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Ent - Larynx > Voice Disorders > Flashcards

Voice Disorders Flashcards

1
Q

Part of larynx that is responsible for phonation

A

Glottis / true vocal cords

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2
Q

Types of presentation of patients in voice disorders

A

Hoarseness
Change of voice
Dysphonia
Aphonia

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3
Q

Causes for the involvement of vocal cords

A

Infection
Nerve palsies / neuromuscular involvement
Structural lesions
Psychogenic / functional lesions

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4
Q

What is structural abnormalities of vocal cords ?

A

This occurs due to change in the structure of the vocal cords like swelling / nodules / polyp / edema

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5
Q

Causes for structural abnormalities of vocal cords

A

Voice abuse
Laryngopharyngeal reflux
Smoking

DIAGNOSED BY LARYNGEAL ENDOSCOPE

MAIN PRESENTATION IS HOARSENESS OF VOICE

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6
Q

Vocal nodules is also known as

A

Singer’s nodules
Teacher’s nodules
Screamer’s nodules

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7
Q

Appearance of the lesion in vocal nodules

A

Bilaterally symmetrical , small(<3mm) , sessile nodule found at the mid point of membranous part of vocal cords (or junction of anterior 1/3rd and posterior 2/3rd of the vocal cord or junction of anterior 1/3rd or middle 1/3rd of vocal cords )

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8
Q

Why does this vocal nodules occur at the midpoint of membranous part ?

A

This is the site of maximum vibration during phonation and hence is mostly affected during chronic vocal abuse

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9
Q

Management of vocal nodules

A

Investigation : laryngeal endoscope

Treatment : voice rest and speed therapy , reflux management , if not yet resolved then excision has to be done

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10
Q

Appearance is the lesion in vocal polyps

A

Unilateral , pedunculated , polyploidal mass of size > 3mm at the junction of anterior 1/3rd and posterior 2/3rd

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11
Q

Cause for vocal polyp

A

Sudden episode of voice abuse in unprepared larynx that leads to sudden hemorrhage in the submucosal tissue of the vocal cords

This sudden abuse is seen in protest , events , fight

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12
Q

Management of vocal polyp

A

Investigation:laryngeal endoscopy

Treatment : excision by micro laryngeal surgery (MLS)

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13
Q

What is the position of the patient for microlaryngeal surgery ?

A

Boyce position / barking dog position / chevalier Jackson position / sniffing the morning air position

Here, the axis of mouth and axis of larynx will be brought to the same line

In this position , there will be extension of Atlanto-occipital joint and flexion at cervico-thoracic / cervical / neck joint

No pillow under the shoulder blade unlike rose position

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14
Q

Cause of vocal cord cyst

A

Voice trauma / phono trauma

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15
Q

Site of vocal cord cyst

A

Site : free edge of the vocal cords

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16
Q

Management of vocal cord cysts

A

Investigation : STROBOSCOPY - flashes of light will be given to the vocal and vibration of each segment of the vocal cord will be interpreted to differentiate between nodules,polyp,cyst

Treatment : MLS

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17
Q

Site of occurrence of arytenoid granuloma

A

Posterior 1/3rd or vocal process of arytenoid or cartilaginous part of vocal cords

18
Q

Causes for arytenoid granuloma

A

Voice abuse
Smoking
Laryngopharyngeal reflux
Trauma most commonly due to intubation

CAN BE UNILTERAL / BILATERAL

19
Q

If arytenoid granuloma occurs due to voice abuse then it is called as what ?

A

Contact ulcer (misnomer since it is not an ulcer ) or contact pachydermia = due to heaping up of epithelium on side due to repeated contact

20
Q

If arytenoid granuloma is due to Laryngopharyngeal reflux then it is called as what?

A

Peptic granuloma

21
Q

If arytenoid granuloma occurs due to intubation (some surgery done under GA ) then it is called as what?

A

Intubation granuloma

22
Q

Management of arytenoid granuloma

A

Investigation : laryngeal endoscopy

Treatment : voice rest , management of reflux , if there’s no benefit then excision is done followed by Botox in thyroarytenoid muscle to prevent slamming of vocal cords

After excision , send the mass for biopsy

23
Q

What is reinke’s edema ?

