Upper Airways and Larynx

Question 1

Major functions of the larynx

Phonation

Answer 1

1) Phonation = production of primary vocal tone at vocal folds–> vocal quality modified by resonation through upper airway and sinonasal tract and articulated into speech

Question 2

Major functions of the larynx

Respiration and swallowing

Answer 2

Airway patency and protection

–> normal swallowing = laryngeal elevation, posterior deflection of epiglottis, closure of true and false vocal folds to prevent aspiration

Question 3

Major functions of the larynx

Valsalva

Answer 3

Incr pressure against tightly closed glottis –> cough, straining, throat clearing

Question 4

5 Layers covering vocal folds

Answer 4

1) epithelium
2) superficial lamina propria
3) intermediate lamina propria
4) deep lamina propria
5) vocalis muscle (medial thyroarytenoid)

Question 5

Movement of mucus through epithelium

Answer 5

1) moved by cilia from trachea to post glottis
2) pushed over nonciliated margin to ciliated ant commissure

Question 6

Why are some diseases more prone to occur in post glottis (TB/Fungal?)

Answer 6

HPV tends to occur in glottis and supraglottis rarely unless you introduce epithelium
because HPV is epithelial disease

respiratory epithelium into squamous epithelium allows flow to become laminar
—> depends on whether vocal folds are together or separated

Question 7

Source of voice production

Vibratory production from where?

Resonance from where?

Answer 7

Pulmonary/infraglottic- diaphragm, intercostal musculature

laryngeal- extrinsic and intrinsic

supraglottic and oral phase

Question 8

Vib

Question 9

Anterior-posterior/infraglottic components

Answer 9

1) tracheobronchial tree, lungs thorax
2) Abdomen- support and expiratory
3) diaphrgam - inspiratory and singing
4) passive force = lungs and rib cage
5) accessory breathing = intercostals

Question 10

Purpose of abdominal support system- infraglottic

Answer 10

1) maintain efficient constant power source
2) inspiratory-expiratory

Question 11

how can msk hurt vocal production

Answer 11

1) small change in posture/stance significant
2) body tension in any muscle can make larynx compensate

Question 12

role of autonomic nervous system in vocal

Answer 12

1) ANS = muscus production and voice stability
2) fine muscular control at risk with symp stim

Question 13

Extrinsic muscles involved in vocal

outside of the trachea

Answer 13

Strap muscles- ansa cervicalis, C1-C3

hold larynx in neck for consistent sound

Question 14

changes in tension, position, tilt of extrinsic muscle changes resting length of ___

Answer 14

intrinsic muscles

Question 15

which muscles are key to vocal consistency

Answer 15

extrinsic muscles

Question 16

extrinsic muscles

infrahyoid

Answer 16

1) thyrohyoid
2) sternohyoid
3) sternothyroid
4) omohyoid

Question 17

Suprahyoid muscles

Answer 17

1) digastric
2) mylohyoid
3) geniohyoid
4) stylohyoid

Question 18

Most important vocal cartilages

functions of each

Answer 18

1) thyroid = open in posterior position
2) cricoid = only complete ring in airway = anatomic limit to size of airway = larger in back than in front
3) paired arytenoids = sit on cricoarytenoid joint

connected by soft tissue to change angles/distances/shape/tension via thyrohyoid membrane and cricothyroid ligament

Question 19

function of intrinsic muscles

where is it located a

what is bulk of vocal fold

most important muscle in larynx is =

Answer 19

control actual motion of larynx

in between thyroid and cricoid and arytenoids

bulk of vocal fold = thyroarytenoid muscle

posterior cricoarytenoid muscle = contracts and pulls vocal folds together

Question 20

vocal fold central innerv

what is role of nervous system

Answer 20

Cerebral cortex

1) speech area of temporal cortex
2) voice area of precentral gyrus
3) corticobulbar tract
4) nucleus ambiguus
5) cranial nerve X and spinal cord

6) coord laryngeal muscles, sensation, and musculature

Question 21

innervation of vagus nerve

innervation of superior laryngeal nerve

• internal
• external

innerv of recurrent laryngeal nerve

Answer 21

1) vagus nerve = meducalla to jugular foramen
2) internal = sensation to supraglottic = incr sensitivity in people with sensitive cough

external = motor to cricothyroid muscle = stretches vocal fold to incr pitch

3) all intrinsics except cricothyroid=

more recurrent on left than right
starts in brain and ends in thyroid

incr sensitivity = incr likelihood of lung or thyroid cancer

Question 22

development of

C3-C4

C6

C7

when?

