C. Richard Stasney M.D. F.A.C.S., Director

Centers of Excellence

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Diseases of the Larynx

This is an example of a normal larynx. The true vocal folds are pearly white, they meet in the midline on phonation, and the surrounding structures are light pink. As you view the following examples of diseases of the larynx, you can compare them to this example.

Nodules are calluses on the vocal folds that occur with improper voice use or overuse. They are most common in children and females.They prevent the vocal folds from meeting in the midline and thus produce an hourglass deformity on closure resulting in a raspy, breathy voice. Most times these will respond to appropriate speech therapy. Occasinally (20% of the time) these may persist after intensive speech therapy and require meticulous microlaryngeal surgery.

Polyps are benign lesions of the larynx, occuring mostly in adult males, that are usually located on the phonating margin (edge) of the vocal folds and prevent the vocal folds from meeting in the midline. Polyps can interfere with voice production and may produce a hoarse, breathy voice that tires easily. These may respond to conservative medical therapy and intensive speech therapy. If the lesion fails to respond, meticulous microsurgery may be indicated. One of the cofactors in the etiology of these lesions may be laryngeal reflux disease.

This is an example of a patient who has acid reflux into the larynx (laryngopharyngeal reflux disease, or LPRD). The larynx is red and swollen. This patient also has leukoplakia, which is a premalignant white growth on the vocal folds. The picture on the left is the first examination, and the picture on the right was taken after just six weeks of medical treatment for LPRD. Notice that the changes on the vocal folds have been reversed, and the redness has subsided dramatically.

Presbylaryngis is a condition that is caused by thinning of the vocal fold muscle and tissues with aging. The vocal folds have less bulk than a normal larynx and therefore do not meet in the midline. As a result, the patient has a hoarse, weak, or breathy voice. This condition can be corrected by injection of fat or other material into both vocal folds to achieve better closure.

Laryngitis sicca is caused by inadequate hydration of the vocal folds. Thick, sticky mucus prevents the folds from vibrating in a fluid, uniform manner.

This is an example of a very early cancer of the vocal folds. If these lesions are detected early, they can be treated with either radiation or surgery, with a cure rate approaching 96%.

Vocal fold hemmorhage is a very rare occurrence that usually is caused by aggressive or improper use of vocal folds (e.g. cheerleading). It is a result of rupture of a blood vessel on the true vocal fold, with bleeding into the tissues of the fold.

Vocal fold paralysis has many causes, and leaves the patient with a very breathy voice, and sometimes with no voice. Thyroplasty is a surgery to correct the gap and restore usable voice. This picture is an example of a patient with vocal fold paralysis before and after thyroplasty. Note the improvement in closure of the vocal folds.

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