Organic Disorders Flashcards
What are the characteristics of organic disorders vs functional disorders
Organic: Purely organic & Typically abnormal anatomy, tissue changes
Functional: May be wholly functional, may have organic factors, typically normal anatomy
What can functional misuse lead to?
organic changes
What is functional misuse?
inadequate breath support
hard glottal attack
supraglottal squeeze
What is the most frequently occurring voice disorders?
nodules
What are the organic classifications?
- Congenital - web, laryngomalacia
- Misuse/abuse: lifestyle - reflux (diet), Reinke’s edema (smoking), personality (nodules)
- Disease - cancer
- Trauma -cartilage dislocation
How many people miss a day at word due to a voice problem?
28 million people
What are vocal fold nodules?
- bilateral
- Benign mass on medial Vocal fold surfaces
- develop at the margin or junction of the anterior and middle two thirds of the vocal fold
- somewhat like callouses and blisters
What causes vocal fold nodules?
-misuse/abuse: yelling got sick, coughing -throat clearing -talking too loudly -speaking/singing in a pitch outside the normal mode of phonation
What are the signs/symptoms of vocal fold nodules?
- hoarseness
- rough voice
- increased vocal effort
- vocal fatigue/strain
- loss of upper range
- voice variability
- VF edema
- hourglass closure
- decrease VF vibration
- hearing loss
How do people who have vocal fold nodules and a hearing loss talk?
loud
What is the hourglass closure?
Vocal folds meet in the middle but there is a gap in front and large gap posterior.
What is a posterior chink?
An opening in the posterior part of the vocal folds.
Why do vocal fold nodules impact higher pitches?
Vocal folds stretch to create higher pitch
What happens if a female has a posterior chink?
It’s okay for a female has a posterior chink but not male.
______ _____ turns into very soft vocal fold nodules.
Pre-nodular swelling
When do you start to see vocal fold nodules?
When they start to get hard.
How do the nodules impact the vocal folds?
Take up space and VF can’t touch.
There is air leak
voice is breathy and hoarse
Look at vocal fold nodule pictures
Label posterior chink
- vocal fold edema around vocal fold nodules
- VF edema
- vascularity is being pushed to the surface
What is a polyp?
soft mass
- usually unilateral
- originates in the superficial layer of lamina propria
- usually in the middle one third of the menbranous vocal fold
- polyps stem off vocal folds
What is the etiology of a polyp?
misuse/abuse
What are the types of polyps?
- Fibrous
- hemorrhagic
- pedunculated
- sessile
What is a fibrous polyp?
Fluid filled; fluid clear to opaque
What is a sessile polyp?
blister like
What is a pedunculated polyp?
Foot-like projection
What is a hemorrhagic polyp?
Red blood filled
A polyp can cause an issue on the opposite vocal fold due to what?
reactive swelling (VF edema)
Can there be two polyps on the vocal folds?
Yes, in different locations.
If a polyp is pedunuculated there is a chance of what?
voice variability
What does yellow around the vocal folds indicate when there is a polyp or there was a poly?
It’s trying to heal or it’s on its way to heal.
What are the signs and symptoms of a vocal fold polyp?
- hoarseness
- rough voice
- increased vocal effort
- vocal fatigue/strain
- breathing problems (dyspnea) depending on size
- voice variability (especially if pedunculated)
- VF edema (reactive swelling)
- throat clearing
- globus sensation (notes and book)
What does a patient with a polyp mean when they complain of global sensation?
They have a sensation of something in their throat.
_____ ______ is when a patient complains of feeling something in their throat?
Global sensation
Look at polyp pictures on power point and book.
Label:
-Pedunculated polyp
Fibrous polyp
-yellow area trying to heal
What is a cyst?
A benign mucous/fluid filled opaque lesion below vocal fold surface.
-anterior 2/3 posterior 1/3
What are the etiologies of cysts?
- entrapment of vocal fold lining (under the lining)
- plugged mucous-secreting gland
- vocal misuse/abuse
What is a laryngocele?
cyst in laryngeal cavity
A _________ is a cyst in a laryngeal cavity.
laryngocele
What are the signs and symptoms of a patient with a cyst?
- hoarseness
- rough voice
- increased vocal effort
- vocal fatigue strain
- vocal fold edema (reactive swelling)
- throat clearing
- globus sensation
- no upper range
Cysts result typically from what?
misuse/abuse
What is the defining characteristic of a cyst?
Pretty round and spherical
What do you report when you cannot differentiate between a cyst or polyp on the right vocal fold?
A right vocal fold lesion
How can a cyst disappear?
More misuse/abuse
vocal rest
A ______ cyst can develop when there is damage to a gland.
ganglion
Look at cyst pictures on power point and book.
-cyst on superior surface
What is papilloma?
HPV wart-like benign growths of the larynx (papillomoatosis)
-it might not surface for a while
What are the etiologies of papilloma?
- acquired at birth
- oral sex
- unknown
How can papilloma be cured?
It can never be cured.
How many strains of HPV can cause papillomatosis?
60
Look at papilloma pictures on power point and book.
