upper airways

Question 1

Layers covering vocal folds

Answer 1

Epithelium, Superficial Lamina Propria, Intermediate Lamina Propria, Deep Lamina propria, Vocalis muscle (medial thyroarytenoid)

Question 2

Describe flow of mucus in upper airway

Answer 2

Flow is circular and posterior and from trachea to post glottis

Question 3

Components of voice production

Answer 3

Source: pulmonary/infraglottic- diaphragm, intercostal muscles. Vibratory production: Laryngeal – extrinsic and intrinsic muscles. Resonance -Supraglottic and oral phase

Question 4

Function of extrinsic muscles

Answer 4

Maintain position of larynx in neck and is essential for consistent sound. Changes tension, positoin and tilt. Changes resting length of intrinsic muscles

Question 5

Which muscles are the extrinsic muscles

Answer 5

Infrahyoid muscles (thyrohyoid, sternothyroid, sternohyoid, omohyoid) and suprahyoid muscles (digastric, mylohyoid, geniohyoid, stylohyoid)

Question 6

Anatomy of laryngeal skeleton

Answer 6

Thyroid, cricoid and paired arytenoid cartilages are connected by soft tissue to allow changes in angles, shape, etc

Question 7

Vocal fold innervation

Answer 7

From cerebral cortex: Speech area, voice area, corticobulbar tract, nucleus ambiguus, cranial nerve X and spinal cord. This Coordinates laryngeal muscles, sensation, abdominal musculature. Also vagus nerve and superior laryngeal nerve (sensation and motor to cricothyroid muscle) and recurrent laryngeal nerve (all intrinsic muscles but CT)

Question 8

Describe larynx position with development

Answer 8

Descent with age leads to lower vocal pitch. Cervical levels: Birth at C3-C4, 5 years at C6, 15-20 yrs at C7

Question 9

How do voice frequencies change with vocal tract length?

Answer 9

Shorter tract= higher fundamental frequencies. Adult male has a longer tract, thus lower frequencies

Question 10

Define hoarseness and what causes it

Answer 10

abnormal voice changes, breathy, raspy, strained, weak. Caused by viral laryngitis (acute), chronic reflux, vocal abuse, allergies, etc

Question 11

Define dysphonia

Answer 11

Dysphonia = general alteration of voice quality. Usually a laryngeal source

Question 12

Define dysarthria

Answer 12

Dysarthria = defect in rhythm, enunciation, articulation. Usually a neurological or muscular source

Question 13

define stridor. What is thumb sign

Answer 13

Stridor = large airway noise from obstruction. Inspiratory is from supraglottic or extrathoracic. Expiratory is from tracheal or large bronchi. Biphasic is from laryngeal or immediate subglottis (ie.croup). Thumb sign is seen on X ray with inspiratory stridor

Question 14

Define stertor

Answer 14

Stertor = snoring sound from nose, nasopharynx, throat

Question 15

define wheezing

Answer 15

Wheezing = pulmonary from smaller airways

Question 16

When to see otolaryngologist regarding hoarseness

Answer 16

If hoarseness lasts longer than 2-3 weeks. If hoarseness is associated with:
– Pain, note ear radiation possible
– Coughing up blood
– Difficulty swallowing
– A lump in the neck
– Complete loss or severe change in voice lasting longer than a few days If hoarseness lasts longer than 2-3 weeks. If hoarseness is associated with:
– Pain, note ear radiation possible
– Coughing up blood
– Difficulty swallowing
– A lump in the neck
– Complete loss or severe change in voice lasting longer than a few days

Question 17

Vocal fold cysts etiology, descriptoin, treatment

Answer 17

• Etiology – Trauma, previous injury • Hemorrhagic verses mucous– Recurrence • Treatment– Therapy, can require surgery • Reactive masses – The other side
– Often resolves with therapy• Etiology – Trauma, previous injury • Hemorrhagic verses mucous– Recurrence • Treatment– Therapy, can require surgery • Reactive masses – The other side
– Often resolves with therapy

Question 18

Vocal fold polyps etiology, description, treatment

Answer 18

• Etiology – Trauma, predisposition • Hemorrhagic verses fibrotic – affects how likely it is to resolve on own • Treatment – Usually requires surgical intervention for resolution

Question 19

granulomas etiology, treatment

Answer 19

• Etiology – Reflux – Vocal Abuse • Treatment – Correct abuses – Surgery /Botox

Question 20

Reinkes edema etiology and treatment

Answer 20

Edema and erythema. etiology- usually smoking. • Treatment – Correct cause – removal of excess material

Question 21

Vocal fold hemorrhage etiology, treatment and degree of resolution

Answer 21

• Etiology – Trauma may be mild (cough, one scream, etc..) • Treatment – Strict Voice Rest • Resolution – Depends on technique and individual healing – Usually complete

Question 22

Vocal fold tear etiology, treatment and degree of resolution

Answer 22

• Etiology – Trauma may be mild (cough, one scream, etc..) • Treatment – Strict Voice Rest • Resolution – Depends on technique and individual healing – Usually complete

Question 23

Sulcuses and webs definition

Answer 23

sulcus is groove in vocal fold. Web is anterior fusing of vocal fold. Can be congenital or traumatic.

Question 24

Presbyphonia and Vocal Fold Bowing cause, treatment, and prevention

Answer 24

cause: superior laryngeal paralysis can be cause. Treatment: increase vocal fold bulk with therapy or surgery. Prevnetion: good techniques and exercise

Question 25

Types of laryngeal trauma

Answer 25

Arytenoid dislocation from intubation or trauma, or cricothyroid joint injury

Question 26

Workup for suspected immobile vocal fold

Answer 26

CT scan of skull base through aortic arch with contrast and laryngeal electromyography (to differentiate btw paralysis and fixation)

Question 27

Laryngopharyngeal reflux

Answer 27

escape of stomach acids from the stomach into the esophagus through the LES. May reach the larynx, oral cavity and lungs

Question 28

Laryngopharyngeal reflux symptoms

Answer 28

Hoarseness, bitter taste, Chronic cough, Foreign Body sensation (globus), Tracheal Stenosis, Chronic ear disease?, Chronic sinusitis?

Question 29

Papilloma etiology and treatment

Answer 29

etiology: viral. Treatment: lifelong disease with transformation to cancer in some