Current Diagnosis and Treatment of Voice Disorders

Current Diagnosis and Treatment of Voice Disorders
Presentation by:Seth H. Dailey, MD
Assistant Professor
University of Wisconsin Hospital and Clinics
University of Wisconsin School of Medicine
Internal Medicine Grand Rounds:February 28th, 2007

Laryngeal Anatomy
* Three surrounding structures- pharynx, trachea and esophagus
* Three levels - supraglottis, glottis and subglottis
* Three fixed structures - hyoid, thyroid and cricoid
* Three mobile structures -epiglottis, false vocal cords and true vocal cords (folds)

Laryngeal Physiology
* Three main functions - airway, swallowing and voice
* Three criteria for voice- generator, vibrator resonator
* Three components for high quality glottic voice - closure, pliability and symmetry

Common disorders affect the “magic three”
* Closure - neuromuscular, joint, vocal fold
* Pliability - “golden layer” - mass, scar
* Symmetry - tension and viscoelasticity
* VOICE DISORDERS ARISE FROM A COMBINATION OF THESE ELEMENTS

Evaluation of Hoarseness
* History is paramount
* Projection - tired, breathy and low volume
* Quality - ”hoarse”, “gruff”, “raspy”
* Range - high, middle and low
* Physical Exam
* Speaking voice
* Range profile
* Fundamental Frequency – F0
* Maximum Phonation Time
* Standard Reading Passages
* Singing if appropriate – local, regional, bodywide
* Voice Lab – Acoustics and Aerodynamics
* Endoscopic exam –
* mirror, flexible endoscope, rigid endoscope
* Digital archiving essential for documentation
* Studies
* CT scan – evaluation of course of RLN
* EMG – 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.
* Studies – the future….
* Aerodynamics and acoustics – Chaos theory and mathematical modeling
* Vocal cord motion – gross arytenoid motion being evaluated endoscopically
* Vocal cord pliability – endoscopic rheometers and vocal fold oscillators
* Ocular Coherence Tomography/Ultrasound

Normal Stroboscopy
Neuromuscular Disorders
Vocal Cord Paralysis
Vocal Cord Paresis
Medialization Thyroplasty
Adduction Arytenopexy
Glottal Incompetence
Medialization Thyroplasty
Cricoarytenoid Joint Dysmobility
Hyperfunction – a.k.a. MTD
Epithelial Diseases
Vocal Cord Papilloma
Vocal Cord Keratosis with Atypia
Vocal Cord Cancer
Subepithelial Diseases
Vocal Cord Nodules
Vocal Cord Polyp
Vocal Fold Cyst
Reinke’s Edema
Vocal Fold Scar
Vocal Cord Sulcus
Vocal Cord Inflammatory Diseases
Arytenoid Granuloma
Summary

Current Diagnosis and Treatment of Voice Disorders