Voice Disorders Flashcards
Part of larynx that is responsible for phonation
Glottis / true vocal cords
Types of presentation of patients in voice disorders
Hoarseness
Change of voice
Dysphonia
Aphonia
Causes for the involvement of vocal cords
Infection
Nerve palsies / neuromuscular involvement
Structural lesions
Psychogenic / functional lesions
What is structural abnormalities of vocal cords ?
This occurs due to change in the structure of the vocal cords like swelling / nodules / polyp / edema
Causes for structural abnormalities of vocal cords
Voice abuse
Laryngopharyngeal reflux
Smoking
DIAGNOSED BY LARYNGEAL ENDOSCOPE
MAIN PRESENTATION IS HOARSENESS OF VOICE
Vocal nodules is also known as
Singer’s nodules
Teacher’s nodules
Screamer’s nodules
Appearance of the lesion in vocal nodules
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 )
Why does this vocal nodules occur at the midpoint of membranous part ?
This is the site of maximum vibration during phonation and hence is mostly affected during chronic vocal abuse
Management of vocal nodules
Investigation : laryngeal endoscope
Treatment : voice rest and speed therapy , reflux management , if not yet resolved then excision has to be done
Appearance is the lesion in vocal polyps
Unilateral , pedunculated , polyploidal mass of size > 3mm at the junction of anterior 1/3rd and posterior 2/3rd
Cause for vocal polyp
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
Management of vocal polyp
Investigation:laryngeal endoscopy
Treatment : excision by micro laryngeal surgery (MLS)
What is the position of the patient for microlaryngeal surgery ?
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
Cause of vocal cord cyst
Voice trauma / phono trauma
Site of vocal cord cyst
Site : free edge of the vocal cords
Management of vocal cord cysts
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
Site of occurrence of arytenoid granuloma
Posterior 1/3rd or vocal process of arytenoid or cartilaginous part of vocal cords
Causes for arytenoid granuloma
Voice abuse
Smoking
Laryngopharyngeal reflux
Trauma most commonly due to intubation
CAN BE UNILTERAL / BILATERAL
If arytenoid granuloma occurs due to voice abuse then it is called as what ?
Contact ulcer (misnomer since it is not an ulcer ) or contact pachydermia = due to heaping up of epithelium on side due to repeated contact
If arytenoid granuloma is due to Laryngopharyngeal reflux then it is called as what?
Peptic granuloma
If arytenoid granuloma occurs due to intubation (some surgery done under GA ) then it is called as what?
Intubation granuloma
Management of arytenoid granuloma
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
What is reinke’s edema ?
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
Predominant factor for development of reinke’s edema
SMOKING
Also voice abuse , LPR reflux
Why is reinke’s space is prone to edema ?
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
Reinke’s edema also known as
Smoker’s larynx
Treatment for reinke’s edema
Stop smoking
Voice therapy
LPR control
If no benefit, then go for reduction glottoplasty
What is Pseudosulcus ?
Formation of sulcus on the medial surface of the vocal cords due to infraglottic edema caused because of LPR reflux
Treatment Is LPR management
What is sulcus vocalis?
Congenital abnormality where epithelium of true vocal cords is adherent to the vocal ligament on its medial surface
IT IS A TRUE SULCUS
What is muscle tension disorder / dysphonia (MTD)?
In stressful conditions , the tension of the muscles of phonation will be altered that causes voice fatigue
What is psychogenic dysphonia / functional aphonia / hysterical aphonia ?
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
What is dysphonia plica ventricularis?
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
What is pubertophonia / mutational falsetto ?
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
Puberophonia is confirmed by what test ?
GUTZMANN PRESSURE TEST - when the larynx is pushed posteriorly and downwards the voice will become low pitched
Management for puberophonia
Type -3 thyroplasty
Here the vocal cord will be made lax / shortening of vocal cords are done by compressing the larynx anteroposteriorly
What is phonesthenia?
Voice fatigue is produced as a result of weakness of muscle of the vocal cords as a result of vocal abuse under stressful conditions
Types of phonesthenia
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
Management of phonesthenia
Speech therapy and voice rest
What is spasmodic dysphonia?
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
Types of spasmodic dysphonia
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
Management of spasmodic dysphonia
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
