Chapter 71 - Hoarseness/Dysphonia Flashcards
How long does acute laryngitis take to resolve?
1-2 wk
which non-acidic refluxed element is associated with LPR inflammation
pepsin
3 systemic diseases affecting larynx and their location
Sarcoid (supraglottic)
Amyloid (glottic)
Wegener (subglottic)
Glottic insufficiency
closed phase lasts less than 45-50% of vibratory cycle
Or incomplete closure
where do vocal nodules occur?
junction of ant/middle thirds TVC
What could be the cause of bilateral VC lesions other than nodules?
a dominant subepithelial lesion with a contralateral reactive lesion
Types of HPV causing RRP
6, 11
Muscle tension dysphonia typically compensates for which underlying condition?
glottic insufficiency
Which requires higher dose/longer treatment … GERD or LPR?
Often LPR
Dysphonia
Issues with quality of sound, increase in vocal effort/fatigue, pain/discomfort with phonation
Site of pain that suggests muscle tension dysphonia
pain in tongue or strap muscles
Causes of glottic insufficiency
Paresis/paralysis TVC
Atrophy TVC
Scar TVC
Sulcus vocalis
Epithelium scarred down to vocal ligament —> no vibration in that area due to loss of SLP
Common causes of dysphonia
GI with Sec MTD Phonotrauma (nodule/polyp/cyst/granuloma/hemorrhage) Leukoplakia/Erythroplakia SCCa Neuro: spasmodic dysphonia, essential tremor, párkinson Inflam: LPR, allergy, irritant, AutoImm RRP (GI or scarring) Primary MTD (supraglott hyperfxn)
Treatment of acute laryngitis (viral)
Hydration
Voice rest
Chronic laryngitis: DX, Tx
4 wk+
Smoking, voice abuse, fungal infection, LPR
Remove irritating factors via smoking cessation, reflux Tx, antifungal, voice rest
GI Tx
Voice therapy Injection augmentation (fat, acellular debris, hyaluronic acid, carboxymethylcellulose, calcium hydroxyapatite) Medialization laryngoplasty (Gore-Tex/Silastic implant lateral to VC)
Add vs Abd spasmodic dysphonia
ADD: voice breaks during voiced vowels, strangled voice. Tx botox to thyroarytenoid/lat cricoarytenoid
ABD: voice breaks during voiceless consonants (P, F), breathy quality. Tx botox to posterior cricoarytenoid
Neurologic diseases leading to hoarsenes
Parkinson, ALS, Polio, MG, EL, MS (hypofunctional, dysphagia as well)
Dystonia, essential tremor, pseudobulbar palsy (hypofunctional, iregular loudness/pitch/straining)
Inflammatory systemic dz leading to hoarseness
RA (cricoarytenoid joint, with VC nodules), sarcoid (supraglottic, nodular/turban-like thickening), amyloid (true and false VC), Wegener (subglottic stenosis)
Differentiating benign VC lesions causing hoarsenes
Polyp: exophytic, soft/smooth, junction of Ant/Mid thirds, opposing reactive lesion (fibrous callous), may be hemorrhagic with trauma
Nodule: bilat, symmetric, junction of Ant/Mid thirds
Cyst: fluid filled or cellular (epidermoid), in SLP
Fibrous: firm, broad, significantly affects wave, Ant/Mid thirds
Varices/ectasias: in middle of VC, singers with intermittent acute dysphonia
Granuloma: fleshy, trauma/glottic insufficiency leading to MTD 2/2 LPR, on vocal process of arytenoids
Who gets polypoid corditis/Reinke edema?
Swelling of SLP
Smoker, hypothyroidism
How often does RRP turn malignant?
1-2%
Treatment of vocal process granulomas
regress spontaneously, become asymptomatic with voice therapy and acid reflux suppression
Goals of voice therapy
retrain patient to produce best sound with least injury
unload/relieve larynx of hyperfunctional behaviors
Instill muscle memory (like training pitcher with injured arm to pitch right)
4-6 wk
Technique for surgical removal of benign VC lesions
medial microflap (lift up epithelium, remove growth). If very adherent, may need to remove epithelium with lesion…could use KTP laser in this situation too
Diseases treatable with steroid injections
scar, nodule, fibrous mass
Uses of KTP laser with benign VC pathology
RRP Ectasia Reinke edema hemorrhagic polyp deep fibrous masses
Membranous vs cartilaginous glottis
Memb: Ant 2/3 of visible length
Cart: post 1/3 of visible length
Why would someone continue to have LPR if on BID PPI?
Pepsin also regurgitates, can be active even at neutral pH
Dietary acids may activate pepsin as well
Must have dietary changes as well!
Lifestyle interventions for LPR
HOB elevated when sleeping avoid tomato based, spicy or fatty foods wait 3-4 hours after eating to go to bed, 60 seconds to stay upright after eating all day Lose weight Don’t exercise after eating No caffeine, alcohol, carbonation Avoid tight clothing No excessive water before bed Avoid overeating
