Hoarseness Flashcards
largest cartilage in the larynx
thyroid cartilage: provides support and protection for the vocal folds
vocal ligaments are attached to the __ of the thyroid cartilage
anterior inner surface
chief moving parts of the larynx
arytenoid cartilage
arytenoid cartilage connects to the cricoid or thyroid via __
intrinsic laryngeal muscles (thyroarytenoid, lateral cricoarytenoid, interarytenoid, posterior cricoarytenoid)
the only complete rigid ring within the airway
cricoid cartilage
adductor muscles
thyroarytenoid lateral cricoarytenoid (major) interarytenoid
only abductor in the larynx
posterior cricoarytenoid
muscle with no direct action on arytenoid motion
cricothyroid myscle
major action of thyroarytenoid muscles
shorten or tense vocal fold and increase cross sectional area
histology of vocal folds
read
nerve supply
superior laryngeal nerves
- internal: sensory
- external: motor
recurrent laryngeal nerves
- supplies other intrinsic laryngeal muscles
mechanisms to close glottis
- elastic recoil of soft tissues (myoelastic)
- negative pressure sucks the folds together (aerodynamic)
disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life
hoarseness
most frequent cause of hoarseness
inflammatory diseases (viral infection)
vocal fold nodules vs reflux laryngitis
vocal fold nodules: voice better in the morning, worsens during day
reflux pharyngitis: worse in the morning, gets better during day
t/f allergic attacks can trigger vocal fold swelling
true
breathy voice finding meanas
inadequate apposition of vocal fold edges (vocal fold paralysis, old age, mass lesions)
general rule in larynx visualization
should be visualized or referred to clinician who can if hoarseness persists for more than 2 weeks with any of the ff:
- history of alcohol/tobacco abuse
- concomitant discovery of neck mass
- after trauma
- assoc hemoptysis, dysphasia, or dyspnea
easiest and least expensive method to visualize larynx
indirect laryngoscopy (mirror)
t/f indirect laryngoscopy is more detailed than laryngeal endoscopy
false, LE is more detailed
indications for direct laryngoscopy
concomitant procedure (needs sedation)
gold standard laryngoscopy
largneal videostroboscopy (LVES)
etiology of vocal fold nodules
due to vocal abuse or misuse
- talkativeness index score
- professions with high vocal commitment
suspect vocal fold nodules in _
- pt who report voice fatigue assoc with voice use
- pt voice worsens at end of day or week
- pt chronically hoarse
clinical presentation of vocal fold nodules
- recurrent eventually chronic hoarseness worse at the end of the work day or week
- harsh, breathy, loss of range, vocal fatigue
- L: smooth bumps at junction of anterior and middle thirds of VFs, bilateral!!, symmetrical
treatment for vocal fold nodule
voice therapy 6-12 wks, surgical excision
etiology of vocal fold hemorrhage
abrupt onset during extreme vocal effort (men in noisy place)
presentation of vocal fold hemorrhage
- rough, husky, easy vocal fatigue, loss of high register
- laryngoscopy: superficial bruise with no vf edge convexity
treatment for vocal fold hemorrhage
voice rest, short voice therapy, laser ablation
etiology of vocal fold polyp
intermittent, severe voice abuse (m>w)
presentation of vocal fold polyp
- hoarseness like vf hemorrhage but worse and longer
- L: unilateral, broad-based or pedunculated mass, prominent vessels
treatment for polyp
voice therapy, steroid use, surgical excision
etiology of vocal fold cyst
congenital: epidermal inclusion cyst
acquired: blocked mucous gland cyst
vocal abuse/misuse
presentation of vocal fold cyst
- chronic or recurrent hoarseness
- rough, breathy, loss of range, fatigue
- L: found on superficial!! layer, unilateral!!
types of vocal fold cyst
mucous retention cyst: mucus, fluid filled
epidermal inclusion cyst: caseous material, pearl like
treatment for vocal fold cyst
trial voice therapy, surgery
etiology of vocal fold granulomas
acid reflux, hoarseness when severe
presentation of vf granuloma
- low gravelly or husky voice
- L: granulomatous, unilateral, mass at posterior portion of vocal fold
treatment for vf granulomas
conservative: reflux control, voice therapy
biopsy and surgery if fails
etiology of reinke’s edema / bilateral diffuse polyposis or polypoid corditis
- chronic irritation or inflammation
- classic: female, smoker, avid talker
- irritation = vascular congestion and venous stasis = edema
presentation of reinke’s edema
- low, coarse and gruff voice
- L: floppy vfs, elephant ear appearance, watery bags attached to vf
treatment for reinke’s edema
- smoking cessation, voice therapy, voice hygiene
- surgery
etiology of laryngeal papilloma
hpv 6 and 11
presentation of laryngeal papilloma
- rough breathy voice
- dyspnea due to obstructive, bulky lesions
treatment of laryngeal papilloma
- serial surgical excision (recurrent)
- intralesional injection with cidofovir (delays growth)
- prevention: immunization, safe sex
etiology of laryngeal cancer
- most common site is vocal fold
- risk factors: smoking and alcohol
presentation of laryngeal cancer
- progressive hoarseness
- L: exophytic or infiltrating, friable irregular mass, can extend outside vf
treatment of laryngeal cancer
surgery, chemoradiation
etiology of vf paralysis
most common is iatrogenic
presentation of vf paralysis
- hoarseness from immobility
- variable presentation
treatment: voice therapy, sugery
etiology of laryngitis
most common: viral infection, bacterial is rare
presentation of laryngitis
- rough voice with aphonia
- associated symptoms
- L: boggy, edematous, erythematous
treatment for laryngitis
non-specific, voice rest, control coughing and throat clearing, hydration, control post nasal drip, nsaid
presentation of laryngopharyngeal reflux
- globus
- frequent throat clearing and irritation
- intermittent cough
- L: post cricoid and arytenoid edema or thickening, vf edema, thick mucus
treatment for laryngoesophageal reflux
long term antacids, dietary restriction, lifestyle modfication
presentation of presbylaryngeus
- loss of tone and deconditioning
- weak, breathy voice, vocal fatigue
- L: vocal fold bowing
treatment: voice therapy, surgery
t/f cold drinks can worsen hoarseness, and ginger gargles helps hoarseness
false
