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Flashcards in Laryngology Deck (220):
1

Approximately what percent of patients with bilateral vocal cord paralysis never require tracheostomy?

50%.

2

In what percent of patients with bilateral vocal cord paralysis is decannulation possible after one of these procedures?

70%.

3

When is medialization thyroplasty appropriate for the treatment of vocal cord paralysis?

Any stable, definitive paralysis in a patient without surgical contraindications.

4

What substances can be used for temporary vocal cord medialization?

Autologous fat, Gelfoam, collagen, and micronized Alloderm.

5

What are the advantages of performing this procedure under local?

Desired voice quality can be precisely obtained and airway can be continually evaluated.

6

What are the indications for endolaryngeal stenting after open repair of laryngeal injuries?

Disruption of the anterior commissure; multiple displaced cartilage fractures; and multiple, severe lacerations.

7

What symptom, other than hoarseness, is most likely to be improved by medialization thyroplasty and arytenoid adduction?

Dysphagia.

8

What are the two primary techniques of laryngeal reinnervation?

End-to-end anastomosis of the recurrent laryngeal nerve to the ansa hypoglossi or nerve-muscle pedicle flap to the thyroarytenoid muscle (using the ansa and a small piece of strap muscle).

9

What is the most likely cause of prolonged dysphonia and vocal fold stiffness after surgery for Reinke's edema?

Excessive suctioning of the superficial lamina propria.

10

True/False: Previous Teflon injection is a contraindication to medialization thyroplasty.

False.

11

True/False: When injecting Teflon in the vocal fold, it should be placed as far medially as possible.

False: It should be placed as far laterally as possible.

12

What is the most common immediate complication after repair of laryngeal injuries?

Granulation tissue.

13

What is the most common complication after insertion of a Blom-Singer indwelling voice prosthesis?

Granulation tissue.

14

What is the primary disadvantage of the indwelling voice prosthesis compared with the nonindwelling prosthesis?

Higher rate of fungal colonization.

15

Which laryngoscopes are best for visualizing the anterior commissure or the subglottis?

Holinger and Benjamin.

16

A 69-year-old man with terminal lung cancer has severe hoarseness secondary to left vocal cord paralysis. What would be the best treatment option?

Left vocal cord medialization with Teflon paste.

17

What are the four main categories of procedures for unilateral vocal cord paralysis?

Medialization thyroplasty, arytenoid adduction, intracordal injection, and laryngeal reinnervation.

18

What would be the best treatment for a 6o-year-old woman who experiences severe dysphagia and aspiration after removal of a high right vagal schwannoma?

Right medialization thyroplasty, arytenoid adduction.

19

What is the optimal treatment for presbylaryngeus?

Speech therapy for 1year; if that fails, then bilateral medialization thyroplasty.

20

Into which plane is the implant placed during medialization thyroplasty?

Subperichondrial.

21

What is the aim of laryngeal reinnervation?

To prevent atrophy of the thyroarytenoid muscle.

22

What is the aim of arytenoid adduction?

To pull the muscular process of the arytenoid laterally, resulting in adduction and lowering of the vocal process.

23

What are five ways to restore the airway in patients with bilateral vocal fold paralysis?

Tracheostomy, stitch lateralization of the arytenoid(s), laser arytenoidectomy, unilateral or bilateral laser cordectomy.

24

True/False: Arytenoid adduction is contraindicated for the treatment of presbylaryngeus.

True: Arytenoid adduction is contraindicated in any patient with mobile vocal folds.

25

Surgical disruption of which layer of the vocal cord is most likely to lead to vocal fold scarring?

Vocal ligament (highest amount of collagen and fibroblasts).

26

Under what anatomic conditions is medialization laryngoplasty most efficacious in the treatment of vocal fold scarring?

When arytenoids are mobile, glottic gap is >1.5 mm, and soft tissue deficiency is confined to the anterior 1/3 of the vocal fold.

27

In what % of patients with bilateral vocal cord paralysis is decannulation possible after one of these procedures

90%

28

What is the incidence of mediastinitis after diverticulectomy

29

What is the normal size (height) of the saccule

15 mm in 8°/o.

30

What % of patients with long-term tracheostomies are colonized with Pseudomonas

>60%.

31

What % of patients with esophageal stricture will develop esophageal cancer

1 -4%.

