Diseases of the Larynx — MCQs

Diseases of the Larynx Indian Medical PG Practice Questions and MCQs

Question 221: What condition is characterized by a mouse-nibbled appearance of the vocal cord?

A. Vocal cord nodules
B. Vocal cord paralysis
C. Laryngeal carcinoma
D. Laryngeal tuberculosis (Correct Answer)

Explanation: ***Laryngeal tuberculosis*** - A **mouse-nibbled appearance** of the vocal cord, characterized by **irregular, ragged edges**, is a classic endoscopic finding in laryngeal tuberculosis. - This presentation results from **granulomatous inflammation** and **ulceration** of the vocal cord tissue. *Vocal cord nodules* - Vocal cord nodules typically present as **bilateral, symmetrical swellings** on the free edge of the vocal cords, often described as "singer's nodules." - They tend to be **smooth and rounded**, not "mouse-nibbled." *Vocal cord paralysis* - Vocal cord paralysis involves an **absence or impairment of vocal cord movement**, leading to an altered glottic closure and voice change. - The vocal cord itself usually appears **structurally normal** in terms of its surface and edges, distinguishing it from an erosive process. *Laryngeal carcinoma* - Laryngeal carcinoma can present with various appearances, including **ulcerations, exophytic masses, or infiltrative lesions**. - While it can cause irregular surfaces, the specific "mouse-nibbled" description is more pathognomonic for **tuberculous laryngitis** due to its characteristic pattern of superficial erosion.

Question 222: A 50-year-old male chronic smoker complains of hoarseness of voice for the past 4 months. Microlaryngoscopic biopsy shows it to be keratosis of the larynx. All are suggested treatment modalities for this condition, except:

A. Stop smoking
B. Stripping of vocal cord
C. Laser vaporization
D. Partial laryngectomy (Correct Answer)

Explanation: ***Partial laryngectomy*** - **Partial laryngectomy** is a surgical procedure typically reserved for **laryngeal cancer** that has invaded deeper tissues or is extensive. - Laryngeal keratosis, even with atypia, is a **premalignant lesion** and does not usually warrant such an aggressive surgical intervention as a primary treatment. *Stop smoking* - **Cigarette smoking** is a major causative factor for laryngeal keratosis and its progression to dysplasia or carcinoma. - **Cessation of smoking** can often lead to regression of the keratosis and is a crucial first step in management. *Laser vaporization* - **Laser vaporization** using CO2 laser is an effective method for precise removal of the keratotic lesions. - It allows for **accurate tissue ablation** while preserving surrounding healthy tissue and maintaining vocal function. *Stripping of vocal cord* - **Vocal cord stripping** is a common surgical technique used to remove superficial lesions like keratosis from the vocal cords. - This procedure involves **peeling off the superficial layer** of the vocal cord while aiming to preserve the deeper structures essential for voice quality.

Question 223: All of the following are seen in superior laryngeal nerve palsy except:

A. Bowed vocal cords
B. Loss of pitch
C. Aspiration
D. Stridor (Correct Answer)

Explanation: ***Stridor*** - **Superior laryngeal nerve palsy** primarily affects the **cricothyroid muscle** (external branch) and sensation above the vocal cords (internal branch). - Stridor typically results from severe **airway obstruction**, which is not a direct consequence of superior laryngeal nerve palsy as the **vocal cords** are not paralyzed open or closed to cause obstruction. *Aspiration* - The **internal branch of the superior laryngeal nerve** provides sensory innervation to the **supraglottic larynx**. - Loss of sensation in this region can impair the protective **cough reflex**, leading to an increased risk of aspiration. *Bowed vocal cords* - **Palsy of the cricothyroid muscle**, innervated by the **external branch of the superior laryngeal nerve**, causes a loss of tension in the vocal cord. - This lack of tension can result in a characteristically **bowed appearance** of the affected vocal cord during phonation. *Loss of pitch* - The **cricothyroid muscle** is responsible for tensing and elongating the vocal cords, which is crucial for **raising vocal pitch**. - Paralysis of this muscle due to **superior laryngeal nerve palsy** directly impairs the ability to achieve higher pitches, leading to a **monotone voice** or loss of pitch.

Question 224: Which of the following statements about laryngomalacia is true?

A. It is characterized by an omega-shaped epiglottis.
B. It requires immediate surgical intervention.
C. It always requires surgical intervention in newborns.
D. It typically presents with inspiratory stridor. (Correct Answer)

Explanation: ***It typically presents with inspiratory stridor.*** - **Laryngomalacia** is the most common cause of **inspiratory stridor** in infants, usually presenting within the first few weeks of life due to collapse of supraglottic structures during inspiration. - The stridor is characteristically **worse when crying, feeding, or lying supine**, and often improves when the infant is prone. *It is characterized by an omega-shaped epiglottis.* - While an **omega-shaped epiglottis** can be a feature seen in laryngomalacia, it is not the sole or defining characteristic and is not universally present. - The primary characteristic is the **collapse of the supraglottic structures** (arytenoids, aryepiglottic folds, and epiglottis) into the laryngeal inlet upon inspiration. *It requires immediate surgical intervention.* - The vast majority of **laryngomalacia cases are mild to moderate** and resolve spontaneously by 12-18 months of age, requiring only conservative management. - **Surgical intervention** (supraglottoplasty) is reserved for severe cases with significant feeding difficulties, failure to thrive, severe airway obstruction, or apneic episodes. *It always requires surgical intervention in newborns.* - As mentioned, **most cases are self-limiting** and do not require surgery, especially in newborns. - Surgical intervention is only considered when there are **severe symptoms** impacting the infant's health and development.

