Exam 2 Flashcards
- Inflammatory condition below the epithelium
- Bilateral
Laryngitis
Where does laryngitis occur on the TVF?
Entire length
Etiology of laryngitis
Infection, phonotrauma, cigarette smoking, autoimmune disease, GERD
- Mass/growth of the epithelium
- Bilateral
Vocal Fold Nodules
Where do vocal fold nodules occur on the TVF?
Junction of the anterior 1/3 and posterior 2/3 membranous portion
Etiology of Vocal Fold Nodules
Usually results from phono traumatic behaviors
- Mass/growth of the epithelium
- Unilateral
Vocal Fold Polyps
Where do vocal fold polyps occur on the TVF?
Middle 1/3 of the membranous TVF
What are the two forms that the fluid-filled vocal fold polyp can take?
Sessile (blister-like) or Pedunculated (polyp is attached to the TVF by a stalk-like appendage)
Etiology of Vocal Fold Polyps
Acute vocal trauma, chronic phono traumatic behaviors
- Mass/growth below the epithelium
- Unilateral
Vocal Fold Cysts
Where do vocal fold cysts occur on the TVF?
Middle 1/3 of the membranous TVF
Etiology of Vocal Fold Cysts
Occasionally congenital, sometimes due to poor lymphatic drainage, most often due to phono traumatic behaviors
-Inflammatory condition below the epithelium
- Bilateral
Reinke’s Edema
Where does Reinke’s Edema occur on the TVF?
Entire membranous length of the TVF
Etiology of Reinke’s Edema
Long-standing trauma or chronic exposure to irritants (such as cigarette smoke or stomach acids)
- Mass/growth of the epithelium
-Unilateral or Bilateral - White plaque-like formation on the vocal fold surface
Leukoplakia
Where does leukoplakia occur on the TVF?
Usually found in the anterior 2/3 of the TVF
Etiology of Leukoplakia
Trauma to the vocal folds caused by inhalation of dust, noxious fumes, cigarette smoke, inhaled drugs such as marijuana, chronic bacterial or fungal infections, chronic laryngitis; also associated with excessive alcohol intake
- Mass/growth of the epithelium
-Unilateral or Bilateral - Presents as wart-like lesions
RRP (Recurrent Respiratory Papillomatosis)
Where does RRP occur on the TVF?
Anywhere along the TVF, but most often at the anterior commissure
Etiology of RRP
Human Papilloma Virus (HPV)
- Unitlateral or Bilateral
- Benign growths
Granulomas
Where do granulomas occur on the TVF?
On the vocal processes; usually in posterior glottis on the arytenoids
Etiology of Granulomas
Phono trauma, LPR (laryngopharyngeal reflux); intubation trauma
- Small piece of connective tissue connecting the vocal folds that can affect phonation and breathing
- Bilateral
Laryngeal Web
Where does Laryngeal Web occur on the TVF?
Anterior commissure of TVF
Etiology of Laryngeal Web
Can form as a consequence of trauma or infection, but most are congenital
- Omega-shaped epiglottis
- Excessive flaccidity of the supra glottic larynx
- Causes collapse of laryngeal cartilages during inspiration
- Bilateral
Laryngomalacia
Etiology of Laryngomalacia
Congenital abnormality without a clear cause (maybe due to insufficient calcium deposition, or related to CNS problems in children)
Which disorders results in problems with complete glottic closure?
- Laryngitis
- Nodules
- Polyps
- Cysts
- RRP
Which disorders result in lowered pitch?
- Laryngitis
- Nodules
- Cysts
- Reinke’s Edema
Which disorders can result in hoarseness?
- Laryngitis
- Nodules
- Polyps
- Cysts
- Leukoplakia
- RRP
Which disorders can result in breathiness?
- Nodules
- Polyps
- Cysts
Primary complaint of granulomas
PAIN
Primary complaint of laryngeal web
SOB, Stridor
Primary complaint of laryngomalacia
SOB, Stridor
What is a functional upper airway disorder?
Disorder where there is no organic abnormality of the larynx
What does paradoxical vocal fold movement entail?
Vocal folds doing the opposite of what they should be
True or False: Inducible laryngeal obstruction (ILO) is a transient problem.
True
True or False: ILO is a problem related to breathing.
