Vocal Fold Mucosal Injury Quiz

Vocal Fold Mucosal Vibratory Injury

• Two main risk factors for vocal fold mucosal vibratory injury:
  • High intrinsic tendency to use the voice (e.g., talkativeness, extroversion)
  • High extrinsic opportunity or necessity to use the voice (e.g., occupation, family needs, social activities)
• Vocal fold lesions may not cause audible changes in the speaking voice.
• Visible vocal fold lesions causing phonatory mismatch or mucosal stiffness lead to noticeable changes in the singing voice.
• Singing voice symptoms of mucosal injury include:
  • Inability to sing softly at high pitches
  • Increased day-to-day variability in singing voice capabilities
  • Phonatory onset delays
  • Reduced vocal endurance
  • Sensation of increased effort
• Small or subtle vocal fold lesions may be missed unless the larynx is examined with high magnification
• Brief initial speech pathology evaluation and treatment are recommended for vocal fold injury due to overuse, misuse, or abuse.
• Speech therapy may be sufficient if the vocal improvement meets the patient's needs, otherwise, it serves as preparation for vocal fold microsurgery.
• Successful vocal fold microsurgery requires:
  • Detailed knowledge of vocal fold microarchitecture and vibratory physiology
  • Proven technical ability of the surgeon
  • Preoperative and postoperative laryngeal videostroboscopy examination to diagnose clearly at the initial presentation and after surgery
  • Access to voice-qualified behavioral (speech pathology) support

Capillary Ectasia

• Can be an incidental finding that may not require treatment.
• Surgical intervention may be indicated if it causes:
  • Decreased vocal endurance
  • Intermittent bruising
  • Hemorrhagic polyp

Contact Ulcers and Granulomas

• Seen as exuberant healing responses to injury including:
  • Aggressive chronic throat clearing
  • Aggressive coughing
  • Endotracheal tube injury
• Acid reflux may contribute
• Treatment is supportive with waiting for maturation, pedunculation, and spontaneous detachment.
• Surgical removal often leads to recurrence.

Saccular Cysts

• Marsupialization of saccular cysts is sometimes followed by recurrence
• Complete removal of saccular cysts is preferred.
• Large ones can often be removed endoscopically.

Recurrent Respiratory Papillomatosis

• Caused by the human papillomavirus
• Treatment involves careful serial laser laryngoscopic treatment with consideration of various adjuvant medications.

Vocal Fold Movement

• Vocal folds move between abducted and adducted positions for breathing and phonation, respectively.

Mucosal Vibration

• The mucosa, which covers the vocal folds, is the primary part that vibrates during phonation.
• Phonation occurs when the vocal folds are adducted and air from the lungs flows through them.
• The mucosa is composed of the epithelium and the superficial layer of the lamina propria (Reinke's potential space).

Canine Study Findings

• A study on canines placed metal pellets at different depths within the vocal fold to track their movement during vibration.
• The pellets placed in the mucosa showed wider trajectories compared to those in the ligament or muscle.
• This study supports the idea that it is mainly the vocal fold mucosa that vibrates to produce sound.

Test your knowledge on vocal fold mucosal vibratory injury, including risk factors, symptoms, and effects on singing voice. This quiz covers essential aspects such as vocal fold lesions, their impacts, and the importance of early evaluation and treatment. Ideal for those interested in speech pathology and vocal health.