Vocal pathology Flashcards
vocal fold nodule
typical location
midmembranous
webs
onset
congenital and acquired
Candida
typical location
oral, laryngeal, and pharyngeal cavities
- pharmacologic tx
- surgical option-thymectomy
- plasmapheresis
- voice therapy focuses on conservation
myasthenia gravis
- inherited autosomal dominant disorder
- mutation on chromosome 4
- targeted to the basal ganglia and cerebral cortex
Huntington’s disease/ chorea
- Thinning or loss of the superficial layer of vocal fold tissue
- etiology undefined- linked to smoking
Sulcus vocalis
Varix/ecstasia onset
acquired
laryngomalacia onset
congenital
- found along the vocal processes
- tend to grow over contact ulcers until cause of irritation is addressed
- unilaterally or bilaterally
- can result from
- laryngopharyngeal reflux
- intubation trauma
- phonotrauma
Granulomas
- congenital occurs when there is a failure of recanalization during embryonic development
- 75% occur at birth
- typically are located anteriorly
- can block up to 75% of the glottal airway
- thickness varies from thin and translucent to thick
- acquired can occur from
- laryngeal trauma
- prolonged intubation
laryngeal web
- often resolves with rest and hydration
- antibiotics
- necessary to pinpoint the cause of the inflammation
- remove the causative irritant or pathogen
- vocal hygiene
laryngitis
a term used to describe a mode of protection used by a patient either purposefully or subconsciously to prevent further injury or pain during voice production
covering
contact ulcers/granuloma
onset
acquired
placement of a breathing tube to aid in ventialtion
intubation
a funcal infection that occurs as a consequence of weakness within the immune system
candidiasis
1 idiopathic voice disorders
paradoxic vocal fold dysfunction
3 etiologic groupings of voice disorders
- functional
- organic
- neurologic
what percentage of voice patients have laryngopharyngeal reflux?
50%
2 types of laryngeal trauma
- penetrating
- blunt
- acid reflux is acid back flow up from the stomach into the esophagus
- acid that reaches the upper pharynx and upper airway
- lining of the larynx is less protective than the esophagus
- common source of irritation in the larynx
- contributes to the formation of granulomas
laryngopharyngeal reflux
- caused by reductions in the peripheral nervous system
- results in a severe decline in muscle’s ability to contract
- typical onset is between the third and sixth decade of life
myasthenia gravis
- fluid filled lesion
- develops in the superficial layer of the lamina propria
- has its own blood supply
- typically forms unilaterally
- cause thought to be from acute vocal trauma or from phonotraumatic behaviors
- can occur as the result of a single traumatic incident
vocal fold polyps
- visually appears firm, callous-like and fixed to the underlying mass of mucosa
chronic vocal fold nodules
- recurrence rate is slow
- tend to be more localized in upper airway
- the causative agents include:
- sexual contact
- trigger tha treduces the autoimmune system
- severe gastroesophageal reflux
laryngeal papilloma in adults
- motor neuron disease
- fatally attacks the neurons responsible for controlling voluntary muscle contraction
- small percentage genetically inherits disease
- affects most individuals randomly
amyotrophic lateral sclerosis (ALS) aka Lou Gherig’s disease
- etiology
- phonotrauma or traumatic injury
- surgical or medical procedures
- prolonged levels of high intensity voice
- excessive crying
- use of anti-coagulant
- phonotrauma or traumatic injury
vocal fold hemorrhage
presbylaryngis
typical location
glottal gap may be present anteriorly or posteriorly
presbylaryngis
onset
acquired
- advances in surgical management have reduced the need for tracheotomy
- in less severe causes, a reconstruction procedure called laryngotracheoplasty is perfromed
- in more cases a cricotracheal resection is completed
subglottic stenosis
what are structural pathologies of the vocal folds?
