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Ent - Larynx > Voice Disorders > Flashcards

Voice Disorders Flashcards

(41 cards)

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1
Q

Part of larynx that is responsible for phonation

A

Glottis / true vocal cords

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2
Q

Types of presentation of patients in voice disorders

A

Hoarseness
Change of voice
Dysphonia
Aphonia

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3
Q

Causes for the involvement of vocal cords

A

Infection
Nerve palsies / neuromuscular involvement
Structural lesions
Psychogenic / functional lesions

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4
Q

What is structural abnormalities of vocal cords ?

A

This occurs due to change in the structure of the vocal cords like swelling / nodules / polyp / edema

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5
Q

Causes for structural abnormalities of vocal cords

A

Voice abuse
Laryngopharyngeal reflux
Smoking

DIAGNOSED BY LARYNGEAL ENDOSCOPE

MAIN PRESENTATION IS HOARSENESS OF VOICE

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6
Q

Vocal nodules is also known as

A

Singer’s nodules
Teacher’s nodules
Screamer’s nodules

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7
Q

Appearance of the lesion in vocal nodules

A

Bilaterally symmetrical , small(<3mm) , sessile nodule found at the mid point of membranous part of vocal cords (or junction of anterior 1/3rd and posterior 2/3rd of the vocal cord or junction of anterior 1/3rd or middle 1/3rd of vocal cords )

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8
Q

Why does this vocal nodules occur at the midpoint of membranous part ?

A

This is the site of maximum vibration during phonation and hence is mostly affected during chronic vocal abuse

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9
Q

Management of vocal nodules

A

Investigation : laryngeal endoscope

Treatment : voice rest and speed therapy , reflux management , if not yet resolved then excision has to be done

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10
Q

Appearance is the lesion in vocal polyps

A

Unilateral , pedunculated , polyploidal mass of size > 3mm at the junction of anterior 1/3rd and posterior 2/3rd

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11
Q

Cause for vocal polyp

A

Sudden episode of voice abuse in unprepared larynx that leads to sudden hemorrhage in the submucosal tissue of the vocal cords

This sudden abuse is seen in protest , events , fight

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12
Q

Management of vocal polyp

A

Investigation:laryngeal endoscopy

Treatment : excision by micro laryngeal surgery (MLS)

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13
Q

What is the position of the patient for microlaryngeal surgery ?

A

Boyce position / barking dog position / chevalier Jackson position / sniffing the morning air position

Here, the axis of mouth and axis of larynx will be brought to the same line

In this position , there will be extension of Atlanto-occipital joint and flexion at cervico-thoracic / cervical / neck joint

No pillow under the shoulder blade unlike rose position

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14
Q

Cause of vocal cord cyst

A

Voice trauma / phono trauma

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15
Q

Site of vocal cord cyst

A

Site : free edge of the vocal cords

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16
Q

Management of vocal cord cysts

A

Investigation : STROBOSCOPY - flashes of light will be given to the vocal and vibration of each segment of the vocal cord will be interpreted to differentiate between nodules,polyp,cyst

Treatment : MLS

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17
Q

Site of occurrence of arytenoid granuloma

Study These Flashcards
A

Posterior 1/3rd or vocal process of arytenoid or cartilaginous part of vocal cords

18
Q

Causes for arytenoid granuloma

Study These Flashcards
A

Voice abuse
Smoking
Laryngopharyngeal reflux
Trauma most commonly due to intubation

CAN BE UNILTERAL / BILATERAL

19
Q

If arytenoid granuloma occurs due to voice abuse then it is called as what ?

Study These Flashcards
A

Contact ulcer (misnomer since it is not an ulcer ) or contact pachydermia = due to heaping up of epithelium on side due to repeated contact

20
Q

If arytenoid granuloma is due to Laryngopharyngeal reflux then it is called as what?

Study These Flashcards
A

Peptic granuloma

21
Q

If arytenoid granuloma occurs due to intubation (some surgery done under GA ) then it is called as what?

