Voice and Resonance Etiologies

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Reinke’s Edema Patient complaints

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1

Reinke’s Edema Patient complaints

  • vocal fatigue

  • hoarseness

  • gravelly voice

  • difficulty breathing

  • lower voice (masculinized)

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2

Reinke’s Edema Perceptual symptoms

  • Severe/persistent deteriorating changes in vocal quality

  • Pitch lowers

  • alternates back and forth Dysphonia = hoarse Aphonia = must whisper

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3

Dysphonia

hoarse

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4

Aphonia

must whisper

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5

Reinke’s Edema Etiology Behavioral

  • smoking

  • alcohol use

  • phonotrauma

    • yelling

    • excessive talking

    • coughing

    • throat clearing

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6

Reinke’s Edema Etiology Medical

  • Hypothyroidism

  • Laryngopharyngeal Reflux LPR

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7

Phonotrauma

  • yelling

  • excessive talking

  • coughing

  • throat clearing

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8

Voice Therapy (behavioral) for medical conditions

Identify, modify, remove sources of vocal abuse/misuse and phonotrauma

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9

Vocal Polyp - Voice Therapy

  • Identify, Modify, eliminate phonotruama

  • vocal rest

    • relative

    • none whatsoever

  • Vocal hygiene

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10

Polyp treatment

May disappear on it’s own

Voice Therapy

Medicine: Low does Oral steroids

Surgical removal if: lesion is very big, lesion has not responded to voice therapy treatment.(Microlaryngoscopy w/surgical excision)

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11

Reinke’s treatment

Voice therapy: identify/modify/remove sources of vocal abuse

Medication: anti reflux

Surgery: Often Unilateral, and vocal folds adjust/balance out

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12

Vocal Polyp -patient reported symptoms

pain when shouting

neck pain

lump in throat (globus)

vocal fatigue

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13

Vocal Polyp - perceptual symptoms

Diplophonia = 2 distinct frequencies

Sudden phonation breaks

Hoarse

Breathy

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14

Diplophonia

voice produces two distinct pitches/frequencies

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15

Why do phonation breaks happen with pedunculates?

it flops in and out of trachea and vocal folds while person is phonating

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16

vocal polyp - Laryngoscopic findings

typically unilateral

fluid/blood filled

found at junction of anterior middle 1/3 of vocal fold margin

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17

What is a vocal polyp?

benign extension of the epithelium on the free margin of the vocal fold; typically unilateral

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18

Nodules - Voice therapy

Program of good vocal hygiene

Behavioral: Identify, modify, eliminate vocal abuse/misuse

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19

What is Reinke’s Edema?

Laryngeal condition caused by vocal fold edema in Reinke’s space (2nd layer under epithelium)

elephant ear configuration

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20

LPR -Medication Management

Medication:

  • Antacids (tums)

  • H2 Blockers (zantac)

  • Protein pump inhibitor (Prilosec)

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21

LPR Mediosurgical Management

Testing: 24 hour Ph monitor

Surgery: fundoplication - tightens LES

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22

Vocal NoduleS-Laryngoscopic Findings

ALWAYS bilateral

Location: juncture of anterior 1/3, posterior 2/3 margins of vocal folds

Acute Stage: soft. reddish vascular

Chronic Stage: hard, white, thickened fibrotic (little edema surrounding nodules)

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23

Vocal Nodules -Treatment

Voice Therapy only: behavioral changes needed

  • identify, modify, remove voice abuse/misuse

Mediosurgical management is contraindicated

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24

Vocal Nodules-Mediosurgical treamtent

Contraindicated for Vocal Nodules, behavioral only

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25

Etiology DRIVES

Treatment

Whatever caused it will suggest how to treat

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26

Vocal Nodules - Perceptual symptoms

Relatively low pitch

Hoarseness (breathiness, harshness)

Scratchy voice

Tightness in Voice

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27

Vocal Nodules - patient reported symptoms

Vocal fatigue

takes effort to speak

tension in throat

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28

Vocal Nodules - etiology

  1. phonotrauma (vocal abuse - excess pitch, singing/speaking, throat clearing, coughing)

  2. Smoking, speaking in smokey environment

  3. alcohol abuse

  4. hard glottal attacks

  5. phonation against resistance (exercise grunt)

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29

Vocal Nodules - 4 facts

  1. One of the most common voice disorders

  2. Public sees “calluses”

  3. Location helps diagnosis

  4. results from vocal abuse/misuse

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30

Vocal Nodules - why is pitch lower

vocal folds are heavier, have more mass, therefore vibrate slower

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31

LPR - Laryngoscopic findings

  1. Ulcers

  2. Erythema (reddening) of the aretnoids

  3. thick, excessive mucus

  4. Edema

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32

LPR - voice therapy behavioral management

  1. identify/modify/eliminate GERD contributors

  2. Avoid foods that relax LES (caffeine, sugar)

  3. lose weight

  4. wear loose fitting clothing

  5. elevate head during sleep

  6. eat 3-4 hours BEFORE lying down

  7. stay hydrated

  8. use air humidifer

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33

Vocal Hygiene

stay hydrated

Use air humidifier

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34

GERD & LPR share these symtpoms

Dysphagia - trouble swallowing

Odynophagia - pain when swallowing

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35

LPR - symptoms

  1. Dysphonia (hoarse)

  2. Excessive mucus

  3. chronic coughing/throat clearing

  4. globus (lump in throat feeling)

  5. breathing difficulties

  6. vocal fatigue

  7. ulcers

Not directly associated with heartburn

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36

LPR/GERD causes

  1. Hiatal Hernia

  2. Obesity/pregnancy

  3. smoking/alcohol (LES relaxes)

  4. Diet high in: caffeine, chocolate, alcohol, citrus fruits (relaxes sphincters)

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37

LPR - etiology

LES relaxes

stomach acid, bile, pepsin escapes

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38

LPR - what is it?

Backflow of gastric fluid through the esophagus into larynx or pharynx (throat)

“Silent reflux” - UES is dysfunctional

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39

GERD - what is it?

Gastroesophogeal Reflux disease - backflow of GASTRIC fluid from stomach into the esophagus (through LES)

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40

Reinke’s - Laryngoscopic findings of vocal folds

  1. floppy

  2. grayish pink or red

  3. fluid filled

  4. enlarged/swollen

  5. elephant ear

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41

Reinke’s - why trouble breathing?

obstruction of airway

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42

Vocal Polyp - etiology

Phonotrauma: shouting, loud talking, throat clearing

Secondary reactions: allergies, thyroid imbalance, upper resp infection, excessive alcohol use, excessive cigarette smoking

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43

Vocal Polyp - types & description

Sessil - broad base attachment of fluid filled pocket

Pedunculated - blood filled, looks like a stalk of broccoli

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44

During these timeframes one should not speak in abusive manners

Allergy episode

URI - Upper respiratory infection

Menstrual cycle (vocal folds bloated)

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45

Medicine risk factors

aspirin - can cause vocal fold hemorrhage

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46
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