Common Voice Disorders Final - Handout.ppt

Clinical AnatomyCommon Voice Disorders SupraglotticL. Arick Forrest, MD, MBAMedical DirectorThe OSU Voice and Swallowing Disorders ClinicThe Ohio State University Wexner Medical CenterHoarseness Changes to the quality of the voice isdysphonia– Usually a vocal cord problem Changes in the ability to articulate isconsidered dysarthria– Central process or difficulty with tonguemotion Memory impairment inhibiting voiceproduction is aphasia Glottic SubglotticNormal Voice Production Airflow produces a wave across thesurface of the true folds TheTh frequencyfoff vibrationib ti isi theth pitchit h The volume is dependent on thesubglottic pressure1

Sessile Polyp Medial edge swelling Treat with voice rest and therapy Surgery if no improvementPolyps Acquired lesion due to trauma/injury Several types based on: Shape– Sessile– Pedunculated Color/content– Hemorrhagic– Angiomatous– HyalinePedunculated Polyp Less responsive to therapy and rest2

Polyp Surgery Conventional– General anesthesia – knife or laser Fiberoptic– Awake with local anesthesia – laserVocal Misuse/Trauma Causes injury at the junction of the anteriorand middle third of the true fold Produces a hemorrhagic lesionNodules Due to repeated voice misuse Bilateral and symmetric Primary treatment is therapyCyst Similar to a polyp Do not respond to therapy Need to remove to improve the voice3

Cancer More common in smokers Reflux may be a factor Anyone with hoarseness over 2 weeksneeds a laryngeal examVocal cord paralysis Etiologies– Iatrogenic (60%)– Idiopathic (20%)– Neoplastic (10%)– Traumatic (5%)– Infectious (5%) Testing– Imaging course ofvagus nerveCancer Warning signs– Progressive dysphonia (can be mild)– Otalgia with normal exam– Do not need: throat ppain or swallowinggcomplaintsParalysis/Paresis Treatment optionsTherapyInjection laryngoplastyMedialization laryngoplasty4

Neurologic Disorders Spasmodic dysphonia Essential tremor Treatment BotoxPapilloma HPV (type 6 and 11) Primary treatment is surgical Cancer riskCandidiasis Common with steroid inhalers– 25% of inhaler users develop hoarseness Following oral steroids or antibiotic use Can have without oral involvementConclusion Any patient with voice changes over 2weeks should have a laryngeal exam Acquired voice disorders (polyps andnodules) need therapy as part of treatment Multiple therapeutic options available andmost voice disorders can be treated withgood results More procedures are performed withoutgeneral anesthesia5

Assessment of the LarynxCommon Voice DisordersB d deSilva,Bradd SilMDJamesCare Voice and Swallowing Disorders ClinicDepartment of Otolaryngology - Head & Neck SurgeryResidency Program DirectorThe Ohio State University Wexner Medical CenterCommon Voice Pathologies Listen Indirect mirror laryngoscopy Flexible/rigid laryngoscopy Direct microlaryngoscopyVideolaryngostroboscopy Vocal fold lesions:– Polyps, nodules, cysts Vocal fold neoplasms:– Papilloma, leukoplakia, carcinoma Inflammatory conditions:– Laryngopharyngeal reflux, sicca, granuloma,edema Neurogenic conditions:– Vocal fold paralysis/paresis, presbylarynx6

High Speed VideolaryngoscopyLaryngopharyngeal Reflux Different clinical entity fromGastroesophageal Reflux Symptoms of globusglobus, throat painpain, throatclearing, dry cough, sticky pharyngealmucous, dysphonia, dysphagia,postnasal drainage Heartburn and indigestion present in 40%Diagnosis of LPRInflammatory Conditions of theLarynx Laryngopharyngeal reflux Vocal fold granuloma Polypoid corditis (Reinke’s edema) HistoryLaryngoscopyEGD/Transnasal awake esophagoscopyBarium esophagrampH probe/impedence testing Laryngeal sicca7

LPR Findings onLaryngoscopyLaryngopharyngeal Reflux Vocal fold edema/erythemaPseudosulcusPostcricoid edemaInterarytenoid mucosal thickening(pachydermia) Dry mucous in piriform sinuses/larynxTreatment of LPRLaryngopharyngeal Reflux H2 blockersProton Pump InhibitorsMucosal protectants: CarafateAvoidance of late night mealsDaily hydrationDietary modificationSurgical interventions8

Vocal Fold GranulomaVocal Fold Granuloma Etiologies:– Intubation, Laryngopharyngeal reflux,throat clearing and cough Exam findings:– Fleshy mass at vocal process Symptoms:– Dysphonia, globus, throat pain, dyspneaVocal Fold GranulomaVocal Fold Granuloma Treatment:– Proton Pump Inhibitor– Cough suppressant– Vocal rest– Surgery: Laryngoscopy with excision Awake LASER treatment Steroid injection9

Polypoid CorditisPolypoid Corditis Edema of superficial lamina propria– Reinke’s edema Causes:– Tobacco abuse– Inhaled medication effects– Inhalant injury– Metabolic disorders: Hypothyroidism– Untreated Obstructive Sleep ApneaPolypoid CorditisPolypoid Corditis10

Polypoid CorditisLaryngeal SiccaLaryngeal SiccaLaryngeal Sicca Etiology– Tobacco abuse, Medication DryingSide Effects, Inhaled Steroid use,Dehydration,y, Autoimmune Laryngeal Findings– Thick/sticky secretions, laryngealcrusting, fungal overgrowth, vocal foldedema/erythema Treatment:– Improving hydration– Tobacco cessation– Minimizing medication use– Sialogogues: Evoxac or Salagen– Diflucan– Laryngeal debridement and culture11

Paradoxical Vocal FoldDysfunctionParadoxical Vocal FoldDysfunction Primarily a breathing disorder– Vocal fold adduction during respiration– Dyspnea at rest, exertion, exposure tochemicals/perfumes Other symptoms– Cough, dysphonia, globus, throat pain– Stridor/wheezing– Laryngeal tightness Treatment:– Rule out other respiratory disorders– Treat concurrent laryngeal irritants: Allergy,Allergy refluxreflux, postnasal drainagedrainage, sicca– Laryngeal control therapy– Manage concurrent psychosocialstressors– Avoidance of triggers– Biofeedback exercisesParadoxical Vocal FoldDysfunctionParadoxical Vocal FoldDysfunction12

Paradoxical Vocal Fold Dysfunction Primarily a breathing disorder – Vocal fold adduction during respiration – Dyspnea at rest, exertion, exposure to chemicals/perfumes Other symptoms – Cough, dysphonia, globus, throat pain – Stridor/wheezing – Laryngeal tightness Paradoxical Vocal Fold Dysfunction Paradoxical Vocal Fold .