Notice the anterior commisure
-supraglottal papilloma
What is a granuloma?
- A benign polyp specifically on vocal process.
- can be unilateral or bilateral
- It’s a polyp but more defined
What muscle attached to the vocal process?
thyrovocalis muscle
A granuloma is a ______ but more defined.
polyp
What exacerbates a granuloma?
clearing of throat
What are the etiologies of a granuloma?
- laryngopharyngeal reflux
- intubation due to surgery or coma
What can cause laryngopharyngeal reflux?
Diet: -soda - tomatoes - chocolate - citrus -spicy foods - high fat - caffeine - alcohol- -dehydration -lifestyle: smoking -eating too late eating too much at once exercising too soon being overweright
Explain how intubation can cause a granuloma?
Tube is placed down through larynx into trachea to help person breathe. The tube sits on back of larynx, tube rubs on vocal process area.
laryngopharyngeal reflux is also known as _____ reflux.
silent
What is the first tissue that gets affected by the laryngopharyngeal reflux?
Interarytenoid tissue, it gets bumpy (pacadermia) and purple
What happens when a granuloma is too big?
It can affect airway and cause breathing problems
What is the size of a granuloma?
All different sizes, the longer is there the bigger it will grow.
What causes dry cough which is a symptom of the presence of a granuloma?
laryngopharyngeal reflux can get into nasal cavity and cause post nasal drip and dry cough.
Where do granulomas develop?
vocal process
How do you treat granulomas?
Surgery, but if it does not work address what causes the granuloma.
What are the signs/symptoms of the presence of a granuloma?
- globus sensation
- heartburn/indigestion (reflux type)
- excessive throat clearing
- dry cough
- post nasal drip
- breathing problems (size dependent)
- may be pedunculated.
What are the organic disorders that can be pedunculated?
polyps and granulomas
Look at pictures of granulomas.
Identify the granulomas on right vocal process and the one developing on left vocal process.
Besides surgery, what is another way to treat granulomas?
Proton pump inhibition
What happens if the granuloma is too big?
It will obstruct air way and cause breathing problems.
A _____ _____ is a pre-granuloma.
contact ulcer
What is a contact ulcer?
- Pre-granuloma
- Raw sores on mucous membrane overlying vocal process of arytenoid
What does a contact ulcer look like?
It starts looking white, then reddish, raw and mad.
A contact ulcer can feel mild pain like a sore throat causing ____ _____.
throat clear
What are the etiologies for a contact ulcer?
- misuse/abuse
- laryngopharyngeal reflux
- smoking
- intubation
With a contact ulcer, erythema is evident where?
vocal process area
What are the signs/symptoms of a contact ulcer?
- hoarseness
- globus sensation
- mild pain when voicing or swallowing
- throat clearing
- erythema
How often do speech pathologists see patients with sulcus vocalis?
Not too often, and it is not seen in children.
-Don’t come to clinic because they don’t always have voice problems.
What is sulcus vocalis?
Thining or absence of superficial lamina propria
-ditch running through vocal fold
_____ ______ is thinning or absence of superficial lamina propria or a ditch running thorough vocal fold.
sulcus vocalis
Sulcus is latin for what?
cleft, furrow
What is the etiology of sulcus vocalis?
unknown-developmental?
genetic?
post hemorrhage?
Book: linked to history of smoking
Is sulcus vocalis unilateral or bilateral?
Both
Look at pictures of sulcus vocalis.
Identify the bilateral sulcus vocalis.
identify unilateral sulcus vocalis
What are the signs/symptoms of sulcus vocalis?
-may not have voice problems
-harsh voice
hoarseness
-high pitch
abnormal VF vibration
When are sulcus vocalis disocvered?
When patients comes for another voice problem.
How do you treat laryngomalacia?
Need surgery to fix it.
Name congenital laryngeal conditions.
- laryngomalacia
- subglottal stenosis
- esophageal atresia
- tracheoesophageal fistula
What is laryngomalacia?
Cartilage fails to stiffen which cause the collapse of epiglottis into airway.
laryngomalacia causes ______ issues.
breathiness
Diagnosis of laryngomalacia is by clinical manifestation of what?
inspiratory stridor
Sometimes a person may _____ laryngomalacia.
outgrow
What is subglottal stenosis?
Narrow subglottal space (Narrowing below the vocal folds/glottis)
What is subglottal stenosis associated with?
malformed cricoid cartilage
What causes acquired subglottal stenosis?
prolonged intubation (intubation trauma)
______ ______ is a narrow subglottal space.
Subglottal stenosis
What is esophageal atresia?
Occlusion of esophagus. Esophagus wasn’t connected to stomach.
- Messed up sphincters
- causes dysphagia
Esophageal atresia can cause?
dysphagia
_____ ______ is an occlusion of the esophagus; esophagus was not connected to stomach.
Esophageal atresia
What is a tracheosophageal fistula?
Openings between trachea and esophagus. It may occur with esophageal pouch.
Where does the tracheoesophageal fistula occur?
Back of trachea wall to front of esophagus wall.
