Laryngopedia

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

Laryngopedia By Bastian Medical Media

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Saccular cyst

A closed sac originating from a formerly open and functioning laryngeal saccule. An analogy for a saccular cyst is a velvet bag used to hold coins which has its opening cinched shut by a drawstring. The mouth of the saccule becomes blocked, and mucus secreted within the saccule cannot escape through the normal opening in the anterior ventricle. This closed sac gradually expands, causing the false cord and aryepiglottic cord to bulge; the sac can further expand over the top of the thyroid cartilage and into the neck.


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Sarcoma

A malignant tumor that originates in mesenchymal tissue. Mesenchymal tissue comprises muscle, bone, fat, connective tissue, blood vessels, and cartilage. If, instead, a malignancy originates in lining or covering tissues—which includes skin, bronchial tubes, the lining of the mouth, throat, and gastrointestinal tract, and breast and salivary gland ducts—then that tumor is called a carcinoma.

Carcinomas are far more common than sarcomas, and sarcomas involving the larynx are rare, with chondrosarcoma (“chondro-” refers to cartilage origin) heading the list. The clinicians at our laryngology practice have seen hundreds of carcinomas in their career, but probably no more than 20 sarcomas.


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Scarring

Refers to fibrous tissue that remains after healing of an injury. In laryngology, leaving trauma out of the picture, scarring is most often seen in the context of surgery, radiation, or prolonged use of an endotracheal tube. If a wound is created, such as after removing a superficial vocal cord cancer, the tissue that results after complete healing is not as flexible as normal tissue would be; the scarred area typically does not vibrate well, or at all. Sometimes progressive fibrosis occurs after radiotherapy. It is thought that the reduced blood supply and lowered tissue oxygen level caused by radiation damage to microvasculature leads to the gradual replacement of tissue with fibroblasts, because they can tolerate lower tissue oxygen levels.



Secondary Gain

Advantage gained from holding on longer than necessary to an illness—be it organic or nonorganic. At our practice, the phenomenon of secondary gain is most commonly seen in nonorganic voice and breathing (tracheal or laryngeal) disorders. An example might be that a person consciously or subconsciously maintains “laryngitis” after the initial organic infection has resolved, for the secondary gain of being excused from school or work. In this case the loss of voice is “worth it” as compared with the “gain” achieved. The secondary gain may have to do with attention, avoiding a responsibility, punishing or controlling another person, or possibly other issues.



Sedation

Sedation is a state of reduced excitement or anxiety induced by the administration of sedative agents such as lorazepam (Ativan) and diazepam (Valium). At our practice, we occasionally administer lorazepam, given orally a couple of hours before a procedure, to allay anxiety.



Segmental vibration


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Sensory Neuropathic Cough

A chronic cough disorder that is thought to have a neurogenic cause. Sensory neuropathic cough (SNC)1 is also sometimes referred to as a cough caused by “laryngeal sensory neuropathy,” or is sometimes grouped within the more general category of “refractory chronic cough.”

Symptoms of sensory neuropathic cough:

A person with SNC may cough dozens to hundreds of times per day, often also waking up at night to cough. A few of these daily coughing attacks may become violent and last 30 seconds to several minutes. The person’s eyes may tear up and the nose may run; the person may gag or throw up; the person may leak urine, or worse; a few of our patients have even broken one or more ribs during a violent coughing attack.

A key characteristic of SNC is that a coughing attack is typically, though not always, preceded by an abrupt sensation in the throat; this sensation may be described as a “tickle,” a “sudden dry patch,” “like inhaling a powdered doughnut,” “dripping mucus,” or something else.

Possible explanation for sensory neuropathic cough:

SNC is thought to be a relative to neuralgia, like post-herpetic neuralgia (persistent pain long after an outbreak of shingles has resolved), or even diabetic neuropathy (“I feel bees stinging my feet”), except that the sensations felt by SNC patients are not painful. With SNC, it may be that the nerve endings in a person’s throat have become damaged, so that they “misfire” and cause this cough-provoking tickling or similar sensations.

