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Laryngopedia

To educate about voice, swallowing, airway, coughing, and other head and neck disorders

Laryngopedia By Bastian Medical Media

Multimedia Encyclopedia


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Bacterial Laryngitis (can be acute or chronic)

Bacterial laryngitis is an infection of the vocal cord mucosa by bacteria (not a virus or fungal organism). During this infection, mucus produced in the larynx is usually colored yellow, green, or brown. This can occur in any person as an acute, self-limited infection. It typically resolves on its own with supportive measures like hydration and relative voice rest. If the patient’s laryngitis continues unabated more than 5 days or so, or if there is a critical need for voice (such as for an upcoming performance), antibiotics can be prescribed. Definitive resolution of chronic bacterial laryngitis is more difficult.

Chronic Bacterial Laryngitis

Chronic bacterial laryngitis is seen in persons who have undergone radiotherapy or who have an immune defect. The laryngitis can often be improved with antibiotics, and hydration, when dryness is part of the problem. It often recurs when antibiotics are discontinued. Sometimes chronic antibiotic administration is needed. Or, motivated patients may learn how to do laryngeal irrigations.
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Bacterial infection? (1 of 5)

This young man has an autoimmune disorder and is taking a immunomodulator drug. He has been chronically hoarse for months. Is this further auto-immunity or a chronic bacterial infection?

Yellow mucus (2 of 5)

Notice yellowish mucus in the subglottis and the intense erythema of the subglottis. Culture shows staph aureus.

Improvement (3 of 5)

After several weeks of dicloxacillin, voice is dramatically improved, as is the laryngeal appearance (compare with photo 1).

Improved voice (4 of 5)

During voicing, excellent vibratory blur, correlating with his much improved voice.

Infection returns (5 of 5)

Some months after discontinuing antibiotics, hoarseness has returned along with infected mucus.


Bilateral Vocal Cord Fixation

Immobility of both vocal cords due to a scarring rather than paralytic cause. The scarring might manifest as a synechia that tethers the vocal cords to each other and prevents them from separating during breathing. Or it could mean that both cricoarytenoid joints are ankylosed, or “frozen.”

The most common cause of bilateral vocal cord fixation is prolonged endotracheal intubation, such as in gravely ill or injured persons, who may spend weeks in an intensive care unit and on a ventilator. Vocal cord fixation can rarely be caused by rheumatoid arthritis. It is also seen infrequently as a progressive, late complication of radiation therapy for larynx cancer.


Photos:

Bilateral vocal cord fixation: Series of 2 photos

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keyhole shaped glottis

Bilateral vocal cord fixation (1 of 2)

After bilateral posterior cordotomies, “keyhole” shaped glottis. Size of opening at posterior commissure is exaggerated by the wide-angle lens of the distal-chip video-endoscope.
Bilateral vocal cord fixation

Bilateral vocal cord fixation (2 of 2)

Persistent posterior opening, but musculomembranous cords come into good contact and have not been damaged by either the original endotracheal tube or the posterior cordotomies, and voice is very serviceable.


Biopsy

Biopsy refers to both the process of removing a bit of tissue from a person so that it can be studied and “diagnosed” by the pathologist, and also to the piece of tissue itself. “The surgeon biopsied (verb) the vocal cord and then sent the biopsy (noun) to the pathologist for examination under the microscope.”


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2-millimeter forceps being used to scrape the area of leukoplakia

HIV Testing (1 of 2)

2-millimeter forceps being used to scrape the area of leukoplakia to retrieve cells for HPV testing. In this case, it was negative.
scraping of the surface of the cords

Biopsy (2 of 2)

Cup forceps closed. Note that there is no biopsy, per se, but just scraping of the surface of the cords.

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Biopsy of lesion involving the petiole

Biopsy, epiglottis (1 of 1)

Biopsy of lesion involving the petiole (low laryngeal surface of epiglottis). The pathology report revealed squamous cell carcinoma, usually caused by smoking.

Biopsy of early vocal cord cancer

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diffusely abnormal-looking tissue on his vocal cords

Chronic hoarseness (1 of 3)

Examination of this man for chronic hoarseness reveals diffusely abnormal-looking tissue on his vocal cords. The area on the upper surface of the right vocal cord (enclosed in dotted circle) appears to be most likely to be diagnostic. Note the bulk, and aberrant blood vessels.
biopsy

Just before biopsy (2 of 3)

A 2 millimeter cup forceps has been passed through a channel scope and is planted on this area in open position, just before the biopsy.
biopsy finds cancer

Cancer finding (3 of 3)

Cup forceps have now been closed to encompass a small fragment of tissue. The pathologist’s answer after looking at this sample under the microscope: cancer


Botox™

Botox™, the trade name of botulinum toxin, is a drug produced by the same bacterial organism (Clostridium botulinum) that causes the disease process called botulism. Tiny, entirely safe quantities of this medication have been used for decades to treat strabismus, facial spasms, spasmodic dysphonia, cervical dystonia, and other neurological disorders characterized by abnormal muscle contractions. Botox is also used by cosmetic surgeons to smooth wrinkles temporarily.



Botulinum Toxin

See Botox.



Breathing Tube Injury: Synechiae

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Vocal cords

Breathing Tube Injury (1 of 4)

Some weeks after a 3-day intubation for a nonorganic breathing problem, some ongoing (and different) breathing symptoms are caused by a synechiae that will not permit full abduction of the vocal cords. The * allows comparison with photo 2.
post-intubation synechiae

Breathing Tube Injury (2 of 4)

Extremely close visualization of the post-intubation synechiae (* to orient with photo 1). Note the opening posterior to the synechiae indicated by the arrows. This makes it less likely that there is a concomitant ankylosis (fixation) of either cricoarytenoid joint.
corrected vocal cords

Breathing Tube Injury (3 of 4)

Several months after surgical release of the synechiae, notice that abduction of the vocal cords again makes a normal, wide-open “v.” Compare with photo 1 to see this clearly.
Closer visualization of the posterior commissure

Breathing Tube Injury (4 of 4)

Closer visualization of the posterior commissure shows evidence of scar at the left base of the synechia. This could be easily overlooked if the patient’s history were not known.

 



Breathy Dysphonia

Breathy dysphonia is a kind of hoarseness caused by “wasting” of air through the glottis (vocal cord level). Also called air-wasting dysphonia. The voice may also be described as whispery, foggy, or fuzzy.



Breathy-pressed phonation or dysphonia

Breathy-pressed phonation or dysphonia is an easily identified dysphonia that combines two phenomenologies – audible muscular effort + a breathy, air-wasting quality. The classic disorder in which this is noted is severe intubation injury.



Bronchoscopy

Bronchoscopy is a procedure during which the examiner looks inside the trachea and bronchial tubes, typically using a slender, flexible fiberoptic or videoscope. At our practice, this procedure is usually performed using topical anesthesia with or without sedation, “in the chair” rather than in a hospital setting.



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