- alteration in the histological organization of the vocal fold
- identified via visual inspection
- use of the ventricular folds during voicing instead of, along with the true vocal folds
- comon conditions associated
- severe muslce tension
- severe true vocal fold dysfunction
ventricular phonation
superficial, prominent veint that is enlarged and dilated
varix
laryngeal trauma
typical location
affects laryngeal cartilages and mucosa
hemorrhage
typical location
membranous vocal fold
subglottic stenosis
onset
congenital or acquired
- autoimmune and inflammatory disease and neurogenic
- progressive demyelination and axonal damage
- more females diagnosed
- may be related to genetics and demographics
- widespread in areas that are further from the equator
- triggered by exposure to environmental toxins, trace metal exposure, and climate
multiple sclerosis
vocal fold nodules
onset
acquired
vocal fold polyps
typical location
- free edge of true vocal fold
- inferior border of true vocal fold
- more diffuse pattern
Hemorrhge
benign/malignant
usually benign
- congenital or acquired
- narrowing of the tissue below the level of the glottis
- no predilliction for sex or race
- associated with a malformed cricoid cartilage occuring in utero
- acquired caused by prolonged intubation or other forms of mechanical trauma
subglottic stenosis
- mucosal irritation of the arytenoid complex
- impact stress from
- loud talking
- shouting
- repetitive arytenoid contact
phonotrauma
Laryngomalacia typical location
upper airways, glottis
3 types of vocal fold nodules
- acute
- chronic
- reactive nodule change
Granular cell tumor onset
acquired
Candida onset
acquired
Vocal fold polyps- onset
acquired
- hyperkinetic movement disorder
- most common movement disorder
- affects the extremitites-hands and limps
- more common in those of advancing age
- essential tremor of the larynx is centrally driven
- tremor is worsened by anxiety, fatigue, and excitement
- symptoms relieved by alcohol intake
essential tremor
sulcus vocalis typical location
vocal fold edge
leukoplakia/hyperkeratosis
onet
acquired
laryngeal trauma
onset
acquired
- increased muscle activity in the head and neck
- responses on case hx often include
- stress
- anxiety
- depression
- high vocal demand
- busy schedule
- complaints of physical and emotional overload
- associated with laryngopharyngeal reflux
muscle tension dysphonia (MTD)
- related to a manifestation of stress, depression, or anxiety
- psychogenic voice disorder
- tends to emerge very quickly
- associated with traumatic event or severe stress
- no evidence of physical or neurologic cause
- significant functional and social impact
conversion aphonia
sulcus vocalis onset
acquired
- formation related to intubation is rare
- mucosa becomes irritated by the endotracheal tube
- a reaction to the irritation, granulation tissue forms
- resolves quickly if from intubation trauma
Intubation trauma contact ulcers/granuloma
muscle tension dysphonia
onset
acquired
- resulting from injury after a traumatic dislocation
- potentially from intubation
- disease such as inflammation
- Results in stiffness and/or fusion of the cricoarytenoid joint
Ankylosis of the cricoarytenoid joint
Laryngitis
typical location
diffuse
reinke’s edema/polypoid degeration/diffuse polyposis
onset
acquired
- damage to the tissues as a result of exposure to blood
- when superficial layer of the lamina propria is affected, the effects can be devastating
- dysphonia
- complete aphonia
- absence of voice
vocal fold hemorrhage
An extreme form of edema when the entire membranous portion of the vocal folds becomes filled with fluid
polypoid degeneration
a wasting and thinning of muscle tissue
sarcopenia
- branch of the vagus nerve
- primarily responsible for vocal fold abduction and adduction
recurrent laryngeal nerve (RLN)
types of edema (4)
- generalized edema
- reinke’s edema
- polypoid degeneration
- diffuse polyposis
granular cell tumor
typical location
originates from the muscle
a stent designed to keep the anterior commissue area from closing
keel
cysts onset
congenital and acquired
papilloma
typical location
musculomembranous region, but may extend into arytenoid, ventricle, and subglottis
Papilloma onset
acquired and congenital
- sarcopenia
- effects on the thyroarytenoid muscle
- becomes thinner
- less pliable
- collagen in the deeper portions becomes dense
presbylaryngis
webs
typical location
- level of the true vocal folds
- some subglottic and supraglottic
What is the initial step in treatment to manage Reinke’s edema that is due to cigarette smoking?
the patient should quit smoking
hemorrhage
onset
acquired
common sites for papillomatosis (5)
- true vocal folds
- trachea/bronchi
- palate
- nasopharynx
- rare instances, lungs
5 factors that can contribute to acid reflux
- ingestion of fatty foods
- chocolate
- caffeine
- alcohol
- cigarette smoking
- neurodegenerative disorder with unknown etiology
- diagnosis exclusively clinical
- iaging exams help rule out other pathologies
progressive supranuclear palsy
- early surgical exploration
- fixation of
- dislocated joints
- displaced laryngeal fractures
- mucosal lacerations
laryngeal trauma
- Unknown origin, thought to be related to basal ganglia dysfunction
- affects the laryngeal adductory and abductory muscles during phonation
- 3 types
- adductor
- abductor
- mixed
- associated with writer’s cramp, essentia tremor, remote diagnosis of mumps or measles, or major life stress
spasmodic dysphonia
- features of visual assessment
- tends to interfere with vocal fold closure
- “wart or raspberry” type appearance
- adult cases usually appear as a solitary lesion
- juvenile cases tend to spread throughout the airway
- increased stiffness
- impedes vibratory amplitude
- mucosal wave may be absent in the area of lesions
- multiple surgical excisions
- cover may be stiff
- interfere significantly with amplitude and vibratory behavior
- ventricular compression can be observed
