Presentation on theme: "Current Diagnosis and Treatment of Voice Disorders"— Presentation transcript:
1 Current Diagnosis and Treatment of Voice Disorders Internal Medicine Grand Rounds:February 28th, 2007Current Diagnosis and Treatment of Voice DisordersSeth H. Dailey, MDAssistant ProfessorUniversity of Wisconsin Hospital and ClinicsUniversity of Wisconsin School of Medicine
7 Laryngeal PhysiologyThree main functions - airway, swallowing and voiceThree criteria for voice- generator, vibrator resonatorThree components for high quality glottic voice - closure, pliability and symmetry
8 Common disorders affect the “magic three” Closure - neuromuscular, joint, vocal foldPliability - “golden layer” - mass, scarSymmetry - tension and viscoelasticityVOICE DISORDERS ARISE FROM A COMBINATION OF THESE ELEMENTS
9 Evaluation of Hoarseness History is paramountProjection - tired, breathy and low volumeQuality - ”hoarse”, “gruff”, “raspy”Range - high, middle and low
10 Evaluation of Hoarseness Physical ExamSpeaking voiceRange profileFundamental Frequency – F0Maximum Phonation TimeStandard Reading PassagesSinging if appropriate – local, regional, bodywideVoice Lab – Acoustics and Aerodynamics
11 Evaluation of Hoarseness Endoscopic exam –mirror, flexible endoscope, rigid endoscopeDigital archiving essential for documentation
12 Evaluation of Hoarseness StudiesCT scan – evaluation of course of RLNEMG – Is there an nerve to muscle problem?Double pH probe – What is the severity of Laryngopharyngeal reflux (LPR)?Microlaryngoscopy – some lesions missed in the office.
13 Evaluation of Hoarseness Studies – the future….Aerodynamics and acoustics – Chaos theory and mathematical modelingVocal cord motion – gross arytenoid motion being evaluated endoscopicallyVocal cord pliability – endoscopic rheometers and vocal fold oscillatorsOcular Coherence Tomography/Ultrasound
23 Glottal Incompetence A “Leaky Valve” pure and simple Loss of total vocal fold volumeLoss of pliable layer from use and scarMost often a function of ageTemporary Injectables – fat and collagenPermanent – Gore-tex, silastic etc.
31 Hyperfunction – a.k.a. MTD Overactivity of supraglottal musculatureCompresses and alters the airstreamOften normal glottic functionInciting events can be ANYTHINGVoice therapy is used to get the voice“back on track”
35 Vocal Cord Papilloma Most common benign tumor of vcs Pediatric and adult formsVoice and airwaySurgery - mechanical or laser debulkingAnti-virals in childrenHigh risk of permanent dysphonia585nm Pulsed Dye Laser – Treatment can now be done in the office!!!
38 Vocal Cord Keratosis with Atypia Smoking and alcoholRepetitive chemical insult to vocal foldsDysplasia into cancerClosure, pliability and symmetryRadiation therapy - not recommendedPhonomicrosurgeryPulsed Dye Laser - Treatment can now be done in the office!!!
41 Vocal Cord Cancer Smoking and Drinking are synergistic U.S. - 2/3 glottic, Europe 2/3 supraglotticHoarsenessClosure pliability and symmetryVoice and airwayRadiationUltra-narrow margin surgeryEndoscopic approach for early cancers – increasing evidence for late cancer also
49 Vocal Cord Polyp Vocal overuse Repetitive microtrauma to mid vocal foldsClosure and pliabilityReduce demandsVoice therapySurgery – Instrumentation and even robotics being applied to improve precision and safety
63 Vocal Fold ScarForms at the junction of epithelium and golden layer (SLP)Decreases the pliability of the membraneDecreases the closure and therefore the efficiencyFatigue and projection problems are commonLOSS OF UPPER REGISTER!!!