Organic voice disorders Flashcards
(99 cards)
1
Q
Fill in the blank
Life span specific pathologies
- 22 to 44 years: _____
- 45 to 64 years: _____
- 65+: ______
A
Life span specific pathologies
- 22 to 44 years: vocal nodules, edema
- 45 to 64 years: polyps and dysphonia (i.e., abnormal voice) without visible pathology
- 65+: vocal fold paralysis
2
Q
T or F: Males present more frequently with cancer, leukoplakias, hyperkeratoses
A
True
3
Q
T or F: Females present less frequently with nodules and psychogenic disorders
A
False - females present MORE frequently with nodules and psychogenic disorders
4
Q
T or F: Vocal nodules are usually bilateral
A
True
5
Q
Vocal nodules are usually located on the 1)______ ______ between the anterior 1/3 and the posterior 2/3s of the vocal fold. It is the point of 2)_______ vibration amplitude.
A
- Medial edge
- Greatest
6
Q
Acute vocal nodules…
A
- can go away on their own
- are caused by traumatic or hyperfunctional voice use
- usually gelatinous and floppy
- overlying epithelium is unchanged
7
Q
T or F: Vocal nodules are benign lesions
A
True
8
Q
Vocal nodules are 1________ ________ of the 2) ________________
A
- Inflammatory degeneration
- superficial layer of the lamina propria
9
Q
Chronic vocal nodules…
A
- are harder, less flexible, increased fibrosis, thickened epithelium
- have increased stiffness of the vocal fold cover during vibration (transition and body layers are often unchanged)
10
Q
Who gets vocal nodules?
A
- Children
- Adult females
- Untrained and economical singers (ex. using voice too much during practice or training in a voice that doesn’t come naturally)
11
Q
Perceptual characteristics of vocal nodules
A
- Roughness
- Breathiness (caused by anterior and posterior gaps)
- Increased laryngeal muscle tension
**roughness + breathiness = hoarseness
12
Q
T or F: Surgical removal of nodules without accompanying voice therapy may result in reoccurrence
A
True
13
Q
In acute cases with accompanying vascular lesions (hemorrhage, varices, hematoma), __________ may be applied.
A
Oral steroids
14
Q
T or F: Phonosurgery should be followed by voice therapy
A
True
15
Q
Vocal fold polyps are believed to be caused by _______ or _______
A
- Acute vocal trauma
- Misuse
16
Q
T or F: Vocal fold polyps are ALWAYS unilateral
A
False. Vocal fold polyps are MOSTLY unilateral (but can be bilateral).
17
Q
A vocal fold polyp…
A
is a fluid-filled lesion in the superficial layer of the lamina propria
18
Q
T or F: Vocal fold polyps (podules) are general bigger and blood is more visible (compared to nodules). It is classified as nodules when it is smaller.
A
True
19
Q
There are 2 forms of vocal fold polyps: _______ and _______
A
- Sessile polyp (blister) - sitting on the VF
- Pedunculated polyp (attached to a stalk) -stalk is attached to VF while the polyp hangs
20
Q
What are the perceptual characteristics of vocal fold polyps?
A
- Mild to severe dyphonia depending on the location and nature of the polyp
- Larger polyps can cause inspiratory stridor (wheezing)
-Vocal fold stiffness depends on the etiology of the polyp: hemmorrhagic polyps are stiffer than edematous polyps
21
Q
T or F: Polyps can lead to cysts
A
True
22
Q
What is the treatment for vocal fold polyps?
A
Voice conservation
23
Q
What is Reinke’s edema?
A
- Reinke’s space (superficial lamina propria) becomes filled with thick fluid
- It is caused by longstanding trauma: e.g., vocal misuse combined with smoking
- Since the swelling affects the whole length of the vocal fold, glottal closure is usually complete
- Vibration might be irregular
24
Q
What is this?
A
Early Reinke’s edema (note redness and swelling)
25
What is this?
Reinke's edema
26
What is polypoid degeneration?
- It is the most severe form of Reinke's edema.
- It is where the Reinke's space is filled with viscous fluid. The vocal folds look swollen and enlarged.
27
What is this?
Advanced unilateral Reinke's edema (polypoid degeneration)
28
What are the perceptual characteristics of Reinke's edema (and polypoid degeneration)?
