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Swallowing and Voice > Structural pathologies and vascular lesions > Flashcards

Structural pathologies and vascular lesions Flashcards

1
Q

What are the 4 classifications of voice pathologies?

A
  1. Structural
  2. Vascular
  3. Neurological
  4. Functional
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2
Q

What are structural pathologies of the vocal folds?

A
  • Change in structure of the mucosa of the VFs
  • Knowing what layer the pathology affects can give an idea of sound produced
  • Nodules, polyps, cysts, laryngitis, contact ulcers/granuloma, papilloma, sulcus vocalis, carcinoma
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3
Q

What are nodules? (What, who, why, where)

A

INFLAMMATORY DEGENERATION OF SLLP, FIBROSIS AND OEDEMA
- One of the most common benign VF pathologies
- Results from phonotrauma (excessive use, people with heavy vocal load)
- Can occur at any age
- More common in children and females (shorter VFs, more vibration, less HA in F)
- May be minimally symptomatic
- Typically form bilaterally at anterior/middle 2/3 of VF
- Areas of high vibratory impact and stress
- Vary in size: pinhead to pea

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4
Q

What are the 3 types of nodules?

A
  1. Acute
    - Due to traumatic/hyperfunctional use
    - Appear gelatinous from oedema in Reinke’s space while epithelium remains normal
  2. Chronic
    - Appear firm, callous-like
    - Fixed to underlying mass of mucosa due to increased fibrosis, thickened epithelium
  3. Reactive nodular change
    - People with polyp, cyst, other mass lesions
    - Creates contralateral reaction on other VF
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5
Q

What are the perceptual signs of nodules?

A
  • Subtle changes in early stage
  • Mechanical effect on VF depends on size
  • Roughness
  • Breathiness
  • Fatigue
  • Singers: loss of vocal range
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6
Q

What are the physiological signs of nodules?

A
  • Increased glottal flow
  • Increased respiratory effort
  • Increased demands on VF due to laryngeal hyperfunction and asymmetric VF vibration
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7
Q

What are the acoustic signs of nodules?

A
  • May present as normal
  • Increased frequency and amplitude perturbation (jitter, shimmer), cycle-to-cycle variation in freq and amp, random changes
  • Reduced phonation range
  • Increased s/z ratio
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8
Q

What are the visual signs of nodules?

A
  • Increased mass/thickness of VF cover
  • Hourglass closure pattern or posterior chink
  • Incomplete closure around site of nodules
  • Reduced mucosal wave at site
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9
Q

Management of nodules

A
  • Behavioural modification
  • Voice therapy
  • Surgery not typical
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10
Q

What are polyps?

A

FLUID-FILLED WITH OWN BLOOD SUPPLY
- Caused by phonotrauma, often one incidence of vocal abuse
- Sudden onset and size increase
- Often unilateral, can produce reactive nodule
- Originate in SLLP
- Typically form in middle 1/3
- Can be subglottic but normally on superior region

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11
Q

What are the 3 types of polyps?

A
  1. Sessile - blister-like
  2. Pedunculated - attached to stalk
  3. Haemorrhagic
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12
Q

What are the perceptual signs of polyps?

A
  • Similar to nodules
  • Depends on size and site, interfere with closure
  • Roughness
  • Breathiness
  • Diplophonia
  • Globus sensation
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13
Q

What are the physiological signs of polyps?

A
  • Increased airflow
  • Increased subglottal pressure
  • Decreased closing times of VF
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14
Q

What are the acoustic signs of polyps?

A
  • Similar to nodules
  • Perturbations
    • May present as normal
  • Increased frequency and amplitude perturbation (jitter, shimmer), cycle-to-cycle variation in freq and amp, random changes
  • Reduced phonation range
  • Increased s/z ratio
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15
Q

What are the visual signs of polyps?

A
  • Appear translucent, can be red
  • Asymmetrical closure
  • Increased aperiodicity
  • Increased mass
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16
Q

Management of polyps

A
  • Behavioural therapy
  • Voice therapy
  • Vocal hygeine
  • Surgery
  • 7% see an ENT
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17
Q

What are cysts?