laryngeal papilloma
- found along vocal processes
- raw sores on the mucus membrane of the arytenoid process
- can result from
- laryngeal reflux
- irritation
- intubation trauma
- phonotrauma
contact ulcers
- white plaque like formation occurring on the vocal fold surface
- usually found at the anterior portion of the vocal fold but may extend into the arytenoid area
- considred a precancerous state and should be biopsied
- primary cause is chronic irritation
leukoplakia/hyperkeratosis
Hyperfunctional/ ventricular phonation onset
acquired
subglottic stenosis
typical location
membranous or cartilaginous
- inflammatory condition of the vocal fold mucosa
- caused by
- reaction to a viral and/or bacterial infection
- traumatic conditions
- autoimmune diseases
laryngitis
5 demographic factors that contribute to the varying incidence of voice disorders
- occupation
- age
- sex
- region
- race
- creates a contralateral reaction
- can develop into a larger and more discrete nodule
reactive nodular change
the buildup of fluid primarily in the superficial layer of the vocal folds
edema
- Features of visual assessment
- commonly bilateral along the entire membranous length
- can be unilateral
- likened to water balloons
- increased stiffness of the superficial layer
- increased mass of the cover and depth of the vibratory edge
- glottic closure is usually complete
- the horizontal vibratory amplitude is often reduced
edema
cysts
typical location
attached to vocal ligament or epithelia basement membrane
- adolescent males who maintain a high voice
- proposed causes
- failure to accept male voice
- social immaturity
- male identity problems
- hearing impairment
- immature laryngeal maturation
- poor neuromuscular cordination
puberphonia
- inflammatory degenration of the superficial layer of the lamina propria
- typically form bilaterally
- caused by phonotraumatic behaviors
vocal nodules
- rapidly progressive neurodegenerative disease process
multiple system atrophy
- branch of the vagus nerve
- bilaterally innervates the cricothyroid
the superior laryngeal nerve (SLN)
- typically occurs w/i the first five years from perinatal infection
- identifiable as elevated growths
- rare
- children born to condylomatous mothers are at risk for developing this
Juvenile laryngeal papilloma
varix/ectasia
typical location
- varies:
- vocal fold edge
- medial surface
- lateral surface
difficulty forming words; presenting with imprecise consonants, hard to understand speech
dysarthria
- originating in the superficial layer of the lamina propria
- direct result of phonotrauma
- midmembranous portion of the vocal fold
- related to high-pressure phonatory events
- more prevalnet in women than men
varix and ectasia
- commonly caused by
- surgical trauma
- malignancies
- endotracheal intubation
- neurologic disease
- idiopathic causes
- life threatening when folds are fixed in paramedian position
- can sometimes be confused with bilateral arytenoid fixation
bilateral true vocal fold paralysis
Pathology classifications (5)
- structural
- neurologic
- systemic disease
- functional
- idiopathic
abnormal antibodies are removed from the blood, immune globulin are given
plasmapheresis
- benign tumors arising from muscle
- often associated with the presence of another in the body
- uncommon overall
- more prevalent in women 30-60 years
- rare in men
granular cell tumor
ventricular folds have grown in size
hypertrophy
- most common cause of inspiratory stridor in infancy
- congenital condition of unknown etiology
- risk of airway obstruction as cartilages are suseptible to collapse during inspiratory phase
- characterized by
- floppy epiglottis
- large aryepiglottic folds
- large arytenoid process
- if the cartilages are very soft the entire larynx may be seen to collapse during inspiration
laryngomalacia
- pathologic tissue change in th emucosa
- identified with biopsy
- abnormal cells are not found to be malignant
- often indicative of early cancerous process
- appears whitish or redish in color due to hypervascularization
- can form a mass, plaque, or irregularity on the vocal fold edge
Dysplasia and laryngeal cancer
- complex disorder where vocal fold adduction occurs on inspiration
- paradoxic vocal fold motion with dysphonia is episodic proxysmal laryngospasm
- describes intrinsic laryngeal abnormal activity
- mistaken for
- asthma
- vocal fold paralysis
- laryngeal edema
paradoxic vocal fold dysfunction
Ways paralysis of the SLN may occur (3)
- trauma
- infectious conditions with viral infections
- damage during surgery to thyroid gland
- benign mucus-filled lesion surrounded by a membrane
- located near the vocal fold surface
- the causes include:
- phonotraumatic behaviors
- glandular blockage
- appear at the midmembranous portion
- can present congenitally
cysts
- a fungal infectio that occurs as a consequence of weakness w/i the immune system
- may occur due to
- sickness
- immune system supressing medication
Candida
- buildup of fluid in the superficial layer
- caused by long-standing trauma or chronic exposure to irritants
edema
puberphonia
onset
acquired
leukoplakia/hyperkeratosis
typical location
- vocal fold surface and/or interarytenoid area
What about shouting contributes to mucosal irritation to the vocal folds?
- repetitive arytenoid contact
neurologic voice disorders occur when there is damage to…
central or peripheral nervous system
- may recurr very rapidly
- can cause searious threat to the airway
- can require surgery every 2 to 4 weeks
- impact on voice quality highlly substantial due to frequent surgeries and subsequent vocal fold scarring
Laryngeal papilloma
Variables to work on with transgender individuals other than pitch: (4)
- resonance
- intonation
- rate
- vocal intensity
- generally result in mild to severe hoarseness
- voice quality is a function of the size, shape, and firmness
- globus sensation may be present
- throat clearing and cough
cysts
cancer
onset
acquired