- Increased mass and stiffness of the vocal fold. The vocal folds can still close properly during speech
- Consistent changes: low pitch, hoarseness
- Johnny Walker type of voice (deep, raspy)
29
What is the treatment for Reinke's edema?
- Phonosurgery: lateral vocal fold incision and extraction of fluid
- Post-operative voice therapy for identification of detrimental behaviours, vocal hygiene, and improved voice production
- Voice therapy to facilitate the use of the new voice since the postoperative change can be quite drastic
30
What are the vascular lesions of the vocal folds?
1. Hemorrhage: Blood flow from ruptured vessels in the vocal fold, often located in Reinke's space
2. Hematoma: Collection of blood that has already leaked out from a vessel
3. Telangiectasias: Visible dilated capillaries
4. Varix: A mass of blood vessels that presents as an indurated, adynamic 'blood blister'
31
What is this?
Unilateral vocal fold hemorrhage
32
What is this?
Bilateral vocal fold hemorrhage
33
What are the consequences of vascular lesions of the vocal folds?
Hemorrhage and the subsequent hematoma can cause significant acute and post-acute dysphonia.
– Mucosal stiffness.
– In severe cases, scarring of the vocal fold cover
Telangiectasias and varix may affect the amplitude, periodicity and symmetry of the mucosal wave.
– The change in vocal quality is usually not marked
but may be of concern to professional voice users.
34
Who suffers from vocal fold
hemorrhage?
- Can occur in anyone.
- Increased incidence among pre-menstrual women using aspirin products.
35
What is the treatment of vascular lesions?
* Hemorrhage/ hematoma: Usually good spontaneous resolution with voice conservation and rest.
– Alternatively: Rapid course of steroids.
* Telangiectasias and varix: If required, laser surgery.
* After resolution of the vascular lesion, voice therapy is recommended to restore voice quality, as well as endurance and range.
36
What is Acute laryngitis?
- Acute laryngitis is the inflammation of the vocal fold mucosa
- Exact etiology unknown; usually associated with viral infections of the upper respiratory tract and bacterial infections
- Also a possible symptom of COVID 19
37
What is this?
Acute laryngitis
38
What is the treatment for acute laryngitis?
- External and internal hydration
- Rest
- If necessary, antibiotics and cough suppressants
39
What is Croup (laryngotracheobronchitis)?
- Croup is a more serious response to a laryngitis in children
- It involves narrowing of the subglottic airway with hoarseness, a hacking cough and inspiratory stridor
- Attacks can last between 30 and 60 minutes
40
What is chronic laryngitis?
- Long-standing mucosal inflammation, viscous mucus, epithelial thickening unassociated with a viral infection
- Mild to severe dysphonia, laryngeal fatigue and unproductive coughing and throat clearing
- Usually painless
41
What is this?
Chronic laryngitis
42
What is this?
Chronic laryngitis with polypoid degeneration
43
What are the causes for chronic laryngitis?
- Repeated acute laryngitis
- Vocal misuse
- Smoking
- Poor hydration
- Sensitivity caused by air pollutants, allergies, dehydrating medication, gastresophageal reflux, repeated vomiting due to bulimia
44
What is the treatment for chronic laryngitis?
- Identify and eliminate causative factors
- Voice therapy can have an important supporting role in the modification of misuse behaviours
45
T or F: Vocal fold granulomas and contact ulcers are usually located on the vocal process of the arytenoid cartilage
True
46
T or F: Granulomas and contact ulcers are not often vascular lesions
False. Granulomas and contact ulcers are OFTEN vascular lesions.
47
Vocal fold granulomas and contact ulcers result from...
tissue irritation in the posterior larynx
48
What is this?
Granuloma
49
What is this?
Granulomatous contact ulcer
50
What is this?
Unilateral contact granuloma
51
What is this?
Bilateral contact granuloma
52
What are the etiologic factors (causes) of granulomas and contact ulcers?
- Gastroesophageal reflux
- Iatrogenic consequence of laryngeal intubation, especially following emergency or long-term intubation
- Persistent voice misuse: low-pitched pressed phonation
53
What are the characteristics of granulomas and contact ulcers?
- Only large lesions affect the membranous vibration of the vocal fold
- Throat pain, vocal fatigue, restricted range
54
What is the treatment of granulomas and contact ulcers?
- Anti-reflux treatment if reflux is a precipitating factor.
- Phonosurgery: Risk of recurrence because of constant movement and mechanical pressure of the arytenoids.