A

BENIGN MUCOUS FLUID LESION SURROUNDED BY A MEMBRANE
- Caused by phonotrauma or glandular blockage
- Near VF surface
- Predominantly unilateral
- Can co-occur with nodules
- Slight yellow colour due to mucous buildup, doesn’t drain spontaneously
- Can rarely present congenitally

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18
Q

What are the 2 types of cysts?

A
  1. Epidermoid: like cysts on skin
  2. Retention: glandular blockage
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19
Q

What is the difference between polyps and cysts?

A

Polyp = blister-like bump from traumatic event
Cyst = Fluid-filled sac from repetitive trauma or clogging in VF mucous glands
Cysts often mistaken for polyps

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20
Q

What are the perceptual features of cysts?

A
  • Roughness
  • Lowered pitch
  • Throat clearing due to globus sensation, depends on size
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21
Q

What are the physiological features of cysts?

A
  • Higher than average airflow
  • Slower closing phase
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22
Q

What are the acoustic signs of cysts?

A
  • Lowered f0
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23
Q

What are the visual signs of cysts?

A
  • Hard to identify
  • Sometimes highlighted by a persistent light reflection from slightly raised area
  • Absence of mucosal wave at site
  • Aperiodicity and lack of closure
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24
Q

Management of cysts

A
  • Therapy not usually effective
  • Surgery
25
Q

What is laryngitis?

A

GENERAL TERMS FOR VARIOUS INFLAMMATORY CONDITIONS
- Caused by medical diagnoses such as exposure to irritants, GORD, environmental agents, upper respiratory tract infection, chronic phonotrauma, can be primary or secondary aetiology
- May lead to tissue changes like nodules

26
Q

What are the perceptual features of laryngitis?

A
  • Roughness
  • Difficulty speaking in a low voice
  • Pitch higher or lower
  • Difficult to get volume
  • Sore throat
27
Q

What are the physiological features of laryngitis?

A
  • Increased airflow
  • Increased pressure
28
Q

What are the acoustic features of laryngitis?

A
  • Perturbation
  • Increased or decreased f0
  • Greater than normal spectral noise
29
Q

What are the visual signs of laryngitis?

A
  • Redness
  • Oedema
  • May be VF asymmetry and aperiodicity
  • Reduced/absent mucosal wave
  • Stiff jerky movement
30
Q

Management of laryngitis

A
  • Rest and hydration
  • Antibiotics if indicated
31
Q

What are contact ulcers/granulomas?

A

BENIGN GROWTHS ALONG VOCAL PROCESSES
- Bilateral or unilateral
- Contact ulcers = raw sores, little protective tissue
- Granulomas = tend to grow over contact ulcer until cause of irritation is resolved

32
Q

What are the 3 causes of contact ulcers/granulomas?

A
  1. Laryngopharyngeal reflux irritation - irritation causing damage to localised tissue
  2. Intubation (granuloma) - can spontaneously resolve
  3. Phonotrauma
33
Q

What are the perceptual features of contact ulcers/granuloma?

A
  • Globus sensation
  • Chronic throat clearing and cough
  • Reduced pitch range
  • Roughness
  • Breathiness
  • Difficulty increasing loudness
  • Pain during swallowing
34
Q

What are the visual features of contact ulcers/granuloma?

A
  • Prevent VF closure
  • Unilateral phase assymetry
35
Q

Management of granuloma

A
  • Depends on aetiology
  • Reflux: diet, lifestyle, meds, invasive surgical treatment
  • Intubation: can resolve spontaneously, steroid injection
  • Phonotrauma: voice behavioural therapy
36
Q

What is candida?

A

FUNGAL INFECTION
- Consequence of weakened immune system

37
Q

What are the perceptual features of candida?

A
  • Pain
  • Pressed voice
  • Hoarseness
  • Breathiness
38
Q

What are the visual features of candida?

A
  • Oedema
  • Erythema
  • VF edges irregular, stiff
  • Incomplete glottic closure
  • Decreased mucosal wave
  • Asymmetric weakness of VF
39
Q

Management of candida

A
  • Medication
  • Oral hygeine
40
Q

What is papilloma?

