FVD: Lab Seven

List all the visual findings and characteristics of Vocal Nodules

Acute: Soft, edematous, moveable "pinpoint" bump

Chronic: Firm, callus-like structure

Reactive Nodular Change: Contralateral response, may become larger and more discrete

• Located at the anterior 2/3 (midmembranous portion)

• Almost always bilateral

• Benign

• Increased mass and stiffness

• Decreased vibratory amplitude and mucosal wave

• Ventricular fold compression may be present

• Mucosal wave may be absent if fibrous or present if edematous

List all the symptom characteristics of Vocal Nodules

• Raspy

• Hoarse

• Breathy

• Easily fatigued voice

• Loss of vocal range

• Loss of vocal endurance

• Reduced vocal loudness

List all the management characteristics of Vocal Nodules

• Vocal rest

• Vocal hygiene

• Voice therapy (Primary treatment)

• Phonosurgery (Rare, last resort)

List all the visual findings and characteristics of Vocal Polyp

• Fluid-filled lesion

• Has its own blood supply

• Typically unilateral

• Sessile (broad base)

• Pedunculated (on a stalk)

• May be hemorrhagic

• Located in superficial layer of lamina propria

• Hourglass glottic closure pattern

• Reduced vibratory amplitude and mucosal wave

• May be large and obstruct the glottis; may affect phase symmetry

• "Ballooning" appearance due to fluid accumulation

• Increased mass may contribute to heavier vocal fold appearance

List all the symptoms characteristics of Vocal Polyp

• Mild to severe dysphonia

• Hoarseness

• Roughness

• Breathiness

• Globus sensation

• Effortful phonation

• Loss of vocal endurance

• Possible breathing difficulty if large

• May be associated with a perceptually lower pitch due to increased mass

List all the management characteristics of Vocal Polyp

• Behavioral voice therapy

• Vocal hygiene

• Medical management; Phonosurgery (common for larger lesions)

List all the visual findings and characteristics of Reinke's Space Edema

• Buildup of fluid in superficial layer

• Entire membranous portion may become fluid-filled

• Usually bilateral

• Increased mass with swollen, translucent appearance

• Reduced vibratory amplitude

• Glottic closure usually complete

• "Water balloon" appearance

List all the symptom characteristics of Reinke's Space Edema

• Lowered pitch;

• Hoarseness

• Increased vocal fold mass

• Dyspnea in severe cases

• Possible sleep apnea

List all the management characteristics of Reinke's Space Edema

• Eliminate irritants (especially smoking)

• Vocal hygiene

• Phonosurgery

• High recurrence if smoking continues

List all the visual findings and characteristics of Cyst

• Benign mucus-filled lesion

• Intracordal

• Located in superficial layer of lamina propria

• Often mid-membranous

• Increased stiffness

• Reduced mucosal wave

• May disrupt normal vibration

• Well-encapsulated lesion

• Mucosal wave is often reduced or absent over the cyst

List all the symptom characteristics of Cyst

• Hoarseness (mild to severe)

• Breathy voice

• Globus sensation

• Throat clearing

• Cough

• Symptoms vary depending on size and stiffness

List all the management characteristics of Cyst

• Vocal hygiene;

• Voice rest (to reduce surrounding edema)

• Phonosurgical removal (most common)

List all the visual findings and characteristics of Candida/Fungal Infections

• Fungal (yeast) infection of the larynx

• May resemble leukoplakia (white patches)

• Edema and erythema present

• Vocal fold edges may appear irregular

• Reduced mucosal wave

• Incomplete glottic closure

List all the symptom characteristics of Candida/Fungal Infections

• Hoarseness

• Breathy voice

• Pressed voice quality

• Possible pain or discomfort

List all the management characteristics of Candida/Fungal Infections

• Antifungal medication (e.g., fluconazole)

• Eliminate contributing factors (e.g., inhaler residue, illness)

• Rinse mouth after inhaler use

• Improve vocal hygiene

• Voice therapy typically not required

List all the visual findings andcharacteristics of Laryngitis

• Inflammation of the vocal fold mucosa

• Vocal folds appear erythematous (red instead of pearly white)

• Generalized edema

• Reduced or absent mucosal wave

• Slight reduction in vibratory amplitude

List all the symptom characteristics of Laryngitis

List all the management characteristics of Laryngitis

• Hoarseness

• Sore throat

• Cough

• Possible fever

• Voice may worsen with continued use

List all the visual findings and characteristics of Granuloma/Contact Ulcers

• Located on vocal processes (posterior larynx)

• Unilateral or bilateral

• Growth on arytenoid region

• May interfere with vocal fold closure

• Often begins as contact ulcer

• May be associated with increased supraglottic activity

• Often begins as a localized ulceration before developing into a granuloma

List all the symptom characteristics of Granuloma/Contact Ulcers

• Globus sensation

• Chronic throat clearing

• Cough

• Pain or discomfort

• Hoarseness

• Breathiness

• Reduced pitch range

• Difficulty increasing loudness

• May have minimal voice change if small

List all the management characteristics of Granuloma/Contact Ulcers

• Treat underlying cause (reflux, trauma, phonotrauma)

