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organic voice disorders Flashcards

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1
Q

3 causes for voice disorders?

A
  1. changes in mass
  2. changes in tension
  3. changes in control
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2
Q

which population do voice pathologies more frequently occur in? (2)

A
  • males
  • older populations (age 45-64)
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3
Q

life-span specific pathologies? (3)

A
  • 22-44 = nodules, edema
  • 45-64 = polyps, edema, cancer
  • 65+ = VF paralysis, cancer
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4
Q

what are the most frequent voice disorders in children? (5)

A
  1. subglottic stenosis
  2. vocal nodules
  3. laryngomalacia
  4. dysphonia
  5. VF paralysis
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5
Q

what are vocal nodules? (3)

A
  • benign lesions
  • inflammatory degeneration of superficial layer of lamina propria
  • usually bilateral
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6
Q

where are vocal nodules usually located?

A

point of greatest vibration amplitude (medial edge)

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7
Q

diff bw acute (3) vs chronic (3) vocal nodules?

A
  • acute: result of trauma or hyperfunctional voice use, usually gelatinous/floppy, overlying epithelium is unchanged
  • chronic: harder/less flexible, thickened epithelium, increased VF stiffness during vibration
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8
Q

who gets vocal nodules? (3)

A
  • male and female children
  • adult females
  • untrained singers
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9
Q

perceptual characteristics of vocal nodules? (2)

A
  • hoarseness
  • +laryngeal muscle tension
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10
Q

roughness + breathiness = ______

A

hoarseness

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11
Q

management of vocal nodules? (3)

A
  • voice tx first choice
  • phonosurgery if not responding to voice tx; will need voice tx after too
  • oral steroids
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12
Q

what are vocal polyps? (3)

A
  • fluid-filled lesion in superficial layer of lamina propria
  • mostly unilateral
  • sometimes related to ruptured blood vessel
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13
Q

location of vocal polyps?

A

medial 1/3 of membranous vocal fold

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14
Q

what are vocal polyps caused by? (2)

A
  • acute vocal trauma
  • misuse
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15
Q

key diff bw nodules vs polyps appearance?

A

polyps are bigger

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16
Q

forms of vocal fold polyps? (2)

A
  1. sessile (blister)
  2. pedunculated (attached to a stalk)
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17
Q

perceptual characteristics of polyps? (2)

A
  • mild to severe dysphonia
  • inspiratory stridor if big enough
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18
Q

which is stiffer; hemorrhagic or edematous polyps?

A

hemorrhagic (blood coagulates over time)

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19
Q

who gets polyps? (2)

A
  • adult males and females
  • children
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20
Q

tx of polyps? (2)

A
  • voice conservation
  • phonosurgery (followed by voice tx)
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21
Q

what is reinke’s edema? what is it caused by? what kind of glottal closure occurs?

A
  • reinke’s space (superficial layer) becomes filled with thick fluid
  • caused by longstanding trauma, i.e., vocal misuse + smoking
  • complete glottal closure since swelliing affects whole VF
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22
Q

what is polypoid degeneration?

A
  • most severe form of reinke’s edema
  • entire membranous portion of VF filled with viscous fluid
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23
Q

perceptual characteristics of reinke’s edema? (2)

A
  • low pitch
  • hoarseness
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24
Q

tx of reinke’s edema? (2)

