Organic Voice Disorders Flashcards
Contact Ulcers
Inflammatory Disease
Small ulcerations that develop on the medial aspect of the vocal process of the arytenoid cartilage due to irritation
Caused by: deterioration of voice after prolonged vocalization or vocal fatigue, low pitch phonation with hard glottal attack, or status post endotracheal intubation
accompanied by pain in the laryngeal area, or may lateralize o one ear
hoarseness, throat clearing, hard glottal attacks, coughing, LPR
respond to therapy status post surgery
Cysts
usually unilateral, soft and pliable
occur on the inner margin, superior or inferior surface of the true vocal fold, or anywhere on the ventricular folds
may be acquired or congenital
refer back to ENT for surgical intervention as systs do not respond to voice therapy
otolaryngologists use a small superficial incision along the superior edge of the vocal fold to excise the cyst
endocrine changes
individual voices are either too low or too high due to endocrine dysfunction
pituitary problems: there is not the normal development of progesterone by the ovaries for girls or testosterone for males
hypothyrodism causes increase mass of the vocal fold which results in lower pitch
premenstrual vocal syndrome: vocal fatigue, reduced pitch range, hypophoni, loss of harmonics
menopause: women experience lower fundamental frequencies. excessive androgenic hormones resulting in the glottal membrane thickening, increase size-mass of the vocal folds. Hormonal therapy is beneficial for this.
Hyperkeratosis
Oral or pharyngeal lesions discovered by the dentist or ENT.
Lesions are biopsied to malignant (cancerous) or nonmalignant (benign).
Hyperkeratosis : pinkish, rough lesion which is nonmalignant but maybe a precursor for malignant tissue change. Therefore, it is watched closely.
Locations: under tongue, on the vocal folds at the anterior commissure, or on the arytenoid prominences.
Chronic irritants: secondhand smoke, LPR
Voice Disorder: Mild-Severe depending on the site and extent of lesion. Surgery, Vocal Hygiene, PPI, Cessation of irritant to the tissue improves the phonation.
Leukoplakia
Whitish-colored patches
Location: lesions to the surface membrane, in the subepithelial space which occur under the tongue and on the vocal folds
Benign precancerous tumors that are watched closely as it often leads to squamous cell carcinoma.
Cause: Heavy smoking, LPR, human papilloma virus (HPV)
Voice: Hoarse, Lower Pitch, & at times, Hypophonic
If located on the glottal margins then vocal fold closure is affected with a breathy voice
Voice Therapy is important to restore normal voice status post surgery
Recurrent Respiratory Papillomatosis
Most common benign laryngeal neoplasm in children
Wartlike growths that occur in dark, moist caverns
Majority are due to Human Papilloma Virus (HPV)
May occur in extralaryngeal sites: oral cavity, trachea, & bronchi.
Can be a serious threat to the airway
Voice: hoarse, shortness of breath
Most papillomas stop recurring with puberty, 20% persists into adulthood
Surgical treatment which is palliative , not curative
Voice Therapy is conducted status post therapy with work on respiration control
Infectious Laryngitis
URI=upper respiratory infections
Severe headache, chest cold, fever, sore throat, cough, odynophagia,
dysphonia
Most are Viral in origin
Bacterial infection associated with high fever & very sore throat
Which responds to antibiotics?
Medication, Amantadine fights off influenza; however, has side effects such as xerostomia & xerophonia
Infectious Laryngitis Treatment Approaches
Voice rest (no whispering) for 2-3 days to be sure the vocal fold tissue does not touch or vibrate when irritated or swollen
Humidifcation, hydration, reduced activity, analgesics
Puberty
Occurs on average of over 4-5 years
Females tend to start at age 9
Males tend to start at ages 11-12
Noticeable laryngeal growth & change in Fundamental Frequency (Hz) occur in the LAST YEAR of puberty
Male voices drop one full octave, Female voices drop almost half an octave
This occurs over 3-6 months, and up to a year
Middle School Years are not optimal for choirs or Glee Clubs
Vocal fatigue, not trained for proper techniques in singing and not aware of physical limitations
Should avoid attempting optimum pitch or modal- pitch because of rapid changes
Sulcus Vocalis
Congenital or Acquired
Sulcus=furrow or indentation
Furrowed medial edge of the vocal fold, bilaterally symmetrical
Spindle configuration= all or any edge of the vocal fold
Involve the superficial layer or penetrate down into the vocal ligament and muscle
Diagnosing Sulcus Vocalis
Videostroboscopy has improved the ability to examine sulcus vocalis as compared to laryngeal mirror examinations
Vocal Folds are abducted: identify the fold furrow
Vocal Folds are adducted: reduced mucosal wave, stiff lamina propria, glottal incompetence, air leakage through the midline of anterior 2/3 of the folds
Vocal Quality: little variability in pitch, strained quality, low intensity, fatigue when attempting to be louder
Periods of Aphonia & Increased Laryngeal Muscle Tension
Treatment of Sulcus Vocalis
Therapy: Glottic Closure, Pitch/Loudness, & Quality
Severe Sulcus: Sulcusectomy where an incision is made above the sulcus; upper & lower borders of the sulcus are sutured together
Mucosal slicing: microvertical slices across the sulcus
Injecting collagen or fat into the sulcus; into the the deep layers of the lamina propria
Replace the scar tissue with implanted atelocollagen sheets into the lamina propria to regenerate vocal fold mucosa and its tissue (gradual improvements over a year time period)
Medialization thyroplasties & strap muscle transpositions
Voice Therapy
Pitch Shifts
Loudness Changes
Lateral Digital Pressure
Firmer Glottal Closure
Auditory feedback with real time amplification
Easy onset of phonation
Webbing
Laryngeal web grows across the glottis between the 2 vocal folds,
congenitally or acquired
Reduces fold vibration, high-pitched, rough sound
Congenital Web: glottal membrane failed to separate in embryonic development
Hear stridor, syncope, high-pitched squeal
Immediate surgery, temporary tracheostomy, recovery over 4-6 weeks
Acquired Webs: bilateral trauma of medial edges of vocal folds
Prolonged infection or prolonged surface tension cause the inner margins of the folds to grow together at the level of the anterior commissure since the folds are so close together at that point to begin with
1/3 the distance from the anterior commissure
Infection, bilateral surgery (laryngeal or tracheal), papilloma, nodules can form a web
Surgery: web is cut, vertical keel is placed between the folds to prevent approximation of the vocal folds
Voice Rest
Voice Therapy
Hemagiomas
similar to contact ulcers and granulomas
however, it is a soft, pliable, blood-filled sac
Location: infantile hemangiomas are in the subglottis, adult hemangiomas are found in the supraglottis.
Associated with vocal hyperfunction, LPR, or intubation trauma
Surgical intervention first, vocal hygiene, and voice therapy next