Answer 22

C3-C4 = birth

C6= 5 y/o

C7 = 15-20 y/p

Question 23

Descent of larynx leads to ____

with aging, more ___

Answer 23

lower vocal pitch

more descent

Question 24

function of vibrator

Answer 24

1) air from bottom
2) opens folds apart
3) pressure incr, and pulls vocal folds together

Question 25

Components of supraglottic - resonance

function?

Answer 25

supraglottic larynx, lips, teeth, tongue, palate, pharynx, nasal cavity, sinuses

!!!!All shape sound quality (resonance)

Question 26

what happens if you have edema from URI, scarring, or muscle tension

Answer 26

decr resonance

Question 27

how can we change frequencies of resonance?

Answer 27

changing shape of vocal tract

(jaw, tongue, lips, nasopharynx)

Question 28

Shorter vocal tract lengths means ___

Answer 28

higher fundamental frequencies

children and female higher

Question 29

Definitions of hoarseness

Answer 29

Hoarseness = abnormal voice changes, breathy, raspy, strained, weak
vocal tremor,strained, altered pitch

Question 30

Definition of dysphonia

usually a __ source

Answer 30

§general alteration of voice quality. (tremulous, muscle tendon…)

Usually a laryngeal source

Question 31

Definition of dysarthria

usually a ___ source

Answer 31

defect in rhythm, enunciation, articulation.

Usually a neurological or muscular source

Question 32

Definition of stridor

Definition of stertor

Answer 32

§Stridor = large airway noise from obstruction
Stertor = snoring sound from nose, nasopharynx

Question 33

Definition of wheezing

Answer 33

pulmonary from smaller airways

Question 34

causes of inspiratory stridor

expiratory stridor

biphasic stridor

Answer 34

§Inspiratory – supraglottic, extrathoracic = fixed obstructive mass above thoracic cavity; vocal cord dysfunction = when breathe in, close glottis
§Expiratory – tracheal, large bronchi intrathoracic = lower lesion
§Biphasic – laryngeal, immediate subglottis = narrowest point in airway so if stridor never goes away; air flow is turbulent = concerning for significant obstruction

Question 35

type of stridor assoc with?

supraglottic, extrathoracic
tracheal, large bronchi intrathoracic
laryngeal, immediate subglottis
§

Answer 35

inspiratory

expiratory

biphasic

Question 36

radiologic sign of inspiratory stridor

Answer 36

thumb sign

Question 37

most common causes of hoarseness

Answer 37

1) acute viral laryngitis
3) chronic reflux

Question 38

when should you see ENT for hoarseness

Answer 38

> 2-3 weeks

assoc with 1) pain, (ear radiation normal), 2) hemoptysis, 3) neck lump 4) complete loss of voice 5) difficulty swallowing with weight loss

Question 39

work up for immobile vocal folds

Answer 39

1) nerve path, CT scan of skull base through aortic arch with contrast
2) laryngeal EMG

Question 40

define laryngopharyngeal reflux

Answer 40

LPR = escape of stomach acid from stomach into esophagus through LES

–> reach larynx, oral cavity, lungs

Question 41

how to treat paralyzed vocal fold

Answer 41

1) thyroplasty
2) injection, medialization

Question 42

concerns with laryngopharyngeal reflux?

Answer 42

1) hoarseness
2) chronic cough
3) foreign body sensation (globus)

4 ) tracheal stenosis

5) chronic ear disease or sinusitis

Question 43

Symptoms of laryngopharyngeal reflux

Answer 43

1) bad breath or bitter taste in a.m.

