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What are the hallmark clinical signs of laryngeal disease regardless of etiology?

Respiratory distress and stridor

What is stridor?

A high-pitched turbulent sound caused by upper airway narrowing

What happens during paradoxical motion in laryngeal disease?

Soft tissues are pulled into the airway during inspiration

Why does paradoxical motion worsen laryngeal disease?

Negative pressure pulls tissue inward, causing more inflammation and edema

When do patients with laryngeal disease often develop a respiratory crisis?

With overheating, excitement, or exercise

How do patients initially compensate for laryngeal airway obstruction?

They limit physical activity

What respiratory rate is typical of laryngeal disease despite severe distress?

Normal to slightly elevated, about 30-40 breaths/min

Why is a 30-40 breaths/min respiratory rate abnormal in severe laryngeal distress?

The rate is too low for the severity of distress

How is inspiration characterized in laryngeal disease?

Prolonged and labored

How is expiration typically characterized in laryngeal disease?

More passive

What complication is laryngeal paralysis particularly associated with?

Aspiration pneumonia

What clinical signs suggest aspiration pneumonia secondary to laryngeal disease?

Cough, lethargy, anorexia, fever, tachypnea, abnormal lung sounds

What are the major differential diagnoses for laryngeal disease?

Laryngeal paralysis, neoplasia, trauma, and foreign body

What are the major differential diagnoses for pharyngeal disease?

Brachycephalic airway syndrome, elongated soft palate, polyp, foreign body, and neoplasia

What clinical signs are more typical of pharyngeal disease?

Stertor, gagging, coughing, reverse sneezing, and dysphagia

When does respiratory distress usually occur with pharyngeal disease?

Usually in later stages

What is the ideal instrument for a laryngeal paralysis exam?

A flexible laryngoscope

Why is a flexible laryngoscope preferred for laryngeal paralysis?

It causes the least distortion of laryngeal structures

What type of anesthetic agent is used for a laryngeal paralysis exam?

A short-acting injectable agent such as propofol

What respiratory pattern should be maintained during a laryngeal paralysis exam?

Spontaneous deep respirations

What should an assistant call out during a laryngeal paralysis exam?

Inspirations and expirations

What should normal arytenoid cartilages do during inspiration?

Abduct or open

What should normal arytenoid cartilages do during expiration?

Close

What happens to arytenoid movement with laryngeal paralysis?

One or both sides fail to abduct sufficiently during inspiration

What drug enhances arytenoid movement during a laryngeal paralysis exam?

IV doxapram

How does doxapram enhance arytenoid movement during the exam?

It increases respiratory rate and effort

What should be administered during a laryngeal paralysis exam?

Flow-by oxygen

What should always be available during a laryngeal paralysis exam?

An endotracheal tube

Why should an endotracheal tube be available during the exam?

For potential respiratory problems during recovery

What is the key diagnostic finding for laryngeal paralysis on laryngoscopy?

One or both arytenoids do not abduct sufficiently during inspiration