Treatment for sensory neuropathic cough:

Many individuals with SNC have found relief through use of a neuralgia medication, such as amitriptyline,2, desipramine3, gabapentin4, pregabalin, oxcarbazepine, and others. These kinds of medications may help to reduce or abolish a person’s coughing by diminishing the nerve-ending “misfires” caused by SNC. In our experience, patients sometimes need to work through more than one of these neuralgia medication options, at varying dosage levels, before they arrive at a satisfactory degree of relief. Another treatment option that can be tried is capsaicin. For more about treatment, see our second video below.


Audio:

Interview with a sensory neuropathic cough patient:

Second interview with a different sensory neuropathic cough patient:

Sensory neuropathic coughing and throat clearing of 36 Years’ duration:

Fourth interview with a different sensory neuropathic cough patient:

SNC cough phenomenology: different than that of pneumonia, asthma, or acid reflux!

Note: Some aspects of these patient’s experiences are atypical; not every patient has the same experience with SNC.

Photos:






Videos:

Sensory Neuropathic Cough, Part I: Coughing That Won’t Go Away
Sensory neuropathic cough is a chronic cough condition that does not respond to the usual treatments. Many individuals who have been coughing for years find relief from treatment with “neuralgia” medications.
Sensory Neuropathic Cough, Part II: Medications
In this video, Dr. Bastian introduces potential medications to treat sensory neuropathic cough.

  1. Bastian RW, Vaidya AM, Delsupehe KG. Sensory neuropathic cough: a common and treatable cause of chronic cough. Otolaryngol Head and Neck Surg. 2006; 135(1): 17-21. 

  2. Jeyakumar A, Brickman TM, Haben M. Effectiveness of amitriptyline versus cough suppressants in the treatment of chronic cough resulting from postviral vagal neuropathy. Laryngoscope. 2006; 116: 2108-2112. 

  3. Bastian ZJ, Bastian RW. The use of neuralgia medications to treat sensory neuropathic cough: our experience in a retrospective cohort of thirty-two patients. PeerJ. 2015; 3:e816. 

  4. Ryan NM, Birring SS, Gibson PG. Gabapentin for refractory chronic cough: a randomized, double-blind, placebo-controlled trial. Lancet. 2012; 380(9853): 1583-9. 



Sensory Neuropathic Cough

Instructions:
Begin with the medication marked with the large “X.” If, over time, the first prescription fails to provide adequate benefit, you will of course let us know this during a phone or encrypted email followup communication. At that point, we would create a new prescription that you would pick up at your pharmacy. You will follow the same procedure, if necessary, for a third medication if the first two do not reduce cough sufficiently. (see Voice Mail and Portal Email Instructions, below).

_______ Option 1: Amitriptyline (Elavil) OR Desipramine (Norpramin): begin with 10 mg 2 hours before bed.

Notes:

1. If grogginess occurs, this often resolves if you persist in taking the medication for two weeks.
2. If you experience some response, but less than 80% reduction of your symptoms, please double to 20 mg. (2 pills) 2 hours before bed.
3. If there is still less than 80% reduction, you may increase step-wise up to 80 mg. (8 pills) 2 hours before bed.
4. If you have afternoon “breakthrough” coughing, you may try adding 10 or 20 mg (1 or 2 pills) at noon.
5. Please leave voicemail or encrypted email for your doctor 14 days after beginning,
as instructed below at *.

______ Option 2: Gabapentin (Neurontin): 300 mg (1 pill) at bedtime for 3 days; then 300 mg noon and bedtime for three days; then 300 mg breakfast, mid-afternoon and bedtime for 3 days; then breakfast, lunch, dinner, and bedtime (300 mg 4 times per day for a total of 1200 mg per day). You may increase slowly in like manner to as much as 600 mg (2 pills) four times a day, assuming side effects allow.