2) a.m. hoarseness or after meals
3) sensation of a lump in the throat (globus)
4) sensation of post-nasal drip but no nasal issues
5) heartburn not always present

Question 44

if patient presents with

§bad breath or bitter taste in a.m.
§a.m. hoarseness or after meals
§sensation of a lump in the throat (globus)
§sensation of post-nasal drip but no nasal issues
§heartburn not always present

Answer 44

laryngopharyngeal reflux

Question 45

laryngeal manifestations of GERD

Answer 45

1) voice complaints
2) > 70% asymptomatic singers have signs on examination
3) > 40 y/o

Question 46

Primary treatment of laryngeal cancer

paradigm change?

Answer 46

primary = chemorads

laryngectomy saved for salvage only

Question 47

___ if hoarsneess lasts 2-3 weeks

Answer 47

Reflux

Question 49

Character of Hoarseness

Hoarseness is a ____ not a diagnosis

a very breathy voice could indicate ___

a weak monotonous quality indicates ___

define voice quality (characters)

Answer 49

1) symptom
2) paralyzed vocal fold
3) neurologic = Parkinson’s
4) hoarse, rough, weak, abnormally low/high pitched

Question 50

if a patient has breathy dysphonia with abnormally high pitched quality ____

if patient has mild-mod hoarseness to complete aphonia _____

if patient has weak “old person quality” with or without tremor ____

if patient has severe hoarseness that fluctuates with voice usage ____

if patient has hoarse and low-pitched for gender ____

if patient has moderate to severe hoarseness for weeks ____

Answer 50

1) vocal cord paralysis
2) larynx cancer
3) presbyphonia (vocal fold atrophy)
4) vocal fold polyp/nodule
5) benign smoker’s polyp
6) acute laryngitis

Question 51

Speech disorders

1) rare neuro disorder that causes changes in intensity, timing of segments, rhythm, cadence
2) difficulty producing specific sounds (what are subtypes)
3) impaired function of larynx or vocal resonance
4) weak or paralyzed speech muscles
5) caused by stroke or neuro; incosistent production of speech osunds and rearranging of sounds

Answer 51

1) dysprosody
2) speech sound disorders - articulation and phonemic
3) voice disorders
4) dysarthria
5) apraxia

Question 52

speech disorders= describe

1) dysprosody
2) speech sound disorders - articulation and phonemic
3) voice disorders
4) dysarthria
5) apraxia

Answer 52

1) rare neuro disorder that causes changes in intensity, timing of segments, rhythm, cadence
2) difficulty producing specific sounds (what are subtypes)
3) impaired function of larynx or vocal resonance
4) weak or paralyzed speech muscles
5) caused by stroke or neuro; incosistent production of speech osunds and rearranging of sounds

Question 53

Mechanism of voice production

Answer 53

1) in and out breathing laminar flow
2) at glottis becomes rhythmic
3) becomes pitches and freq

Question 54

what drug do you use if person’s voice quivers or spasms on stage?

Answer 54

use beta blockers

Question 55

nDescribe croup

Answer 55

airflow gets skinny for long time (inflammed airway below glottis)

Question 56

Vocal nodules due to …

Answer 56

calluses = talking too muc

treated by speech or if become fibrotic then go surgery

Question 57

Causes of inspiratory stridor

Answer 57

1) laryngomalacia = soft cartilage of upper larynx collapses inward during inhalation —> obstruction
2) epiglottitis = swollen infectious epiglottis
3) epiglottic cancer = biphasic fixed mass

Question 58

Causes of biphasic stridor

Answer 58

1) patient intubated for long period of time –> tube in airway
and develop granulation tissue around so can’t open

2) croup = airflow gets skinny for long time

Question 59

Describe:

1) vocal fold cysts

Answer 59

1) created by surgery with layer of squamous epithelium enters or from trauma
2) after screaming so much; treat with speech

3)