Laryngeal & Nasopharyngeal Disease

Question 1

signs of laryngeal disease

Answer 1

stridor
voice change
panting
exercise intolerance
heat intolerance
hyperthermia
+/- swallowing impairment

Question 2

signs of nasopharyngeal disease

Answer 2

stertor
reverse sneezing

Question 3

types of laryngeal disease

Answer 3

structural:
- neoplasia
- mass
- foreign body

functional:
- laryngeal paralysis

both: laryngeal collapse

Question 4

types of nasopharyngeal disease

Answer 4

nasopharyngeal polyps
nasopharyngitis
nasopharyngeal stenosis

Question 5

signalment of laryngeal paralysis

Answer 5

older large breeds
LABRADOR RETREIVERS

Question 6

causes of laryngeal paralysis

Answer 6

GOLPP
trauma to recurrent laryngeal nerve
mediastinal mass

Question 7

GOLPP

Answer 7

geriatric onset laryngeal paralysis and polyneuropathy

age related degeneration of major nerves
- recurrent laryngeal
- sciatic
- vagus

leads to concurrent laryngeal paralysis, swallowing impairment, and hind limb weakness

Question 8

diagnosis of laryngeal paralysis

Answer 8

1. PE
2. cervical & thoracic radiographs
3. laryngeal exam
4. +/- swallow fluoroscopy

Question 9

how to do a laryngeal exam

Answer 9

propofol + doxapram
- propofol for sedation
- doxapram to stimulate CNS to properly assess laryngeal function

look for laryngeal paralysis and paradoxical movement

Question 10

when should arytenoids be open and closed

Answer 10

open - inspiration
closed - expiration

Question 11

paradoxical movement

Answer 11

arytenoids close during inhalation and open during expiration

Question 12

in hospital management of laryngeal paralysis

Answer 12

O2 supplementation
sedation - butorphanol
anti-inflammatory steroids

Question 13

at home management of laryngeal paralysis

Answer 13

lifestyle modification
- weight loss
- avoid hyperthermia
- avoid strenuous exercise
- paced, elevated feeding and water

Question 14

surgical management of laryngeal paralysis

Answer 14

unilateral arytenoid lateralization
“laryngeal tie back”

Question 15

most common complication of laryngeal tie back

Answer 15

aspiration pneumonia

Question 16

norwich upper airway obstructive syndrome

Answer 16

congenital laryngeal disease of norwich terriers
- redundant supraarytenoid folds
- laryngeal narrowing and collapse
- everted laryngeal saccules

causes respiratory noise and effort

dx on laryngeal exam
tx with surgery if clinically severe

Question 17

signalment for nasopharyngeal polyps

Answer 17

young cats

Question 18

etiology of nasopharyngeal polyps

Answer 18

polyp of benign inflammatory fibrous tissue that grows from the epithelial lining of the dorsolateral compartment of the bullae

extends aurally to the middle ear OR up the auditory tube into the nasopharynx

Question 19

clinical signs of nasopharyngeal polyps

Answer 19

stertor
reverse sneezing
sneezing
nasal discharge

Question 20

diagnosis of nasopharyngeal polyps

Answer 20

1. PE
2. skull & thoracic radiographs (check for bullae involvement)
3. soft palate rostral traction
4. CT/nasopharyngoscopy

Question 21

treatment of nasopharyngal polyps

Answer 21

traction avulsion procedure

use rostral traction on the soft palate to expose the polyp in the nasopharynx

grasp the polyp from the stalk and slowly pull using traction and avulsion

Question 22

signalment of nasopharyngitis

Answer 22

cats
high stress and shelter environments

Question 23

what causes nasopharyngitis

Answer 23

herpesvirus
calicivirus

Question 24

clinical signs of nasopharyngitis

Answer 24

painful, hard swallowing
history of URI
ocular signs (herpes)
oral and lingual ulcers (calici)