- Voice therapy for reduction of the medial vocal fold compression and anti-reflux behaviours
55
What are cysts of the vocal folds?
- Fluid-filled sessile (firmly attached) growths, whitish and transparent
- Epithelial sacs on the vocal folds, the ventricular folds, or in the laryngeal ventricle
56
What causes cysts?
- Blocked mucosal gland (mucus can't drain, so it builds up into a cyst)
- May also be the consequence of vocal misuse (i.e., develop from a polyp)
57
T or F: Cysts of the vocal folds are usually bilateral
False. **Cysts are usually unilateral**. Contralateral irritation of the mucosa may suggest a bilateral lesion such as vocal nodules.
58
What is this?
Vocal fold cyst
59
What is this?
Intracordal vocal fold cyst
60
What is this?
Intracordal cyst
61
What are the characteristics of vocal fold cysts?
- Stiff, adynamic segment dampens mucosal wave.
- Because of their stiffness, even small cysts may have a strong negative effect on the singing voice.
- Large cysts can inhibit glottal closure to the degree of aphonia.
62
What is the treatment for vocal fold cysts?
- Cysts do not respond to behavioural treatment.
- Phonosurgery
- Post-operative voice therapy
63
What is papilloma?
- Wartlike benign tumours that develop in the epithelium and can invade the lamina propria and the vocalis muscle.
- Probably caused by viral infection with Human Papilloma Virus (HPV).
- Most common in children (Juvenile Onset Recurrent Respiratory Papilloma; JORRP), incidence decreases with age.
- Less common in adults (but increasing incidence)
64
What is this?
Papilloma
65
Effects of papillomatosis of the vocal folds...
- Severe dysphonia may result.
- The lesions affect the mass and stiffness of the body and cover of the vocal fold in numerous locations.
- Potential complications: Papillomas may spread throughout the airway and compromise breathing.
- Occasionally, the disease is fatal
66
What is the treatment for vocal fold papilloma?
- Rapid spreading of the papilloma
- Aggressive treatment
- Interferon medication may be used to help slow down or stop the virus from making more growths.
- Laser surgery is often used to remove them, and this may be repeated as necessary
- If the airway is severely compromised due to it, and make it hard to breathe, a tracheotomy (breathing tube in the neck) might be needed.
67
What is the role of voice therapy in papillomatosis?
- Acute phase: Some physicians argue (with limited evidence) that papilloma growth and severity can be reduced through relaxed voice use.
- Post-operative phase: Rehabilitation of vocal function, especially in patients with extensive scarring from multiple operations
68
What are congenital laryngeal webs?
- It is a tissue bridge between between the vocal folds, usually at the anterior commissure (but may extend further posteriorly)
- Results from insufficient separation of the vocal folds during the 10th week of gestation
- Depending on the extent of the web, laryngeal stridor and/or respiratory distress may occur
- Depending on the size and thickness of the web, voice quality may be mildly to severely impaired
My notes:
- anterior won't vibrate (very reduced)
- only vibration happens at posterior part
- this causes VF being able to vibrate only a little, making pitch go ^
69
What is this?
Anterior congenital web
70
What is the therapy for congenital laryngeal webs?
- Phonosurgical removal of the web
- Insertion of a keel for several weeks prevents reformation of a web (temporary tracheostomy necessary)
- Post-surgical voice rehabilitation
71
What are acquired laryngeal webs?
- A microweb (synechia) of the anterior portion of the vocal fold can result from phonosurgery, laryngeal trauma or long-term intubation
- Variable effect on voice quality
- Therapy: if necessary, phonosurgery
72
What is this?
Vocal fold trauma with posttraumatic webbing
73
What is sulcus vocalis?
- It’s like a groove or dent (called a furrow) that runs along the vibrating part of the vocal fold.
- This groove affects the superficial layer of the vocal fold, making it stiffer than normal. That stiffness messes with how well the fold can vibrate.
- Because of this, the vocal folds don’t close fully during speech. There's a spindle-shaped gap between them, which is called bowing.
- It usually happens on both sides (bilateral).
- The effect on the voice depends on how big the glottal gap is.
My notes:
- It is commonly found in singers (likely due to seeing ENT's more)
74
What is this?
Sulcus vocalis
75
What is the therapy for sulcus vocalis?
- May not require treatment.
- Surgery is possible.
