Etiology
This syndrome results from injury to the superior laryngeal nerve. This injury may be unilateral or bilateral. The superior laryngeal nerve supplies sensory information to the larynx and hypopharynx as well as motor innervation to the cricothyroid muscle.
Diagnosis
History
Typical complaints
- choking
- trouble swallowing liquids
- problems with singing
- problem started after neck surgery
- thyroid gland removal
- carotid artery surgery
- anterior cervical fusion
Character of a patient with Superior Laryngeal Nerve Injury
- anyone
- Talkativeness scale: any
- though at times the patient will rate their current ability to talk rather than their innate degree of talkativeness and give a low rating
Vocal capabilities
- Speaking voice
- should be unaffected. This is important as unless you ask someone to try speaking at a high pitch they will not particularily notice this impairment.
- Yelling voice
- may be loss of projection and volume, especially at higher pitches
- Maximum phonation time
- may be normal at anchor pitch
- Pitch range
- loss or impairment of upper pitch range and falsetto
Laryngeal Exam
- rigid laryngoscope
- may see rotation of larynx during attempted high pitch phonation if injury is unilateral
- pooling of secretions on affected side(s) in piriform sinuses
- flexible laryngoscope
- same
- loss of sensation to touch on the affected aryepiglottic fold by the endoscope
- neck exam
- The cricothyroid space may not close off during attempts at high pitch phonation
- Thus, cricothyroid joint fixation may mimic a superior laryngeal nerve paresis.
Treatment
Medical
- swallowing may be improved by head positioning
Behavioral
Surgical
- I have seen a case report by Steven Zeitels and in several patients have myself disarticulated the cricothyroid joint and manually advanced the cricoid cartilage with a suture to put the joint in a permanently tighter position.
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