Overview of Laryngeal Disorders

By Clarence T. Sasaki, MD, American Laryngological Association;Dysphagia;Yale University School of Medicine

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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version

Laryngeal Disorders
Overview of Laryngeal Disorders
Benign Laryngeal Tumors
Laryngitis
Laryngoceles
Spasmodic Dysphonia
Vocal Cord Paralysis
Vocal Cord Polyps, Nodules, and Granulomas
Laryngeal Contact Ulcers

The larynx contains the vocal cords and serves as the opening to the tracheobronchial tree. Laryngeal disorders include

Other disorders that affect the larynx include acute laryngotracheobronchitis (croup), epiglottitis, and laryngomalacia (see Table Some Causes of Stridor). For removal of a foreign body via the Heimlich maneuver, see Clearing and Opening the Upper Airway.

Most laryngeal disorders cause dysphonia, which is impairment of the voice (see The Professional Voice). A persistent change in the voice (eg, > 3 wk) requires visualization of the vocal cords, including their mobility. Although the voice changes with advancing age, becoming breathy and aperiodic, acute or prominent changes in the elderly should not be presumed to result from aging, and evaluation is required.

The voice should be assessed and recorded, particularly if surgical procedures are planned. Examination of the larynx includes external inspection and palpation of the neck and internal visualization of the epiglottis, false cords, true cords, arytenoids, pyriform sinuses, and subglottic region below the cords. Internal visualization is accomplished by either indirect mirror examination (see Figure: Laryngeal disorders) or direct flexible fiberoptic laryngoscopy in an outpatient setting with a topical anesthetic. Rigid laryngoscopy with the patient under general anesthesia provides the most thorough examination of the vocal cords, including

Visualization of the undersurfaces
Assessment of passive mobility when immobilized by either paralysis or fixation
Biopsy

Laryngeal disorders

When relaxed, the vocal cords normally form a V-shaped opening that allows air to pass freely through to the trachea. The cords open during inspiration and close during swallowing or speech. When a mirror is held in the back of a patient’s mouth, the vocal cords can often be seen and checked for disorders, such as contact ulcers, polyps, nodules, paralysis, and cancer. Paralysis may affect one (unilateral) or both vocal cords (bilateral—not shown).

When relaxed, the vocal cords normally form a V-shaped opening that allows air to pass freely through to the trachea. The cords open during inspiration and close during swallowing or speech. When a mirror is held in the back of a patient’s mouth, the vocal cords can often be seen and checked for disorders, such as contact ulcers, polyps, nodules, paralysis, and cancer. Paralysis may affect one (unilateral) or both vocal cords (bilateral—not shown).

The Professional Voice

People who use their voice professionally for public speaking and singing often experience voice disorders manifesting as hoarseness or breathiness, lowered vocal pitch, vocal fatigue, nonproductive cough, persistent throat clearing, and/or throat ache. These symptoms often have benign causes, such as vocal nodules, vocal fold edema, polyps, or granulomas. Such disorders are usually caused by vocal fold hyperfunction (excessive laryngeal muscular tension when speaking) and possibly gastroesophageal reflux. Treatment in most cases includes the following: Voice evaluation by a speech pathologist or experienced physician, including, when available, use of a computer-assisted program to assess pitch and intensity and to determine parameters of vocal acoustics Behavioral treatment (decreasing musculoskeletal laryngeal tension when speaking) using a computer program for visual and auditory biofeedback A vocal hygiene program to eliminate vocally abusive behaviors, such as excessive loudness, long duration (continuous speech for > 1 h), vocal tension (excessive muscular strain during phonation), and habitual throat clearing An antireflux regimen, when appropriate Adequate hydration to promote an adequate glottal mucosal wave Diet and behavioral modification before vocal performances, which may include avoidance of alcohol, caffeine, and ambient tobacco smoke and other inhaled irritants

People who use their voice professionally for public speaking and singing often experience voice disorders manifesting as hoarseness or breathiness, lowered vocal pitch, vocal fatigue, nonproductive cough, persistent throat clearing, and/or throat ache. These symptoms often have benign causes, such as vocal nodules, vocal fold edema, polyps, or granulomas. Such disorders are usually caused by vocal fold hyperfunction (excessive laryngeal muscular tension when speaking) and possibly gastroesophageal reflux.

Treatment in most cases includes the following:

Voice evaluation by a speech pathologist or experienced physician, including, when available, use of a computer-assisted program to assess pitch and intensity and to determine parameters of vocal acoustics
Behavioral treatment (decreasing musculoskeletal laryngeal tension when speaking) using a computer program for visual and auditory biofeedback
A vocal hygiene program to eliminate vocally abusive behaviors, such as excessive loudness, long duration (continuous speech for > 1 h), vocal tension (excessive muscular strain during phonation), and habitual throat clearing
An antireflux regimen, when appropriate
Adequate hydration to promote an adequate glottal mucosal wave
Diet and behavioral modification before vocal performances, which may include avoidance of alcohol, caffeine, and ambient tobacco smoke and other inhaled irritants