- Voice therapy may help to achieve optimum vocal efficiency with minimal strain.
76
What is presbylarynx?
- Age-related changes in the laryngeal structure and function
- Decreased respiratory efficiency
- Decreased elasticity of the vocal fold mucosa
- Decreased intrinsic muscle tone of the vocal fold
77
What are the characteristics of presbylarynx?
- Decreased loudness
- Pitch and loudness instability, pitch drop
- Decreased voice quality
- Usually from age 65+
- Vocal fold bowing presumably because of decreased bulk of vocal fold bulk and cover
- Often falsetto compensation
- Therapy: Voice therapy (ex: sustaining a vowel for as long as possible)
78
Epithelial hyperplasia: leukoplakia and hyperkeratosis...
- Involve irregular thickening of the epithelium
- Lesions may penetrate into the lamina propria
- Are often pre-cancerous
79
What is leukoplakia?
- "White plaque"
- Thick white substance that adheres to the vocal fold in diffuse patches
- Benign or malignant in nature
80
What is this?
Leukoplakia
81
What is hyperkeratosis?
It is the thickening of the epithelium due to excess keratin (a protein found in hair, feathers, finger nails, and hooves)
82
What is this?
Hyperkeratosis
83
What is the treatment for epithelial hyperplasia?
- Surgical removal because of the pre-cancerous nature of these cells
- Biopsy and histological analysis of potential malignancy
- Patient education to prevent recurrence
- Post-operative voice therapy
84
Endocrine growth hormones...
change voice throughout the life-span.
85
T or F: During puberty, there is a more marked change in voice for females than males
False. Most marked changes occur in males during puberty.
In females, the onset of puberty, the menstrual cycle, pregnancies, and menopause may alter voice quality.
My notes:
In women, F0 drops only a couple of semitones in women.
86
What is rheumatoid arthritis?
A disorder that affects synovial joints including the cricothyroid and cricoarytenoid joints.
87
What are the symptoms and treatment of rheumatoid arthritis?
- Symptoms: Pain during speech and swallowing, in severe cases mechanical fixation of the joints.
- Treatment: Anti-inflammatories, corticosteroids
88
T or F: Anti-histamines can cause mucosal dryness
True
89
T or F: Prolonged intake of steroids can change the vocal folds
True
90
T or F: Pharyngeal and nasal secretions may change resonance and affect the larynx
True
91
Yeast infection - Candida albicans is:
- A fungus infection that can lead to hoarseness, dryness, and mild laryngitis
- Common in patients with compromised immune systems
Treatment: Anti-fungal rinse
My notes:
Radiation therapy can cause this too
92
What is this?
Yeast infection - Candida albicans
93
Gastroesophageal reflux disease (GERD) ..
- Can cause throat pain and dysphonia
- Persistent GERD can lead to ulcerations or granuloma in the posterior larynx
- is usually confined to the posterior larynx
94
What is the assessment and treatment of GERD?
- Assessment: Transnasal PH-monitor for 24 hours.
- **Treatment:** Antacids, anti-reflux medication.
- **Behavioural changes:** Diet changes, weight changes, elimination of alcohol and caffeine (inhibit digestion), loose clothing, elevated headrest at night.
95
What is congenital subglottic stenosis?
- Narrowing of the trachea below the level of the glottis.
- Caused by malformation of the cricoid cartilage or the conus elasticus during embryonic development.
- Airway obstruction with inhalatory stridor, even early after birth.
Therapy: If necessary, surgical correction.
96
What is this?
Laryngeal stenosis (a general term meaning narrowing anywhere in the larynx)
97
What is congenital laryngomalacia?
- Developmental delay of the epiglottis cartilage
- Epiglottis stays soft and pliable (not stiff enough) and causes stridor during inspiration and expiration
- **Treatment:** Wait-and-see treatment, as the cartilage will normally mature by the third year
- **Posture adjustments** (e.g., sleeping on the stomach) usually helps to keep the patient’s airway open
98
What is laryngeal cleft?
- Rare congenital disorder that results in
tracheoesophageal communication.
- Possible symptoms are reduced weight gain,
aspiration, pneumonia, or cyanosis.
- Laryngeal clefts are divided into severity
types I-IV.
- Shallow clefts may not require treatment or
can be treated with injections.
- Deeper clefts require surgical repair.
99
What is this?
Laryngeal cleft
