voice: organic disorders Flashcards
Unilateral adductor paralysis
Descr: one fold can adduct, other is retracted
Etio: damage to SLN or RLN (likely) from surgery, tumor compression, trauma, cancer
Acoustic: PHIB
Rx: Teflon/gel foam paste inject to build mass, thyroplasty, surgical reposition arytenoid, electric shock, reinnervation, pushing for other VF to compensate
Gross adjustment of vf
Paralyses of adductor or abductor
Myasthenia laryngis
Ankylosis
Bilateral adductor paralysis
Descr: both folds retracted, weak flaccid no tonus
Etio: cva, brain tumor, degenerat brain disease, unilateral neuro damage
Acoustic: aphonia (biological phonation), PHIB very b
Rx: surgical reposition, Teflon, electro, pushing, spontaneous recovery depends on lesion, degree, elapsed time (<8 mos), age
Bilateral abductor paralysis
Descr: both VF in add or para
Etio: CVA, tumor, degenerative, unilateral injury
Acoustic:
Rx: tracheostomy, surgical repos, electro
Unilateral abductor paralysis
Descr: VF fixed in add or paramedian
Etio: SLN RLN damage from surgery, tumor compression, trauma, cancer
Acoustic: laryngeal strider, passive breathing fine but active may be difficult
Rx: tracheostomy? Surgical repos? Electro
Myasthenia laryngis
Desc: bowed weak musculature, lack of tonus
Etiology: purist= acetylcholine deficit; other= fatigue from pollux, abuse, prolonged speaking, wrong P I, tumor load, calcium in jt
Acoustic: PIB phonasthenia, hoarseness?
Rx: purist acetylcholine chloride; vocal retraining
Ankylosis
Descr: arytenoids anchored by edema, inflamm, swell; aryt maybe distorted
Etio: dislocation aryt by trauma, arthritis calcium deposits in jt
Acoustic: strained, hoarse harsh aphonia, reduced range, poor glottal closure (PIB)
Rx: surgery calcium, arthr med, compensating movt
Localized organic deviations
Polyps Papilloma Hyperplasia Keratosis Leukoplakia Laryngeal web Contact ulcers Vocal nodules
Progression of pathology
1 misuse abuse
2 Swelling: edema, hyperplasia, metaplasia
3 benign growth
4 malignant 85% on anterior 3rd
Polyps
Descr: enlarged sect of tissue (blood fat epithelium), anterior 2/3, sessile flat, peduncular stalk, freq unilateral
Etio: abuse, one incident
Acoustic: sessile- PHIB, peduncular caught btw folds- intermittent PHIB
Rx: fresh =therapy, old=surgery and voice tx
Prevalence: 80% female 85 87
Papilloma
Descr: red warty growth (blood), anywhere, spreads rapidly
Etio: viral? Endocrine? Abuse (unlikely)?
Acoustic: on VF= PHIB, extensive= aphonia
Rx: medical vaccine, surgical laser (then tx?), radiation
Prev: 56% male 64 34
Hyperplasia
Descr: incr in # cells= enlarged, swollen rounded ridges (wavy) on VF or superficial
Etio: 2nd to laryngitis, abuse, diet
Acoustic: PHIB, possibly increased P if swells anteriorly
Rx: diet change, vocal rest and tx, surgery not necessarily good as cuts into tissue, laser less risky
Keratosis
Descr: premalignant, hardened tissue along VF edge
Etio: abuse, smoker, genetic cancer
Acoustic: PHB NO I
Rx: Surgery (recur), tx elim abuse, quit smoke drink
Prev: males 65% 80 75
Leukoplakia
Descr: filmy white membrane superficial- anterior 3rd, bilateral or uni, blood?
Etio: abuse, smoke drink, genetic cancer
Acoustic: hoarse, cough
Rx: remove cause (smoke), stop abuse, surgery
Prev: 80% males 88 55
Prevalence
Males 80 leukoplakia 65 keratosis 56 pap Female 80 Polyp
Treatment outcomes
85 87 polyps
80 75 keratosis
88 50 leukoplakia
64 35 papilloma
Laryngeal web
Descr: smooth white web btw folds (anterior 3rd)
Etio: congenital, acquired: nodule surgery (damaged VF secrete fibrin and web develops)
Acoustic: stridor w inhalation, hoarse, high pitch?
Tx: split web, place strut (tantalum keel), VF heal and web dries out, vocal retrain
Sulcus vocalis
Descr: split in fold- superficial or complete, unilateral or bi, congenital or acquired
Etio: cleft? Atavistic? Tb
Acoustic: depending on severity of split- complete = quadrophonia, breathy, hoarse
Tx:
Prevalence:
Contact ulcers
Descr: irritation–> membrane erosion, pain–> muscle erosion/ severe pain
Etio: forceful phonation- grind arytenoids, hard driving perfectionist, smoke drink
Acoustic: hoarse, vocal fatigue, PAIN
Tx: cortisone for healing, vocal rest, hygiene, psych tx, life change
Prevalence: 80% male
Nodules
Descr: callous thick epithelium @ jn of anterior 3rds VF, unilateral in (male) kids, bilateral (female) adults acute soft pink, chronic hard white
Etio: abuse misuse, aggressive, thyroid imbalance, allergies, tobacco alcohol, Pollux
acoustic: PHIB w fatigue, aphonia in AM and afternoon
Tx: acute voice tx, chronic surgery then voice tx (retrain)
Prevalence: 58% female 93 85
Systemic edema
Descr: swell due to fluid pressure
Etio: diet changes, poor circ, local injury, allergies PND, glandular imbalance (thyroid), meds (iodine aspirin)
Acoustic: hoarse, phonasthenia, low P
Tx: vocal rest, meds, reduced salt/fluid
Systemic anemia
Descr: inadequate vasc -> local or general weakness
Etio: def RBC, bone marrow defect, genetic (sickle cell or Cooley), hodgkins, S (insuff oxy) or L RBC (blockage), cancer blood loss
Acoustic: phonasthenia, hoarse, monotone
Tx: b12, iron, folic
Parkinson’s
Descr: rigid or sluggish artic/laryngeal muscles, variable tension in adduction
Etio: damage in CNS extrapyramidal tract
Acoustic: monotone, hyper nasal, artic disorder, progressively worse
Tx: L dopa to stop degen
Hormonal: incomplete mutation
Descr: small vocal structures, small stature
Etio: decreased pituitary and thyroid activity
Acoustic: small vocal range, hi p
Tx: hormone treatments
Prevalence:
