Voice

Question 1

larynx anatomy

Answer 1

ADD

Question 2

larynx function

Answer 2

incl. voice production

Question 3

larynx malignancy

Answer 3

SCC commonest
RF: smoking, genetics, alcohol

glottis: hoarseness, stridor (late), little spread (no lymphatics)
sub/supraglottis: irritation, cough, otalgia, LN, voice (later)
exam: raised thick irregular cord, leukoplakia, red, narrow ariway, ?cord fixation

Rx: excision or RDT; may need tracheostomy

Question 4

RLN palsy:

1/3 idiopathic, 1/3 surgical, 1/3 tumour

Answer 4

weak voice, tires, discomfort, choking fluids, high pitch, diplophonia, weak bovine cough
Ix: CXR, CT skull-thorax, ?Ba swallow, ?endoscopy
Rx: watch/wait, therapy (compensation), medialisation

Question 5

muscular tension dysphonia

Answer 5

abuse, fluids, tea/caffeine/fizz, late/fatty foods; structural defect; poor resp fx

1o: strain, skill, psych, ageing
2o: inflammation, tumour, neuromuscular, resp, postural, congenital

variable hoarseness, tires, pitch change, breathy/bizzare/aphonc, dry/discomfort
exam: constriction, normal cords
Rx: therapy, underlying cause(s)

Question 6

benign vocal lesions

Answer 6

polyps: sharp pain, cuts out; unilateral central red/grey swelling
nodules/nodes: gradual, use worse; bilateral ‘hourglass’ white thickening
cysts (mucous retention/epidermoid): husky, breaks, effort; unilateral swelling
Reinke’s: deep gravelly voice; total bilateral oedema
Papillomatosis: hoarse; ‘jelly tot’ multiple lesions; steroids/INF, laser removal; SCC risk

Question 7

polyps and nodules

Rx: therapy, surgery

Answer 7

polyps: supf focal oedema; husky, worse with use, sharp pain, cuts out;
strain/shouting with cold/reflux; M >F, 30-50yo
-unilateral central grey/red swelling

nodes: vocal abuse; gruff/horse, fatigue, loss of high range, discomfort; F»>M
- small white nodular ‘hourglass’ thickening (ant 1/3-post 2/3 junction); soft then firm (fibrosis)

Question 8

Reinke’s oedema

Answer 8

bilateral grey/red total swelling of cords
smoking, voice abuse, reflux; M+F
deep gravelly voice; choking if severe
Rx: smoking, reflex meds, voice therapy; surgical reduction

Question 9

reduced mobility

Answer 9

viral infection
neoplasia: cord or nerves
damage: reflux, intubation, irritants (caffeine, dry, spice, late night eating)
laryngitis
functional dystonia

Question 10

laryngitis

Answer 10

acute: isolated/general; pain, odyno, systemic; red swollen larynx + cords;
epiglottitis: SEVERE; dysphagia, drooling, voice change, tripod/acc mm; airways + IV ABx
croup: Hib; diffuse inflamm of airwats; ABx + neb adr
diphtheria: rare; hoarse, cough, stridor;
chronic: multifactorial inflammation; red, thick, swollen cord; CIS risk; therapy
tracheitis: post laryngectomy bloody mucus
non-infectious: GORD, allergy; globus, dysphagia, cough/clearing

Question 11

functional dystonia

Answer 11

non-organic
weak/hoarse, tires, abnormal pitch
aetio: vocal strain, stress, psych
Rx: reassure, therapy (tension), psych (rare)

Question 12

assessment

Answer 12

history: use/abuse, vocal hygiene
listen: rough (?vibration), breathy (?palsy/adduction)
visualise: fibreoptic/rigid scope, or mirror
palpate neck: tension, nodes, lumps

Question 13

malignant features

Answer 13

smoking history
older age
change in voice e.g. hoarse >2/52
stridor
otalgia
dysphagia
duration >6/52

Question 14

MDT management

Answer 14

voice hygiene
voice therapy
medical treatments (??)
phonosurgery
medialisation: injection (collagen)/support (thyroplasty)