Structural voice disorders

Question 1

Describe acute nodules

Answer 1

• inflammatory degeneration of the SF layer of the LP with associated edema and fibrosis
• usually bilateral
• filled with blood or ISF
• located between anterior 1/3 and posterior 2/3
• caused by traumatic or hyper functional voice use
• overlying epithelium unchanged
• protuberant

Question 2

Describe chronic nodules

Answer 2

• harder and less flexible
• increased fibrosis with thickened epithelium
• stiffness leads to decreased vibration (out of phase) and an hourglass closure
• smoother

Question 3

Perceptual characteristics of nodules

Answer 3

roughness, breathiness and increased muscle tension

Question 4

Treatment of nodules

Answer 4

• Voice therapy is first choice
• Phonosurgery only if a compliant client doesn’t respond to therapy (followed by voice therapy)
• In acute cases (without vascular lesions), steroids may be applied

Question 5

Describe sessile polyps

Answer 5

• fluid filled lesions in SF layer of LP
• Located at medial 1/3 of membranous VFs
• usually unilateral
• Caused by acute trauma or abuse or a ruptured blood vessel

Question 6

Describe pedunculate polyps

Answer 6

• attached to a stalk
• feels like something is in the throat
• can move above and below glottis

Question 7

Perceptual characteristics of polyps

Answer 7

• mild to severe dysphonia depending

- larger polyps cause inspiratory stridor

Question 8

Treatment of polyps

Answer 8

• Voice conservation

- if no rapid improvement, phono surgery followed by voice therapy

Question 9

Describe Reinke’s Edema/polypoid degeneration

Answer 9

• Reinke’s space (SF layer of LP) becomes filled with thick fluid
• Caused by longstanding trauma (alcohol, smoking + vocal abuse)
• If swelling affects whole length of VFs, closure is usually complete
• VFs appear swollen and reddish
• Usually bilateral
• May have difficulties adducting posteriorly

Question 10

Perceptual characteristics of Reinke’s edema

Answer 10

low pitch and hoarseness

Question 11

Treatment of Reinke’s Edema

Answer 11

• phonosurgery (lateral VF incision and extraction of fluid)

- Post-op voice therapy for identification of detrimental behaviours, vocal hygiene and improved voice production

Question 12

What is a hemorrhage?

Answer 12

• Blood flow from ruptured vessels in the vocal folds, often located in Reinke’s space-
• Usually result in acute voice loss and dysphonia

Question 13

What is a hematoma?

Answer 13

• Accumulation of blood that has leaked form a vessel

- Some post-acute dysphonia

Question 14

What is a varix?

Answer 14

• Mass of blood capillaries that appears as an indurated, adynamic “blood blister”
• Not caused by one traumatic event
• May affect amplitude, periodicity and symmetry of mucosal wave
• Unmarked changes in voice

Question 15

Treatment for hemorrhages and hematoma?

Answer 15

• Voice conservation and rest
• Alternatively rapid course of steroids
• Voice therapy recommended after resolution to restore voice quality, endurance and range

Question 16

Treatment for varices?

Answer 16

• Laser vaporization

- Voice therapy recommended

Question 17

Describe acute laryngitis

Answer 17

• Inflammation of VF mucosa
• Associated with viral infections of upper respiratory tract (resolves) or bacterial infections (need antibiotics)
• Voice will be hoarse

Question 18

Treatment for acute laryngitis

Answer 18

• Internal and external hydration

- If necessary: antibiotics and cough suppressants (to prevent more damage)

Question 19

Describe chronic laryngitis and its causes

Answer 19

• Long standing mucosal inflammation, with viscous mucous and epithelial thickening that is unassociated with a viral infection
• Usually painless
• Mild to severe dysphonia, laryngeal fatigue and unproductive throat clearing/coughing
• Causes: smoking, GERD, repeated acute laryngitis, vocal misuse and abuse, allergies, bulimia

Question 20

Treatment of chronic laryngitis

Answer 20

• Identify and eliminate causative factors

- Voice therapy

Question 21

Describe vocal fold granulomas/contact ulcers and causes

Answer 21

• Often vascular lesions
• Result from tissue irritation on posterior larynx
• Usually located on vocal process of arytenoid cartilage, don’t impact VF vibration unless they are very large
• May impact VF closure and inhalation
• Causes: GERD, iatrogenic consequence of intubation or persistent low pitched pressed phonation

Question 22

Treatment of vocal fold granulomas

Answer 22

• Reflux medication
• Phonosurgery (high recurrence rates)
• voice therapy (reduce VF compression and anti-reflux behaviours)

Question 23

Describe cysts of the VFs and their causes

Answer 23

• Fluid filled sessile growths
• Whitish and transparent
• Epithelial sacs on the VFs, FVFs or ventricle
• Caused by blocked mucosal glands or vocal abuse
• Usually unilateral
• Stiffness dampens mucosal wave, even if very small

Question 24

Treatment of VF cysts

Answer 24

• DON’T RESPOND TO VOICE THERAPY
• Phonosurgery
• Post-op voice therapy

Question 25

Describe Papillomas

Answer 25

- wartlike benign tumours that develop in the epithelium and invade the lamina propr. and vocals muscle - caused by HPV - Concern is that it is heading towards airway

Question 26

Perceptual characteristics of papilloma

Answer 26

-Severe dysphonia

Question 27

Treatment of papillomas

Answer 27

- Aggressive treatment - Interferon medication (suppresses virus replication) - Laser surgery - Tracheostomy may be required - Voice therapy (acute and post-op)

Question 28

Describe congential laryngeal webs

Answer 28

- Tissue bridge b/w the VFs at the anterior commissure - Results from insufficient separation of the VFs during 10th week of gestation - Depending on extent, laryngeal stridor and respiratory distress may result - Voice quality may be mildly to severely impaired - Higher F0

Question 29

Describe acquired laryngeal webs

Answer 29

-a microweb of anterior portion of VFs can result from phono surgery, laryngeal trauma or long term intubation

Question 30

Treatment of laryngeal webs

Answer 30

- Phonosurgery to remove web, involves placement of a keel to prevent reformation - Temporary tracheostomy necessary - Post-op vocal therapy

Question 31

Describe sulcus vocalis

Answer 31

- A furrow or ridge along the entire membranous portion of the VFs in the SF layer of LP - Increases the stiffness of the VF cover - Leads to bowing of VFs - Variable effect on voice quality - Etiology unclear - Can be a result of phono surgery, aging or VF paralysis - Optimal treatment not yet identified

Question 32

Describe presbylaryngeus and its treatment

Answer 32

Age related changes in the laryngeal structure and function. - Decreased elasticity of VF mucosa - Decreases intrinsic tone of VF body (bowing) - Decreased loudness, pitch and loudness instability and decreased voice quality - Treatment: voice therapy

Question 33

Briefly describe epithelial hyperplasias and their treatment

Answer 33

- Pre cancerous - Abnormal mucosal changes of the VFs. Hyper plastic and irregular thickening of epithelium - Caused by hyper function, chemical or toxic irritants and smoking and alcohol - Treatment: surgical removal, biopsy, education to prevent recurrence. Post-op voice therapy