Dysphonia
abnormality in speaking voice (hoarseness)
primary Sx of laryngeal disease
hoareness & stridor
Hoarseness
abnormal vocal quality caused by abnormal vibrations of vocal cords
Breathy Voice indicates what
unilateral vocal fold paralysis or vocal fold mass
Harsh voice indicates
laryngitis
Most common cause of hoarseness
Acute laryngitis
< 3 weeks
Tx of Acute laryngitis
avoid vigorous use of voice until Sx improve
Tx of Chronic Laryngitis
remove offending agent
Pt w/ rapidly developing sore throat, odynophagia out of proportion to exam & drooling
Suspect Epiglottitis or Supraglottitis
Dx of Epiglottitis or Supraglottitis
indirect larygoscopy safe in adults
Lateral neck soft tissue xray (Thumb sign)
Tx of Epiglottitis or Supraglottitis
Admit for IV ceftriaxone & IV dexamethasone
followed w/tapered corticosteroid & 10 day PO ABX
Laryngopharygeal Reflux (LPR) associated with
hoarseness, throat irritation, chronic cough
occur when upright & 1/2 dont experience heartburn
Dx of LPR made with
response to PPI ; omeprazole 40mg PO x 3 months
3months after initiating PPI therapy for LPR and Sx’s have improved what can be done
dose can be lowered as long as they remain asymptomatic
Prior to starting PPI’s to eval and Tx LPR what must be done
Laryngoscopy to r/o other causes of chronic hoarseness
common lesions of larynx & other sites where ciliated & squamous epithelia meet, almost always HPV 6 & 11
Respiratory Papllomatosis (Papillomas)
Most common Laryngeal Tumor in children
Respiratory Papillomatosis
Sx’s of Respiratory Papillomatosis
Hoarseness progress to stridor over weeks/months
Extension can occur in Trachea & lungs
multiple warty lesions on vocal cords
Tx of Papillomatosis
repeat laser vaporization / cord knife resection
cure not usually achieved
permit to develop voice / preserve structure, avoid trach
Prevention of Papillomatosis
Immunization w/Gardasil & Gardasil 9
What are considered manifestations of chronic vocal fold irritation
Vocal Cord Nodules &
Vocal Cord Polyps
common cause of hoarseness from abuse, w/smooth paired lesions @ junction of anterior 1/3 & posterior 2/3 of vocal folds
Vocal Fold Nodule
Tx of Vocal Fold Nodule
modify voice habit
refer to speech therapist
Recalcitrant nodules may require surgical excision
this is r/t truama (ie. smoking), unilat masses form w/in suerficial lamina propria of vocal fold
Vocal Fold Polyps
Tx of Vocal Fold Polyps
small polyps- conservative measure (voice rest & corticosteroids)
Large polyps- irreversible require surgical removal to restore voice
Form from mucous-secreting glands on inferior aspect of vocal fold, change in size from week-week, commonly cause hoarseness
(Can be True or Pseudo)
Vocal Fold Cyst
vocal folds appear swollen & floppy may cause respiratory Sx’s in severe cases
Polypoid Corditis (Reinke’s edema)
the changes in polypoid corditis (Reinke’s edema) are associated w/?
smoking
vocal abuse
chemical irritants
hypothyroidism
Pt presentation of Polypoid corditis (Reinke’s edema)
Typically smoker, middle aged woman, w/ husky low-pitched voice
Tx of Polypoid corditis(Reinke’s edema)
smoking cessation, acid reflux management, & voice therapy
Tx of Polypoid corditis (Reinke’s edema) w/presence of stridor
surgical debulking/recontouring
found in association w/ hoarseness in smokers, could be benign-malignant & what is needed
Laryngeal leukoplakia;
biopsy
Tx of Laryngeal leukoplakia
smoking cessation
PPI’s (mainstay of Tx)
close follow w/laryngovideostroboscopy
serial resection & external radiation therapy
essentials to Diagnosis of Squamous Cell Carcinoma of larynx
new/persistent hoarseness Persistent throat/ear pain especially w/swallowing neck mass Hemoptysis Stridor / other compromised airway
Most common Malignancy of Larynx
Squamous Cell Carcinoma
Tx of early glottic & supraglottic cancer
SOC is radiation cure rate 95%
Hoarseness > 2wks absence of acute respiratory infection Sx need to do what? (w/Hx of tobacco smoking)
complete ENT exam
Most Common Cause of Vocal Cord Paralysis
Iatrogenic
Pt’s voices w/ vocal cord paralysis sound
breathy dysphonia or “effortful voicing”
what is damaged in vocal cord paralysis
either the vagus nerve or unilateral recurrent laryngeal nerve
what surgeries may cause vocal cord paralysis
thyroid, esophageal, C-spine, thoracic
What is required for a work up of vocal cord paralysis
Need thorough NC exam
CT w/ contrast
what is required for Pt’s w/vocal cord paralysis & cranial neuropathy present
MRI
When is early surgical medialization indicated in unilateral vocal cord paralysis?
severe Sx’s (aspiration pneumonia)
Disabling Breathy Disphonia
ineffective cough/disabling dyspnea
Mild Sx w/denervation on laryngeal elecrography
Tx of mild unilateral vocal cord paralysis
voice/speech therapy
Get laryngeal electromyography
Pt with mild unilateral vocal cord paralysis w/evidence of denervation/little activity on laryngeal electromyography
require referral for surgical medialization
what is an acute/chronic syndrome w/ paradoxical vocal cord adduction?
Vocal Cord Dysfunction (VCD) or Paradoxical Vocal Fold Movement (PVFM)
Triggers of VCD or PVFM?
GERD inhaled allergens post nasal drip excercise neurological condition psychosocial/stress
Pt has dyspnea & wheezing that is not responding to bronchodilators, what is it?
Vocal Cord Disfunction (VCD)
how to Diagnosis VCD?
direct visualization of Vocal cords showing adduction w/both inspiration & expiration
Tx of VCD
stop any unnecessar Tx
1st line Tx speech therapy
Acute Tx of VCD
CPAP & Breathing exercises
Long term Tx of VCD
Speech therapy
Botox
severe- trach for relief