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Data and Picture Interpretation Stations: Cases 1–45
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
Unilateral vocal cord paralysis presents with dysphonia (often breathy voice), dysphagia and shortness of breath. It can result from direct trauma to vocal cord (such as intubation) or secondary to damage to the recurrent laryngeal nerve e.g. by cancer, trauma or surgery. The recurrent laryngeal nerve arises from vagus nerve and courses from the brainstem through the neck and chest. Diagnosis is usually made with clinic based flexible nasendoscopy. A CT scan from the skull base to diaphragm covers the entire length of the recurrent laryngeal nerve and is an important investigation in establishing a diagnosis. Speech and language therapy can improve voice projection and pitch control. Voice quality can also be improved by surgical medialisation procedures including vocal cord injections, thyroplasty and in some instances laryngeal reinnervation procedures.
Pulmonary – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Dysphonia commonly occurs due to deposition of inhaled corticosteroid particles locally in the oropharynx, around the vocal cords, and local side effects such as oral candidiasis and hoarseness of voice may also develop. Use of a large volume spacer device and careful rinsing of the mouth after the use of inhaled corticosteroids reduces the risk of these local effects. Systemic side effects include bruising and atrophy of the skin, cataract formation, glaucoma and reduced bone mineral density. Suppression of the adrenocortical axis can occur with high-dose inhaled corticosteroids and specific advice on use of corticosteroid replacement therapy during intercurrent illness should be considered in patients who genuinely require long-term high-dose therapy. Systemic effects occur partly due to gastrointestinal absorption of swallowed particles and partly due to systemic absorption via the airways. The use of spacer devices, dry powder mechanisms and mouth rinsing after inhaler use minimise adverse effects. Another approach to minimise local side effects is to use Ciclesonide, a pro-drug which is activated by contact with the lower airway epithelium. Drugs with high first-pass metabolism in the liver such as budesonide and fluticasone have less systemic side effects than beclomethasone, but at high doses (>800–1,000 mcg daily of budesonide or >500 mcg daily of fluticasone) systemic absorption through the buccal and airway mucosa becomes increasingly important.
Voice Disorders and Laryngitis
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Laryngitis is a descriptive term indicating a degree of erythema, oedema, epithelial change that may include ulceration, leukoplakia, and/or stiffness of the mucosa of the vocal fold. Often there is an increased amount of thick mucus present. Most acute laryngitis is associated with upper respiratory tract infections. Chronic laryngitis has close links with smoking, alcohol, reflux, occupational exposures, social activities, allergies, and vocal/throat hygiene. The voice is usually hoarse (rough, strained, breathy, or whispery), which may be due to vocal fold stiffness from the inflammatory process and/or secondary to muscle tension imbalance. The majority of acute infections are self-limiting. Treatment of chronic laryngitis consists of voice hygiene (VH) with reduced use/abuse and rest.
Acoustic parameter changes after bariatric surgery
Published in Logopedics Phoniatrics Vocology, 2022
Fakih Cihat Eravci, Barış Doğu Yildiz, Kürşat Murat Özcan, Münevver Moran, Mustafa Çolak, Süleyman Emre Karakurt, Mehmet Fatih Karakuş, Aykut Ikinciogullari
The voice is used as a vital tool for communication and is another fingerprint in social life representing the individual with its unique characteristics, and many use the voice in professional life. The voice is produced by the larynx with the motor power of airflow generated by the lungs. After the production of the voice, all the upper levels of the airway path contribute to the acoustic characteristics. Therefore, the supralaryngeal vocal tract size and configuration is a determinative factor in the features of the voice [6]. Changes in any part of the voice production process (i.e. the lung capacity, laryngeal tract, and supralaryngeal vocal tract) result in differences in voice characteristics. Changes in the length and shape of the vocal tract, or height and position of the tongue can result in changes especially in formant frequencies in the acoustic analysis [7].
The effect of nasal septum deviation on voice aging
Published in Logopedics Phoniatrics Vocology, 2022
Ceren Ersoz Unlu, Ozlem Akkoca
The voice often reflects a person’s age. We can often guess the approximate age of people when their voice is heard even if we do not see them. While the most prominent change in voice occurs during childhood, deterioration in the quality of voice is typically observed after the age of 50 years. The deterioration of the voice is the result of anatomical and histological changes in the larynx. Displacement of the larynx to a lower position in the neck with increasing age affects the resonance of the voice. Ossification of laryngeal cartilages decreases the elasticity of the larynx. Vocal fold bowing due to the aging process is responsible for increased breathiness and reduced volume of the voice, which is largely attributable to vocal muscle atrophy [1]. Changes in the structure of the lamina propria such as increase in collagen fibers (especially mature type I fibers) and elastin (but elasticity properties diminish) and a decrease in hyaluronic acid affect the vibratory properties of the vocal folds [2,3]. Decrease in epithelial thickness and salivary gland function also have an effect on the aging voice. However, voice changes associated with aging are often masked by submucosal edema in women and voice characteristics of aging differ in both genders [1].
Voice evaluation – contribution of the speech-language pathologist voice specialist – SLP-V: part A. History of the problem and vocal behaviour data, self-assessment and auditory perceptual judgement
Published in Hearing, Balance and Communication, 2021
Mara Behlau, Glaucya Madazio, Thays Vaiano, Claudia Pacheco, Flávia Badaró
The human voice is a product perceived aurally, which immediately impacts the relationship with the listeners. Its production complexity involves three brain systems: innate vocalizations, emotional vocalizations, and highly sophisticated and volitional vocalizations, such as singing [1]. In addition, the phonation depends on a balance of aerodynamic (subglottic pressure and trans-lingual flow) and muscle forces (with highly developed interdependence and synergy). A third important aspect is the active participation of the mucosa that covers the vocal folds, a multi-laminated vibrator with different mechanical properties. Although animal vocalisation is impressive, with an open-ended, highly modifiable, and cognitively rich set of meanings [2], the use of voice by human beings is unique. It encompasses physical survival, professional exercise, cultural manifestation, and above all, identity. Therefore, having a normal voice is critical for human development. A voice disorder, called dysphonia, is usually characterised by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life [3]. Dysphonia can significantly impact different aspects of an individual’s life and deserves to be recognised, evaluated, and treated.