3. Voice: classification

Inflammation: what

local response to tissue injury

Inflammation: symptoms (3)

swelling, redness, sometimes discomfort

Inflammation: infective causes (2)

acute viral/bacterial infections, chronic viral/bacterial/fungal infections

Inflammation: specific infective cause examples (3)

candida from inhaler use, TB, leprosy, HPV

Inflammation: non-infective causes (4)

acute allergic response, autoimmune diseases, acute injury, response to irritants

Inflammation: non-infective causes examples

anaphylaxis, rheumatoid arthritis, burn, surgery, acid reflux, radiotherapy

Neuromuscular: what

abnormal control/co-ordination/strength of laryngeal muscles caused by neurological/degeneration of nervous system

Neuromuscular: Recurrent Laryngeal Nerve problems when…

damage secondary to viral infection / conditions that compress e.g. tumours/surgery

Neuromuscular: Recurrent Laryngeal Nerve damage leads to…

vc palsy

VC palsy (3 characteristics)

uni/bi paralysis, possible diplophonia, usually breathy

Neuromuscular: Superior Laryngeal Nerve internal sensory branch (2 characteristics)

too much coughing or reduced coughing reflex, increased aspiration risk

Neuromuscular: Superior Laryngeal Nerve external motor branch (1 characteristic)

pitch changes

Neuromuscular: Superior Laryngeal Nerve leads to…

spasmodic dysphonia (adductor, abductor, mixed)

spasmodic dysphonia (characteristic, brought on by…)

voice breaks (words - loss of speech), inherited or triggered by illness/truama/stress

MTI: primary

no structural lesion, includes psychogenic

MTI: secondary

in addition / compensating for another cause

MTI: causes (4)

high vocal demand, hormonal change, voice abuse, stress

MTI: symptoms (4)

voice fatigue, voice/pitch breaks, reduced voice quality, tight = normal

posterior glottic gap (MTI): who?

fitness instructors who speak when out of breath

presbylarynx (MTI) (3)

age-related, atrophy, bowing

presbyphonia (MTI) (3)

breathy, asthenic, fatigue

incomplete closure (MTI) (2 x or y)

whisper/breathy or high pitch breathy strain, psychosomatic or puberphonia

cricothyroid tension (MTI) (3)

thyroid rocks on top of cricoid, can’t reach high pitches, pain projecting

lateral constriction (MTI) (2)

false folds pulled into midline, rough

AP constriction (MTI) (what - 3)

arytenoids pulled forwards, epiglottis pushed back, vc obscured

pharyngeal constriction (MTI) (who)

common in menopauses when squeezing for high pitch

Structural: what

anything on/in vc altering straight edge

Structural: symptoms (4)

persistant dysphonia/sore throat/earache/coughing, painful swallow/breathing, neck swelling, reduced pitch range

Structural: pre-malignant vocal fold lesions (dysplasia) (3)

vc cells keratosis (leukoplakia, erythroplasia), interrupt vibration (hoarseness), can become malignant

Structural: malignant vocal fold lesions (cancer) (4)

squamous cell carcinoma, sarcoma, lymphoma, can lead to vc fixation

Benign vocal fold lesions: vc nodules (where, cause, who)

bilateral vc midpoint epithelium, phonotrauma/repetitive overuse, women/children most common

Benign vocal fold lesions: vc polyp (where, description, cause)

unilateral vc midpoint epithelium, haemorrhagic/fibrotic/translucent, larger than nodule, abuse leads to erythema and vasodilation

Benign vocal fold lesions: vc cyst (common type, what, why)

mucus retention cysts, opaque spheroid mass under epithelium, accumulation of mucus as gland blocked, voice overuse/upper airway infection

Benign vocal fold lesions: vc sulcus (what, onset, why)

elongated grove along lamina propria, slow onset, congenital or after ruptured cyst

Benign vocal fold lesions: vc hemorrhage (what, onset, location, cause, treatment possible)

blood vessels burst, sudden onset, epithelium or lamina propria, phonotrauma, absolute rest

Benign vocal fold lesions: vc granuloma (where, what, cause, symptom)

epithelium at vocal process level, mass containing inflammatory cells, due to persistent irritants or surgery, lump in throat

Benign vocal fold lesions: vc papilloma (where, results in, cause, who common)

epithelium around glottis, narrow airway, HPV, children

Benign vocal fold lesions: Reinke’s oedema (what where, why, can co-occur with)

swelling under epithelium, smoking / voice abuse / reflux irritant, leukoplakia dysplasia

Inflammation: non-infective symptoms (6)

dryness, mucus, coughing urge, roughness, reduced amplitude and pitch, increased sensory awareness