Voice disorders

Question 1

diseases of larynx - image attached

Answer 1

Question 2

structure and function larynx

-functions larynx (3)

Answer 2

-functions larynx (3)

>protect lower airways from blockage and contamination by foods, drinks, secretions

>allows production of effective cough helping clear airway

>produces sound vibrations

Question 3

structure and function larynx

-structure larynx

>bounderies superiorly (2) inf (1) post (1)

>three regions of the larynx

>innervation of vocal cords (1)

Answer 3

-structure larnyx

>connects superiorly with pharynx then oral cavity. below becomes trachia. behind larynx is oesophagus

>three regions of larynx - supraglottis, glottis, subglottis

>recurrant laryngeal nn supplies vocal cords. has a long course esp on lhs therefore is susceptible to disease

Question 4

• three regions of larynx*
• -what does supra glottis contain (5)*
• -what does glottis contain*
• -what does epiglottis contain*

Answer 4

• -epiglottis, false cords, ventricles, arytenoids, aryeppiglotic folds*
• -vocal folds. and anterior and posterior commissures =spaces anterior and posterior*
• -inf surface of vocal folds and trachea*

Question 5

how speech is produced

• -the vocal folds/cords are some times called the glottis. they are supported by cartilaginous framework of the larynx. they lie suspended in the airwat, attached in front to thyroid cartilage and behind to two small cartilages , the arytenoids.*
• what is function of arytenoids in speech production (1)
• the vocal folds/cords have a complex layered structure which allows superficial coverings of the cords to be relatively mobile while the body of the cord remains stiffer
• -*what is function of cords in speech production (1)
• what then modifies the vibrations/speech (5)

Answer 5

• arytenoids can slide away and towards each others, backwards and forwards then the position and tension of the vocal cords and therefore pitch of the sound may be adjusted
• the movement of air upwards between vocal cords/folds causes the coverings to drawn together. the vibration of the coverings causes the column of air above the folds to oscillate. hence sound is produced.
• these sounds can be modified by pharynx, oral cav, tongue, lips, teeth

Question 6

• what may be involved MDT treatment of voice disorders
• in laryngeal malignancy. doctors (6). health care professionsal (5)

Answer 6

-in laryngeal malignancy

>doctors - histopathologist, radiologist, ent surgeon, plastic and reconstructive surgeon, oral/maxillofacial surgeon

>health care professionals - radiotherapist, specialist nurse, mcmillian nurse, speech therapist, physiotherapist, dietician

Question 7

-what is most common type of malignant tumour of larynx. (1) what are most important aetiological factors (2)

Answer 7

• what is most common type of malignant tumour of larynx is squamous cell carcinoma. most important aetiological factors are smoking and alcohol.
• staging is done with tnm classification. do not need to memorize*

Question 8

• laryngeal malignancy of glottis - pc (1) hpc timing (2) prognosis (1) why(2)
• laryngeal malignancy of supra and subglottis - early pcs (4) late pcs (2) inx for unexplained neck node (1)

Answer 8

-laryngeal malignancy of glottis

> pc hoarse voice, persistant, more than 3 weeks. MUST REFER ALL PTS URGENTLY.

>prognosis good - present with hoarseness early and area has poor lymph drainage.

-laryngeal malignancy of supra and subglottis

>early pcs inc throat irritation, cough, referred otalgia, node in neck.

MUST REFER ALL PTS URGENTY WITH UNEXPLAINED NECK NODE

>later pcs inc hoarseness and airway compromisations

>inx by endoscopic examination of whole aerodigestive tracts for primary tumour site

Question 9

laryngeal malignancy

-mx options (4)

Answer 9

-mx options - endoscopic removal, radiotherapy, chemotherapy, radical surgical excision

Question 10

laryngeal malignancy

-options regarding speech (3)

Answer 10

-laryngectomy

> gruff oesophageal speech

-laryngectomy with tracheo-oesophageal fistula

> increased strengh and fluency of speech when pt occludes tracheostome

-laryngectomy with artificial vibrating larynx

> robotic speech

Question 11

benign vocal cord lesion / laryngeal papillomatosis

• most often seen in what age (1). aeotiology (3) most common site (1) possible sites (1)
• pcs (2). course (2).
• mx

Answer 11

• most often seen in children
• aeotiology - hpv virus infection, inhalation most probable use, possible a defect in immune system
• most common site is vocal cord. however may affect anywhere in larynx and resp tree
• pcs - hoarseness, and in severe cases stridor
• course - may undergo spontaneous regression at puberty, in adults may turn to scc

-mx - surgery

Question 12

-recurrant laryngeal nn palsy. main pc (1)

>recurrant laryngeal nn is a branch of vagus nn.

>it has a long course esp on lhs

>therefore it is an risk of damage in disease and intrathoracic surgery. close relation to various structures eg lungs, oesophagus, thyroid.

Answer 12

-main pc is hoarseness

Question 13

mm tension dysphonia aka functional dysphonia

• this diagnosis includes a wide variety of voice disorders do not need to know detail
• pcs (4)
• aetiology (3)
• mx (3)

Answer 13

• pcs - hoarse voice, weak voice that tired easily, abnormally pitched voice, even no voice
• aetiology - vocal strain/stress, psychiatrisc problems
• mx - education/reassurance there is no serious cause, speech therapy relieve tension, retrain larynx, sometimes psychiatric input

Question 14

main pc for diseases of larynx is horseness. image shows causes

Answer 14

Question 15

stages of swallowing (3) image attached

Answer 15