Upper Airways & Larynx

Question 1

How does the epithelial layer of the vocal cords differ from the rest of the pulmonary/respiratory system?

Answer 1

It has a mucosal layer. This actually makes it the “stop gate” of the respiratory system because the muscosal layer makes it the narrowest portion.

Question 2

Why can’t someone with a coughing fit or an asthma attack talk to you?

Answer 2

They can’t create a constant source for the noise, which is typically a constant stream of air that passes through the vocal folds.

Question 3

What are the 3 components of voice production?

Answer 3

Source (air), vibratory production (larynx), and resonance (supraglottic and oral phase).

Question 4

Why does a cold change your voice? What component of vocal sound is being changed?

Answer 4

Since the nose is stuffed there is no nasal resonance. The resonance component is being changed.

Question 5

T or F?

The thyroarytenoid muscles are the fasting twitching muscles in the body

Answer 5

False.

Second fastest. The eyes are faster, but the point is to remember that those muscles are moving a ton.

Question 6

Why does the larynx move up when you swallow?

Answer 6

To keep whatever you’re swallowing from getting into the airway.

We’re the only organism that shares a common airway and digestive opening.

Question 7

What is the only complete ring in the larynx?

Answer 7

The cricoid.

Question 8

What muscle is the only muscle to open the vocal folds?

Answer 8

The posterior cricoarytenoid muscle.

Question 9

What nerve and cancers should be considered when someone gets a hoarse voice?

Answer 9

Lung or thyroid cancers.

The nerve is the recurrent laryngeal nerve along the left side of the larynx that a mass can impinge upon.

Question 10

T or F?

The larynx is located relatively lower in the neck in children than in adults.

Answer 10

False

It’s located higher, gives them a higher pitch.

Men’s larynx elongates during puberty, make pitch even lower.

Question 11

What are the frequencies of men’s and women’s voices?

Answer 11

Men’s=150-200 Hz.

Women’s=200-300 Hz.

Question 12

Differentiate between dysphonia and dysarthria

Answer 12

Dysphonia=general alteration of voice quality. Laryngeal source.

Dysarthria=defect in rhythm. Basically it’s a neurological/muscular source (often after stroke)

Question 13

Someone has inspiratory stridor, what is most likely involved?

What about for expiratory stridor?

Both?

Answer 13

Inspiratory: Supraglottic, extrathoracic

Expiratory: Tracheal, Large bronchi intrathoracic

Biphasic: laryngeal, immediate subglottis. (Subglottic stenosis)

Question 14

You look at an X Ray image for a patient and notice a thumb sign around the neck. What is this indicative of?

Answer 14

Inspiratory stridor.

Question 15

What are the MOST COMMON causes for acute and chronic hoarseness?

Answer 15

Acute=Viral laryngitis

Chronic=Reflux

Question 16

A preppy cheerleader comes into your clinic with vocal nodules on her vocal folds. How should you treat her?

Answer 16

Speech therapy. If you remove them then they’ll come back.

Question 17

Vocal fold cysts are not fun either. How should they be treated.

Answer 17

You have to remove them and make sure the patient doesn’t talk for a few days afterwards.

Question 18

T or F?

Granulomas of the vocal folds are extremely dangerous and have a dire prognosis.

Answer 18

False.

They’re pretty much just like a cut on the hand except for in the larynx that gets puffy and covered in mucosal tissue to heal. They are usually not problematic

*they MAY block airways which can get tricky.

Question 19

What is the cause and who has Reinke’s edema?

Answer 19

It’s the old lady smokers with the raspy voice. They get a thick superficial lamina propia that makes their vocal folds like big bags of water.

Question 20

A patient comes in thinking that they have a lump in the throat. Their wife complains of bad breath in the morning, and they seem to be hoarse in the morning and after meals. What is the likely diagnosis?

Answer 20

Laryngopharyngeal Reflux

This is a really common condition.

Question 21

What are the manifestations of HPV in the neck?

Answer 21

Papillomas in the vocal folds. These are terrible things and require lots of surgeries.

Question 22

When should patients be referred for hoarseness issues to an ENT?

Answer 22

After 2-3 weeks.