Organic Voice Disorders Flashcards
what are the differences between organic and functional voice disorders?
organic: purely organic, typically abnormal anatomy, tissue changes
functional: wholly functional, may have organic factors, typically normal anatomy
functional misuse such as inadequate breath support, hard glottal attacks, and supraglottal squeeze can lead to what?
organic changes
what are the organic classifications?
congenital (web, laryngomalacia), misuse/abuse (lifestyle: reflux, Reinke’s edema, personality), disease (cancer), trauma (cartilage dislocation)
what are the organic disorders?
nodules, polyps, cysts, papilloma, granuloma, contact ulcer, sulcus vocalis, congenital, web, hemmorhage, laryngitis, Reinke’s edema, leukoplakia, cancer
what are vocal nodules?
benign mass(es) on medial vf surface(s)
what is the etiology of vocal nodules?
misuse/abuse
where do the vocal nodules develop?
anterior 2/3 portion, posterior 1/3 portion (nodules develop in this junction)
what are signs/symptoms of vocal nodules?
hoarseness, rough voice, increased vocal effort, vocal fatigue/strain, loss of upper range, voice variability, vf edema, hourglass closure, decrease vf vibration, strong personality, hearing loss
why may there be an increase in vf vibration?
cells are being brought in to try to heal the problem and increases fluids of the vf
why may there be loss of upper range?
during upper ranges, the vf stretch out; with nodules there may not be closure in the back and when the VF stretch they become further apart and lose the high range
why can vocal nodules be bilateral?
reactive swelling
what are polyps?
soft mass on the vf
are polyps bilateral or unilateral?
usually unilateral
what is the etiology of polyps?
misuse/abuse
what are the types of polyps?
fibrous, hemmorhagic, pedunculated
describe a fibrous polyp.
made up of cells inside it; either sessile or the color of mucosa
describe a hemmorhagic polyp.
blood vessels have hemmorhaged and bled into polyp; red color ranges
describe a pedunculated polyp.
foot-like; there is a stem attaching it to the VF but polyp is moving around. when pt. breathes in to voice, the polyp can get sucked under epiglottis; can be big enough to block the airway
what are signs/symptoms of polyps?
hoarseness, rough voice, ↑ vocal effort, vocal fatigue/strain, breathing problems (depending on size), voice variability (especially if pedunculated), vf edema (reactive swelling), throat clearing
what is a cyst?
benign opaque mass originating below vf surface
where does a cyst form?
below the epithelial area, sometimes into lamina propia layers
what are the etiologies of a cyst?
entrapment of vf lining (under the lining) or plugged mucous-secreting gland, vocal misuse/abuse
what is the most common etiology of a cyst?
misuse/abuse
do cysts occur bilaterally or unilaterally?
unilaterally
what are signs/symptoms of cysts?
hoarseness, rough voice, ↑ vocal effort, vocal fatigue/strain, vocal fold edema (reactive swelling), throat clearing
how do you surgically treat cysts?
cut vf in and flap it over and remove cyst and put flap back
what is laryngocele?
cyst in laryngeal cavity
what is papilloma?
HPV wart-like benign growths of the larynx (papillomatisis); can be on VF or false VF or anywhere
what are the etiologies of papilloma?
acquired at both, oral sex, unknown
what are the signs/symptoms of papilloma?
hoarseness, rough/scratchy voice, cough/throat clear, globus sensation, breathing problems (depending on how much they are obstructing airway), ↓ vf vibration, scarring (recurrent), postules grow on each other
how can a person get papilloma at birth?
because the baby comes from birth canal; can get it from mother by ingesting; might not surface right away; can have outbreaks and then it can subsides
what is globus sensation?
the feeling that something is there
what does pain for papilloma usually consist of?
sorethroat, achy, dry rough feeling
is papilloma removable?
the wart growths are removable but the papilloma is still there and can come back
how many strains of HPV are there that cause laryngeal papillomatosis?
more than 60
what is granuloma?
benign growth on vocal process (attach thyrovocalis to arytenoid; back of vf)
are granulomas bilateral or unilateral?
can be both
what are granulomas sometimes classified as?
polyps; same family of lesions but different etiologies
what are the etiologies of granuloma?