• Diet modification and medication for reflux

• Voice therapy

• Patient education

• Surgery for large or persistent lesions

List all the visual findings and characteristics of Sulcus Vocalis

• Groove or furrow along vocal fold

• Loss/thinning of superficial layer

• Reduced or absent mucosal wave

• Spindle-shaped glottic gap

• Does not vibrate normally

List all the symptom characteristics of Sulcus Vocalis

• Weak voice

• Breathy

• Hoarse

• Vocal fatigue

• Increased effort

List all the management characteristics of Sulcus Vocalis

• Surgical intervention

• Tissue augmentation (fat, fascia, collagen)

List all the visual findings and characteristics of Laryngeal Papilloma

Juvenile: Multiple and widespread

Adult: More localized

• "Wart-like" or "raspberry-like" lesions

• Can occur throughout airway

• Interferes with vocal fold closure

• Increased stiffness

• Reduced vibratory amplitude

• Clustered grape-like growth patterns may be observed

List all the symptom characteristics of Laryngeal Papilloma

• Rough voice

• Breathiness

• Vibratory asymmetry

• Dyspnea and inspiratory stridor

• Chronic cough

• Weak cry

• Periods of aphonia

List all the management characteristics of Laryngeal Papilloma

• Surgical intervention is always required due to high recurrence rates

• Primary treatment is airway management followed by voice outcomes

• Repeated surgical removal

• Antiviral medications

List all the visual findings and characteristics of Presbyphonia/Presbylarynx

• Thinning (atrophy) of vocal folds

• Bowing of folds

• Increased glottal gap

• Reduced vibratory amplitude

• Reduced speed of closure

List all the symptom characteristics of Presbyphonia/Presbylarynx

• Softer voice

• Altered pitch

• Roughness

• Reduced loudness

• Vocal fatigue

List all the management characteristics of Presbyphonia/Presbylarynx

• Voice therapy

• Medialization procedures

• Injectables

• Utilization of voice

List all the visual findings and characteristics of Cancer

• Irregular mass, plaque, or lesion

• Abnormal tissue growth

• Increased stiffness

• Reduced vibratory function

• May appear as irregular, heterogeneous tissue with plaque-like or mass-like characteristics

• "Cottage cheese" appearance

List all the symptom characteristics of Cancer

• Hoarseness

• Lower pitch

• Vocal strain

• Persistent cough

• Stridor

• Sore throat

• Possible breathing difficulty

List all the management characteristics of Cancer

• Surgery

• Radiation

• Chemotherapy

• Ongoing monitoring and follow up

List types of occupational-related voice disorders and why:

• Teachers: High vocal demand and prolonged speaking leads to phonotrauma

• Singers/Performers: Frequent voice use at high intensity and pitch causing strain

• Coaches: Yelling and loud voice impact vocal fold stress

• HM: Factory workers, Preachers, telemarketers, Tv and radio show broadcasters, Aerobic/fitness instructors, air traffic controllers/pilots, lawyers, military personnel, ministers, sales personnel, and stage performers

List the types of vocal pathologies:

• Structural; neurogenic

• Systemic disease

• Phonotraumatic

• Idiopathic

List all examples of structural vocal pathology:

• Vocal fold nodules

• Vocal fold polyps

• Vocal fold cysts

Vocal fold nodules

One of the most common benign vocal fold pathologies resulting from phonotraumatic behaviors

List the types of nodules:

• Acute

• Chronic

• Reactive nodular change

Bilateral

Nodules are unilateral or bilateral

Sessile: flat/base attached. Pedunculated: on a narrow stalk

The difference between sessile polyps and pedunculated polyps

Polypoid degeneration (Reinke's Edema)

Extreme form of edema when the entire membranous portion of the vocal folds becomes filled with fluid

Rest and hydration

Laryngitis often resolves with

List the causes of contact ulcers and granuloma

• Laryngopharyngeal reflux irritation

• Intubation trauma

• Phonotrauma

List factors that contribute to acid reflux:

• Fatty foods

• Chocolate

• Caffeine

• HM: Alcohol, cigarette smoking, obesity, pregnancy, and delayed stomach emptying

Intubation

Placement of a breathing tube to aid in ventilation is called

It interferes with vocal fold closure

A granuloma causes a hoarse breathy voice quality when

Intracordal

Cysts typically are _____, occurring underneath the mucosa of the vocal fold, located in the superficial layer of the lamina propria

Candidiasis

A fungal infection caused by yeast (candida) that occurs as a consequence of weakness within the immune system

Human papilloma virus (HPV)

Laryngeal papilloma is caused by the

Care for airway obstruction and ensure that ventilatory support is adequate

The first goal of intervention for treating papilloma

Laryngeal trauma; often from intubation

Acquired laryngeal webs can occur due to

List the symptoms associated with laryngeal webs

• Dyspnea

• Inspiratory stridor

The superficial layer of the lamina propria

The layer of the lamina propria sulcus vocalis affects

Leukoplakia

A white plaque-like formation occurring on the vocal fold surface; usually found at the anterior portion but may extend into the interarytenoid area; considered a precancerous state

Dysplasia

Pathologic tissue change in the mucosa; often indicative of early cancerous process

Subglottic stenosis

Narrowing of the tissue below the level of the glottis; etiology is congenital or acquired

Laryngomalacia

The common cause of inspiratory stridor in infancy

Laryngectomy

Complete removal of the larynx (Vocal folds are part of the larynx and are removed)