Diseases of the Larynx
This is an example of a normal larynx. The true vocal folds are pearly white, they meet in the midline on phonation, and the surrounding structures are light pink. As you view the following examples of diseases of the larynx, you can compare them to this example.
Nodules are calluses on the vocal folds that occur with improper voice use or overuse. They are most common in children and females.They prevent the vocal folds from meeting in the midline and thus produce an hourglass deformity on closure resulting in a raspy, breathy voice. Most time,s these will respond to appropriate speech therapy. Occasionally (20% of the time), these may persist after intensive speech therapy and will require meticulous microlaryngeal surgery.
Polyps are benign lesions of the larynx, occurring mostly in adult males, that are usually located on the phonating margin (edge) of the vocal folds and prevent the vocal folds from meeting in the midline. Polyps can interfere with voice production and may produce a hoarse, breathy voice that tires easily. These may respond to conservative medical therapy and intensive speech therapy. If the lesion fails to respond, meticulous microsurgery may be indicated. One of the cofactors in the cause of these lesions may be laryngeal reflux disease.
sicca is caused by inadequate hydration of the vocal folds. Thick,
sticky mucus prevents the folds from vibrating in a fluid, uniform manner.
Vocal fold hemorrhage
This is an
example of a very early cancer of the vocal folds. If
these lesions are detected early, they can be treated with either radiation
or surgery, with a cure rate approaching 96%.
Impaired Vocal Fold Mobility, a condition where one or both of the vocal folds do not move appropriately, can be due to paralysis, paresis, scarring, or inflammation of the crico-arytenoid joint.
Vocal fold paralysis or paresis results from a lesion of the neural or muscular mechanism.
Unilateral vocal fold paralysis can be caused by a variety of diseases or disorders that prevent movement in one vocal fold. When one weakened vocal fold does not move well enough to meet the other fold in the midline during speech, air leaks out too quickly. This causes the voice to sound breathy and weak, making it necessary for the speaker to take more frequent breaths during speech. After a full day of talking, someone with a weak vocal fold can feel exhausted due to the frequent breathing, and can experience choking and coughing on food or liquids.
Bilateral vocal fold paralysis: When both vocal folds have movement problems, the situation can be much more serious. With both vocal folds paralyzed in the midline position, the person has difficulty breathing and a tracheotomy may be necessary to establish an airway. If both folds are paralyzed near the midline, although the voice may be good the airway may be compromised. If both folds are paralyzed far apart, there may be no voice.
Vocal fold bowing, can result from neural, muscular, traumatic, congenital, or functional causes, with or without vocal fold atrophy, and can result in vocal weakness.
Presbylaryngis is a condition that is caused by thinning of the vocal fold muscle and tissues with aging. The vocal folds have less bulk than a normal larynx and therefore do not meet in the midline. As a result, the patient has a hoarse, weak, or breathy voice. This condition can be corrected by injection of fat or other material into both vocal folds to achieve better closure.
Laryngeal Dystonia (Spasmodic Dysphonia)
Laryngeal dystonia, or spasmodic dysphonia (SD) is a voice disorder caused by involuntary movements of one or more muscles of the larynx. There are two major types of spasmodic dysphonia: adductor and abductor, although most are a mixture of both types.
Adductor SD, with spasms causing sporadic vocal fold closures, are identified by a strained, strangled voice.
Abductor SD, with spasms causing sporadic vocal fold closures, produces a voice with interruptions of air.
Muscle tension disorder: Excessive laryngeal muscle tension squeezes the vocal folds and surrounding muscles into a “fist” configuration, preventing air from moving through the vocal folds to enable normal vibration. The voice is reduced to a “squeaky” sound.
Dysphonia plica ventricularis: A laryngeal function disorder caused by phonation of the ventricular folds (false folds) rather than the true vocal folds. When the ventricular folds are squeezed together, the resulting voice is harsh and strained. This can be a learned behavior, but may be the result of true vocal fold weakness.
Paradoxical vocal fold dysfunction: Paradoxical vocal fold dysfunction is the result of the vocal folds coming together during inspiration, instead of normally opening to allow air to flow freely. This can alarm the patient and those nearby, as the patient is gasping for air. Frequently, these patients are seen in the emergency room and treated (incorrectly) for asthma. The typical symptom of this disorder is phonation during inspiration. The diagnosis can be suspected by the history and physical exam, and confirmed by examination of the larynx with a flexible fiberoptic laryngoscope during an attack. Laryngopharyngeal reflux can exacerbate the symptoms. Treatment may involve several specialties, especially Speech-Language Pathology.
This is an example of a patient who has acid reflux into the larynx (laryngopharyngeal reflux disease, or LPRD). The larynx is red and swollen. This patient also has leukoplakia, which is a premalignant white growth on the vocal folds. The picture on the left is the first examination, and the picture on the right was taken after just six weeks of medical treatment for LPRD. Notice that the changes on the vocal folds have been reversed, and the redness has subsided dramatically.
Disorders - Treatment Options
Laryngeal Dystonia (Spasmodic Dysphonia): Whether the spasms occur with the vocal folds open or closed, this neurological disorder improves with Botox® injections and supplemental speech therapy.
Incompetent Larynx: Treatment for incomplete vocal fold closure may involve specialized speech therapy and/or surgical management.
Benign Lesions: Treatment may include medication, voice rest, increased hydration, vocal hygiene, extensive speech therapy and/or surgical intervention.
Malignant Lesions: A biopsy will be performed on suspicious lesions, followed by recommendations for appropriate treatment.
Functional Disorders involve inappropriate laryngeal muscle movement, and often require extensive speech therapy.
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