Paralysis And Paresis Of The Vocal Folds

Front 1

What three functions does the larynx provide?

Back 1

1. airway support
2. airway protection
3. voice

Front 2

Vocal fold paralysis can affect ____, ____, ____, or ____.

Back 2

voice, airway, swallowing, or all three

Front 3

How can you distinguish between paralysis and fixation?

Back 3

Palpation of the cricoarytenoid joint.

Front 4

True or False

Motor loss is responsible for significant functional difficulty.

Back 4

False.

Motor or sensory loss can be responsible for significant functional difficulty.

Front 5

True or False

Isolated sensory loss cannot occur in the absence of motor deficit

Back 5

False. Sure it can.

Front 6

____, ____, and _____ can be seen in unilateral sensory loss. Bilateral sensory loss leads to ______ and _____.

Back 6

Throat clearing, paroxysmal coughing, vague foreign body sensations.
severe aspiration & pneumonia

Front 7

Disorders that can result in isolated sensory loss include ____ and ____.

Back 7

Guillan-Barré and diabetes

Front 8

Above the vocal folds the sensory innervation of the larynx is via the ____. Below the vocal folds it is by way of branches of the ____.

Back 8

Above the vocal folds the sensory innervation of the larynx is via the INTERNAL (SUPERIOR) LARYNGEAL NERVE. Below the vocal folds it is by way of branches of the RECURRENT LARYNGEAL NERVE.

Front 9

Which nerve innervates the cricothyroid?

Back 9

The external branch of the superior laryngeal nerve.

Front 10

True or False

Superior Laryngeal nerve paralysis is generally an isolated phenomenon unrelated to other neurological or laryngeal diseases.

Back 10

True

Front 11

Can superior laryngeal nerve paralysis be caused by viral neuropathy?

Back 11

Sure

Front 12

_____ and ____ are common symptoms of superior laryngeal nerve paralysis, because of the rotation of the posterior commisure (part of the glottis between the arytenoids) toward ________.

Back 12

Diplophonia & easy fatiguability
the side of paralysis

Front 13

Approximately ____ of patients experiencing superior laryngeal nerve paralysis recover spontaneously and without intervention within ____ of onset.

Back 13

60%
1 year

Front 14

If a person does not recover from superior laryngeal nerve paralysis, what procedure might work? Is this necessary?

Back 14

nerve-muscle pedicle reinnervation.
Rarely, since the voice change is really minimal for speaking.

Front 15

The voice quality is breathy and diplophonic and the patient cannot perform a good glottal stop. What could be wrong?

Back 15

Unilateral paralysis of the recurrent laryngeal nerve.

Front 16

Anterior Commissure

Back 16

What's A?

Front 17

True Vocal Fold

Back 17

What's B?

Front 18

Corniculate Cartilage

Back 18

What's C

Front 19

Arytenoid Cartilage

Back 19

What's D

Front 20

Vocal Process

Back 20

What's E?

Front 21

Pyriform Sinus?

Back 21

What's F?

Front 22

Aryepiglottic Fold

Back 22

What's G?

Front 23

False Vocal Folds

Back 23

What's H?

Front 24

Valleculae

Back 24

What's I?

Front 25

Epiglottis

Back 25

What's above I?

Front 26

open glottis

Back 26

What's a?

Front 27

Closed glottis.

Back 27

What's b?

Front 28

Thyroid cartilage

Back 28

What's 1?

Front 29

Ring of the cricoid cartilage

Back 29

What's 2?

Front 30

rima of the glottis

Back 30

What's 3?

Front 31

Axis of rotation for the arytenoid cartilage.

Back 31

What's 4?

Front 32

Cricoid cartilage plate

Back 32

What's 5?

Front 33

Cricothyroid muscle.
Tilting movements and rough vocal chord tension

Back 33

What's 6 and what does it do?

Front 34

Vocalis muscle
Fine adjustment of vocal chord tension

Back 34

What's 7 and what does it do?

Front 35

Lateral cricoarytenoid muscle.
TVF adductor

Back 35

What's 8 and what does it do?

Front 36

Thyroarytenoid muscle
Adducts the TVF

Back 36

What's 9 and what does it do?

Front 37

Posterior cricoarytenoid.
Abducts the TVF.

Back 37

What's 10 and what does it do?

Front 38

a
TVF abducted.

Back 38

a or b? What's the result?
Contraction of the opening muscles and relaxation of the closing muscles

Front 39

b
TVF adducted.

Back 39

a or b? What's the result.

Contraction of the closing muscles and relaxation of the opening muscles.

Front 40

b

Back 40

a or b?

Which position corresponds to the partial paralysis of the recurrent laryngeal nerve?

Front 41

In unilateral paralysis of the recurrent laryngeal nerve, the paralyzed VF rests in the ______ position rather than the _____ position because of the unopposed _____ pull of the intact ______ muscle innervated by ______ branch of the vagus.