_____ ______ develops abnormally. Designed to be there for something to pass.
tracheoesophageal fistula
What is the tracheoesophageal fistula designed for?
for something to pass.
What can esophageal pouch co-occur with?
tracheoesophageal fistula
What is a web?
Web of tissue across larynx, usually anterior
Are webs usually seen anterior or posterior?
usually anterior, only seen posterior once.
What are the etiologies of web?
- congenital (more often)
- post surgical
A _____ develops at the anterior commisure after laser surgery for papilloma.
web
Why does a patient develop a web post-surgery?
Patient does not observe voice rest after surgery, tissue is raw, open and will attach.
What signs/symptoms does a web display?
May not have voice problems
usually no problems breathing problems in adults.
_____ is deterrent when you have a web.
Mytomicin C
Look at pictures of webs.
Powerpoint and book
Where does a hemorrhage occur?
Bleeding into superficial lamina propria
What happens in a hemorrhage?
Blood vessels blow or bleed causing swelling or edema of vocal folds.
In a hemorrhage what is bright red and what happens when it starts healing.
- vocal folds are bright red
- it has a yellowish appearance when it’s healing
What are the etiologies of a hemorrhage?
-misuse/abuse
medications (blood thinners) Coumadin, aspirin, ibuprofen
, pain killers
What are the signs and symptoms of a hemorrhage?
- hoarseness
- VF erythema
- VF edema
- decreased vocal fold vibration
- loss of pitch range
- varix (varices): blood spot/blood vessels on vf
What is varix?
blood spot/blood vessel on vocal folds present due to hemorrhage
Look at hemorrhage pictures on power point and book.
- Identify little lesion on right vocal fold
- healing stages
- erythema on left vocal fold
- complete right vocal fold hemorrhage
What is laryngitis?
Inflammation of vocal folds.
________ is inflammation of vocal folds.
laryngitis
What are the etiologies of laryngitis?
- infection
- laryngopharyngeal reflux
- allergies
What are signs and symptoms of laryngitis?
- hoarseness
- sore throat
- cough fever
- vf edema
- erythema
Look at laryngitis in vocal folds on power point.
Identify bumpy purple because of no vocal rest, more organic problem if they don’t let it heal
-Pinpoint nodules developing due to no vocal rest
Reinke’s edema is also known as what?
polypoid corditis
What is reinke’s edema?
Swelling of entire superficial lamina propria.
The superficial lamina propria used to be called what?
Reinke’s layer
What is the etiology of Reinke’s edema?
smoking
What are the signs/symptoms of Reinke’s edema?
- gravelly voice
- low pitch (lower than appropriate pitch)
- VF edema
- impaired breathing (VF swell together)
Why is the pitch lower than appropriate in Reinke’s edema?
Vocal folds are taking a lot of liquid which is increasing the mass of the vocal folds.
Look at Reinke’s edema on power point and book.
- Identify the vocal folds that have been drained.
- identify the airway
Why does the swelling of the superficial lamina propria need to be reduced in reinke’s edema?
To check if there is cancer under all the fluid (edema).
You always send ______ for biopsy.
Leukoplakia
What is leukoplakia?
- white patches/growths on epithelium
- precancerous
What are the etiologies for leukoplakia?
smoking
chemical exposure
What are the signs/symptoms of leukoplakia?
- hoarseness
- decreased vocal fold vibration
- vocal fold edema
In a patient with leukoplakia, where would you see a decrease of vocal fold vibration?
around leuokoplakia patches
Why are the vocal folds not moving in leukoplakia?
Cancer is growing into muscle of vocal folds.
What is the number one cause of leukoplakia?
smoking
______ ______ has the same appearance as leukoplakia.
Candida fungus
How can you differentiate between candida and leukoplakia?
Patient takes anti-fungal medications for 10-14 days. If it’s gone it was candida fungal infection. If it’s in the same areas, it’s leukoplakia.
Candida fungus has the same appearance as what?
Leukoplakia.
Look at pictures of leukoplakia on power point.
- identify the swollen red area
- Identify the cluster that is probably cancer
What are the different types of cancer?
- Glottic (larynx-vocal folds)
- Supraglottic
- subglottic (below level of glottis)
What is the most common type of cancer?
Glottic (larynx-vocal folds)
What is the most rare form of cancer?
subglottic
What are the etiologies for cancer?
- smoking
- heavy alcohol consumption
- asbestos (lung cancer)
- chemical exposure
What are the signs/symptoms of cancer?
- hoarseness
- rough voice
- pain
- strain
- difficulty/pain swallowing
You _____ your risk of getting cancer if you’re a smoker or heavy drinker.
quadruple
When do SLPs see a patient with cancer?
We see them when they can’t make a noise and have trouble breathing. May not voice/swallow.
When do patients with cancer experience pain?
When swallowing and voicing
Look at cancer pictures.
It can look like candida, white patches
-bloody
What are the etiologies for laryngeal trauma?
- hit in the neck
- weight lifting
- hemorrhage
- foreign bodies
What can help laryngeal trauma?
steroids
antibiotics
Look at laryngeal trauma pictures on power point.
Identify healing
Identify hemorrhage due to a fishbone
