Laryngeal Cancer

Laryngeal Cancer
Presentation by:Anh Q. Truong
University of Washington, SOM

Anatomy
Anatomy – subdivision
Incidence by Site
Supraglottic
Glottic
Subglottic
Epidemiology
Risk Factors
* Signs and symptoms
Clinical Presentation
* Physical Exam
o Complete head and neck exam
+ Palpation for nodes; restricted laryngeal crepitus.
o Quality of voice
+ Breathy voice = cord paralysis
+ Muffled voice = supraglottic lesion
o Laryngoscopy
+ Laryngeal mirror
+ Fiberoptic exam (lack depth perception)
+ Note: contour, color, vibration, cord mobility, lesions.
o Stroboscopic video laryngoscopy
+ Highlights subtle irregularities: vibration, periodicity, cord closure
Differential Diagnosis
* Infectious
* Inflammatory
* Granulomatous disease (TB, sarcoidosis)
* Papillomatosis
* Lymphoma
Imaging
* CT or MRI
* PET
* Ultrasound
Biopsy and Histology
* Glottis
* Subglottis
Staging
* Nodes
* Mets
Stage Grouping
Advanced stage
* Surgery
o Microlaryngeal surgery
o Hemilargyngectomy
o Supraglottic laryngectomy
o Near-total laryngectomy
o Total laryngectomy
* Photodynamic Therapy
* Radiation
* Chemothrapy
Treatments – Options
Treatment – Early Stage (I/II)
Dose Fractionation
Treatment – Advanced Stage (III/IV) – VA Study
Overall Survival
Treatment – Advanced Stage (III/IV) – RTOG 91-11 Study
Laryngeal Preservation
Concurrent chemoXRT
Anticipated Toxicities
Take Home Points
An Actual Picture of a Laryngeal Cancer

Laryngeal Cancer.ppt

Read more...

Speech Generation and Perception

Speech Generation and Perception

Schematic diagram of the human speech production
Organs of Speech :
* Lungs and trachea :
o source of air during speech.
o The vocal organs work by using compressed air; this is supplied by the lungs and delivered to the system by way of the trachea.
o These organs also control the loudness of the resulting speech.
o The trachea and lungs together constitute the pulmonary tract.
* The Larynx :
o This is a complicated system of cartilages and muscle containing and controlling the vocal cords. Principle parts are :
o The place where the vocal folds come together is called the glottis.
* The Vocal Tract :
o Laryngeal pharynx
o Oral pharynx
o Nasal pharynx
o Oral cavity
o Nasal cavity
Vocal Tract
Vocal Tract Model
A General Discrete-Time Model For Speech Production
Time Waveform Of Volume Velocity Of The Glottal Source Excitation
Magnitude Spectrum Of One Pulse Of The Volume Velocity At The Glottis
Position Of The Vocal Cords And Cartilages (a) For Phonation (b) For Whispering
Speech Production :
* The operation of the system is divided into two functions :
o Excitation
o Modulation
* Excitation :is done in several ways

Hearing and perception :
The structure of peripheral auditory system :
Sectional View Of The Human Ear
Hearing
The Cochlea as It Would Appear If Unwound
Cross Section Of One Turn Of The Cochlea
Position Of Maximum Amplitude Along Basilar Membrance As A Function Of Applied Frequency
Frequency Response Of a Point On The Basilar Membrance

Speech Generation and Perception.ppt

Read more...

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

Read more...