32

What are the 3 stages of injury after caustic ingestion

1. Necrosis, bacterial invasion, sloughing of the mucosa. 2. Granulation tissue and reepithelialization (day 5 - several weeks). 3. Scar formation and contraction.

33

What is the starting dose of botulinum toxin for treatment in a patient with harsh, strained voice with intermittent pitch breaks and glottal fry

1.0 - 2.5 MU into each thyroarytenoid muscle if administering bilaterally; 5 - 30 MU if administering unilaterally.

34

What % of cases of SO are familial

12%.

35

What % of laryngectomy patients who fail voice restoration following tracheoesophageal puncture (TEP) suffer from cricopharyngeal spasm

12%.

36

In what age groups is caustic ingestion most common

18 - 24 months, 20 - 30 years.

37

What is the incidence of tracheoinnominate fistula after tracheostomy

2%.

38

What is the tracheal wall mucosal capillary pressure

20 - 30 mm Hg.

39

What % of patients with glottic insufficiency will attain complete closure after voice therapy

20%.

40

When is the ideal time to perform endoscopy after ingestion

24 - 48 hours post-ingestion.

41

What does medical management of laryngeal injuries consist of?

24 hours or more of airway observation, voice rest, elevation of the head, humidified air, H2 blockers, steroids; antibiotics if lacerations are present.

42

What % of patients with tracheoinnominate fistulae survive

25%.

43

What is the lethal dose of botulinum toxin for humans

2500 to 3000 MU.

44

What is the starting dose of botulinum toxin for treatment in a patient with a breathy, hypophonic voice with abnormal whispered segments of speech

3.75 MU into the most active posterior cricoarytenoid muscle.

45

What is the mortality from colon interposition

4- I 5%.

46

What % of patients with unilateral vocal cord paralysis require surgical treatment

40%.

47

After 3 months of voice therapy, what % of benign vocal cord lesions will reduce in size or resolve

46% will reduce in size and 11 °/o will completely resolve.

48

Approximately what % of patients with bilateral vocal cord paralysis never require tracheostomy

50%.

49

What % of all instances of tracheal bleeding developing 48 hours or longer after surgery are caused by tracheoinnominate fistulae

50%.

50

What % of children with esophageal burns will develop esophageal stricture

7 - 15%.

51

What % of patients experience improvement in voice after nerve-muscle implantation

76%.

52

What % of patients without oropharyngeal burn will have evidence of esophageal injury

8 - 20%.

53

How many serotypes of botulinum toxin exist? Which is the most useful clinically

8 serotypes (A through G) with type A being the most useful.

54

What is the incidence of complications after PEG

9-15%).

55

What % of patients are eventually able to swallow well after this procedure

92%.

56

Voiceless consonants is suggestive of what disorder

Abductor SO.

57

What is a laryngocele

Abnormal dilatation of the laryngeal saccule.

58

What % of patients develop a granuloma after Teflon injection

About 35°/o.

59

How does the injury differ after ingestion of acidic substances versus ingestion of basic substances

Acidic substances cause coagulation necrosis; the eschar limits the depth of injury. Basic substances cause liquefaction necrosis and are likely to cause deeper injury.

60

What are the two types of spasmodic dysphonia (SO)

Adductor and abductor.

61

Which is more common

Adductor SO.

62

Which of these is characterized by a harsh, strained voice with inappropriate pitch breaks, breathiness, and glottal fry

Adductor SO.

63

The inability to sustain vowels during speech is suggestive of what disorder

Adductor SO.

64

When should PEG be performed when done as part of an oncologic resection

After the primary resection to avoid inadvertent spread of tumor cells to the gastrostomy site.

65

What factors are associated with the highest success with esophageal dilatation for treatment of strictures secondary to caustic ingestion

Age

66

Which drugs potentiate the effect of botulinum toxin

Aminoglycoside antibiotics.

67

When is medialization thyroplasty appropriate for the treatment of vocal cord paralysis

Any stable, definitive paralysis in a patient without surgical contraindications.

68

Where are vocal nodules most commonly located

At the junction of the anterior I /3 and posterior 2/3 of the vocal fold.

69

What substances can be used for temporary vocal cord medialization

Autologous fat, Gelfoam, collagen, micronized alloderm.

