voice: organic disorders

Question 0

Unilateral adductor paralysis

Answer 0

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

Question 1

Gross adjustment of vf

Answer 1

Paralyses of adductor or abductor
Myasthenia laryngis
Ankylosis

Question 2

Bilateral adductor paralysis

Answer 2

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

Question 3

Bilateral abductor paralysis

Answer 3

Descr: both VF in add or para
Etio: CVA, tumor, degenerative, unilateral injury
Acoustic:
Rx: tracheostomy, surgical repos, electro

Question 4

Unilateral abductor paralysis

Answer 4

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

Question 5

Myasthenia laryngis

Answer 5

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

Question 6

Ankylosis

Answer 6

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

Question 7

Localized organic deviations

Answer 7

Polyps
Papilloma
Hyperplasia
Keratosis
Leukoplakia
Laryngeal web
Contact ulcers 
Vocal nodules

Question 8

Progression of pathology

Answer 8

1 misuse abuse
2 Swelling: edema, hyperplasia, metaplasia
3 benign growth
4 malignant 85% on anterior 3rd

Question 9

Polyps

Answer 9

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

Question 10

Papilloma

Answer 10

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

Question 11

Hyperplasia

Answer 11

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

Question 12

Keratosis

Answer 12

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

Question 13

Leukoplakia

Answer 13

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

Question 14

Prevalence

Answer 14

Males
80 leukoplakia
65 keratosis
56 pap
Female
80 Polyp

Question 15

Treatment outcomes

Answer 15

85 87 polyps
80 75 keratosis
88 50 leukoplakia
64 35 papilloma

Question 16

Laryngeal web

Answer 16

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

Question 17

Sulcus vocalis

Answer 17

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:

Question 18

Contact ulcers

Answer 18

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

Question 19

Nodules

Answer 19

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

Question 20

Systemic edema

Answer 20

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

Question 21

Systemic anemia

Answer 21

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

Question 22

Parkinson’s

Answer 22

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

Question 23

Hormonal: incomplete mutation

Answer 23

Descr: small vocal structures, small stature
Etio: decreased pituitary and thyroid activity
Acoustic: small vocal range, hi p
Tx: hormone treatments
Prevalence:

Question 24

Hormonal: precocious vocal mutation

Answer 24

Descr: vocal over developed for chron age
Etio: overactive adrenal, gonad, thyroid, pituitary
Acoustic: males- low pitch, adult voice; females-adult pitch
Tx: hormone treatment

Question 25

Menopausal voice change

Answer 25

Descr: virtualization, no laryngeal changes?
Etio: incr adrenal and gonadal activity
Acoustic: low voice, range, harsh
Tx: hormone treatment, counsel

Question 26

Cretinism hormonal

Answer 26

Descr: underdeveloped structures, retardation
Etio: deficient thyroid
Acoustic: small range
Tx: none