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organic voice disorders 2. - Contact ulcers(granulomas) -Reflux - Webbing. topics. Contact Ulcers( granulomas ). Cause/etiology Hard glottal attack along with throat clearing and coughing Laryngopharyngeal reflux (most common cause) Postnasal drip Endotracheal intubation
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-Contact ulcers(granulomas) -Reflux -Webbing topics
Cause/etiology • Hard glottal attack along with throat clearing and coughing • Laryngopharyngeal reflux (most common cause) • Postnasal drip • Endotracheal intubation • Surgery on the VFs • Teflon granuloma of the larynx • Removal of cysts 1、Contact Ulcers (granulomas)
Segmentation of VFs • The anterior two - thirds • Muscle - vocalis portion of the thyroarytenoids • Menbrane • Posterior third • Arytenoids • Menbrane 1、Contact Ulcers (granulomas)
Location • Medial aspect of the vocal processes of the arytenoid cartilages • Bilateral (mostly) • Typical symptoms • Vocal fatigue - after prolonged vocalization • Hoarseness or roughness • Pain in laryngeal area or/and one ear 1、Contact Ulcers (granulomas)
1、Contact Ulcers (granulomas) Contact ulcers with granulomas
Treatments 1、Contact Ulcers (granulomas)
Treatments 1、Contact Ulcers (granulomas)
The focus of voice therapy • Elevate pitch • Greater mouth and jaw relaxation • Lower level of volume • Eliminate all traces of excessively hard glottal attack 1、Contact Ulcers (granulomas)
Attention • If surgical revision of the larynx has resulted in a better voice, and then months or years afterwards the voice deteriorates, the larynx should be reexamined using endoscopy or stroboscopy in order to identify possible reactive granuloma 1、Contact Ulcers (granulomas)
Location • Lower esophageal sphincter • Upper esophageal sphincter • Types • GERD - Gastroesophageal reflux disease • LPR or EER- Laryngopharyngeal reflux or Extraesophageal reflux 2、Reflux
Symptoms 2、 Reflux
Examinations 2、 Reflux
Treatments 2、 Reflux
Behavioral therapy • Elevating the head of the bed • Remaining upright at least 60 mins after meals • Avoid spicy food • No exercise after eating • Cutting down caffeine, carbonated drinks and alcohol, esp afternoon and evening 2、 Reflux
Behavioral therapy • Don’t drink too much water right before bed • No activities that compress the abdomen • Weight loss • Wearing looser clothing around the waist • Eliminating smoking 2、 Reflux
Pharmacy • PPI (proton - pump inhibitor 质子泵抑制剂) • Prokinetic agent 胃肠蠕动促进剂 • Surgery • Surgical laparoscopic fundoplication (腹腔镜下胃底折叠术) 2、 Reflux
Types • Congenital • Acquired • Cause/etiology • Chromosome 22q deletion - Congenital • Bilateral trauma of the medial edges of the VFs – Acquired • Bilateral surgery (laryngeal or tracheal) • External trauma 3、Webbing
Location • Anterior one-third of VFs (mostly) • Typical symptoms • High - pitched rough sound • Shorter length of VFs • Shortness of breath • Seriously compromising the open glottis 3、Webbing
3、Webbing Webbing
Examinations 3、Webbing
Treatments 3、Webbing