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Published byEvangeline Hutchinson
Modified over 2 years ago
Common referral Hoarseness reflects any abnormality of normal phonation
Cricoarytenoid Joint True synovial joint
Intrinsic Musculature Abductors Adductors Tensors
Vocal Fold Anatomy
Laryngeal function Sphincteric function Respiration Phonation Other – Stabilizes the thorax by preventing exhalation during lifting – Compresses abdominal cavity during coughing or straining
Phonation Physical act of sound production by means of passive vocal fold interaction with the exhaled airstream Pitch Quality Volume
Sound Production – Contraction of expiratory muscles – Rise in subglottic air pressure – Escape through glottis – Closure Bernoulli effect elasticity
Phonation Glottal puff – Release of air as upper margins of TVC separate Phase delay – Delay of closure between upper and lower margins of TVC Mucosal wave – Horizontal and vertical components
Mucosal wave/Phase delay
Body-Cover Theory Changes to mucosal wave – Stiffness – tension
Mucosal wave Velocity increases – Increased airflow – Increased subglottic pressure
Fundamental Frequency Pitch (measure in Hertz) Changes in vibration frequency – Mass – Stiffness – viscosity
Workup “Any patient with hoarseness of two weeks duration or longer must undergo visualization of the vocal cords”
Workup History Physical Examination Ancillary tests
History URI – Laryngitis – Overuse with edema and inflammation – Paralyses – Granulomas from coughing
History Trauma – Arytenoid dislocation – Nerve paralysis – Laryngeal fractures – Mucosal lacerations
History Intubation – Arytenoid dislocations – Nerve injury – granulomas
History Pulmonary conditions – power source – COPD – Asthma
History Gastrointestinal – LPR Autoimmune – RA Endocrine – Hypothyroidism
Surgical History Skullbase procedures Carotid endarterectomies Thyroidectomies Aortic aneurysm repairs
Social History Tobacco Alcohol ?Inflammation ?Drying of secretions ?malignancy
Occupational History Voice abuse
Physical Examination Head & neck examination Laryngeal examination – Physiologic position – Image quality – Magnification – Cost – Required equipment – Time/skill necessary
Laryngeal examination Indirect mirror Flexible laryngoscopy Rigid laryngoscopy
Indirect mirror examination Advantages – Quick – Inexpensive – Little equipment Disadvantages – Gag – Anatomic features – nonphysiologic
Flexible laryngoscopy Advantages – Well tolerated – Complete examination – Video documentation Disadvantages – More time – Expensive
Rigid laryngoscopy Advantages – Best images – Magnification – Video documentation Disadvantages – Expensive – Nonphysiologic – Gag – Anatomic features
Videostroboscopy Light quasi-synchronized with vocal fold vibrations – Bell microphone – Electroglottography Video recording – Detailed review – Comparison after treatment
Videostroboscopy Synchronous = motionless Asynchronous = slow motion
Videostroboscopy Vocal fold closure pattern Vocal fold vibratory pattern Mucosal wave of each vocal fold Symmetry
Radiographic studies MRI CT
Laryngeal EMG Myopathy – normal frequency of firing but decreased amplitude Neuropathy – decreased frequency but occasional normal amplitudes Polyphasic reinnervation potentials indicate some loss of function but reinnervation has begun
Differential Congenital Inflammatory Neoplastic Traumatic Neurologic Endocrine Iatrogenic Local factors
Vocal Nodules Usually bilateral Voice rest and speech therapy for 6 months Surgical removal
Vocal cord granulomas LPR Intubation Treat medically
Vocal Cord Paralysis Lesion at nuclear level – cadaveric Lesion above nodose ganglion – abducted Lesion below nodose ganglion - paramedian
Vocal Cord Paralysis Superior laryngeal nerve – subtle voice changes with decreased pitch range, tilting of the larynx with a rotation of the glottis
Vocal Cord Paralysis Children – Neurologic – Traumatic – Idiopathic Adults – Iatrogenic – Traumatic – Neoplastic – Idiopathic – neurologic
Vocal Cord Paralysis
Current Diagnosis and Treatment of Voice Disorders Seth H. Dailey, MD Assistant Professor University of Wisconsin Hospital and Clinics University of Wisconsin.
What is Hoarseness? Diplophonia
Laryngeal Structure & Function; Vocal Fold Vibration
Phonation Physiology Phonation = series of openings and closings of the vocal folds Two phases 1.Prephonation phase: period during which VFs move from.
Hoarseness Of Voice Saba Yahya Abdelnabi. Introduction Human voice is so complex that it not only conveys meaning, it also is capable of conveying subtle.
Peter R. LaPine, Ph.D. Department of Audiology and Speech Sciences Michigan State University.
CSD 2230 HUMAN COMMUNICATION DISORDERS
Laryngeal Pathology. Vocal Hyperfunction Misuse of laryngeal muscles Excessive adductory force Often results in laryngitis (inflammation of folds) Etiology:
Current Diagnosis and Treatment of Voice Disorders
Unit Seven Voice Disorders.
Hoarseness and Benign Vocal Fold Mucosal Disorders
Anatomy and Physiology of the Speech Mechanism. Major Biological Systems Respiratory System Laryngeal System Supralaryngeal System.
Summary: Lesions to Vagus nerve and its branches 1.Lesions above pharyngeal branch: Adductor paralysis with palatopharyngeal paralysis.
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Topic 3b: Phonation.
SPPA 2000 Voice Lecture Stephen Tasko The Voice & Voice Disorders SPPA 2000 Stephen Tasko.
By Dr. Supreet Singh Nayyar, AFMC For more presentations, visit 7/15/12 1 Physiology Of Phonation.
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