Objective Measures of Phonatory Function
This terminology is used widely to refer to machine-made measures of acoustic, aerodynamic, and electroglottographic output of the voice. At our practice we use quotes around the term objective because, for several basic reasons, these measures are not as objective as they are given credit for. First, the result of such measures may vary markedly with seemingly small changes in voice production, within the same voice. Second, the measures may be entirely non-specific to any particular diagnosis or condition. In other words, one might have the same or highly similar jitter, shimmer, and aerodynamic measures for any one of several completely different diagnoses, e.g., vocal cord cancer, vocal cord paralysis, vocal cord bowing, nonorganic voice disorder, and so forth.
Obligatory falsetto is part of the phenomenology often seen with vocal cord paralysis, or in the early days to weeks following a laryngeal Botox™ injection. Regardless of effort or skill level, the individual cannot get the voice to phonate in other than falsetto register; hence, “obligatory falsetto.”
The olympic button is a self-retaining “mini-trach” device that requires no ties or dressings, used in individuals who are not technically tracheotomy-dependent but who may need a “back door” to breathe through on an intermittent basis. Examples include individuals with marginal airways who are functional with plugged Olympic button through the day but whose airway further collapses during sleep at night. In such a case, the plug is removed from the Olympic button only at night.
Onset delay is the phenomenon of slight delay from the moment of intended phonation until sound actually commences. Often there is a faint hiss of air heard before the start of vocal cord vibration.
Open Epidermoid Cyst
An open epidermoid cyst occurs when it spontaneously ruptures, but yet not empty all of its contents (keratin). The outline of the partially-emptied cyst may still be very evident, but it usually assumes an oval shape with the long axis oriented anteriorly and posteriorly. If the cyst empties nearly completely, the white oval is no longer seen, but the vocal cord may have a mottled appearance. If the cyst empties completely, a sulcus lined by epithelium remains.
Photos of open epidermoid cyst:
White Lesion on Right Vocal Cord (1 of 6)
This young man is known as vocally exuberant. For some years, he has used his voice socially to the point of hoarseness countless times, including at heavy metal rock concerts. In the past year or so, his hoarseness never went away. In this distant view, a white lesion is seen on his right vocal cord (left of photo).
White Lesion Under Strobe Light (2 of 6)
Under strobe light and with higher magnification, the open phase of vibration shows this lesion as a white nubbin protruding from a fossa.
White Lesion Under Strobe Light (3 of 6)
The closed phase of vibration shows more clearly the depression from which the lesion is protruding.
White Lesion Removed (4 of 6)
After surgical removal and healing, voice is improved though not fully restored. The lesion was granulation and keratosis. It was plucked from the depression without deepening the pre-existing “divot.”
Vocal Cords (5 of 6)
At the open phase of vibration, showing the trough from which the lesion was removed. There is a smaller depression on the left also consistent with vibratory trauma.
Capillary ectasia and white submucosal abnormality (1 of 3)
Left vocal cord (right of photo) has not only overlying capillary ectasia, but a white submucosal abnormality.
Hoarse voice (1 of 4)
A young woman with a history of repeated loud cheering during athletic activities, to the point of hoarseness. She has a sulcus of the right cord (left of photo), and an open cyst of the left (right of photo). Openings from sulcus and cyst are indicated by dotted lines.
Cyst + sulcus (2 of 4)
Narrow band light. The lateral lip of a sulcus is often bordered by a prominent capillary as seen here. An open cyst assumes an elliptical shape in the anteroposterior direction. It fails to empty completely because the opening draining it is smaller than the diameter of the cyst.
Margin swelling (1 of 6)
Breathing position of the vocal cords of a very hoarse actor. Note the margin swelling of both sides. The white material on the left vocal cord (right of photo) is keratin debris emerging from an open cyst. Find the sulcus of the right vocal cord (left of photo) which is more easily seen in the next photo.
Narrow band light (2 of 6)
Further magnified and under narrow band light. The right sulcus is within the dotted outline. Compare now with photo 1.
Open phase, strobe light (3 of 6)
Under strobe light, open phase of vibration at A3 (220 Hz). The full length of the cords participate in vibration.
Closed phase, same pitch (4 of 6)
At the same pitch, the closed phase again includes the full length of the cords.
Segmental vibration (5 of 6)
At the much higher pitch of C5 (523 Hz) a “tin whistle” quality is heard and only the anterior segment (at arrows) is opening for vibration. The posterior opening is static and not oscillating, as seen in the next photo.
Chronic hoarseness (1 of 4)
This woman suffers from chronic hoarseness. Note the relatively normal left vocal cord (right of photo) but that the right side has a whitish lesion at the margin. Equally important is the faint white submucosal collection of keratin indicated by dotted line.
Cyst under narrow band light (2 of 4)
Under narrow band light, the arrow indicates the sulcus opening that allows what was likely an epidermoid cyst to partially empty.
Closed phase (3 of 4)
Under strobe light, closed phase also shows a slight “divot” at the opening into the presumed collapsed cyst.
Short form for otorhinolaryngologist, an otolaryngologist is the official name of an ear, nose, and throat (ENT) physician.
Outpatient surgery is surgery done in a day center, or in the day surgery section of a hospital where the patient is not expected to stay overnight. Most often, the patient reports early the morning of surgery for admission to the hospital, has the procedure done, and then departs from recovery room to home.