Notes:

1. You must “taper on” and “taper off” this medication as described above.
2. Side effects are dramatically different between individuals. Some experience none in spite of high dose; a few notice significant side effects with even one pill per day.
3. Main side effect is sleepiness, or a mild feeling of being “drunk.” Also occasionally swelling of feet.
4. To minimize side effects, take the medication with food.
5. If you cannot tolerate side effects, back off to the next lower dose and maintain until you are tolerating the medication well, then try to increase again by one pill.
6. Please leave voicemail or encrypted email for your doctor approximately 14 days after beginning, as instructed below at *.

______ Option 3: Citalopram (Celexa): Start at 20 mg (1 pill) every evening. After one week, increase to 2 pills (40 mg)

*Notes:

1. You must “taper on” and “taper off” this medication, and do not make sudden large changes in dose.
2. Main side effects include drowsiness and dry mouth.
3. Please leave a voicemail for your doctor 7-10 days after beginning, as instructed below.

*Voicemail Instructions:

Information we need from you each time you call/email:
a. Your name (Please spell).
b. Name of medication and how long you have been taking it.
c. Your current dose level.
d. What % reduction of symptoms you are experiencing.
e. Side effects, if any.
f. Daytime and evening phone numbers.
g. Any other comments you wish to make, or questions you have.

Sample Voicemail:
“This is John Doe, I’ve been on the amitryptyline 10 days. I increased to 50 mg (5 pills) each evening. My symptoms are diminished by 50%. Side effects are: ________________. My phone numbers are_______________ and _____________. I’d like to know what to do next.”



Sessile

Attached completely at the base and without an intervening stalk; the opposite of pedunculated.



Shattered vibration

Shattered vibration is a chaotic kind of vibration in which there may be several independent segments vibrating erratically to create a characteristic sound quality. May be seen, for example, in an individual who has vocal cords that are not symmetrical with respect to vocal cord mass, flaccidity, and tension, and that are not “of one piece” within themselves, so that a fold may have two different vibratory patterns within itself.



Shimmer

The cycle-to-cycle variability of the period amplitude of vocal cord vibration. Shimmer is used as one of the measures for the micro-instability of vocal cord vibrations. Given that shimmer may vary dramatically with changes of voice production within the same voice, and also that a given shimmer measurement is non-specific to any particular voice disorder, this measure is considered superfluous to the integrative diagnostic model. Shimmer is therefore not used routinely at our practice.



Silastic

A highly inert silicone rubber that has wide use for medical applications. The term silastic comes from the combination of the words silicone and plastic.

Laryngologists commonly place silastic implants into flaccid, paralyzed vocal cords in order to plump and firm them up so that they can serve as better partners to the non-paralyzed cord. See also: medialization laryngoplasty.


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Silent aspiration

Aspiration that does not provoke an expected, normal response of coughing or throat clearing. Silent aspiration suggests a very high risk of aspiration pneumonia.



Singing voice qualified

Singing voice qualified, when used to refer to a speech pathologist or physician, means that the clinician has personal knowledge of the expected phenomenology and capabilities of the voice, including those only encountered in the singing voice. Typically, this kind of qualification comes from personal voice training and singing experience on the part of the clinician.



Single modality treatment

Single modality treatment refers to a situation in which only one treatment modality is chosen from among several options available for that disease process. This is in contrast to combined modality treatment or even multi-modality treatment.



Siren

An uninterrupted sound that begins very low in a person’s vocal range and ascends to a very high pitch, sometimes the highest possible pitch that person can produce. A single siren could also go from low to high and back to low one or more times without interruption. A clinician might ask a patient to perform a siren during the vocal capability battery in order to assess pitch range capability or even vocal skill.



SLAD-R

SLAD-R (Selective laryngeal adductor denervation-reinnervation). This procedure was introduced by Dr. Gerald Berke of UCLA in the late 1990’s. It is a surgical option for adductory spasmodic dysphonia. The concept is to sever the anterior branch of the recurrent laryngeal nerve. This denervates the spasming laryngeal adductors (particularly thyroarytenoid and lateral cricoarytenoid muscles). The squeezed, strained quality and/ or “catching, cutting out, stopping” of the voice are replaced initially with an extremely breathy and weak voice. This initially weak voice is analogous to what one might sound like after a Botox injection that is far too high a dose. To return strength to the voice, a branch of the ansa cervicalis nerve that normally supplies some relatively “unimportant” neck muscles is anastomosed (connected) to the severed nerve. It takes 3 months to a year for tone to begin to return to the adductory muscles. Since the “unimportant” neck muscles were not affected by the dystonia, the hope is that the new nerve supply to the laryngeal muscles may not be affected by dystonia.


