Structural voice disorders Flashcards
Describe acute nodules
- 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
Describe chronic nodules
- harder and less flexible
- increased fibrosis with thickened epithelium
- stiffness leads to decreased vibration (out of phase) and an hourglass closure
- smoother
Perceptual characteristics of nodules
roughness, breathiness and increased muscle tension
Treatment of nodules
- 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
Describe sessile polyps
- 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
Describe pedunculate polyps
- attached to a stalk
- feels like something is in the throat
- can move above and below glottis
Perceptual characteristics of polyps
- mild to severe dysphonia depending
- larger polyps cause inspiratory stridor
Treatment of polyps
- Voice conservation
- if no rapid improvement, phono surgery followed by voice therapy
Describe Reinke’s Edema/polypoid degeneration
- 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
Perceptual characteristics of Reinke’s edema
low pitch and hoarseness
Treatment of Reinke’s Edema
- phonosurgery (lateral VF incision and extraction of fluid)
- Post-op voice therapy for identification of detrimental behaviours, vocal hygiene and improved voice production
What is a hemorrhage?
- Blood flow from ruptured vessels in the vocal folds, often located in Reinke’s space-
- Usually result in acute voice loss and dysphonia
What is a hematoma?
- Accumulation of blood that has leaked form a vessel
- Some post-acute dysphonia
What is a varix?
- 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
Treatment for hemorrhages and hematoma?
- Voice conservation and rest
- Alternatively rapid course of steroids
- Voice therapy recommended after resolution to restore voice quality, endurance and range
Treatment for varices?
- Laser vaporization
- Voice therapy recommended
Describe acute laryngitis
- Inflammation of VF mucosa
- Associated with viral infections of upper respiratory tract (resolves) or bacterial infections (need antibiotics)
- Voice will be hoarse
Treatment for acute laryngitis
- Internal and external hydration
- If necessary: antibiotics and cough suppressants (to prevent more damage)
Describe chronic laryngitis and its causes
- 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
Treatment of chronic laryngitis
- Identify and eliminate causative factors
- Voice therapy
Describe vocal fold granulomas/contact ulcers and causes
- 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
Treatment of vocal fold granulomas
- Reflux medication
- Phonosurgery (high recurrence rates)
- voice therapy (reduce VF compression and anti-reflux behaviours)
Describe cysts of the VFs and their causes
- 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
Treatment of VF cysts
- DON’T RESPOND TO VOICE THERAPY
- Phonosurgery
- Post-op voice therapy
Describe Papillomas
- 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
Perceptual characteristics of papilloma
-Severe dysphonia
Treatment of papillomas
- Aggressive treatment
- Interferon medication (suppresses virus replication)
- Laser surgery
- Tracheostomy may be required
- Voice therapy (acute and post-op)
Describe congential laryngeal webs
- 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
Describe acquired laryngeal webs
-a microweb of anterior portion of VFs can result from phono surgery, laryngeal trauma or long term intubation
Treatment of laryngeal webs
- Phonosurgery to remove web, involves placement of a keel to prevent reformation
- Temporary tracheostomy necessary
- Post-op vocal therapy
Describe sulcus vocalis
- 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
Describe presbylaryngeus and its treatment
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
Briefly describe epithelial hyperplasias and their treatment
- 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
