Diseases of the Larynx Practice Questions

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

Laryngeal tuberculosis. ***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.

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

Stridor. ***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.

Q: 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:

Partial laryngectomy. ***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.

Q: Which of the following statements about laryngomalacia is true?

It typically presents with inspiratory stridor.. ***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.

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

Type II (Subepithelial cordectomy). ***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.

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

Preserved voice quality (Normal voice). ***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.

Q: Turban epiglottis is seen in -

TB. ***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.

Question 1

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

Accepted Answer

Laryngeal tuberculosis

Answer

Vocal cord nodules

Answer

Vocal cord paralysis

Answer

Laryngeal carcinoma

Question 2

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

Accepted Answer

Stridor

Answer

Bowed vocal cords

Answer

Loss of pitch

Answer

Aspiration

Question 3

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:

Accepted Answer

Partial laryngectomy

Answer

Stop smoking

Answer

Stripping of vocal cord

Answer

Laser vaporization

Question 4

Which of the following statements about laryngomalacia is true?

Accepted Answer

It typically presents with inspiratory stridor.

Answer

It is characterized by an omega-shaped epiglottis.

Answer

It requires immediate surgical intervention.

Answer

It always requires surgical intervention in newborns.

Question 5

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

Accepted Answer

Type II (Subepithelial cordectomy)

Answer

Type Va (Subligamental cordectomy)

Answer

Type IV (Total cordectomy)

Answer

Type III (Transmuscular cordectomy)

Question 6

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

Accepted Answer

Preserved voice quality (Normal voice)

Answer

High-pitched voice (Puberphonia)

Answer

Vocal fatigue (Phonasthenia)

Answer

Strained voice (Dysphonia plicae ventricularis)

Question 7

Turban epiglottis is seen in -

Accepted Answer

TB

Answer

Epiglottitis

Answer

Laryngeal papilloma

Answer

Leprosy

Diseases of the Larynx — MCQs

Diseases of the Larynx — MCQs

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