False
The majority of people diagnosed with ILO are _____.
adults
Which noise is most associated with ILO?
Stridor
True or False: ILO is most likely to occur on inspiration.
True
True or False: Asthma inhalers are effective with symptoms of EILO.
False
What are the proposed etiologies of ILO?
- Laxity of muscles, ligaments, or cartilages of the larynx, making it prone to movement during high intensity breathing that narrows the airway
- Hyperactive laryngeal adductor reflex
- Co-morbidities (asthma, gastro-esophageal or laryngeal reflux)
- Psychological contribution
Besides the true vocal folds, what other structures can narrow the airway in an episode of ILO?
False vocal folds, epiglottis, arytenoids
What is one difference in symptom presentation between EILO and asthma?
ILO usually has one or few triggers; asthma usually has multiple or many triggers
True or False: At rest, the larynx looks normal at rest before a trigger brings on an episode of ILO.
True
What are symptoms associated with ILO besides dyspnea?
- Tightening in the throat or chest
- Feeling of suffocation
- Dizziness
Similarities between laryngitis and vocal fold nodules
- Occur bilaterally
- Causes hoarse/rough voice
- Causes low pitch
- Incomplete glottic closure
- Decreased vibration
- Can be caused by phono trauma
Differences between laryngitis and vocal fold nodules
- Nodules result in specifically an hourglass incomplete closure pattern
- Laryngitis is an inflammatory condition of the epithelium, whereas nodules are masses/growths of the epithelium
- Laryngitis can be caused by infectious agents
Similarities between vocal fold polyps and vocal fold cysts
- Occur unilaterally
- Occur in the middle 1/3
- Can be caused by phono trauma
- Cause rough, breathy voice
- Hourglass closure pattern
- Asymmetrical vibration
Differences between vocal fold polyps and vocal fold cysts
- Cysts are masses below the epithelium, polyps are masses of the epithelium
- Cysts can be congenital or caused by lymphatic drainage issues
- Polyps can be pedunculated or sessile
- Cysts cause a lowered pitch
- Polyps can cause SOB
Similarities between leukoplakia and RRP
- Masses/growths of the epithelium
- Can be unilateral or bilateral
- Can cause hoarseness
- Decreased vibration
Differences between leukoplakia and RRP
- RRP can occur anywhere whereas leukoplakia usually is found at the anterior 1/3
- RRP can cause total loss of voice
- Leukoplakia can be caused by trauma to the vocal folds or infection while RRP is caused by HPV
Similarities between Reinke’s Edema and laryngitis
- Inflammatory condition
- Involves entire length of TVF
- Both can be caused by phono trauma or irritant exposure
- Lowered pitch
- Hoarseness
Differences between Reinke’s Edema and laryngitis
- Laryngitis is an inflammatory condition of the epithelium while Reinke’s is an inflammatory condition below the epithelium
- Laryngitis can cause incomplete glottic closure while closure is usually complete with Reinke’s
- Reinke’s can cause SOB
Similarities between granulomas and vocal fold cysts
- Can be caused by phono trauma
- Occur unilaterally
- Globus sensation
Differences between granulomas and vocal fold cysts
- Granulomas can be found bilaterally
- Granulomas are pound in the posterior glottis and do not usually interfere with glottic closure or vibration
- Primary compliant with granulomas is pain
Similarities between laryngeal webs and laryngomalacia
- Occur bilaterally
- Often congenital
- Primary complaint is SOB, stridor
Differences between laryngeal webs and laryngomalacia
- Web occurs at the anterior glottis, whereas laryngomalacia occurs mostly outside the TVF and involves the supraglottis
- Symptoms are most present upon inhalation with laryngomalacia but are present upon inhalation and exhalation with web
- Laryngomalacia can be characterized by an omega-shaped epiglottis
- Web can cause a high-pitched voice
Similarities between vocal fold nodules and vocal fold polyps
- Caused by phono trauma
- Mass/growth of the epithelium
- Rough, hoarse, breathy voice
- Hourglass closure pattern
- Decreased vibration
Differences between vocal fold nodules and vocal fold polyps
- Polyps are unilateral, nodules are bilateral
- Nodules lowers pitch
- Polyps can cause difficulty breathing
- Polyps can be sessile or pedunculated
Similarities between unilateral vocal fold paralysis and bilateral vocal fold paralysis