A
  • phonosurgery to extract fluid
  • post-op voice tx bc new voice = drastic changes
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25
diff bw vascular lesions: a) hemorrhage b) hematoma c) telangiectasias d) varix
a) blood flow from ruptured vessels, often in reinke's space b) accumulation of blood that leaked from vessel c) dilated capillaries d) mass of blood vessels; blood blister
26
out of the following, which are more permenant: a) hemorrhage b) hematoma c) telangiectasias d) varix
telangiectasias and varices
27
consequences of: a) hemorrhage and hematoma vs b) telangiectasias and varices
a) significant acute and post-acute dysphonia (due to stiffness, scarring) b) affect amplitude, periodicity, symmetry of mucosal wave (not big impact on vocal quality)
28
who suffers from VF hemorrhage?
anyone!
29
tx of hemorrhage/hematoma? (3)
- voice conservation - steroids - voice tx once healed
30
tx of telangiectasias and varices? (2)
- laser surgery - voice tx once healed
31
what is acute laryngitis? etiologies?
- inflammation of VF mucosa - unknown; usually viruses
32
acute laryngitis tx? (3)
- rest - hydration - antibiotics, cough suppressants
33
what is croup? (2)
- more serious response to laryngitis in children - narrowing of subglottic airway
34
croup symptoms? (3) how long do attacks last?
- symptoms: hoarseness, hacking cough, inspiratory stridor - 30-60min
35
what is chronic laryngitis? (2)
- long-term mucosal inflammation - epithelial thickening not associated with viral infection
36
chronic laryngitis symptoms? (3)
- mild to severe dysphonia - laryngeal fatigue - unproductive coughs/throat clears
37
T or F: chronic laryngitis is usually painful
false -- usually painless
38
chronic laryngitis causes? (5)
- repeated acute laryngitis - vocal misuse - smoking - poor hydration - sensitivity (GERD, pollutants, allergies, meds)
39
chronic laryngitis tx?
- ID and eliminate causes - voice tx (behaviour mod role)
40
what are vocal fold granulomas/contact ulcers? what do they result from? where are they usually located?
- often vascular lesions - result from tissue irritation in posterior larynx (i.e., arytenoid friction) - vocal process of arytenoid
41
whats the diff bw polyps vs granulomas?
granulomas occur on cartilage
42
etiological factors of granulomas/contact ulcers? (3)
1. GERD 2. intubation 3. voice misuse (esp low pitch phonation)
43
granulomas/contact ulcers tx? (3)
1. anti-reflux tx 2. phonosurgery 3. voice tx
44
what are cysts? where do they occur? what are they caused by?
- fluid-filled whitish and transparent sessile growths - epithelial sacs on VFs, ventricular folds, or in laryngeal ventricle - caused by blocked mucosal gland duct
45
T or F: cysts are usually bilateral
false -- unilateral which may result in bilateral lesion such as vocal nodules
46
what effects do cysts have on the VFs? (2)
- stiff = dampen mucosal wave - can inhibit glottal closure = aphonia
47
cyst tx? (2)
- phonosurgery - voice tx post-surgery
48
T or F: cysts do NOT respond to behavioural tx
true
49
what is papilloma? where does it occur? what is it caused by? who is it more common in?
- wartlike benign tumours - in epithelium that can invade lamina propria + muscles - caused by HPV - most common in children
50
effects of papilloma on VFs? (3)
- severe dysphonia - stiffness - may spread thru airway and compromise breathing
51
papiloma tx? (3)
1. interferon meds (suppresses virus replication) 2. laser surgery 3. tracheotomy if airway compromised
52
what is the role of voice therapy in papillomatosis? (2)
- acute phase: limited evidence than papilloma growth can be reduced thru relaxed voice use - post-op phase: rehab of vocal function
53
what are congenital laryngeal webs? when do they occur?
- tissue bw VFs usually at anterior commissure - occur when there's insufficient separation of VFs in 10th week of gestation
54
effects of congenital laryngeal webs? (2)
- stridor and/or resp distress - voice quality impaired
55
congenital laryngeal web tx? (3)
- phonosurgery - keel for several weeks - post-op voice tx
56
what might acquired laryngeal webs result from? (3)
- phonosurgery - larynx trauma - long-term intubation
57
what kind of pitch would result from laryngeal web?
high pitch
58
types of laryngeal trauma? (3)
1. blunt/penetrating 2. inhalation 3. thermal
59
what is sulcus vocalis? which layer of lamina propria does it involve? what shape does it result in?
- furrow/ridge along entire VF - superficial layer - bow shaped gap
60
etiology of sulcus vocalis? (4)
- disturbance of embryologic maturation of VF cover - phonosurgery - aging - VF paralysis
61
tx of sulcus vocalis? (3)
- may not require tx - surgery - voice tx to reduce strain
62
what is presbylarynx (1)? what does it result in? (3)
- age-related larynx changes - decreased resp efficiency - decreased elasticity - decreased muscle tone of VF
63
what is a common compensation for presbylarynx?
falsetto
64
what are the 2 epithelial hyperplasias?
1. leukoplakia 2. hyperkeratosis
65
what is epithelial hyperplasia (2)? causes (3)?
- abnormal mucosal changes of VFs - often pre-cancerous - smoking, alcohol, other irritants
66
what is leukoplakia? is it benign or malignant?
- white plaques adhering to VFs - either or
67
what is hyperkeratosis? what is it caused by?
- build-up of keratinized cells of VFs - cell over-growth
68
epithelial hyperplasia tx? (4)
- surgery - biopsy + analysis - patient education to prevent recurrence - post-op voice tx
69
pharmaceutical effects on voice: a) bronchdilators b) diuretics/corticosteroids/decongestants c) antihistamines/antitussives/antirefluxiva
a) influence airflow b) influence tissue fluid level c) reduce secretions
70
when do hormones affect voice in males (1) vs females? (4)
- males: puberty - females: puberty, menstrual cycle, pregnancy, menopause
71
how might rheumatoid arthritis impact voice (1)? symptoms (2)?
- affects synovial joints including cricothyroid and thyroarytenoid joints - symptoms: pain during speech and swallowing, mechanical fixation
72
rehumatoid arthritis tx (2)?
- anti-inflammatories - corticosteroids
73
what is candida albicans (1)? voice impacts (3)? tx (1)?
- fungal infection (yeast) - dryness, hoarseness, mild laryngitis - antifungal rinse
74
complications of GERD (3)?
- throat pain and dysphonia - ulcerations/granuloma in posterior larynx - pachydermia laryngis (erythema, edema, hyperplasia of interarytenoid rim)
75
ax of GERD (1)? treatment (3)?
- ax: transnasal pH-monitor for 24hrs - tx: antacids, anti-reflux meds, lifestyle changes
76
what is congenital subglottic stenosis (1)? causes (1)? symptoms (1)? treatment (1)?
- trachea narrowing below glottis - malformed cricoid cartilage or conus elasticus - inhalatory stridor - surgery if necessary
77
what is congenital laryngomalacia (1)? symptoms (1)? treatment (2)?
- dev delay of epiglottis - stridor - wait and see, posture adjustments
78
what is laryngeal cleft (1)? symptoms (4)? treatment (3)?
- tracheoesophageal communication; cleft b/w arytenoids - reduced weight gain, aspiration, pneumonia, cyanosis - shallow may not require tx, injections, or surgery
79
who is papilloma most common in?
- children (JORRP)

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