Voice Resonance Week 4: Organic Voice Disorders

What is an organic voice disorder? 

When there is a structural problem 

Vocal Nodules

Bilateral, benign, symmetrical VF masses that form over time and typically respond to voice therapy 

Where do nodules occur?

Anterior 2/3 of the VF

What do nodules cause?

Hoarse voice, reduced pitch, reduced loudness

Acute Nodules

Gelatinous in appearance; arises from traumatic or hyper-functional voice use 

Chronic Nodules

Form over time; more callous-like in appearance

Vocal Polyps 

Unilateral, benign VF masses; can be bilateral (asymmetrical if so)

Qualities of Vocal Polyps

-Have a blood supply

-Can occur anywhere on the VF

-Can occur after just one phono-traumatic event 

-Surgically removed 

Sessile Vocal Polyp

No stem and on the surface of the VF

Pedunculated Vocal Polyp

Attached to a stem and not directly attached to the surface of the VF

Impacts on Voice Quality for Nodules and Polyps

1. Vital capacity not impacted 

2. MAFR is higher (adduction is impacted) 

3. Variation in SPL is lower (loudness control is limited) 

4. Voice Efficiency is lower (low sub-glottal pressure) 

How do you make a differential diagnosis between nodules and polyps? 

Can not be made just by listening to the voice because they present in the same way perceptually; must look at the VF (Is it bilateral or unilateral? Is it on the anterior 2/3 of the VF or somewhere else?

Laryngitis

Inflammation of the larynx because of infection; variable vocal symptoms; resolves spontaneously

Reinke’s Edema

Swollen Reinke’s space; thick, gelatinous material that accumulates in the superficial layer of the lamina propria (Reinke’s Space)

Laryngeal Cyst (fluid-filled)

Mass made up of a collection of material, usually mucus, that is surrounded by a membrane. 

Where can a laryngeal cyst occur?

Anywhere on the VF; found underneath the mucosa within the superficial lamina propria (deeper origins)

What does a laryngeal cyst do to the voice?

Perceptually, the voice sounds similar to what it sounds like with nodules and polyps. 

Laryngeal Cele

Can occur anywhere on VF and impacts all the same voice qualities as a laryngeal cyst, but it is air-filled. 

Similarities between a laryngeal cyst and cele

Both phono-trauma-related and neither respond to voice therapy (have to be surgically removed)

Intubation Granuloma

Growths due to intubation tubes in the vocal process; tube damages the VF while inside, impacting voice quality 

Contact Ulcer

Reflux-related, bilateral lesions in the posterior parts of the VF (closer to the esophagus)

What is a contact ulcer related to?

Laryngeal Pharyngeal Reflux (acid spills over the esophagus and enters the trachea)

How does the contact ulcer impact voice?

Voice is not usually impacted because the ulcer is not typically on the vibrating portion of the VF

Candida

White, peppered spots throughout the VF; edema and stiff/irregular VF; Causes a weakened immune system and minimal to moderate voice changes

Papilloma

Viral infections leading to a mass in the supraglottal, glottal, and subglottal regions (unilateral or bilateral)

What is a papilloma related to? What can it cause?

Relates to HPV 6 and 11; they are precancerous and can cause voice problems (must be surgically removed)

Leukoplakia

Pre-cancerous lesions due to several factors (alcohol, smoking)

Laryngeal Web 

Webbing of the glottal region due to irritation of the mucosal surfaces

Primary symptoms of a laryngeal web

Respiratory difficulties, shortness of breath, quality of voice impacted (because mucosal wave is messed up)

Sulcus Vocalis

Bilateral, symmetrical groove in the VF that could penetrate deep into the vocal ligament

What does a sulcus vocalis impact?

Quality (cepstral measure) would be off because the mucosal wave is messed up; needs to be surgically fixed

Varix 

Superficial, prominent vein that is enlarged and dilated 

Ecstasia

Fused lesioning of the blood vessel; takes up more space on the VF than a varix

Varix and Ecstasia

-Superficial layer of the lamina propria

-Blood-filled lesions

-Would impact all the same things that nodules impact

Sub-Glottal Stenosis (Congenital)

Malformed (smaller) cricoid cartilage formed in utero

Sub-Glottal Stenosis (Acquired) 

Intubation or trach 

What is impacted by sub-glottal stenosis?

Breathing (coughing, stridor:noisy breathing, dyspnea:impaired breathing)