Question 25

diagnosis of nasopharyngitis

Answer 25

PCR of oral swab for viral etiology

Question 26

what causes nasopharyngeal stenosis

Answer 26

acquired due to inflammation dogs - often from aspiration under anesthesia

Question 27

clinical signs of nasopharyngeal stenosis

Answer 27

constant stertor lack of airflow +/- nasal discharge

Question 28

pathology of nasopharyngeal stenosis in dogs and cats

Answer 28

cats - thin band of fibrous tissue dogs - thick band of fibrous tissue

Question 29

diagnosis of nasopharyngeal stenosis

Answer 29

CT caudal rhinoscopy

Question 30

treatment of nasopharyngeal stenosis

Answer 30

cats: balloon dilation dogs: balloon dilation + temporary or permanent stent

Question 31

anatomy of feline bullae

Answer 31

2 compartments - ventromedial - dorsolateral

Question 32

where to nasopharyngeal polyps arise from

Answer 32

dorsolateral compartment of the bullae

Question 33

what medication should be provided post-op traction avulsion procedure

Answer 33

NSAIDs or steroids x10-14 days PRN

Question 34

what are complications of nasopharyngeal polyp surgery

Answer 34

minor bleeding 10-50% recurrence rate - may require VBO if recurrent transient Horner's syndrome

Question 35

otic canal polyps

Answer 35

middle ear polyp extends up the ear canal instead of through the auditory tube

Question 36

clinical signs of otic polyps

Answer 36

head shaking, pawing at ear, head tilt, otic discharge

Question 37

ventral bulla osteotomy

Answer 37

debridement of the polyp attachment to the wall of the bulla in the dorsolateral compartment

Question 38

indications for ventral bulla osteotomy

Answer 38

1. recurrent nasopharyngeal polyps after traction-avulsion 2. bony changes associated with the bulla 3. polyp limited to the middle ear with intact tympanic membrane 4. otic polyp extending into ear canal and owner cannot manage

Question 39

what is the most common complication of VBO

Answer 39

seroma

Question 40

do otic or nasopharyngeal polyps have a higher recurrence rate

Answer 40

otic UNLESS VBO procedure is performed

Question 41

unilateral arytenoid lateralization

Answer 41

performed on the left arytenoid suture the arytenoid laterally to the cricoid cartilage to widen the laryngeal opening

Question 42

approach for laryngeal tie back

Answer 42

lateral approach into the cartilage pull cuneiform process of the left arytenoid laterally and suture to the adjacent cricoid cartilage

Question 43

postop care for arytenoid lateralization

Answer 43

NPO IV fluids analgesia respiratory monitoring

Question 44

does laryngeal tie back cure the upper respiratory obstruction

Answer 44

NO - only improved increased risk of aspiration pneumonia

Question 45

complications with laryngeal tie back

Answer 45

seroma change in bark dry cough recurrent bronchitis aspiration pneumonia esophageal or pharyngeal dysfunction failure of lateralization

Question 46

progression timeline of GOLPP

Answer 46

most dogs with idiopathic laryngeal paralysis are likely to develop generalized polyneuropathy within 1 year

Question 47

what causes laryngeal collapse

Answer 47

primary cartilage problem vs secondary to other respiratory disease that causes increased respiratory effort

Question 48

signalment for laryngeal collapse

Answer 48

small breeds brachycephalics

Question 49

medical vs surgical management of laryngeal collapse

Answer 49

medical: lifestyle modification; can avoid surgery as long as patient compensates surgical: permanent tracheostomy (SALVAGE PROCEDURE) - end stage disease only

Question 50

epiglottic retroversion signalment

Answer 50

middle aged to older overweight small breed dogs

Question 51

how does epiglottic retroversion occur

Answer 51

secondary to chronic increased inspiratory airway pressures pulls epiglottis backwards/caudally leading to intermittent obstruction

Question 52

clinical signs of epiglottic retroversion

Answer 52

stridor dyspnea normal signs of upper airway obstruction

Question 53

treatment of epiglottic retroversion

Answer 53

permanent vs temporary tracheostomy permanent 1. primary epiglottic retroversion 2. concurrent disorders that are chronic or ongoing temporary 1. secondary epiglottic retroversion when concurrent disorder can be treated