LPR (diet, lifestyle), intubation (surgery, coma)
what are signs/symptoms of granuloma?
globus sensation, heartburn/indigestion (reflux-type), excessive throat clearing, dry cough, post-nasal drip, breathing problems (size-dependent), may be pedunculated
how is granuloma treated?
PPI (proton pump inhibitor) should typically be taken twice a day (one in the morning 30 minutes before food/drink, the second one later in the day 30 min before dinner)
⁃ there are also H2 blockers
what is a contact ulcer?
raw sores on mucous membrane overlying vocal process of arytenoid; something alcerating the tissues
what are the etiologies of contact ulcers?
misuse/abuse, LPR, smoking, intubation
what are the symptoms of contact ulcer?
hoarseness, globus sensation, mild pain when voicing or swallowing, throat clearing, erythema
what is the process of a contact ulcer?
start out like raw sores: red, irittated, sometimes white because tissue is in process of being burned
what is sulcus vocalis?
thinning or absence of superficial lamina propia, creates ditch look on VF
what are the etiologies of sulcus vocalis?
unknown. could be developmental, genetic, post-hemmorhage cyst
what are signs/symptoms of sulcus vocalis?
abnormal vibration, may not have voice problems, harsh voice, hoarseness, higher pitch; vf stretched more than normal
is sulcus vocalis seen in children?
no
what is a varyx?
blood spot
what are congenital organic voice disorders?
laryngomalacia, subglottal stenosis, esophageal atresia, tracheoesophageal fistula
what is laryngomalacia?
cartilages fail to stiffen; collapse of epiglottis into airway, stridor, may outgrow
what is subglottal stenosis?
narrow subglottal space; arrested development of cricoid cartilage (could collapse if doesnt stiffen); intubation trauma
what is esophageal atresia?
occlusion of esophagus; could range from the esophagus being occluded to there being no esophagus
what is tracheoesophageal fistula?
opening between trachea and esophagus; may co-occur with esophageal pouch
what is a web?
web of tissue across larynx, usually across anterior commissure area; mitomycin C is deterrent
what are the etiologies of a web?
congenital, post-surgical
what are the signs/symptoms of a web?
may not have voice problems, usually no problems breathing unless web is large and blocking airway
what is a hemmorhage?
bleeding into superficial lamina propia
what are the etiologies of a hemmorhage?
misuse/abuse, medications such as blood thinners (coumadin, aspirin)
what are the signs/symptoms of hemmorhage?
hoarseness, vf erythema, vf edema, ↓ vf vibration, loss of pitch range, varix (varices)
what is vascularity?
many blood vessels surfacing and running through VF due to fluid in superficial lamina propia
what are varicose?
blood spots
what is laryngitis?
inflammation of VF
what are the etiologies of laryngitis?
infection, LPR, allergies
what are the signs/symptoms of laryngitis?
hoarseness, sore throat, dry cough, fever, vf edema, erythema
what is treatment for laryngitis?
voice rest
can laryngitis lead to nodules or other organic disorder?
yes
what is reinke’s edema?
swelling of entire superficial lamina propia (Reinke’s layer)
reinke’s edema is also called?
polypoid corditis
what is the etiology of reinke’s edema?
smoking
what are signs/symptoms of reinke’s edema?
gravelly voice, low pitch, vf edema, impaired breathing, swelling increases mass of vf making them slower
what is leukoplakia?
white patches/growths on epithelium
what are the etiologies of leukoplakia?
smoking, chemical exposure
what percentage of leukoplakia cases are from chemical exposure?
less than 10%
what are signs/symptoms of leukoplakia?
hoarseness, decreased vf vibration, vf edema
is leukoplakia precancerous or cancerous?
Can be either. It’s precancerous but can lead to cancer
where does cancer occur?
can be glottic (larynx-vocal folds), supraglottic, subglottic (rare)
what are the the etiologies of cancer?
smoking, heavy alcohol consumption, asbestos or chemical exposure
what percentage of cancer cases are from chemical exposure?
less than 10%
what are the signs/symptoms of cancer?
hoarseness, rough voice, stabbing pain, strain, difficulty/pain swallowing
what percentage of cancer cases are from smoking?
over 90%
can cancer metastasize to other places?
yes
what are the etiologies of laryngeal trauma?
hit in the neck, weight lifting, foreign bodies
can there be hemmorhaging in laryngeal trauma?
yes
