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Larynx and Voice Disorders – Dr. Michael Agostino

Larynx and Voice Disorders – Dr. Michael Agostino. Larynx and Voice Disorders. Introduction Anatomy Physiology Methods of evaluation Common Disorders Treatments Conclusions. Larynx and Voice Disorders. Objectives Learn to obtain Pertinent History & Physical

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Larynx and Voice Disorders – Dr. Michael Agostino

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  1. Larynx and Voice Disorders – Dr. Michael Agostino

  2. Larynx and Voice Disorders • Introduction • Anatomy • Physiology • Methods of evaluation • Common Disorders • Treatments • Conclusions

  3. Larynx and Voice Disorders • Objectives • Learn to obtain Pertinent History & Physical • Know the appropriate work-up for disorders • Know when to refer • Know Medical Options and Surgical Options

  4. Larynx and Voice Disorders Introduction • Very common problems • Multiple contributing factors • Psychologic factors contibute to vocal problems • Voice is one of our most unique identifiers • Patients are extremely happy if voice returns to “normal”

  5. Larynx and Voice Disorders Anatomy • Skeletal Framework • Muscular Structures • Blood Flow • Nervous Input • Connective Tissues • Surface Tissues “Froggy” from the Little Rascals

  6. Larynx and Voice Disorders Anatomy • Skeletal Framework • Muscular Structures • Blood Flow • Nervous Input • Connective Tissues • Surface Tissues “Froggy” from the Little Rascals

  7. Larynx and Voice Disorders Anatomy • Skeletal Framework • Muscular Structures • Blood Flow • Nervous Input • Connective Tissues • Surface Tissues

  8. Larynx and Voice Disorders Anatomy • Skeletal Framework • Muscular Structures • Blood Flow • Nervous Input • Connective Tissues • Surface Tissues “Froggy” from the Little Rascals

  9. Larynx and Voice Disorders Anatomy • Skeletal Framework • Muscular Structures • Blood Flow • Nervous Input • Connective Tissues • Surface Tissues

  10. Larynx and Voice Disorders • Anatomy • Skeletal Framework • Muscular Structures • Blood Flow • Nervous Input • Connective Tissues • Surface Tissues

  11. Larynx and Voice Disorders • Anatomy • Skeletal Framework • Muscular Structures • Blood Flow • Nervous Input • Connective Tissues • Surface Tissues

  12. Larynx and Voice Disorders • Anatomy • Skeletal Framework • Muscular Structures • Blood Flow • Nervous Input • Connective Tissues • Surface Tissues

  13. Larynx and Voice Disorders • Anatomy • Skeletal Framework • Muscular Structures • Blood Flow • Nervous Input • Connective Tissues • Surface Tissues

  14. Larynx and Voice Disorders Physiology “What does the larynx do?” • Airway Protection during Swallowing 2. Phonation • Resistance for Respiration • Chest Fixation to bear down

  15. Larynx and Voice Disorders Voice Disorders occur if Patients have abnormal Anatomy or Physiology or BOTH

  16. Larynx and Voice Disorders- Methods of Evaluation - Objective # 1 Learn to obtain Pertinent History & Physical Objective # 2 Know the appropriate Work-up for Disorders

  17. Larynx and Voice Disorders- Methods of Evaluation - Objective # 1 Learn to obtain Pertinent History & Physical History • Feeling as if there is a mass in one’s neck with abnormal anatomy • Loss of one or more functions

  18. Larynx and Voice Disorders- Methods of Evaluation - Objective # 1 History – due to mass effect 1. Difficulty Swallowing with choking on liquids • Extra force needed to get voice • Increased effort to take a breath. 4. Feeling of lump in one’s throat.

  19. Larynx and Voice Disorders- Methods of Evaluation - Objective # 1 History – due to loss of function • Vocal fatigue  • Unreliable voice with delayed voice initiation  • Low, gravelly voice with low pitch • Voice breaks in first passages of sentences • Airy or breathy voice  • Inability to sing in high, soft voice 7. Hoarse and rough voice quality 8. Frequent throat clearing

  20. Larynx and Voice Disorders- Methods of Evaluation - Objective # 1 • History - Serious Complaints • Pain • Bleeding • Visual Change in Appearance of Larynx • Otalgia with no other ear complaints • Halitosis • Noisy Breathing • Weight Loss

  21. Larynx and Voice Disorders- Methods of Evaluation - Objective # 1 Physical Examination 1. External a. Inspect Neck for Distortion and Asymmetry of the Larynx. b. Palpate Neck for Normal Firmness and Crepitance c. Listen for Abnormal Voicing or Breathing

  22. Larynx and Voice Disorders- Methods of Evaluation - Objective # 1 Physical Examination 2. Internal a. Indirect Mirror Exam of the Larynx b. Flexible Nasolaryngoscopy c. Rigid Fiberoptic Laryngoscopy d. Video-stroboscopy e. If not tolerable of Office exam, Direct Laryngoscopy in OR f. Microscopic or Telescopic Laryngoscopy in the OR

  23. Larynx and Voice Disorders- Work-up for the disorder - • Objective #2 Additional Work-up depends upon one’s index of suspicion after completing the history and the physical examination. Work-up is tied into the suspected cause.