70

What is the test of choice for diagnosis of Zenker's diverticulum

Barium swallow.

71

Where are internal laryngoceles located

Beneath the mucosa of the false vocal cord and aryepiglottic folds.

72

What is the best way to successfully restore the airway in a one-stage procedure in patients with bilateral vocal fold paralysis (other than tracheostomy)

Bilateral laser cordotomy.

73

What problems are seen in patients with vocal cord paralysis due to a brainstem disorder

Breathiness; pitch changes; chronic aspiration; VPI.

74

What are the typical features of abductor SO

Breathy, effortful hypnotic voice with abnormal whispered segments of speech.

75

When do most laryngoceles present

Can present at any time, but most commonly arise in the sixth decade of life.

76

What is the most significant early complication of this procedure

Cervical anastomotic leak (50%).

77

What is the most significant late complication of this procedure

Cervical anastomotic stricture ( 44% ).

78

What is the preferred method of treatment for SD

Chemical denervation with botulinum toxin.

79

Which patients are at a higher risk of pneumothorax after tracheostomy

Children.

80

What is the most common esophageal bypass procedure

Colon interposition.

81

What are the indications for esophageal bypass

Complete esophageal stenosis and failure to establish a lumen with dilatation. Irregularity and diverticuli of the esophagus. Mediastinitis secondary to dilatation. Fistula formation. Inability to maintain a lumen of 40 Fr or greater with dilatation. Patient intolerance of frequent procedures.

82

What is the best test to differentiate between cricopharyngeal spasm and stricture in patients who fail voice restoration following TEP

Contrast video fluoroscopy.

83

What are the signs of a tracheoesophageal fistula after tracheostomy

Copious secretions, food aspiration, and air leak around the cuff 'with abdominal distension.

84

What test should be done if the history and physical exam do not explain the etiology of vocal cord paralysis

CT scan from skull base to A-P window.

85

Which complication is most likely to be avoided with endoscopic diverticulectomy versus open diverticulectomy

Damage to the recurrent laryngeal nerve.

86

How does the pattern of the EMG wave appear in the presence of a myopathy

Decreased amplitude, normal frequency.

87

How does the pattern of the EMG wave appear in the presence of a neuropathy

Decreased frequency with normal amplitude.

88

What effect does damage to the superior laryngeal nerve have on voice

Decreased range of pitch.

89

What accounts for vocal fold bowing observed with vocal fold paralysis

Denervation atrophy of the thyroarytenoid muscle.

90

What are the advantages of performing this procedure under local

Desired voice quality can be precisely obtained and airway can be continually evaluated.

91

What are the indications for endolaryngeal stenting after open repair of laryngeal injuries

Disruption of the anterior commissure, multiple displaced cartilage fractures, and multiple, severe lacerations.

92

After caustic ingestion, what sign is most likely to signal the development of a complication

Drooling.

93

What are the potential adverse effects of botulinum toxin injections into these muscles for treatment of blepharospasm

Due to diffusion of the toxin, ptosis, diplopia, epiphora, lagophthalmos.

94

What symptom, other than hoarseness, is most likely to be improved by medialization thyroplasty and arytenoid adduction

Dysphagia.

95

What are the most common manifestations of laryngopharyngeal reflux (LPR)

Dysphonia (71°/o), chronic cough (51°/o), globus (47%), chronic throat clearing (42%), dysphagia (35%).

96

Which types of laryngeal injuries are best managed medically

Edema; small hematoma with intact mucosa; small glottic or supraglottic lacerations not involving the free margin of the vocal cords or the anterior commissure and without cartilage exposure; single nondisplaced thyroid cartilage fractures.

97

How is the cricopharyngeus muscle identified with EMG

Electrical activity occurs at rest and diminishes or stops with swallowing.

98

What is the test of choice in the evaluation of caustic ingestion

Endoscopy.

99

What are the 2 primary techniques of laryngeal reinnervation

End-to-end anastomosis of the recurrent laryngeal nerve to the ansa hypoglossi or nerve-muscle pedicle flap to the thyroarytenoid muscle (using the ansa and a small piece of strap muscle).

100

What is the management of patients with evidence of grade 2 or 3 injury (transmucosal or transmural) on endoscopic exam

Esophageal rest (NPO), reflux precautions, +/steroids, +/antibiotics, +/- lathyrogens, +/subcutaneous heparin, +/- NGT, +/ prophylactic bougienage.