A

BENIGN TUMOUR CAUSED BY EXPOSURE TO HPV VIRUS
- Childhood or adulthood
- Common sites at true VF, trachea, bronchi, palate, nasopharynx
- Juvenile papillomas occur within first 5yrs, contracted from infected mother
- Papillomas can recur rapidly, surgery every 2-4 weeks to minimise threat to airway
- Substantial impact on vocal quality due to frequent surgeries and scarring
- Recurrence rate slower in adult form

41
Q

What are the perceptual signs of papilloma?

A
  • Roughness (asymmetric VF vibration)
  • Breathiness (if closure affected)
  • SOB and inspiratory stridor (if lesions are large and diffuse)
  • Chronic cough
  • Periods of aphonia
42
Q

What are the visual features of papilloma?

A
  • Incomplete glottal closure
  • ‘Wart/raspberry’ appearance
  • Increased stiffness of VFs (lesion/scarring), impeded vibratory amplitude
  • Mucosal wave may be absent in lesion area
43
Q

Management of papilloma

A
  • Ensure airway efficiency
  • Voice quality secondary
  • Laser surgery
  • Microsurgery and drug therapy (with side effects)
  • Tracheotomy, photodynamic therapy, antiviral drugs
  • Non-useful treatment includes steroids and voice treatment as primary treatment
44
Q

What is laryngeal web?

A

WEB OF TISSUE JOINING VFS TOGETHER
- 75% occur at birth
- Can be acquired from intubation, trauma
- Failure of recanalisation of larynx during embryonic dev (4-10th week)
- Can block up to 75% of glottal airway
- Thickness varies

45
Q

What are the perceptual features of laryngeal web?

A
  • SOB
  • Inspiratory stridor
  • Roughness
  • Difficulty sustaining phonation
46
Q

Management of laryngeal web

A
  • Resection of web
47
Q

What is sulcus vocalis?

A

THINNING OR LOSS OF SLLP TISSUE
- Aetiology unclear
- Possibly poor vocal behaviours, congenital, chronic inflammatory processes

48
Q

What are the perceptual features of sulcus vocalis?

A
  • Roughness
  • Weakness
  • Increased effort
  • Vocal fatigue
49
Q

What are the visual signs of sulcus vocalis?

A
  • Groove or furrow on medial surface of VF
  • Sulcus area doesn’t vibrate normally during voicing
  • Tissue loss causes spindle-shaped glottic gap
50
Q

Management of sulcus vocalis

51
Q

What is carcinoma?

A

CANCER IN EPITHELIAL TISSUE
- Can affect structures of oral cavity, pharynx and larynx
- Smoking is a primary aetiology
- Men > women 5:1
Roughness is primary sign

52
Q

What is carcinoma

A

CANCER THAT FORMS IN EPITHELIAL TISSUE
- Can affect structures of oral cavity, pharynx, larynx
- Smoking is a primary aetiology
- Men > women 5:1
- Roughness is a primary sign

53
Q

What are some vascular lesions affecting voice?

A
  • Haemorrhage
  • Varix and ecstasy
  • Inhalation and thermal trauma
54
Q

What is haemorrhage?

A
  • Typically unilateral
  • Appears red and yellowish
  • Significant swelling
  • Typically a result of a single traumatic event
  • Can be result of heavy voice use and use of anticoagulants and salicylates (eg. aspirin), or extended steroid use
  • Results in dysphonia/aphonia
55
Q

Management of haemorrhage

A
  • Surgery (prevention)
  • Complete vocal rest in acute phase
  • Augmentative procedures
56
Q

What is varix and ecstasia?

A

Varix = Prominent vein that is enlarge and dilated
Ecstasia = Lesioning of blood vessel
Reduced mucosal wave due to stiffness

57
Q

What are the perceptual features of varix and ecstasia?

A
  • May be absent
  • Loss of vocal range, esp high frequencies
  • Roughness
58
Q

Management of varix and ecstasia

A
  • Vocal rest
  • AAC
59
Q

What is inhalation and thermal trauma?

A
  • Often referred to as chemical tracheobronchitis
  • Voice quality secondary concern
  • Pathophysiology not well understood: peripheral nerve damage, changes to laryngeal mucosa, CNS damage from hypoxia, subsequent surgery
  • Role of treatment may be limited

Swallowing and Voice (11 decks)

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