[18] Vocal and Laryngeal Pathology

• Process of voice production

  1. get air from the lungs (respiration)
  2. air will vibrate the larynx (phonation)
  3. vibration will produce tone (phonation)
  4. It will be shaped by resonating and articulating cavity (resonance)
• High pitch

  • elongated VF
  • diminished bulk

  Low pitch

  • Shorter VF
  • thicker
• To have healthy voice: fluidity, symmetry, movement
• Functional Voice Disorders

  • faulty use (abuse vs misuse)
  • Hard glottal attack
  • inappropriate pitch level
  • too loud or too soft
  • seen in children who mimic cartoons
• Abuse

  • excessive use of voice
  • shouting

  Misuse

  • inappropriate use
  • singing voice used in talking voice
• types of functional disorders

  • muscle tension dysphonia
  • psychogenic voice disorders
• Muscle tension dysphonia

  • excessive muscle tension during phonation
  • hyperfunction adduction of false VF and/or supra glottis
  • involuntary
• Muscle tension dysphonia manifestation

  • pain in neck, jaw, and shoulders since it is associated with vagus nerve
  • breathy, monotonous, low frequency
  • sometimes scratchy due to minimal contact
• Psychogenic voice disorders

  • no known etiology
  • emotional stress
• Psychogenic voice disorders types

  1. Puberphonia/falsetto/mutational falsetto/juvenile voice/incomplete voice mutation
  2. Functional Aphonia
  3. Somatization Aphonia
• Puberphonia

  • use of high pitch voice beyond puberty age (11-16 years old)
  • may have psychologic origin
• Functional Aphonia

  • speak different from normal voice consistently (whisper)
  • breathy/labored/strained
• Nodules

  • edge of VF
  • anterior middle 3rd junction
  • vocal rest
  • benign
  • usually bilaterally
  • abuse (low pitch)
• Polyps

  • within VF
  • glottal margin
  • surgery
  • blisters
  • benign; focal
  • over function VF
  • Low pitch
• Cyst

  • inside SLP (Superior Lamina Propria)
  • intracordal; thyrovocalis
  • surgery
  • benign; focal
  • clogged mucus; phonotrauma
  • low pitch
• Reinke's Edema

  • chronic diffuse swelling of SLP
  • also called polypoid degeneration
  • associated with smoking, vocal abuse, reflux
  • affects 2/3 of the glottal margin (initial contact of VF, where acids deposits)
• Granuloma (contact ulcers)

  • big cyst on non-vibrating part
  • posteriorly on vocal process
  • hard granulation
  • might be due to intubation or trauma abuse
• Sulcus Vocalis

  • congenital or acquired
  • burrowing along the edge on vocal folds
  • within SLP
• Acid Reflux Disease implicated in the occurrence of

  • VF erythema and edema
  • Contact ulcers and granulomas
  • Laryngitis
  • Chronic rhinitis
  • Sinusitis
  • Globus pharyngeus
  • Respiratory compromise
  • Otitis media
  • Laryngomalacia
  • Subglottic stenosis
• Acid Reflux Disease

  • GERD: Gastroesophageal reflux Disease
  • LPRD: Laryngopharyngeal reflux Disease
• Neurogenic Voice Disorders

  • results from problems with the central or peripheral nervous system innervation to the larynx which affects the functioning of the vocal mechanisms
• VF Paralysis

  • unilateral or bilateral
  • VF of Arytenoid is fixed in medial, paramedian, or fully abducted position
  • due to damage in recurrent laryngeal nerve
  • mass along nerve course
  • viral infections
  • idiosyncratic onsets
• Unilateral VF paralysis

  • most common
  • affect innervation to LCA
  • harsh, breathy, diplophonia
• Bilateral VF Paralysis

  • brainstem infarct
  • breathing and swallowing affected
  • adductor paralysis: severely breathy and aphonic
  • abductor paralysis: stridor, shortness of breath
• Spasmodic Dysphonia

  • unknown etiology: can be neurologic, muscular, psychological
  • common with middle-age female
  • adductor type: uncontrolled/untimed closing
  • abductor type: uncontrolled/untimed opening
  • paiba-iba