101

What is the most likely cause of prolonged dysphonia and vocal fold stiffness after surgery for Reinke's edema

Excessive suctioning of the superficial lamina propria.

102

What are mixed laryngoceles

External laryngoceles with a dilated internal component.

103

T/F: Previous Teflon injection is a contraindication to medialization thyroplasty

False

104

T/F: During medialization thyroplasty, the resected fragment of thyroid cartilage should be replaced in its original position after graft insertion

False.

105

T/F: Cricopharyngeal myotomy as an adjunctive procedure to diverticulectomy has been shown to significantly decrease the incidence of recurrence

False.

106

T/F: When injecting Teflon in the vocal fold, it should be placed as far medial as possible

False; it should be placed as far lateral as possible.

107

What is the greatest advantage of bronchoscopic visualization during percutaneous dilational tracheostomy

Fewer major complications occur.

108

What kind of dystonia is spasmodic dysphonia

Focal.

109

What factors are thought to account for diminished responses to botulinum toxin

Formation of antibodies, high cumulative dose, drug interactions.

110

What condition would cause a tense sounding voice, vocal fatigue, and a prolonged closed phase with reduced vibratory and mucosal wave amplitude during videostroboscopy

Glottic hyperabduction dysphonia.

111

What are the contraindications to steroid use

Grade 3 burns, esophageal or gastric perforation.

112

What is the most common complication after insertion of a Blom-Singer indwelling voice prosthesis

Granulation tissue.

113

What is the most common immediate complication after repair of laryngeal injuries

Granulation tissue.

114

What is Schaefer's classification system of laryngeal injuries

Group I: minor hematomas or lacerations, no fractures, and minimal airway compromise. Group I I: moderate edema, lacerations, mucosal disruption without exposed cartilage, nondisplaced fractures, and varying degrees of airway compromise. Group Ill: massive edema, mucosal disruption, displaced fractures, cord immobility, and varying degrees of airway compromise. Group IV: same as Ill but with 2 or more fracture lines and/or skeletal instability or significant anterior commissure trauma.

115

Which drugs limit the effect of botulinum toxin

Guanidine and aminopyridines.

116

What is the disadvantage of the indwelling voice prosthesis compared to the non-indwelling prosthesis

Higher rate of fungal colonization.

117

What is a MU

I M U is the dose required to kill 50% of a batch of mice.

118

Which type of vocal cord granuloma has the worst prognosis

Idiopathic.

119

What are the indications for panendoscopy in patients with vocal cord paralysis

If history, physical exam, CT scan, electrolytes, RPR, TFT's do not reveal etiology.

120

What should be done for the patient who has ingested a battery

If the battery is still in the esophagus (confirmed by radiographs), immediate esophagoscopy is indicated. If it has passed into the stomach, it can be allowed to pass.

121

Your patient has a unilateral vocal cord paralysis after thyroidectomy for goiter. What are the indications for surgical intervention

If the paralysis is well tolerated (e.g. no aspiration and voice quality acceptable to the patient), 12 months is allowed for spontaneous recovery before proceeding with surgery. If the symptoms are severe, early surgery, typically a reversible procedure, is indicated.

122

What are the contraindications to percutaneous endoscopic gastrostomy

Inability to perform upper endoscopy safely; inability to transilluminate the abdominal wall; presence of ascites, coagulopathy, or intra-abdominal infection.

123

What are the characteristics of focal dystonias

Inappropriate and excessive efferent activity of motor neurons in small areas.

124

What would be the histologic findings on muscle biopsies at the site of botulinum toxin injections

Increased unmyelinated axonal sprouts; no change in muscle fibers histologically.

125

What is the significance of a "picket fence" pattern on E:M G

Indicates partial reinnervation (polyphasic action potentials).

126

If the vocal cord is in the paramedian position, why is aspiration less likely

Indicates that the superior laryngeal nerve is intact, and hence, laryngeal sensation is intact.

127

What is the mechanism of action of botulinum toxin

Inhibition of acetylcholine release from cholinergic nerve endings.

128

What can be done if symptoms persist after complete paralysis of the posterior cricoarytenoid

Inject the contralateral posterior cricoarytenoid muscle with very small increments of toxin or inject the cricothyroid muscle.

