Vocal Folds

Question 1

5 layers covering vocal folds

Answer 1

Epithelium
Superficial Lamina Propria
Intermediate Lamina Propria
Deep Lamina propria
Vocalis muscle (medial thyroarytenoid

Question 2

Hoarseness

Answer 2

abnormal voice changes, breathy, raspy, strained, weak

Question 3

Dysphonia

Answer 3

general alteration of voice quality. Usually a laryngeal source

Question 4

Dysarthria

Answer 4

defect in rhythm, enunciation, articulation. Usually a neurological or
muscular source

Question 5

Stridor

Answer 5

• large airway noise from obstruction
• Inspiratory – supraglottic, extrathoracic
• Expiratory – tracheal, large bronchi intrathoracic
• Biphasic – laryngeal, immediate subglottis

Question 6

Stertor

Answer 6

snoring sound from nose, nasopharynx, throat

Question 7

Wheezing

Answer 7

pulmonary from smaller airways

Question 8

Hoarseness-Causes

Answer 8

  Viral laryngitis – acute
  Reflux - chronic
  Vocal abuse
  Allergies, PND
  Chronic cough
  Nodules
  Polyps
  Trauma
  Age
  Neurological disorders 
  Smoking without malignancy
  Malignancies of thyroid, larynx, lungs
  Others

Question 9

Vocal Fold Cysts

Answer 9

  Etiology
–  Trauma, previous injury
  Hemorrhagic verses mucous
–  Recurrence
  Treatment
–  Therapy, can require surgery
  Reactive masses
–  The other side
–  Often resolves with therapy

Question 10

Vocal Fold Polyps

Answer 10

 Etiology
– Trauma, predisposition
 Hemorrhagic verses fibrotic
– affects how likely it is to resolve on own
 Treatment
– Usually requires surgical intervention for resolution

Question 11

Granulomas

Answer 11

  Contact verses vocal process
  Etiology
–  Reflux
–  Vocal Abuse
  Treatment
–  Correct abuses
–  Surgery /Botox

Question 12

Reinke’s Edema

Answer 12

  Smoker
–  Usual but not always
  Edema, Erythema
  Treatment
–  Correct cause
–  removal of excess material

Question 13

Vocal Fold Hemorrhage

Answer 13

 Etiology
– Trauma may be mild (cough, one scream, etc..)
 Treatment
– Strict Voice Rest
 Resolution
– Depends on technique and individual healing
– Usually complete

Question 14

Vocal Fold Tear

Answer 14

  Etiology
–  Same as hemorrhage or intubation
  Treatment
–  Same as hemorrhage
  Resolution

Question 15

Sulcuses and Webs

Answer 15

  Definitions
–  Sulcus: groove in VF
–  Web: anterior fusing of VF
  Congenital or Traumatic
  Can be asymptotic
  Treatment
–  Difficult surgical problems if symptomatic

Question 16

Presbyphonia and Vocal Fold Bowing

Answer 16

  Aging and the Voice
–  What’s normal? What’s not?
  Superior Laryngeal paralysis can be a cause
  Treatment
–  Increase VF bulk (therapy, surgery)
  Prevention
–  Good techniques, exercise

Question 17

Laryngeal Trauma

Answer 17

  Skeleton Injuries
  Arytenoid Dislocations
–  Etiology
  Intubation, trauma
–  Treatment
  Quick diagnosis critical
  Cricothyroid Joint Injuries

Question 18

Immobile Vocal Fold

Answer 18

  Remember Nerve Path
  w/u includes CT scan of skull base through aortic arch with contrast
  Laryngeal EMG
  Intubation Trauma -> dislocation
  Rheumatoid Arthritis
  Relapsing Polychondritis 
  Most reliable method of differentiating between paralysis and fixation is laryngeal 
electromyography (LEMG). 
  Normal implies fixation
  Abnormal implies paralysis

Question 19

Laryngopharyngeal Reflux

Answer 19

  Hoarseness
  Chronic cough
  Foreign Body sensation (globus)
  Tracheal Stenosis
  Chronic ear disease?
  Chronic sinusitis?

Question 20

Symptoms of reflux include

Answer 20

 bad breath or bitter taste in a.m.
 a.m. hoarseness or after meals
 sensation of a lump in the throat (globus)
 sensation of post-nasal drip but no nasal issues
 heartburn not always present

Question 21

Precancerous and Cancerous Lesions

Answer 21

  Smoker/ Drinker, but not always
  Early treatment important
  Stage and type important
  Treatment
–  Conservative Surgery
–  Radiation

Question 22

Papillomas

Answer 22

  Adult verses Juvenile onset
  Etiology
–  Viral
  Treatment
–  Lifelong disease
  Transformation to cancer occurs in some

Question 23

Vocal Cord Dysfunction (VCD)

Answer 23

Diagnosed by fiberoptic laryngoscopy
Bronchoprovocation studies can exacerbate VCD.
VCD may worsen with bronchoprovocation, but will not change FEV1 or PC20
Acute treatment is anxiolytics, helium-oxygen mixture
Long term treatment is speech therapy, underlying triggers
Avoid over treating asthma