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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