- Damage to the RLN
- TVF may appear bowed
- May have pooling of secretions if paralyzed in the intermediate or lateral position
- Incomplete glottic closure if paralyzed in the intermediate or lateral position
- Breathy, hoarse voice if paralyzed in intermediate or lateral position
- Possible dysphagia
Differences between unilateral vocal fold paralysis and bilateral vocal fold paralysis
- Critical breathing difficulties if bilateral paralysis is in the median position
- May have no voice symptoms at all if bilateral paralysis in the median position
Similarities between adductor spasmodic dysphonia and abductor spasmodic dysphonia
- Focal dystonia
- Onset in middle age
- Most prevalent in females
- Unknown etiology
- Voice symptoms do not occur at rest or during non-phonatory tasks
- Occur less during laughter or signing
- Tension throughout the larynx can be seen
Differences between adductor spasmodic dysphonia and abductor spasmodic dysphonia
- Abductor SD causes a weak/breathy voice
- Adductor SD causes a strained/strangled quality
- Adductor SD most often involves spasming of the TA muscle or other muscles of adduction
- Abductor SD involves spasming of the CTA
Similarities between essential voice tremor and spasmodic dysphonia
- Involuntary movement
- Voice breaks
- Can cause slower speaking rate
Differences between essential voice tremor and spasmodic dysphonia
- Essential tremor can involve multiple sites of extraneous movement such as the soft palate and pharyngeal walls in addition to the larynx
- Voice is described as shaky or quivery with essential tremor
Similarities between Parkinson’s hypophonia and unilateral vocal fold paralysis
- TVF bowing
- Incomplete glottic closure
- Breathy voice quality
- Decreased loudness
- Asymmetrical vibration
Differences between Parkinson’s hypophonia and unilateral vocal fold paralysis
- PD hypophonia is related to hypokinetic dysarthria and paralysis is due to damage to the RLN
- TVF are fully mobile with PD hypophonia
- Speech rate is affected in PD hypophonia
Similarities between primary muscle tension dysphonia and secondary muscle tension dysphonia
- Excessive muscle effort
- Vocal strain
- Compression can be seen laterally and anteroposterior
- Strained, harsh voice
- Vocal fatigue
- Globus sensation
Differences between primary muscle tension dysphonia and secondary muscle tension dysphonia
- Primary MTD is due to maladaptive behaviors with no underlying laryngeal abnormality
- Secondary MTD is due to maladaptive behaviors due to an underlying laryngeal pathology
- Stress is a primary MTD
Similarities between mutational falsetto and muscle tension dysphonia
- Psychological distress can cause both
- Can have incomplete glottic closure
- Pitch is high
Differences between mutational falsetto and muscle tension dysphonia
- MTD mostly affects females ages 40-50, mutational falsetto mostly affects males age 11-15
- Voice can be very weak in mutational falsetto
Similarities between muscle tension dysphonia and conversion aphonia
- Can be caused by stress
- Larynx may look normal at rest
- Significant compression can be seen during phonation
- Voice can be strained
- Voice can be high-pitched
- Pain reported
Differences between muscle tension dysphonia and conversion aphonia
- In conversion aphonia, the TVF may not fully adduct
- Patient may only be able to whisper in conversion aphonia
- Vegetative phonation is often normal in conversion aphonia
Similarities between conversion aphonia and mutational falsetto
- Can be caused by psychological distress
- Pitch is high
- Larynx looks normal at rest
- May have incomplete glottic closure
Differences between conversion aphonia and mutational falsetto
- Mutational falsetto typically occurs in adolescent males, conversion aphonia can occur in anyone
- Vegetation phonation is often normal in conversion aphonia
What is an unproductive cough?
A cough that does not produce any phlegm or mucus
A chronic cough is one that lasts for more than _____ weeks.
8
Peak incidence of chronic cough is in the age range of:
5th and 6th decades of life (50s and 60s)
What is hypersensitivity?
Reaction to lower dose stimulus; incidental and non-harmful stimuli
What is learned hypersensitivity?
An initial irritant “primes” the system which then becomes a generalized physiologic response
What is allotussia?
Cough is triggered by incidental and mostly non-harmful stimuli
