1. organic voice disorders 2

2. topics
-Contact ulcers(granulomas) -Reflux -Webbing

3. Contact Ulcers(granulomas)

4. 1、Contact Ulcers (granulomas)
Cause/etiology
Hard glottal attack along with throat clearing and coughing
Laryngopharyngeal reflux (most common cause)
Postnasal drip
Endotracheal intubation
Surgery on the VFs
Teflon granuloma of the larynx
Removal of cysts

5. 1、Contact Ulcers (granulomas)
Segmentation of VFs
The anterior two - thirds
Muscle - vocalis portion of the thyroarytenoids
Menbrane
Posterior third
Arytenoids

6. 1、Contact Ulcers (granulomas)
Location
Medial aspect of the vocal processes of the arytenoid cartilages
Bilateral (mostly)
Typical symptoms
Vocal fatigue - after prolonged vocalization
Hoarseness or roughness
Pain in laryngeal area or/and one ear

7. 1、Contact Ulcers (granulomas)
Contact ulcers with granulomas

8. 1、Contact Ulcers (granulomas)
Treatments
HGA
Low pitch
Excessive HGA
Increased loudness
Voice therapy
cause
symptoms
Treatment

9. 1、Contact Ulcers (granulomas)
Treatments
LPR
Morning hoarseness
Voice therapy
Sour taste in the mouth
Medicine & surgery
Frequent throat clearing & coughing
cause
symptoms
Treatment

10. 1、Contact Ulcers (granulomas)
The focus of voice therapy
Elevate pitch
Greater mouth and jaw relaxation
Lower level of volume
Eliminate all traces of excessively hard glottal attack

11. 1、Contact Ulcers (granulomas)
Attention
If surgical revision of the larynx has resulted in a better voice, and then months or years afterwards the voice deteriorates, the larynx should be reexamined using endoscopy or stroboscopy in order to identify possible reactive granuloma

12. Reflux

13. 2、Reflux Location Types Lower esophageal sphincter
Upper esophageal sphincter
Types
GERD - Gastroesophageal reflux disease
LPR or EER- Laryngopharyngeal reflux or Extraesophageal reflux

14. 2、 Reflux

15. 2、 Reflux

16. More severe when head is lower than abdominal area
2、 Reflux
Symptoms
Reflux
Atypical symptoms
Heartburn
Choking
Typical symptoms
Morning hoarseness
Sour taste & bad breath
Frequent coughing and throating
More severe when head is lower than abdominal area

17. 2、 Reflux Examinations Ambulatory 24-hour pH mornitoring
Esophageal biopsy
Upper gastrointestinal endoscopy
Reflux Symptom Index (RSI)

18. 2、 Reflux Treatments Combination of aboves Behavioral therapy Pharmacy
Surgery

19. 2、 Reflux Behavioral therapy Elevating the head of the bed
Remaining upright at least 60 mins after meals
Avoid spicy food
No exercise after eating
Cutting down caffeine, carbonated drinks and alcohol, esp afternoon and evening

20. 2、 Reflux Behavioral therapy
Don’t drink too much water right before bed
No activities that compress the abdomen
Weight loss
Wearing looser clothing around the waist
Eliminating smoking

21. 2、 Reflux Pharmacy Surgery PPI (proton - pump inhibitor 质子泵抑制剂)
Prokinetic agent 胃肠蠕动促进剂
Surgery
Surgical laparoscopic fundoplication (腹腔镜下胃底折叠术)

22. Webbing

23. 3、Webbing Types Cause/etiology Congenital Acquired
Chromosome 22q deletion - Congenital
Bilateral trauma of the medial edges of the VFs – Acquired
Bilateral surgery (laryngeal or tracheal)
External trauma

24. 3、Webbing Location Typical symptoms Anterior one-third of VFs (mostly)
High - pitched rough sound
Shorter length of VFs
Shortness of breath
Seriously compromising the open glottis

25. 3、Webbing
Webbing

26. 3、Webbing Examinations Congenital Testing for chromosome 22q
Endoscopy or stroboscope
Acquired
Endoscopy or stroboscope

27. 3、Webbing Treatments Surgery Cut webbing Voice therapy
Restore normal phonation

28. Its all for today!