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5.2 Organic Voice Disorders Flashcards

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1
Q

Organic Voice Disorders

A

1.Voice disorders resulting from organic disease or trauma
a. Structural abnormalities of the VFs

  1. Unrelated to how the voice is used
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2
Q

List of Organic Voice Disorders

A
  1. VF cysts
  2. Contact Ulcers and Granuloma
  3. Sulcus Vocalis
  4. Laryngeal Webs
  5. Papilloma
  6. Laryngeal Cancer
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3
Q

Cyst

A
  1. Fluid-filled sac on VF
  2. Usually unilateral
    a. contalateral VF edema
  3. Typically affects glottal margin or superior/inferior surfaces of VFs
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4
Q

Cyst Types

A
  1. Mucus retention
    a. Blockage of granular duct
  2. Epidermoid (sebaceous)
    a. Accumulation of keratin or epithelium
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5
Q

Cyst Etiology

A
  1. Congenital anomaly
  2. Blocked glandular duct on inferior part of VF
  3. Traumatic contact between VFs
    a. Causes ingrowth of squamous cell elements.
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6
Q

Cyst Auditory-perceptual and acoustic features

A
  1. Breathy, strained, or raspy voice quality

2.Pitch often decreased

  1. Vocal fatigue
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7
Q

Cyst Laryngeal imaging characteristics

A
  1. Rigidity of involved VF
    a. Absent amplitude of vibration and mucosal wave in the affected area
  2. Hourglass glottal closure pattern
  3. Aperiodicity and asymmetry
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8
Q

Cyst Aerodynamics

A
  1. ±Increased airflow (if incomplete closure)
  2. Decreased subglottal pressure
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9
Q

Cyst Management

A
  1. Surgical Management
  2. Follow-up Voice Therapy
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10
Q

Sulcus Vocalis

A
  1. Furrow along upper medial edge of VFs
    a. Inner margin of VFs
  2. Unilateral or Bilateral
  3. Vary in length and depth
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11
Q

Sulcus Vocalis Etiology

A
  1. Congenital

2/ Acquired: phonotrauma may be contributing factor

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12
Q

Sulcus Vocalis
Auditory-perceptual and acoustic features

A
  1. Hoarseness, high pitch voice
  2. Decreased loudness
  3. Increased effort, vocal fatigue
  4. Mild breathiness
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13
Q

Sulcus Vocalis Aerodynamic characteristics

A

±Elevated airflow

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14
Q

Sulcus Vocalis Laryngeal Imaging Characteristics

A
  1. Longitudinal groove
    a. Parallel to glottis
  2. Spindle-shaped glottal closure
  3. Decreased mucosal wave and amplitude of vibration
  4. ±Compensatory supraglottic hyperfunction
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15
Q

Sulcus Vocalis Management

A
  1. Voice therapy may improve function
  2. If voice therapy is not sufficient, surgical management
    a. Fat or other type of implantation
    b. Excision of sulcus with CO2 laser
    c. After surgery, voice therapy
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16
Q

Laryngeal Web

A
  1. band of tissues connecting VFs at anterior end
  2. May seriously compromise airway (laryngeal stenosis)
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17
Q

Laryngeal Web etiology

A

Congenital: failure of normal tissue reabsorption in embryonic development → glottis formation

Acquired: bilateral trauma of VFs, medial edge
a. Can occur after bilateral VF surgery

b.Prolonged trauma → tissue growths together

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18
Q

Laryngeal Web
Auditory-perceptual and acoustics features

A
  1. Hoarseness, high-pitch voice
  2. Difficulty sustaining phonation
  3. Stridor if webbing is severe, respiratory distress
  4. Children: weak cry, stridor
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19
Q

Laryngeal Web: Laryngeal imaging characteristics

A
  1. Tissue starts in anterior commissure
  2. Inhibits normal vibration, reduced vibratory amplitude
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20
Q

Laryngeal Web
Aerodynamics features

A
  1. Reduced airflow
  2. ±Subglottal pressure
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21
Q

Laryngeal Web: Management

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A
  1. Surgical intervention
    a. Webbing is cut and removed
    b. Wedge placed between to prevent fusion
  2. Severe obstruction: immediate surgery with temporary tracheostomy
  3. Voice therapy post-surgery to optimize voice
22
Q

Papilloma

Study These Flashcards
A
  1. Wart-like growths that can cause airway obstruction
  2. Occur in children and adults
    a. Juvenile papilloma more common
  3. Location: subglottal, glottal, or supraglottal
    a.Glottal: affects VF vibration and respiration
23
Q

