Organic disorders Flashcards
General info about organic disorders?
- Disease states that affect phonation but generally not due to way voice used
- Principally treated by medical or surgical interventions
- Can be congenital or acquired
- Lead to disordered pitch, quality or loudness
- If SLP treats, generally for pre-surgical counseling and subsequent management for compensatory work
What are the problems created by structural changes?
- 1) increase or decrease in mass of folds or surrounding areas
- 2) alteration in shape of vocal folds, especially the edge
- 3) restriction in mobility
- 4) change in tension
- 5) change in size, shape of glottis or supra/infra glottic space
- 6) prevention of complete adduction of edges of folds
- 7) irregular or chaotic vibratory patterns
What are structural voice problems?
- Cri du Chat or Lejeune Syndrome
- Congenital laryngeal stridor
- Laryngomalacia
- Congenital Subglottic Stenosis/ Atresia
- Laryngotracheal Cleft
- Congenital and acquired Laryngeal Web
- Congenital Cysts and Sulcus Vocalis
- Papillomatosis
- Down’s Syndrome
- Congenital Subglottic Hemangioma
- Laryngocele
- Endocrine Disorders
- Trauma
Cri du Chat or Lejeune Syndrome
- genetic
- distinctive high pitched wail
- rare
- manifestations
Congenital laryngeal stridor
- involuntary sound on inhalation or exhalation
- airway obstruction
- in most cases, harmless and resolves
Laryngomalacia
- soft cartilages, Omega-shaped epiglottis instead of broad and flat
- respiration problem bc the aryt. Aren’t form enough to hold art epiglottis folds open, they get sucked in
- low pitched flutter or high pitched crowing
- generally resolves in few months-1 year; surgery possible
- may be one of unrecognized causes of SIDS
- can cooccur with gerd
Congenital Subglottic Stenosis/
Narrowing of airway between glottis and 1st tracheal ring
-arrested development of conus elasticus or cricoid ring
-obstruction 2-3 cm below glottis
-stridorous voice at birth; often outgrow condition
Also can be acquired, especially from intubation
Surgery is intervention
Laryngotracheal Cleft
- Failure of posterior sides of cricoid cartilage to fuse
- Rare
Congenital Laryngeal Web
failure of cords to separate at 10 weeks
- tissue, thin or thick, between cords
- Need to differentiate from acquired
- Congenital form often part of velocardiofacial (VCF) syndrome (22q deletion)
- 75% at level of cords; rest equally sub or supraglottic
- Weak cry, stridor, difficulty breathing
- Surgery
Acquired Laryngeal Web
- Typically at anterior commissure
- Thin or thick; can be asymptomatic
- Secondary to trauma to vocal cords: irritates and inflames tissue; common after removal of papilloma
- Posterior Glottic Stenosis
- Often related to prolonged intubation, but also ingestion of caustic material, trauma, long term NG tube placement
- Both treated surgically if patient is symptomatic
Congenital Cysts
is fluid filled, non-pedunculated on any laryngeal tissue, mostly in ventricle
- Displace cords depending on size
- Surgery
Sulcus Vocalis
result of ruptured cyst leaving a pit or groove or congenital split along medial edge of cord; can be deep or shallow
- Difficult to remediate with surgery or tx: need to teach to not begin pattern of phonotrauma; work with vocal hygiene
Papillomatosis
- Main problem: recurrence and airway obstruction, voice disorder
- Caused by human papillomavirus (HPV), specifically HPV 6 and 11, which also associated with genital warts
- Cauliflower or raspberry appearance
- -Sessile or on stalk (pedunculated)
- Occur anywhere in larynx
- Surgical approaches: cold steel dissection
- CO2 laser
- Microdebrider removal
- Radiofrequency ablation
- Nonsurgical management: interferon, indole-3-carbinol, cidofovir (anti-viral), vaccines
- May require trach, either temporary or permanent
- Voice therapy: compensatory techniques, vocal hygiene and counseling
Downs syndrome
- -distinctive cry: flat intonation, low pitch, tense-strident sound
- Pitch and loudness perturbations and spectral-to-noise ratios that abnormal
- Relate to shape and tone in resonating chambers
Congenital Subglottic Hemangioma
rare
- -large purple-red tumors, sessile
- -enlarges for 6-12 months, then regresses, usually by 2 years of age
- -does not affect voice as not on cords
- -does affect respiration and possibly swallowing
- -if large, may need trach
