2.4 Voice: structural management

when might solve on own?

size < 1/3 vc

when might heal with advice?

< 3 month since onset

when more likely to heal?

soft appearance

phonosurgery: primary treatment for…

benign vocal lesions

what is phonosurgery?

any surgery designed primarily for improvement or restoration of voice

SLT intervention pre-op

direct + indirect to manage underlying causative factors + address px expectations

SLT intervention post-op to… (2 direct, 1 indirect)

improve vibratory characteristics, treat compensatory muscle imbalance, voice care to aid wound healing

Botulinum Toxin Injection: for what conditions?

adductor spasmodic dysphonia, severe MTI

BTI: what is it? (2)

percutaneous injection using a laryngeal EMG to locate injection site, nerve blocker to reduce responsiveness

BTI: how?

needle position based on EMG signal when saying /i/

vc aug: what for?

treat incomplete vc closure (e.g. palsy, paresis, atrophy)

vc aug: premise

vc rebulked so come together for speaking

vc aug: types (2)

medialisation laryngoplasty (thyroplasty), injection laryngoplasty

vc aug: materials (4: inj/surg, short/long/perm)

hyaluronic acid (IT), calcium hydroxypatite (IL), silcone (SP), titanium implant with silicon balloon (SP)

vc aug: SLT role (5)

assess, triage, educate, SDM, pre- post- voice therapy

vc aug: not appropriate (4)

small gap, px preference, palliative px, no easy neck access

pharmacological: for reflux (3)

PPIs, alginates, behaviour

pharmacological: for inflammatory changes

steroids

pharmocological: antibiotics (2 who for, 1 not)

confirmed bacterial infection (e.g. streptococcus), some effect with cough, acute laryngitis usually viral

pharmacological: for allergies (2)

sinus rinse to aid nasal mucus clearing, meds e.g. nasal sprays, antihistamines

pharmacological: review meds…

with drying effects (e.g. mentholated) or cough effects (lisinopril)

pharmacological: SLT role

don’t prescribe, just be aware for onward referral

cancer: surgery (3)

laser, cordectomy, partial laryngectomy

cancer: laser surgery: what?

intense narrow light beam to remove/destroy cancer cells

cancer: laser surgery: effects

voice changes short or long term

cancer: cordectomy: what

surgical removal of all/part of vc

cancer: partial laryngectomy: what?

remove part of larynx

cancer: partial laryngectomy: SLT role

voice therapy to improve opening/closing of neoglottis

cancer: partial laryngectomy: how is voice then produced?

through vibration of remaining arytenoid with neoglottis

cancer: radiotherapy: when?

stand alone, or in addition to surgery

cancer: radiotherapy: voice changes (4)

long term, hoarse, dry, late fibrosis

cancer: radiotherapy: larynx changes (4)

oedema, increase mucus, fatigue, pain

cancer: chemotherapy: when, voice (2)

often with RT, voice often reduced

post-cancer: voice therapy effectiveness depends on (3)

extent of treatment, mucosal wave preservation, px motivation

post-cancer: if px unable to implement therapy…

may need to consider alternative ways e.g. amplifier

what for palsy?

injection laryngoplasty for medialisation (filler)