Papilloma Etiology

24
Q

Papilloma
Auditory-perceptual and acoustic characteristics

Study These Flashcards
A
  1. Hoarseness (harsh), breathy, can be aphonic
  2. ±low pitch
  3. ±stridor during inhalation
  4. Children: weak cry, stridor, swallowing difficulties
25
Papilloma: Laryngeal Imaging
1. Unique tissue changes: Dx with biopsy 2. Tissue is stiff in affected region a. Decreased or absent vibratory amplitude and mucosal wave 3. Aperiodicity, asymmetry, irregular glottal closure
26
Papilloma Management
1. Usually surgical (often requires multiple surgeries) a. High rate of recurrence, especially in children b. CO2laser surgery: lower rate of reoccurrence 2. Antiviral agents often used with surgery 3. ±Behavioral voice therapy a. Reduce hyperfunctional, compensatory behaviors
27
Laryngomalacia
1.Most frequent congenital condition 2. Specific pediatric disorder 3. Immature cartilage development → soft tissue collapse during inhalation
28
Laryngomalacia: Auditory-perceptual characteristics
1. Inspiratory stridor 2. Weak cry
29
Laryngomalacia Laryngeal imaging
1. Collapse of laryngeal cartilages 2. Omega shape epiglottis
30
Laryngomalacia Management
1. Surgery 2. CO2 laser supraglottoplasty
31
Contact Ulcer & Granuloma
Benign growths along the VF process a. Posterior third of glottal margin
32
Contact Ulcer & Granuloma Etiology
1. Gastric reflux –LPR a. Stomach acid irritates area around arytenoids b. Contributing factor can be voice misuse 2. Intubation (extubation) with associated tissue trauma
33
When does Granuloma occur?
Granuloma occurs after initial contact ulcer a. Vascularized growth in response to tissue damage b. Tissue healing response i. Increased capillaries and fibrous tissue, forms mass
34
Laryngopharyngeal Reflux (LPR)
*Acid backflow from the stomach into pharynx/larynx *Acid affects mucosal lining of pharynx and larynx *Very common in voice disorders *No symptoms of reflux in up to 50% *Reddening of posterior 1/3 of VFs and arytenoids complex *Voice often worse in the morning *Medical evaluation and management *pH monitoring *Proton pump inhibitor (Omeprazole, Pantoprazole) *H2 blockers (Zantac, Ranitidine) *Behavioral management strategies
35
Contact Ulcer & Granuloma: Auditory-perceptual and acoustic characteristics
1. May or may not affect voice 2. When voice is affected: a. Breathy and hoarse voice quality b. Pressed, effortful c. Intermittent dysphonia d. Vocal fatigue e. Decreased pitch and decreased dynamic range f. ±Laryngeal pain, globus sensation
36
Contact Ulcer & Granuloma: Laryngeal imaging characteristics
1. Mass usually on cartilaginous portion of VF a. Can become very large 2. May impede VF adduction a. Posterior glottal gap 3. ±Decreased vibratory amplitude 4. Phase asymmetry
37
Contact Ulcer & Granuloma: Aerodynamic characteristics
Can produce increased airflow, decreased subglottal pressure, decreased laryngeal resistance
38
Contact Ulcer & Granuloma: Management
1. Medical and behavioral management of reflux 2. ±Surgery 3. Behavioral voice therapy & vocal hygiene a. Reduce hard glottal attacks or other misuse b. Train improved vibratory patterns
39
Presbyphonia (Prebylarynx)
1. Dysphonia due to age-related structural changes to VFs and larynx 2. Beyond levels of normal aging a. Adversely affects function 3. May be associated with VF atrophy 4. Other possible physical/neurological disease should be ruled out
40
Presbyphonia: Auditory-perceptual and acoustic features
1. Breathiness, hoarseness 2. Decreased loudness 3. Unstable phonation –pitch breaks
41
Presbyphonia: Aerodynamic characteristics
1. Increased airflow 2. Decreased subglottal pressure 3. Decreased laryngeal resistance
42
Presbyphonia: Laryngeal imaging characteristics
1. Bowing of VFs a. Oval-shaped gap 2. Reduced amplitude of VF excursion 3. Reduced mucosal wave
43
Presbyphonia: Management
1. Voice therapy a. To improve glottal closure b. Posture and respiratory support
44
Carcinoma (dysplasia) or Laryngeal Cancer
1. Squamous cell carcinoma a. Stratified squamous epithelium of VFs
45
Carcinoma (dysplasia) or Laryngeal Cancer: Etiology
1. Smoking 2. Heavy alcohol use 3. HPV 4. Environmental irritants, chemicals 5. Metabolic abnormalities
46
Carcinoma or Laryngeal Cancer: Auditory-perceptual and acoustic characteristics
1. Progressive and persistent hoarseness 2. Decreased pitch and loudness 3. Breathy and strained voice quality 4. Vocal effort, fatigue
47
Carcinoma or Laryngeal Cancer: Other characteristics
1. Odynophagia, globus sensation 2. Persistent cough or throat-clearing 3. Lump in the neck, broadening of larynx, tenderness in the neck
48
Carcinoma or Laryngeal Cancer: Laryngeal imaging characteristics
1. Irregular ulcerated lesions 2. Leukoplakia in early lesions 3. Reduced vibratory amplitude, mucosal wave 4. Asymmetry and impaired glottic closure 5. Supraglottic compression (compensatory) *Requires biopsy and histological analysis
49
Carcinoma or Laryngeal Cancer: Aerodynamic Features
Increased airflow, elevated laryngeal resistance
50
Carcinoma or Laryngeal Cancer: Management
1. Surgery 2. Radiation therapy 3. Chemotherapy 4. Behavioral voice therapy a. Best voice possible b. Alternative means of communication 5. Counseling

Voice (11 decks)

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