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Organic voice disorders (Contact ulcers, granulomas (Perceptual,…
Organic voice disorders
Laryngeal web
Mgm
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Surgical resection knife, laser
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Perceptual, physiological signs
Dyspnea: Breathlessness, X get air thru
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Laryngomalacia
Aetiology
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Immature cartilaginous dev eg. floppy epiglottis, large aryepiglottic folds, large arytenoid processes
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Perceptual, physiological signs
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Mgm
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10-20% aryepiglottic fold incision, C02 laser supraglottoplasty
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Laryngeal papilloma
Aetiology
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Viral=aggressive, diffuse
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Adult forms: occurs from gastroesophageal reflux disorder, immunosuppression which activates dormant virus
Perceptual, physiological signs
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Just bcos warts are large, X mean they are severe
If papilloma interferes w glottal closure, voice can be breathy
If lesions are large, diffuse--> dyspnea, inspiratory stridor may be present. X produce much voice at all. Always get help from ENT!
Mgm
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Can recur very quickly--> require surgery every 2-4 weeks to minimise threat to airway--> impact on voice bcos surgeries, subsequent VF scarring
Voice Tx (after surgery, in b/w) to max vocal quality, minimise compensatory strategies pt might be using
Types
Disorders bcos trauma eg. intubation granuloma, vocal process granuloma, injuries
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Cysts
Aetiology
Can be congenital (rare), result of phonotrauma
Pathophysio
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Located near VF surface, typically intracordal, but can be anywhere along VF, false VF, Reinke's space
Perceptual, physiological signs
Mild to severe hoarseness (VF asymmetry, irregular VF closure)
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Habitual throat clearing, cough
Mgm
Vocal hygiene Tx, voice rest-effort to reduce swelling
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Contact ulcers, granulomas
Aetiology
LP reflux
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Factors
Fatty foods, spicy foods, chocolate, caffeine, alcohol
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Intubation trauma: mucosa overlying arytenoid process becomes irritated by placement of endotracheal tube. Rxn to irritation: granulation tissue forms
Phonotrauma
Repeated, forceful hyperadduction of vocal processes
Hard glottal attack, low pitch (ppl more prone to contact ulcers) , glottal fry
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What is it?
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Continued irritation in presence of bacteria--> ulcer, granulation tissue
Pathophysio
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cup, saucer appearance: usually adjacent to each other.
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Perceptual, physiological signs
Globus sensation, discomfort +/- pain
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Breathiness, hoarseness--> air escape thru glottis
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Increased subglottal pressure, air flow, intensity
Mgm
LPR problem: Lifestyle mgm (diet modification, medication)
LPR problem: Phonosurgery +/- surgeon wrap stomach around oesophagus to stop contents from spilling out IF granuloma continues, only happens 3 months after behavioral modification, medication
Intubation problem: resolve spontaneously, steroid injections if severe
Phonotrauma problem: Voice Tx targetting factors that cause high impact stress to posterior glottis, arytenoid mucosa. Loud talking, shouting, long talking time
VF haemorrhage
Aetiology
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Caused by phonotrauma (high intensity voice use), traumatic injury to VF
Blood thinners (aspirin, warfarin)
Perceptual signs, symptoms
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Mgm
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Chronic: residual dysphonia as result of scar tissue can be treated thru VF augmentation w fat/collagen-injected to relieve scar tissue