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Voice > Structural voice disorders > Flashcards

Structural voice disorders Flashcards

1
Q

Describe acute nodules

A
  • inflammatory degeneration of the SF layer of the LP with associated edema and fibrosis
  • usually bilateral
  • filled with blood or ISF
  • located between anterior 1/3 and posterior 2/3
  • caused by traumatic or hyper functional voice use
  • overlying epithelium unchanged
  • protuberant
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2
Q

Describe chronic nodules

A
  • harder and less flexible
  • increased fibrosis with thickened epithelium
  • stiffness leads to decreased vibration (out of phase) and an hourglass closure
  • smoother
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3
Q

Perceptual characteristics of nodules

A

roughness, breathiness and increased muscle tension

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4
Q

Treatment of nodules

A
  • Voice therapy is first choice
  • Phonosurgery only if a compliant client doesn’t respond to therapy (followed by voice therapy)
  • In acute cases (without vascular lesions), steroids may be applied
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5
Q

Describe sessile polyps

A
  • fluid filled lesions in SF layer of LP
  • Located at medial 1/3 of membranous VFs
  • usually unilateral
  • Caused by acute trauma or abuse or a ruptured blood vessel
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6
Q

Describe pedunculate polyps

A
  • attached to a stalk
  • feels like something is in the throat
  • can move above and below glottis
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7
Q

Perceptual characteristics of polyps

A
  • mild to severe dysphonia depending

- larger polyps cause inspiratory stridor

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8
Q

Treatment of polyps

A
  • Voice conservation

- if no rapid improvement, phono surgery followed by voice therapy

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9
Q

Describe Reinke’s Edema/polypoid degeneration

A
  • Reinke’s space (SF layer of LP) becomes filled with thick fluid
  • Caused by longstanding trauma (alcohol, smoking + vocal abuse)
  • If swelling affects whole length of VFs, closure is usually complete
  • VFs appear swollen and reddish
  • Usually bilateral
  • May have difficulties adducting posteriorly
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10
Q

Perceptual characteristics of Reinke’s edema

A

low pitch and hoarseness

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11
Q

Treatment of Reinke’s Edema

A
  • phonosurgery (lateral VF incision and extraction of fluid)

- Post-op voice therapy for identification of detrimental behaviours, vocal hygiene and improved voice production

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12
Q

What is a hemorrhage?

A
  • Blood flow from ruptured vessels in the vocal folds, often located in Reinke’s space-
  • Usually result in acute voice loss and dysphonia
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13
Q

What is a hematoma?

A
  • Accumulation of blood that has leaked form a vessel

- Some post-acute dysphonia

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14
Q

What is a varix?

A
  • Mass of blood capillaries that appears as an indurated, adynamic “blood blister”
  • Not caused by one traumatic event
  • May affect amplitude, periodicity and symmetry of mucosal wave
  • Unmarked changes in voice
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15
Q

Treatment for hemorrhages and hematoma?

A
  • Voice conservation and rest
  • Alternatively rapid course of steroids
  • Voice therapy recommended after resolution to restore voice quality, endurance and range
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16
Q

Treatment for varices?

A
  • Laser vaporization

- Voice therapy recommended

17
Q

Describe acute laryngitis

A
  • Inflammation of VF mucosa
  • Associated with viral infections of upper respiratory tract (resolves) or bacterial infections (need antibiotics)
  • Voice will be hoarse
18
Q

Treatment for acute laryngitis

A
  • Internal and external hydration

- If necessary: antibiotics and cough suppressants (to prevent more damage)

19
Q

Describe chronic laryngitis and its causes

A
  • Long standing mucosal inflammation, with viscous mucous and epithelial thickening that is unassociated with a viral infection
  • Usually painless
  • Mild to severe dysphonia, laryngeal fatigue and unproductive throat clearing/coughing
  • Causes: smoking, GERD, repeated acute laryngitis, vocal misuse and abuse, allergies, bulimia
20
Q

Treatment of chronic laryngitis

A
  • Identify and eliminate causative factors

- Voice therapy

21
Q

Describe vocal fold granulomas/contact ulcers and causes

A
  • Often vascular lesions
  • Result from tissue irritation on posterior larynx
  • Usually located on vocal process of arytenoid cartilage, don’t impact VF vibration unless they are very large
  • May impact VF closure and inhalation
  • Causes: GERD, iatrogenic consequence of intubation or persistent low pitched pressed phonation
22
Q

Treatment of vocal fold granulomas

A
  • Reflux medication
  • Phonosurgery (high recurrence rates)
  • voice therapy (reduce VF compression and anti-reflux behaviours)
23
Q

Describe cysts of the VFs and their causes

A
  • Fluid filled sessile growths
  • Whitish and transparent
  • Epithelial sacs on the VFs, FVFs or ventricle
  • Caused by blocked mucosal glands or vocal abuse
  • Usually unilateral
  • Stiffness dampens mucosal wave, even if very small
24
Q

Treatment of VF cysts

A
  • DON’T RESPOND TO VOICE THERAPY
  • Phonosurgery
  • Post-op voice therapy
25
Q

Describe Papillomas

A
  • wartlike benign tumours that develop in the epithelium and invade the lamina propr. and vocals muscle
  • caused by HPV
  • Concern is that it is heading towards airway
26
Q

Perceptual characteristics of papilloma

A

-Severe dysphonia

27
Q

Treatment of papillomas

A
  • Aggressive treatment
  • Interferon medication (suppresses virus replication)
  • Laser surgery
  • Tracheostomy may be required
  • Voice therapy (acute and post-op)
28
Q

Describe congential laryngeal webs

A
  • Tissue bridge b/w the VFs at the anterior commissure
  • Results from insufficient separation of the VFs during 10th week of gestation
  • Depending on extent, laryngeal stridor and respiratory distress may result
  • Voice quality may be mildly to severely impaired
  • Higher F0
29
Q

Describe acquired laryngeal webs

A

-a microweb of anterior portion of VFs can result from phono surgery, laryngeal trauma or long term intubation

30
Q

Treatment of laryngeal webs

A
  • Phonosurgery to remove web, involves placement of a keel to prevent reformation
  • Temporary tracheostomy necessary
  • Post-op vocal therapy
31
Q

Describe sulcus vocalis

A
  • A furrow or ridge along the entire membranous portion of the VFs in the SF layer of LP
  • Increases the stiffness of the VF cover
  • Leads to bowing of VFs
  • Variable effect on voice quality
  • Etiology unclear
  • Can be a result of phono surgery, aging or VF paralysis
  • Optimal treatment not yet identified
32
Q

Describe presbylaryngeus and its treatment

A

Age related changes in the laryngeal structure and function.

  • Decreased elasticity of VF mucosa
  • Decreases intrinsic tone of VF body (bowing)
  • Decreased loudness, pitch and loudness instability and decreased voice quality
  • Treatment: voice therapy
33
Q

Briefly describe epithelial hyperplasias and their treatment

A
  • Pre cancerous
  • Abnormal mucosal changes of the VFs. Hyper plastic and irregular thickening of epithelium
  • Caused by hyper function, chemical or toxic irritants and smoking and alcohol
  • Treatment: surgical removal, biopsy, education to prevent recurrence. Post-op voice therapy

Voice (11 decks)

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