129

Compared to men, women have a significantly higher incidence of vocal cord granulomas caused by what

Intubation.

130

Which types of laryngeal injuries require open exploration and repair

Lacerations involving the free margin of the vocal cord or anterior commissure; large mucosal lacerations with exposed cartilage; multiple displaced cartilage fractures; avulsed or dislocated arytenoids; vocal cord immobility.

131

What are the contraindications to percutaneous dilatational tracheostomy

Large thyroid goiter or other neck mass, marked obesity, coagulopathy, previous neck surgery, neck trauma including bums, and inadequate access to the trachea.

132

What is the most common congenital anomaly of the larynx

Laryngomalacia.

133

What position will the vocal cord be in if the nerve is damaged at or above the nodose ganglion

Lateral.

134

In patients with unilateral vocal cord paralysis, which side is most commonly involved

Left.

135

What are the physical findings of type 2 sulcus vocalis or "sulcus vergeture"

Linear sulcus along the medial edge of the fold separating the superior and inferior lips of the membranous vocal fold by a rigid contracted band.

136

What are the operative and pathologic findings of patients with pathologic sulcus vocalis

Loss of superficial lamina propria and fixation of a thinned epithelium to underlying vocal ligament.

137

What muscles are injected when using botulinum toxin to treat oromandibular dystonia

Masseter, temporalis, medial and lateral pterygoid muscles.

138

What are the available treatments for cricopharyngeal dysphagia

Mechanical dilation, pharyngeal plexus neurectomy, cricopharyngeal myotomy, or botulinum toxin.

139

What are the 4 main categories of procedures for unilateral vocal cord paralysis

Medialization thyroplasty, arytenoid adduction, intracordal injection, and laryngeal reinnervation.

140

What syndrome is associated with blepharospasm

Meige's syndrome.

141

What is the most useful stroboscopic parameter in differentiating a vocal fold cyst from a polyp

Mucosal wave.

142

What condition is characterized by generalized tension in all laryngeal muscles

Muscular tension dysphonia.

143

Breathiness that progressively worsens as the day wears on is classic for which autoimmune disease

Myasthenia gravis.

144

What disease does a fatiguing pattern on EMG suggest

Myasthenia gravis.

145

What precaution should be taken for a patient with a tracheostomy undergoing general anesthesia

Nitrous oxide should be avoided as it diffuses into the cuff and can increase the pressure by up to 40mm Hg. If it used during induction, the cuff should be deflated temporarily.

146

What is the management of patients with evidence of grade 1 injury (superficial) on endoscopic exam

No intervention; schedule for esophagogram in 3 weeks.

147

What is the most likely consequence of ingesting hair relaxer

No long-term sequelae.

148

What is the difference in impedance values and stimulus response thresholds between intramuscular needle electrodes and endotracheal tube-mounted surface wire electrodes for recording laryngeal muscle activity

No significant difference.

149

What effect does adductor laryngeal breathing dystonia have on the voice

None.

150

In which part of the world is Zenker's diverticulum most common

Northern Europe.

151

Where are post-intubation granulomas typically located

On the vocal process of the arytenoid.

152

When is CT scan indicated in the evaluation of these patients

Only for group I and II patients where there is questionable fracture.

153

When is Teflon paste used

Only in patients who are terminally ill with a permanent vocal cord paralysis.

154

What are the onset, peak, and duration of effects of botulinum toxin

Onset 24 to 72 hours, peak effect at I 0 - 14 days, duration 3 - 6 months.

155

Which muscles are involved in blepharospasm

Orbicularis oculi, procerus, and corrugator supercilii.

156

What is adductor laryngeal breathing dystonia

Paradoxical adduction of the vocal folds during inspiration, causing inspiratory stridor that worsens with exertion and disappears during sleep.

157

What are the 4 etiologies of vocal cord immobility

Paralysis, synkinesis, cricoarytenoid joint fixation, and interarytenoid scar.

158

What position will the vocal cord be in if the nerve is damaged below the nodose ganglion

Paramedian, due to innervation from the superior laryngeal nerve.

159

What effect does tracheostomy have on the incidence of pneumonia

Patients on a ventilator are at a higher risk of pneumonia after tracheostomy and also tend to develop more serious pneumonias (Pseudomonas) secondary to antibiotic resistance.

