Voice Disorders EXAM 2 Spring 2005
Terms
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- Talbot's Law
- Images greater than 5/sec appear to be moving.
- Most practical clinical techniques is?
- to observe movement of the vocal folds
- Observing movement of vocal folds provides info. about:
-
Nature of vf vibration
immediate image of presence/absence of pathologic condition
Permanate record - Observable characteristics of the vf vibratory pattern include
-
Glottic Closure
Phase closure
Vertical level of vf
amplitude
mucosal wave
vibratory behavior
phase symmetry
periodicity - Glottal closure is rated as:
- Complete or incomplete or sometimes inconsistent
- Periodicity
- the regularity of successive cycles
-
Periodicity interpretation
Asymmetry - Marked asymmetry in mechanical properties of vocal folds, unilateral paralysis, unilateral lesion
-
Periodicity interpretation
Interference with homogeneity - Interference with homogeneity of vocal folds by cyst or carcinoma
-
Periodicity interpretation
Unsteady tone - Incapability of maintaining a steady tonus of laryngeal muscles, spastic dysphonia or other neruomuscular disease
-
Periodicity interpretation
Inconsistent force - Incapability of exhaling air from lungs with consistent force; neuromuscular disease or pulmonary disease
- In normal conditions are the supraglottic structures involved in vibratory movements?
- NO
-
Phonosurgery
Designed to...
Distinguish form conservation laryngeal surgery -
Improve or restore voice
Need to remove diseased tissue, but also improve voice!
In conservation laryngeal surgery primary aim is eradication of the cancer, voice restoration is impt but 2ndary. -
Dysphonia
Pathologic condt. may include...
May result from..
Is a comprehensive voice eval necessary? -
Presenting symptom of the phonosurgical patient
Condition may include various benign vf lesions
May result from normal aging process, exc use, vocal abuse.
Yes it is necessary to perform a comph. voice eval, identify pathologic condition, select approp. surgical candidate. -
VF nodule
Occur where?
Looks like?
Symmetrical/asymmetrical
Layers affected?
Mass and stiffness of what are increased? -
-Occur along edge at the anteroposterior midpoint of the membranous vf
-Whitish, small, and usually bilateral
-Usually symmetrical and interferes with complete closure
-Confined to sup lam propria
-Mass and stiffness of the cover are increased slightly -
VF polyp
Develop where?
Look like?
Layers affected?
Mass increase? where?
Does it interfere with opposite vf? -
-Dev around edge of vf at mid of membranous vf
-Looks reddish/whitish, small/large, sessile/or pedunculated, unilateral/bilateral
-Affects Sup lam. prop layer
-Mass of cover increase
-Yes interfere with contralateral vf -
Reinke's Edema
Occurs where?
Looks like?
Layers affected?
Symmetrical/asymmetrical?
bilateral?
Complete Closure?
Mass increase?
Does it interfere with opposite vf? -
-occures on Membraneous vf
-looks like swollen along entire length
-In the sup lam prop layer
-lesion usually bilateral but can be asymmetrical
-VF usually close completely
-Mass of cover increase, but stiffness decreases
-Yes it interferes with opposite fold -
Sulcul Vocalis
Occurs where?
Looks like
Bilateral/unilateral?
Complete closure?
Symmetrical?
Layer affected?
Mass increase? -
-A furrow along edge of membranous vf
-Edge is bowed to some extent
-Usually lesion is bilateral
-Glottis does not close completly, forms spindle shaped chink
-Roughly symmetrical
-Affects sup lam. propria
-Cover's mass decreases, stiffness increases -
Vocal Fold Scar
Occur in what layer?
Produced by?
Consists of what type of fiber and what kind of tissue?
Complete closure? -
-Can occur in any layer
-Produced by trauma, surgery, burn or inflammation
-Scar tissue consists of dense collagenous fiber and is stiffer than normal tissue
-Scar tissue often impeded glottis closure during phonation. - Hyperplasia
-
Increased growth and thickening
Precancerous -
Carcinoma of VF
Layers?
symmetrical?
Complete closure? -
Profound effect of voice
Enters deeper structures, muscle
asymmetrical
Impeaded glottic closure
My get so stiff it wont vibrate -
Papilloma
Symmetrical
closure?
Opposite fold affected? -
Life threatening virus
-asymmetrical
-disturbed glottic closure
-mass interferes with opposite vf -
VF Cyst
Layer?
Cause of?
Layers?
Occurs where?
unilateral? or bilateral?
Mass/stiffness increase or decrease? -
-Arise in superficial layer
-Result of blocked mucosal gland
-Occasional extension into intermediate and deep layers
-Anywhere on membranous portion of vf
-Usually unilateral
-Mass and stiffness will be increased. -
Vocal Hemorrhage and Varix
Caused from?
Stiffness can cause?
Cause voice to do?
rest recommended? -
-Varicose vein on sup. surface of vf will rupture causing bleeding into reinke's space
-Mucosal disruption of stiffness can scar vf cover
-Voice-Can cause acute dysphonia at time of bleed, cont. hoarseness for some time.
-STRICT VOCAL REST!! - Vocal Fold Nodule
-
-Midpoint of membraneous vf
-whitish small sessile usually bilateral
-symmetrical
-mass and stiffness of cover are increased slightly but transition and body are not affected - Polyp
-
-Dev around edge at middle of membranous vf
-reddish/whitish, sessile/pedunculated, unilateral/bilateral
-On superficial layer of lam. prop
-Interferes with opp. vf - Reinke's Edema
-
Membranous vf is edematous and swollen along entire length
-usually bilateral, can be asymmetrical
-Mass of cover increases, but stiffness decreases - Sulcus Vocalis
-
-Furrow along edge of memb. vf
-Edge is bowed
-Usually lesion is bilateral
-Roughly symmetrical
-Cover's mass decreases, stiffness increases - VF Scar
-
-Can occur in any layer
-Produced by trauma, surgery, burn/inflammation
-Scar tissue consists of dense collagenous fiber and is stiffer than normal tissue
-Scar tissue usually impedes glottic closure - Epithelial Hyperplasia
-
-Pathology in which thickening of the epithelium is primary lesion
-Regarded as precancerous
-Originates from cover, may enter sup lam prop
-Vocal ligament not involved unless lesion becomes malignent - Carcinoma of VF
-
Most are squamous cell carcinoma
-Originate from cover and go deeper
-Originally unilateral
-tissue is asymmetrical
-Glottic Closure impeded
-Lesion inteferes w/ vibratory movements of opp vf - Papilloma
-
-Lesion is asymmetrical
-Proliferated newplastic epithelial cells growing in a appillary fashion
-Glottic closure disturbed
-Mass interferes with opp vf - VF Cyst
-
-Arise in Sup layer
-Result of blocked mucosal gland duct, with occasional extension into intermediate and deep layers of vf
-Can occur anywhere on membranous portion of vf
-Usually unilateral
-Mass and stiffness increase - Vocal Hemorrhage and Varix
-
Varicose vein on sup surface of vf wil rupture causing bleeding into reinke's space
-Mucosal distruption of stiffness can scar vf
-Can cause acute dysphonia
-Strict voice rest!!!