Voice Disorders Ch. 6

Front 1

organic diseases which affect phonation

Back 1

biological disease process. organic diseases are not caused by VF misuse or abuse. treatment primary medical (pharmological) or surgical.

Front 2

SLP role in organic diseases

Back 2

knowledge of how they affect the phonatory system, offer services as needed, pre-surgical treatment counseling, voice therapy along with subsequent medical interventions

Front 3

keratosis

Back 3

abnormal and excess growth of epithelial tissues on the VF (AKA leukoplakia, hyperkeratosis, keratosis with cellular atypia and dyskeratosis). two types of lesions on mucosal surface: leukoplakia: flat, white, plaque-like lesions and papillary keratosis: irregular wart like growth. kera is benign but may signify pre-Ca.

Front 4

etiology factors of keratosis

Back 4

smoking, environmental pollutants, GERD, occur more often in med, lesions uni or bi, lesions usually asym, rough/irregular glottal edge

Front 5

physiology of keratosis

Back 5

glottic chink if extensive, increases mass and stiffness of cover, fairly normal mucosal wave (look with strobe, if abnormal=Ca), hoarseness and roughness, lower F0.

Front 6

laryngeal granulomas

Back 6

slight injury to cover or process and ulcer occurs which leads to scarring or build up of granulation tissue. 2/2 duration, method, and followup care of intubation, patient's age, general health. women more prone 2/2 smaller larynges and thinner mucosal layer.

Front 7

physiology and characteristics of granulomas

Back 7

irregular shaped masses at either site of the vocal processes of the arytenoids, can appear elsewhere if not from intubation (trach site/stoma). primary affects vocal processes of arytenoids. voice is hoarse and breathy if glottic closure incomplete.

Front 8

vocal process granuloma: contact ulcer

Back 8

(aka contact ulcer, contact granuloma, arytenoid granuloma, vocal process granuloma) small ulceration on medial surface of vocal processes of arytenoid cartilages. cup and saucer appearance (continued irrirtation leads to ulceration on one side and granulation tissue on the other).

Front 9

etiology of contact ulcer

Back 9

2/2 GERD, sometimes pain involved. used to be prevalent in type A 50 y.o. males. hyperfunctional (anatomical and physiological variations of phonation), hyperacidic (GERD and throat clearing) and post nasal drip all contribute.

Front 10

voice characteristics of contact ulcer

Back 10

horaseness, some breathiness, low pitch, globus, stabbing pain radiating to ear, diathesis (strands of mucous btw 2 vocal processes), inflammation. tx=GERD mmt, voice tx

Front 11

pachydermia laryngis

Back 11

rare w/unknown cause (smoking and GERD?). physiology: thickening of the epithelium w. cellular overgrowth, white mass of tissue in the interarytenoid space. tx: smoke/alc cessation, GERD, surgical removal. voice is hoarse.

Front 12

papilloma

Back 12

etiology: virus? occurs in kids and adults. resistant to eradication, multiple cold knife surgeries (laser=airborne=contagious), may obstruct airway. can occur in various parts of the larynx including glottus and may require trach.

Front 13

papilloma phys/tx/voice

Back 13

whitish cluster of tissue, rasp or frog-egg like. increases mass and stiffness of cover. treatment is surgery , drugs, phototherapy, voice therapy to achieve best voice. voice is hoarse and breathy.

Front 14

ankylosis of the cricoarytenoid joint

Back 14

fixation of the joint, hard to distinguish from paralysis (ACJ has pain on phonation and pyriform sinuses open). may have to manipulate the joint under direct laryngoscopy. 2/2 arthritis (will see edema and redness at joint), trauma, joint disease (degenerative joint disease DJD). tx is surgery, voice therapy not helpful.

Front 15

vascular disorders: hemorrhage

Back 15

usually uni but can be bi. can involve whole length of VF or part. usually in adult women, c/o pain at x of event (single abusive event). physiology: collection of blood beneath cover of VF w/edema and redness. prominent blood vessel, if ruptures bleeds into submucosal layer. voice is hoarse, intermittently aphonic, reduced pitch range.

Front 16

vascular disorders: varix

Back 16

varix- distended blood vessel on the surface of the VF (may be on sup surface or free edge, may be seen after resorption of hemorrhage with hemorrhagic polyp). 2/2 vocal abuse or single trauma.

Front 17

vascular disorders: ectasia

Back 17

dilation of a small vessel. may affect vibration. voice is hoarse, area involved with blood vessel will have altered vibratory characteristics.

Front 18

vascular disorders: laryngeal web

Back 18

often congenital, sheet of tissue btw the VF. in peds weak cry, stridor, difficulty breathing. adults have hoarseness, high pitch and SOB. careful surgery because can recur. voice therapy for best voice

Front 19

blunt or penetrating trauma

Back 19

attempted strangulation, penetrating neck wound, blow to neck, body thrown by force. med/surgical mmt. voice restoration after: best voice, ask for info about altered anatomy, know constraint of phon system after repair.

Front 20

inhalation and thermal trauma

Back 20

very little info in lit about long term effects. usually termed chem tracheobronchitis (excludes laryngeal and supraglottal damage even tho these are more severe). hot fumes-->reflexive glottal closure and cooling action of upper resp tract-->protection of trachea and lower tract. edema can obstruct airway (intubation/trach).

Front 21

inhalation physiology

Back 21

edema, inflammation, burns, soot around nose/mouth etc, resp stridor and distress, wheezing, hypoxia and brian damage. voice is hoarse, breathy, aphonic. voice tx only after recovery from injuries unless vocal hygiene.

Front 22

carcinoma and other tumors

Back 22

voice is hoarse (7 signs of cancer), but if Ca doesn't affect phon, voice may be the same. 2/2 smoking, environmental pollutants, chemicals, ETOH, ETOH+smoking, cigar, pipe smoke, snuff--> oral ca.

Front 23

Ca terminology and staging

Back 23

T=site of primary tumor, N=lymph node involvement, M=spread to other body parts. rated 1-5, lower numbers=less involvement. situ=confined to epithelium not invading connective tissue.

Front 24

Ca signs and symptoms

Back 24

lump in neck, broadening of larynx to palpation, tenderness in neck, dysphagia, odynophagia (pain with swallowing), dyspnea (labored breathing), unexplained wt loss

Front 25

physiological signs of Ca

Back 25

small well defined tumor better than tumor not well differentiated. large diffuse tumor-worse prognosis. can be on any laryngeal or oral structure. well defined on stroboscopy because small embedded lesion will still disrupt the mucosal wave. squamous cell carcinoma of epithelium can become more invasive.

Front 26

treatment of Ca

Back 26

surgery (laryngectomy, supraglottic laryngectomy, hemilaryngectomy, near total laryngectomy, glossectomy jaw removal), radiation and chemo. any combo of the 3. SLP: pre and post surgical consult, alternate means of communication (trach, TEP, electrolarynx), skin care, ROM of tongue, neck and jaw, swallow.