160

How do laryngoceles become external

Penetrate the thyrohyoid membrane at the site of entry of the superior laryngeal artery and nerve.

161

What are some examples of lathyrogens

Penicillamine, beta aminopropionitrile, N-acetylceptine.

162

How is injection into the cricothyroid muscle accomplished, and how is proper placement confirmed

Peroral route; confirm by having the patient sing an ascending scale and observing an increase in EMG activity as the pitch increases.

163

What are the risk factors for innominate artery rupture after tracheostomy

Placement of trach below the 3rd ring; aberrant course of the innominate artery; use of a long, curved tube; overhyperextension of the neck during the procedure; prolonged pressure by inflated cuff; and tracheal infection.

164

What is the most common cause of mortality in pediatric patients who undergo tracheostomy

Plugging or accidental decannulation in children

165

What pathologic changes occur in the larynx as a result of G ERD

Polypoid corditis (Reinke's edema), posterior glottic and arytenoid edema/erythema.

166

Which muscle is responsible for abductor SD

Posterior cricoarytenoid muscle.

167

Which of these is most common

Posterior glottic edema.

168

What distinguishes type 1 or physiologic sulcus from pathologic sulcus

Preservation of vocal cord vibratory activity on videostroboscopy, signifying intact superficial lamina propria (Type I).

169

Once the ABC's have been stabilized, what is the acute management of caustic ingestion injury

Prevent ongoing injury with irrigation of eyes, skin, and mouth, +/flushing of the esophagus and stomach with water or milk

170

What are the clinical criteria for pediatric decannulation

Recovery from the original indication for tracheotomy, cessation of mechanical ventilation for at least 3 months, minimal present oxygen requirement, and an absence of frequent pulmonary infections or severe swallowing dysfunction.

171

What is felt to be the safest way to address severe esophageal strictures with dilatation

Retrograde technique using Tucker dilators over a guide string.

172

What would be the best treatment for a 60-year-old woman who experiences severe dysphagia and aspiration after removal of a high right vagal schwannoma

Right medialization thyroplasty, arytenoid adduction.

173

Why should all patients with history of caustic ingestion be followed for life with repeated esophagograms and endoscopy

Risk of SCC A of the esophagus is 1 000 times that of the general population.

174

What are the features of type 3 sulcus vocalis

Severe dysphonia, vocal fold stiffness, and a medial pit-shaped sulcus.

175

What are the features of a denervation pattern on EMG

Sharp waves or fibrillation potentials, complex repetitive discharges, and little or no electrical activity during attempts at voluntary contraction.

176

What are the primary advantages of endoscopic versus open resection for Zenker's diverticulum

Shorter operative time with no significant difference in complication rate: absence of skin incision; minimal postoperative pain; quicker resumption of oral feeding; shorter hospital stay.

177

What factor is most important regarding the risk of surgical complications in patients undergoing Zenker's diverticulectomy

Size of the diverticulum.

178

What are the primary limitations to endoscopic diverticulectomy

Size of the sac; difficult to perform in very small or large sacs ( 10 cm); limitations in access due to anatomic factors (ie, inability to extend the neck or limited jaw excursion).

179

Which types of laryngeal injuries are more common in children than adults

Soft tissue injury with edema, arytenoid dislocation, and recurrent laryngeal nerve injury; telescoping injuries where the cricoid becomes displaced under the thyroid.

180

What is the optimal treatment for presbylaryngeus

Speech therapy for I year; if that fails, then bilateral medialization thyroplasty.

181

What is the significance of a denervation pattern 1 year after injury

Spontaneous recovery is very unlikely.

182

Where is the most likely site of injury after ingestion of an acidic caustic agent

Stomach.

183

What are the adverse effects of posterior cricoarytenoid injections

Stridor (particularly with exertion), airway compromise, dysphagia and aspiration.

184

What injuries are more commonly associated with laryngotracheal separation than with other laryngeal injuries

Subglottic stenosis and bilateral recurrent laryngeal nerve injury.

185

Which area of the larynx is involved in Wegener's granulomatosis

Subglottis.

186

Into which plane is the implant placed during medialization thyroplasty

Subperichondrial.

187

What are lathyrogens

Substances that interfere with the cross-linking of collagen.

