the true vocal folds, but these are
less common in the literature. May see tenderness on
palpation of the larynx.

Question 14

What percentage of patients with rheumatoid
arthritis have radiologic evidence of cricoarytenoid
joint involvement?

Answer 14

54 to 72%. The most common findings on CT are
cricoarytenoid prominence, density and volume change,
subluxation, decreased joint space, and pyriform sinus
narrowing. However, radiologic involvement does not
always correlate with symptoms.

Question 15

How is cricoarytenoid joint dysfunction associated

with rheumatoid arthritis treated?

Answer 15

Mild symptoms: High-dose corticosteroids or immune
modulating medications used for rheumatoid arthritis. If
this fails, corticosteroid injection of the cricoarytenoid joint
can be considered. For acute airway obstruction (rare), consider tracheostomy, arytenoidectomy, or arytenoidopexy.