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most common laryngeal pathologies for young adults vs middle age vs older adults
young adults:
male: edema
female: edema, polyps, nodules
middle age:
male: polyps
female: edema, polyps, nodules
older adults:
male: VF paralysis
female: VF paralysis
chronic dysphonia is more common in …
women
Those w/ reflux or frequent URI
voice disorders have a higher prevalence with who?
Occupations with heavy vocal demands
structural pathologies of TVF are identified via:
Visual examination
History of voice use
Disorder onset/course/remission
Audioperceputal quality of voice
audioperceputal quality of voice is identified by changes in…
mucosal layers / T VF muscle body impact mass, size, stiffness, flexibility and tension, glottal closure
audioperceputal quality of voice varies with
Lesion severity
Habitual voice usage
Compensatory strategies- both productive or maladaptive
Malignant Epithelial Dysplasia – AKA
laryngeal cancer
Malignant Epithelial Dysplasia common symptoms
Hoarseness
Difficulty breathing
Laryngeal pain
Referred ear pain
Dysphagia
Malignant Epithelial Dysplasia typical cause
Chronic irritation to laryngeal epithelium/mucosa
Malignant Epithelial Dysplasia treatment options
Radiation
Surgical excision
Chemotherapy
Malignant Epithelial Dysplasia SLP role
Education
Laryngeal or alaryngeal voice rehabilitation
TVF nodules- AKA
Midmembranous Phonotraumatic Lesions
midmembranous phonotraumatic lesions
Most common of benign lesions
Bilateral and symmetric
Medial edge near junction of anterior ⅓ posterior ⅔
Midmembranous Phonotraumatic Lesions typical cause
Inappropriate vocal techniques, talkative, socially aggressive or Tense
Midmembranous Phonotraumatic Lesions population
Most common in children and adult females
Midmembranous Phonotraumatic Lesions symptoms
Roughness, breathiness and strain
Midmembranous Phonotraumatic Lesions treatment
Voice Therapy
Surgical excision + postsurgical Voice Tx
polyps
Fluid filled
Develops in superficial layer, usually mid ⅓ cord
Sessile vs. pedunculated
Usually w/ active blood supply
TVF polyps typical causes
Voice misuse, acute vocal trauma
TVF polyps population
Most common in adults
TVF polyps symptoms
Varies- based on location, type and impact on glottic closure
TVF polyps treatment
Strict voice rest
Surgery
Surgery + voice rehab.
cysts
Fluid filled, sessile
Typically embedded in superficial layer of LP, sometimes extend to intermediate and deep layers
Sometimes associated w/ reactive lesion on contralateral cord
vocal folds cysts typical causes
Congenital or acquired w/o clear etiology
vocal folds cysts symptoms
Varies- based on location, size
vocal folds cysts treatment
surgery
NOT responsive to voice therapy
reinke’s edema AKA
polypoid degeneration
Superficial layer of LP becomes filled w/ fluid
Fluid filled bags / balloons
reinke’s edema
reinke’s edema typical causes
Chronic vocal abuse and smoking
reinke’s edema symptoms
Lower pitch, husky voice 2’ increased stiffness/mass
Reduced amplitude and mucosal wave during vibration
reinke’s edema treatment
Surgery
Post-op voice rehab
Permanent tissue changes to lamina propria
vocal fold scarring
vocal fold scarring typical causes
Chronic vocal abuse, lesion, post-surgery
vocal folds scarring symptoms
Increased stiffness and reduced mucosal wave
Roughness, strain, reduced vocal range, loudness and endurance
vocal fold scarring treatment
Voice therapy for compensation
Phonosurgical tx
Special TVF scar- furrow along the superficial layer of LP - causes concave appearance
sulcus vocalis
vascular, exophytic and inflammatory lesion
granuloma
ulcerated lesion
Contact ulcer
vocal fold granuloma/contact ulcer typical causes
Intubation
LPR (laryngopharyngeal reflux)
Persistent voice misuse (pressed, low pitch)
vocal fold granuloma/contact ulcer symptoms
Can be painful, sore throat or ear pain
Doesn’t typically impact voice
vocal fold granuloma/contact ulcer treatment
Medical
Surgical
Voice Therapy
leukoplakia
white plaque
1. Benign or malignant
2. Bilateral or unilateral
keratosis, leukoplakia, erthroplasia typical causes
Chemical irritants (alcohol. tobacco)
Hyperfunctional voice
keratosis, leukoplakia, erthroplasia symptoms
Increase mass /stiffness of VF cover
keratosis, leukoplakia, erthroplasia treatment
Surgery / biopsy
Voice Therapy
abnormal mucosal change
epithelial hyperplasia