188

Where is Reinke's edema located

Superficial layer of the lamina propria.

189

Which area of the larynx is involved in sarcoidosis

Supraglottis.

190

What are the 2 most common causes of vocal cord paralysis in adults

Surgical trauma (#I ), and lung cancer (#2).

191

Subcutaneous emphysema may prelude what condition after tracheostomy

Tension pneumomediastinum.

192

What is the premise behind pursuing long-term dilatation therapy

The native esophagus is the best esophagus.

193

What is the difference in using the right versus left colon

The right colon is interposed in an isoperistaltic fashion whereas the left colon is interposed in an antiperistaltic fashion.

194

Why are they commonly located there

This is the point of maximum velocity of the vocal cords during forceful adduction.

195

Which laryngeal muscles are typically analyzed with EMG

Thyroarytenoid and cricothyroid muscles.

196

Which muscles are responsible for adductor SD

Thyroarytenoid and lateral cricoarytenoid muscles.

197

What structure is most likely to be fractured after blunt trauma to the anterior neck

Thyroid cartilage.

198

What is the primary purpose of laryngeal EMG in patients with vocal cord paralysis

To distinguish paralysis from mechanical fixation.

199

What is the aim of laryngeal reinnervation

To prevent atrophy of the thyroarytenoid muscle.

200

What is the aim of arytenoid adduction

To pull the muscular process of the arytenoid laterally, resulting in adduction and lowering of the vocal process.

201

What should be done if the posterior tracheal wall is disrupted during tracheostomy

Tracheostomy tube should be replaced with an endotracheal tube.

202

What are some of the surgical options for treatment of bilateral vocal cord paralysis

Tracheostomy, horizontal cordotomy, arytenoidectomy, lateral cordotomy.

203

What are two ways to deliver botulinum toxin to the posterior cricoarytenoid muscle

Transcricoid and retrograde (rotating the larynx away from the side of injection).

204

T/F: Greater duration of symptom control has been demonstrated with unilateral versus bilateral injections

True.

205

T/F: Inducing emesis and activated charcoal are contraindicated in the management of caustic ingestion

True.

206

T/F: Arytenoid adduction is contraindicated for the treatment of presbylaryngeus

True; arytenoid adduction is contraindicated in any patient with mobile vocal folds.

207

What is the best treatment for patients with type 2 sulcus

Undermining and segmental slicing (Pontes and Behlau).

208

In which patients is this most commonly seen

Untrained occupational and professional voice users.

209

How can one confirm placement of the needle in the posterior cricoarytenoid muscle

Using EMG guidance, have the patient snif.f.

210

What are the typical features of esophageal cancer occurring after esophageal stricture from burn injury

Usually SCCA, with onset 25 - 70 years post-injury, occurring within the scar tissue, with a lower incidence of distant metastases and higher chance of cure with surgical resection.

211

How is recovery of function accomplished

Via sprouting of new nerve terminals and an increase in the number of postjunctional receptors.

212

What are the risk factors for developing a vocal fold granuloma

Vocal abuse, GERD, prolonged intubation, trauma, surgery.

213

What are the physical findings in patients with muscular tension dysphonia

Vocal cord nodules, posterior glottic chink.

214

What are the clinical findings associated with pathologic sulcus vocalis

Vocal fold stiffness, fullness, edema, and bowing; capillary ectasia; and vibratory disturbances.

215

Surgical disruption of which layer of the vocal cord is most likely to lead to vocal fold scarring

Vocal ligament (highest amount of collagen and fibroblasts).

216

In which situations is medialization laryngoplasty most efficacious in the treatment of vocal fold scarring

When arytenoids are mobile, glottic gap is > 1.5 mm, and soft tissue deficiency is confined to the anterior I /3 of the vocal fold.

217

When is polysomnography indicated to determine readiness for decannulation in children

When the tracheotomy was performed due to a dynamic airway disorder (OSA, craniofacial anomalies, pharyngeal hypotonia).

218

When should open exploration be performed after injury

Within 24 hours.

219

How soon will deep mucosal ulcerations and exposure of tracheal cartilage occur when cuff-to-tracheal wall tension exceeds mucosal capillary tension

Within I week.

220

What muscles are injected when using botulinum toxin to treat hemifacial spasm

Zygomaticus major and minor, levator anguli oris, and risorius.