Photos:



Videos:

One Man’s Experience Over Time with SLAD-R
SLAD-R is a surgical alternative to ongoing “botox” injections for treatment of adductory spasmodic dysphonia. The surgery involves intentionally cutting the nerves that close the vocal cords for voice and reconnecting a different nearby nerve supply (reinnervating the nerves). This surgery requires the patient’s willingness to endure an extremely breathy voice for many months after the procedure, while awaiting reinnervation.


Smoker’s polyps

Diffuse swelling of the vocal cords, due to build-up of edema fluid within the mucosa. Smoker’s polyps are also referred to as Reinke’s edema or polypoid degeneration.


Audio with photos:

Voice sample of a patient with smoker’s polyps, BEFORE surgery (see this patient’s photos just below):

Same patient, two months AFTER surgery (the occasional syllable dropouts are due to the recentness of surgery):


Photos:









 


Videos:

Smoker’s Polyps (aka Polypoid Degeneration or Reinke’s Edema)
This video illustrates how smoker’s polyps can be seen more easily when the patient makes voice while breathing in (called inspiratory phonation). During inspiratory phonation, the polyps are drawn inward and become easier to identify.


Spasmodic Dysphonia: Definition and Treatments

A non-life-threatening neurological disorder in which the muscles of the larynx involuntarily spasm and interfere with the voice. Spasmodic dysphonia (SD) is a focal dystonia, in this case involving the larynx—i.e., laryngeal dystonia. Laryngeal dystonia typically affects the voice, but can occasionally also affect breathing (respiratory dystonia). The term spasmodic dysphonia refers specifically to voice-affecting laryngeal dystonia.

Adductor vs. abductor:

There are two main variants of spasmodic dysphonia (SD). In the first variant, adductor SD (AD-SD), the vocal cords are pressed together excessively, intermittently cutting off words or giving the voice a constant strangled quality; this variant comprises 90% of the cases of SD. In the second variant, abductor SD (AB-SD), the vocal cords are abruptly and momentarily pulled apart while talking, causing the voice to drop out completely or down to a whispery, breathy sound. There are some cases in which a person has both of these variants: this is called mixed AB-AD SD.

Classic vs. tonic:

Another distinction that can be made is between classic variant and tonic variant cases of SD. In classic variant SD, the spasms cause phonatory arrests—that is, while the person is speaking, intermittent words or syllables are choked off (with AD-SD) or drop out (with AB-SD). In tonic variant SD, the spasms are more continuously sustained, so that the voice continuously sounds either strained (with AD-SD) or breathy (with AB-SD), but without any actual phonatory arrests. Because the presence of phonatory arrests is the symptom most often associated with SD, tonic variant SD goes undiagnosed or misdiagnosed far more frequently than does classic variant SD.

Treatment for spasmodic dysphonia:

There is no definitive “cure” for SD, but for most patients, periodic injections of Botox™ into the muscles of the larynx help a great deal, if there is optimal dosage and placement. These injections relax the malfunctioning muscles of the larynx, thereby minimizing the spasms and their impact on the voice. The effect of an injection typically lasts a few months, and then another injection is needed. For those having difficulty getting good results with Botox™ therapy, see our video below “Spasmodic Dysphonia: When Botox Disappoints.”

The leading surgical treatment currently offered for SD, Selective Laryngeal Adductor Denervation-Reinnervation, can be an option for individuals with the AD-SD variant. However, no treatment for SD works satisfactorily for all. The history of each of the several surgical treatments for SD always includes some failures.