  24. Larynx and Voice Disorders- Work-up for the disorder - • Objective #2 1. Analysis of Masses with Structural Issues - CT Scans to examine larynx for tumor - MRI is useful for soft tissue masses - CT-PET Scan for suspected cancers - Ultimately, unresolved masses need to be biopsied or removed

  25. Larynx and Voice Disorders- Work-up for the disorder - • Objective #2 2. Analysis of Functional Laryngeal Problems - Videostroboscopy for voice changes - Laryngeal EMG is muscle weakness or nerve paralysis suspected - Modified Barium Swallow for aspiration - FEES for aspiration concerns - Ultrasound, possibly for laryngomalacia - Laryngeal Culture if suspected Infection

  26. Larynx and Voice Disorders Categories of Diseases from ICD-9 coding Infections Neoplasms Endocrine Disorders Blood Disorders Mental Disorders Nervous System Disorders Circulatory Disorders Respiratory Disorders Digestive Disorders GU Disorders Pregnancy Skin Disorders Muscular Disorders Congenital Disorders Peri-Natal Disorders Ill-defined Conditions Injury

  27. Larynx and Voice Disorders Infectious Laryngitis acute viral infection or acute bacterial infection or chronic tuberculosis or chronic fungal infection

  28. Larynx and Voice Disorders Neoplasms • Benign – e.g., papilloma 2. Malignant

  29. Larynx and Voice Disorders Neoplasms • Benign • Malignant – Squamous cell Carcinoma

  30. Larynx and Voice Disorders Neoplasms • Benign • Malignant – Squamous cell Carcinoma

  31. Larynx and Voice Disorders Metabolic Disorders • Hypothyroidism and Laryngeal Edema 2. Auto-immune disorders with joint fixation or relapsing polychondritis

  32. Larynx and Voice Disorders Hematologic Disorders • Hemorrhage with thrombocytopenia and screaming.

  33. Larynx and Voice Disorders Mental Disorders • Abuse of larynx with screaming. (Nodules at friction point) 2. Anxiety

  34. Larynx and Voice Disorders Mental Disorders • Abuse of larynx • Anxiety and Paradoxical Vocal fold motion

  35. Larynx and Voice Disorders Neurologic Disorders • Vocal fold Paralysis

  36. Larynx and Voice Disorders Respiratory Disorders • Vocal fold Nodules • Vocal fold Cysts • Vocal fold Polyps

  37. Larynx and Voice Disorders Respiratory Disorders • Vocal fold Nodules • Vocal fold Cysts 3. Vocal fold Polyps

  38. Larynx and Voice Disorders Respiratory Disorders • Vocal fold Nodules • Vocal fold Cysts • Vocal fold Polyps

  39. Larynx and Voice Disorders GI Disorders • Gastro-esophageal Reflux (Diffuse erythema and interarytenoid hypertrophy)

  40. Larynx and Voice Disorders Pregnancy Disorders • PyogenicGranuloma develops on the arytenoid vocal process.

  41. Larynx and Voice Disorders Muscular Disorders • Muscle Tension Disorders (false folds close) 2. Spasmodic Dysphonia (Diane Rehm)

  42. Larynx and Voice Disorders Congenital Disorders • Laryngomalacia • Laryngeal web • Laryngeal clefts

  43. Larynx and Voice Disorders Congenital Disorders • Laryngomalacia • Laryngeal web 3. Laryngeal clefts

  44. Larynx and Voice Disorders Congenital Disorders • Laryngomalacia 2. Laryngeal web 3. Laryngeal clefts

  45. Larynx and Voice Disorders Perinatal Disorders • Sub-glotticstenosis after intubation of a neonate

  46. Larynx and Voice Disorders Ill-defined conditions • Stridor Non-organic causes with normal exam

  47. Larynx and Voice Disorders Injuries • Fractures 2. Wounds 3. Foreign Bodies • Chemical Burns • Toxic Medications • Anaphylactic Rxns. • Intubation Trauma

  48. Larynx and Voice Disorders Injuries • Fractures • Wounds • Foreign Bodies • Chemical Burns • Toxic Medications • Anaphylactic Rxns. • Intubation Trauma Chicken bone on left side of larynx

  49. Larynx and Voice Disorders Injuries • Fractures • Wounds • Foreign Bodies • Chemical Burns • Toxic Medications • Anaphylactic Rxns. • Intubation Trauma

  50. Larynx and Voice Disorders Injuries • Fractures • Wounds • Foreign Bodies • Chemical Burns • Toxic Medications • Anaphylaxis • Intubation Trauma

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