Study These Flashcards
A

Intubation granuloma

22
Q

Management of arytenoid granuloma

Study These Flashcards
A

Investigation : laryngeal endoscopy

Treatment : voice rest , management of reflux , if there’s no benefit then excision is done followed by Botox in thyroarytenoid muscle to prevent slamming of vocal cords

After excision , send the mass for biopsy

23
Q

What is reinke’s edema ?

Study These Flashcards
A

It is the edema of the submucosal space of the true vocal cords (reinke’s space)

Always bilateral and affects the whole length of the vocal cords

24
Q

Predominant factor for development of reinke’s edema

Study These Flashcards
A

SMOKING

Also voice abuse , LPR reflux

25
Why is reinke’s space is prone to edema ?
This is because the submucosa is not tightly adherent to the vocal ligament and also vocal cords are devoid of lymphatics making it impossible for the fluid to drain resulting in edema
26
Reinke’s edema also known as
Smoker’s larynx
27
Treatment for reinke’s edema
Stop smoking Voice therapy LPR control If no benefit, then go for reduction glottoplasty
28
What is Pseudosulcus ?
Formation of sulcus on the medial surface of the vocal cords due to infraglottic edema caused because of LPR reflux Treatment Is LPR management
29
What is sulcus vocalis?
Congenital abnormality where epithelium of true vocal cords is adherent to the vocal ligament on its medial surface IT IS A TRUE SULCUS
30
What is muscle tension disorder / dysphonia (MTD)?
In stressful conditions , the tension of the muscles of phonation will be altered that causes voice fatigue
31
What is psychogenic dysphonia / functional aphonia / hysterical aphonia ?
Occurs a result of stressful events seen in emotionally labile females Here the vocal cords will not adduct the person tries to speak remains abducted but when the person coughs the vocal cords adduct ruling out nerve palsies unaccompanied by other laryngeal symptoms Here,there will be sudden loss of voice and the patient will be whispering Treatment:psychotherapy
32
What is dysphonia plica ventricularis?
Voice is produced as a result of adduction of false vocal cords /vestibular folds / ventricular folds even before the true vocal cords can adduct Cause is because of nerve palsies or functional Treatment : speech therapy
33
What is pubertophonia / mutational falsetto ?
Abnormal increase in the tension of the vocal cords producing a persistence high pitch female voice in pubertal males (introverts usually) Normally the vocal cords will grow longer , more than the anteroposterior diameter of the larynx making the vocal cord lax producing a low pitch voice
34
Puberophonia is confirmed by what test ?
GUTZMANN PRESSURE TEST - when the larynx is pushed posteriorly and downwards the voice will become low pitched
35
Management for puberophonia
Type -3 thyroplasty Here the vocal cord will be made lax / shortening of vocal cords are done by compressing the larynx anteroposteriorly
36
What is phonesthenia?
Voice fatigue is produced as a result of weakness of muscle of the vocal cords as a result of vocal abuse under stressful conditions
37
Types of phonesthenia
Depends upon the muscles involved PHONATORY / ELLIPTICAL GAP = due to weakness of thyroarytenoid muscles TRIANGULAR GAP = due to weakness of inter arytenoid muscle ; seen posteriorly KEY HOLE GAP = due to weakness of both inter arytenoid and thyroarytenoid muscles
38
Management of phonesthenia
Speech therapy and voice rest
39
What is spasmodic dysphonia?
Neurological conditions resembling muscle tension dysphonia (functional dysphonia) differentiated from MTD by the history of voice fatigue present only during speaking and not during laughing , singing , respiration while in MTD voice fatigue is present all the times
40
Types of spasmodic dysphonia
ADDUCTOR DYSPHONIA (most common )- spasm during adduction creaky / scratchy /strangulated / croaky voice will be produced since the vocal cords will not be vibrating effectively ABDUCTOR DYSPHONIA - spasm during abduction ; voice will be breathy MIXED DYSPHONIA
41
Management of spasmodic dysphonia
ADDUCTOR = Botox given in thyroarytenoid muscle ABDUCTOR = Botox given In posterior cricoarytenoid muscle If the patient doesn’t respond to toxin then treat with thyroplasty type 1

Ent - Larynx (7 decks)

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