Back 41

In unilateral VF paralysis, the paralyzed VF rests in the paramedian position rather than the neutral or intermediate position because of the unopposed medializing pull of the intact cricothyroid muscle innervated by external superior laryngeal branch of the vagus.

Front 42

True or False

With unilateral paralysis of the recurrent laryngeal nerve, the mobile vocal fold often eventually compensates for the paralyzed vocal fold.

Back 42

True

Front 43

True or False

With unilateral paralysis of the recurrent laryngeal nerve, the patient may complain of shortness of breath because of rapid air escape, necessitating frequent breaths.

Back 43

False

only on speaking

Front 44

True or False

With unilateral paralysis of the recurrent laryngeal nerve, there may still appear to be slight adduction on phonatory effort. However, the vocal fold does not adduct from its position of rest.

Back 44

False.

abduct from its position of rest.

Front 45

What are three symptoms of an isolated sensory loss?

Back 45

Throat clearing, paroxysmal coughing, and vague foreign body sensations.

Front 46

True or False.

Recurrent laryngeal nerve paralysis is frequently idiopathic.

Back 46

True

Front 47

True or False.

Bilateral recurrent laryngeal nerve paralysis occurs most often as the result of stroke or other TBI.

Back 47

False.

most frequently occurs as the result of surgical or other trauma

Front 48

Why can serious airway compromise occur from bilateral recurrent laryngeal nerve paralysis?

Back 48

The patient has lost the ability to abduct the vocal folds.

Front 49

In bilateral recurrent laryngeal nerve paralysis, because the ______ nerve activity adducts the paralyzed vocal folds close to midline, _____ is usually close to normal, but _____ is generally affected.

Back 49

Superior laryngeal nerve activity adducts the paralyzed vocal folds close to midline, voicing is usually close to normal, but pitch control is generally affected.

Front 50

True or False

Combined paralyses of recurrent and superior laryngeal nerves are more common than isolated nerve palsies.

Back 50

False.

They are less common.

Front 51

What would cause bilateral paralyses of the recurrent and superior laryngeal nerves?

Back 51

Damage to CNS or base of skull where the nerve branches are in close proximity.

Front 52

True or False

Immobile vocal folds are slightly more abducted in isolated bilateral recurrent nerve paralysis than in combined bilateral paralysis.

Back 52

False.

More abducted with combined bilateral paralysis.

Front 53

Are findings in combined unilateral paralysis more like those found in unilateral recurrent or unilateral superior laryngeal nerve paralysis?

Back 53

unilateral recurrent

Front 54

True or false

Competency of the glottis is worse with combined unilateral paralysis.

Back 54

True

Loss of sensation in the supraglottic area results in paroxysmal coughing and aspiration

Front 55

True or False

In many cases, vocal fold paralysis or dysfunction recovers spontaneously within 6 months of onset, providing the nerve is not destroyed.

Back 55

False

1 year.

Front 56

Why is an accurate diagnosis of vocal fold paralysis or dysfunction critical?

Back 56

So that the interventions chosen will not prevent spontaneous recovery or compensation.

Front 57

Irreversible intervention should not be considered until 1 year after onset of TVF dysfunction, except:

Back 57

to stabilize the airway and/or deal with intractable aspiration

Front 58

___ of patients with a unilateral recurrent laryngeal nerve paralysis should receive voice therapy.

Back 58

100%

Front 59

Surgical intervention is necessary in ____ of cases of unilateral recurrent laryngeal nerve paralysis. Procedures include _____, _____ and _____,

Back 59

10-15%
Teflon (gelfoam) injection
Surgial medialization
Reinnervation

Front 60

______ is the only technique currently available that restores ability to change tension in the vocal fold for pitch control as well as active medialization.

Back 60

Reinnervation

Front 61

True or False

Bilateral recurrent laryngeal nerve paralysis usually requires intervention to stabilize the airway.

Back 61

True

Front 62

What three interventions are often used with bilateral recurrent laryngeal nerve paralysis?

Back 62

Tracheotomy
Surgical lateralization
Nerve-Muscle Pedicle Reinnervation

Front 63

Surgical lateralization techniques that remove the arytenoid cartilage and/or lateralize the paralyzed vocal fold will regain airway at the expense of what?

Back 63

Residual voice

Front 64

Nerve muscle pedicles can be transposed from the ____ to the ___ to acheive abduction within _____.

Back 64

omohyoid
cricoarytenoid
2-6 months

Front 65

Nerve-muscle pedicle reinnervations are successful in restoring adequate airway in _____ of cases.

Back 65

80%

Front 66

What three things should be considered regarding bilateral VF paralysis?

Back 66

1. adequate airway
2. eating and drinking without aspiration
3. managing own secretions