Question 225: According to the European Laryngological Society, how is subligamental cordectomy classified within their classification system?

A. Type Va (Subligamental cordectomy)
B. Type IV (Total cordectomy)
C. Type II (Subepithelial cordectomy) (Correct Answer)
D. Type III (Transmuscular cordectomy)

Explanation: ***Type II (Subepithelial cordectomy)*** - According to the **European Laryngological Society (ELS) classification**, **Type II cordectomy** is specifically defined as **subligamental cordectomy**. - This procedure removes the **epithelium, Reinke's space, and vocal ligament**, but remains **superficial to the vocalis muscle**. - Type II is the correct classification for subligamental procedures, as it extends through the ligament but does not penetrate the underlying muscle layer. *Type III (Transmuscular cordectomy)* - **Type III cordectomy** extends **deeper than Type II**, involving excision that includes the **vocalis muscle**. - This is a **transmuscular** resection that goes beyond the ligament into the muscle layer, making it more extensive than a subligamental cordectomy. - The key differentiating feature is that Type III penetrates the vocalis muscle, whereas subligamental (Type II) stops at the ligament level. *Type IV (Total cordectomy)* - **Type IV cordectomy** involves **complete removal** of the entire vocal cord from the **vocal process to the anterior commissure**. - This is the most extensive single-cord resection, removing all layers including epithelium, ligament, and the entire vocalis muscle. - This far exceeds the depth and extent of a subligamental cordectomy. *Type Va (Subligamental cordectomy)* - In the ELS classification, **Type V cordectomies** are **extended cordectomies** with various subclassifications (Va, Vb, Vc, Vd). - **Type Va** specifically refers to **cordectomy with contralateral arytenoid**, not subligamental cordectomy. - The term "subligamental" in this option is a misnomer; the ELS system uses **Type II** for subligamental procedures, not Type Va.

Question 226: What is the expected voice quality in a patient with bilateral abductor paralysis of the larynx?

A. High-pitched voice (Puberphonia)
B. Vocal fatigue (Phonasthenia)
C. Strained voice (Dysphonia plicae ventricularis)
D. Preserved voice quality (Normal voice) (Correct Answer)

Explanation: ***Preserved voice quality (Normal voice)*** - In **bilateral abductor paralysis**, the vocal cords are fixed in or near the midline, primarily affecting the **airway** and causing inspiratory stridor. - While breathing is severely compromised, the **vocal cords can still adduct sufficiently for phonation**, meaning the voice quality often remains largely normal, albeit with possibly reduced intensity. *High-pitched voice (Puberphonia)* - **Puberphonia** is a functional voice disorder characterized by the persistent use of a high-pitched voice after puberty, despite a normal mature larynx. - It is not directly related to laryngeal paralysis but rather a **phonatory habit or psychological cause**. *Vocal fatigue (Phonasthenia)* - **Vocal fatigue** is a symptom often associated with vocal misuse, overuse, or certain laryngeal pathologies causing inefficient vocal production. - While a patient with laryngeal paralysis might vocalize less due to respiratory distress, the paralysis itself does not directly cause vocal fatigue as a primary voice quality. *Strained voice (Dysphonia plicae ventricularis)* - **Dysphonia plicae ventricularis**, or **ventricular dysphonia**, occurs when the false vocal cords (ventricular folds) vibrate during phonation instead of or in addition to the true vocal cords, resulting in a low-pitched, harsh, or strained voice. - This condition is not a direct consequence of bilateral abductor paralysis, which primarily impacts true vocal cord movement and airway patency.

Question 227: Turban epiglottis is seen in -

A. Epiglottitis
B. Laryngeal papilloma
C. Leprosy
D. TB (Correct Answer)

Explanation: ***TB*** - **Turban epiglottis** is a classic finding in **laryngeal tuberculosis**, characterized by a thickened, swollen, and often nodular epiglottis that resembles a turban. - This appearance results from granulomatous inflammation and edema of the laryngeal structures due to *Mycobacterium tuberculosis* infection. *Leprosy* - **Laryngeal involvement in leprosy** is rare but can cause mucosal thickening, nodules, and even stenosis. - While it can affect the larynx, the specific 'turban epiglottis' morphology is not characteristic of leprosy. *Laryngeal papilloma* - **Laryngeal papillomas** appear as wart-like growths, often cauliflower-like, on the vocal cords or other laryngeal surfaces. - They are caused by **Human Papillomavirus (HPV)** and do not typically present as a diffusely thickened or turban-shaped epiglottis. *Epiglottitis* - **Epiglottitis** presents with a rapidly swollen and cherry-red epiglottis, which can obstruct the airway. - This is an acute bacterial infection, usually by *Haemophilus influenzae type b*, and while the epiglottis is inflamed, the appearance is distinct from the chronic, nodular 'turban' described in TB.

Practice by Chapter

Acute Laryngitis

Practice Questions

Chronic Laryngitis

Practice Questions

Vocal Cord Nodules and Polyps

Practice Questions

Reinke's Edema

Practice Questions

Laryngeal Papillomatosis

Practice Questions

Vocal Cord Paralysis

Practice Questions

Laryngeal Trauma

Practice Questions

Laryngeal Stenosis

Practice Questions

Laryngeal Cancer

Practice Questions

Laryngomalacia

Practice Questions

Epiglottitis

Practice Questions

Voice Disorders

Practice Questions

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