A

It is the edema of the submucosal space of the true vocal cords (reinke’s space)

Always bilateral and affects the whole length of the vocal cords

24
Q

Predominant factor for development of reinke’s edema

A

SMOKING

Also voice abuse , LPR reflux

25
Q

Why is reinke’s space is prone to edema ?

A

This is because the submucosa is not tightly adherent to the vocal ligament and also vocal cords are devoid of lymphatics making it impossible for the fluid to drain resulting in edema

26
Q

Reinke’s edema also known as

A

Smoker’s larynx

27
Q

Treatment for reinke’s edema

A

Stop smoking
Voice therapy
LPR control

If no benefit, then go for reduction glottoplasty

28
Q

What is Pseudosulcus ?

A

Formation of sulcus on the medial surface of the vocal cords due to infraglottic edema caused because of LPR reflux

Treatment Is LPR management

29
Q

What is sulcus vocalis?

A

Congenital abnormality where epithelium of true vocal cords is adherent to the vocal ligament on its medial surface

IT IS A TRUE SULCUS

30
Q

What is muscle tension disorder / dysphonia (MTD)?

A

In stressful conditions , the tension of the muscles of phonation will be altered that causes voice fatigue

31
Q

What is psychogenic dysphonia / functional aphonia / hysterical aphonia ?

A

Occurs a result of stressful events seen in emotionally labile females

Here the vocal cords will not adduct the person tries to speak remains abducted but when the person coughs the vocal cords adduct ruling out nerve palsies unaccompanied by other laryngeal symptoms

Here,there will be sudden loss of voice and the patient will be whispering

Treatment:psychotherapy

32
Q

What is dysphonia plica ventricularis?

A

Voice is produced as a result of adduction of false vocal cords /vestibular folds / ventricular folds even before the true vocal cords can adduct

Cause is because of nerve palsies or functional

Treatment : speech therapy

33
Q

What is pubertophonia / mutational falsetto ?

A

Abnormal increase in the tension of the vocal cords producing a persistence high pitch female voice in pubertal males (introverts usually)

Normally the vocal cords will grow longer , more than the anteroposterior diameter of the larynx making the vocal cord lax producing a low pitch voice

34
Q

Puberophonia is confirmed by what test ?

A

GUTZMANN PRESSURE TEST - when the larynx is pushed posteriorly and downwards the voice will become low pitched

35
Q

Management for puberophonia

A

Type -3 thyroplasty

Here the vocal cord will be made lax / shortening of vocal cords are done by compressing the larynx anteroposteriorly

36
Q

What is phonesthenia?

A

Voice fatigue is produced as a result of weakness of muscle of the vocal cords as a result of vocal abuse under stressful conditions

37
Q

Types of phonesthenia

A

Depends upon the muscles involved

PHONATORY / ELLIPTICAL GAP = due to weakness of thyroarytenoid muscles

TRIANGULAR GAP = due to weakness of inter arytenoid muscle ; seen posteriorly

KEY HOLE GAP = due to weakness of both inter arytenoid and thyroarytenoid muscles

38
Q

Management of phonesthenia

A

Speech therapy and voice rest

39
Q

What is spasmodic dysphonia?

A

Neurological conditions resembling muscle tension dysphonia (functional dysphonia) differentiated from MTD by the history of voice fatigue present only during speaking and not during laughing , singing , respiration while in MTD voice fatigue is present all the times

40
Q

Types of spasmodic dysphonia

A

ADDUCTOR DYSPHONIA (most common )- spasm during adduction creaky / scratchy /strangulated / croaky voice will be produced since the vocal cords will not be vibrating effectively

ABDUCTOR DYSPHONIA - spasm during abduction ; voice will be breathy

MIXED DYSPHONIA

41
Q

Management of spasmodic dysphonia

A

ADDUCTOR = Botox given in thyroarytenoid muscle
ABDUCTOR = Botox given In posterior cricoarytenoid muscle

If the patient doesn’t respond to toxin then treat with thyroplasty type 1

Ent - Larynx (7 decks)

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