Speech therapy is another treatment sometimes suggested for SD. While there are strong and even passionate individual proponents of speech therapy, the consensus view is that speech therapy is not expected to substantially improve the voice’s capabilities or reduce spasms other than perhaps in the therapy room1. A brief course of speech therapy can be very helpful for patient education and perhaps a search for sensory tricks. Much confusion surrounds this subject, because individuals who have a nonorganic voice disorder can be mistakenly diagnosed with SD, and nonorganic voice disorders are routinely “cured” with speech therapy alone.


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Spasmodic Dysphonia: A Peculiar Voice Disorder
Dr. Robert Bastian reviews the various types and subtypes of spasmodic dysphonia (SD). Numerous voice examples are included, along with video of the vocal folds. SD is a rare neurological disorder caused by laryngeal dystonia, and it interferes with the smooth functioning of the voice. Tiny spasms of the vocal folds may cause the voice to catch or cut out, strain or squeeze away, and sometimes to drop momentarily to a whisper.
Spasmodic Dysphonia: When Botox Disappoints
In this video, Dr. Bastian discusses common problems with Botox treatment for spasmodic dysphonia (SD) and offers clear, practical advice to increase the effectiveness of these treatments.
2014 NSDA 25th Anniversary Symposium
In this video, Dr. Bastian leads a panel discussion on Spasmodic Dysphonia.

  1. Ludlow CL. Treatment for spasmodic dysphonia: limitations of current approaches. Curr Opin Otolaryngol Head Neck Surg. 2009; 17(3): 160–165. 

  2. Ludlow CL. Treatment for spasmodic dysphonia: limitations of current approaches. Curr Opin Otolaryngol Head Neck Surg. 2009; 17(3): 160–165. 



Speech-language pathologist

An individual who has a graduate degree (master’s or doctorate) in speech-language pathology. After successful completion of the CFY (clinical fellowship year), a speech pathologist may work behaviorally with a wide variety of conditions that affect breathing, voice, and swallowing. Some speech pathologists are generalists, potentially working within the same day with: a child whose speech is not clear; a person who is trying to recover clear speech after a stroke; a singer with vocal nodules; and an elderly person who is aspirating when she swallows. A speech pathologist’s activities may be divided between evaluation (including by use of the videofluoroscopic swallowing study or videostroboscopy to assess the voice) and therapy or treatment – teaching and coaching the patient in ways that improve their voice, breathing, and swallowing. At our practice, our speech pathologist is singing voice qualified, working nearly exclusively with voice and breathing disorders. Adjunct speech pathologists from Good Samaritan Hospital are typically involved with our patients who have swallowing disorders.

Speech pathologist demonstrating

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Spirometry

Spirometry measures the breathing capacity of the lungs using an instrument that measures expired lung volumes and flow-volume curves.



Squeezedown (of the voice)

A vocal phenomenology term coined to refer to adductory spasms that do not “complete” all the way to a phonatory arrest. Virtually exclusively a manifestation of spasmodic dysphonia.




Stenosis

Abnormal narrowing of a passageway in the body. At our practice, stenosis typically refers to narrowing in the breathing passage, such as for narrowing in the glottic, subglottic, or tracheal areas.

Stenosis in the airway can be the result of prolonged endotracheal intubation, external trauma such as gunshot wound, crush injury, or tracheotomy, an inflammatory or auto-immune process, surgical resection of part of the airway for tumor, or other causes. Persons with airway stenosis will note a reduced capacity for exercise. Often the clinician hears noisy breathing on inhalation, especially when the patient is asked to fill the lungs quickly. Esophageal stenosis gives symptoms of difficulty swallowing solids more so than liquids.


Photos of Stenosis:

































Videos:

Tracheal Stenosis: Before and After
In this video, trachea (windpipe) blockage causes shortness of breath until the narrowed segment is removed. You will see views of the trachea before and after surgical repair.
Post-Radiation Hypopharyngeal Stenosis
People with larynx or pharynx (voice box or throat) cancer often undergo radiation therapy as part of their treatment regimen. An uncommon complication is narrowing or scarring of the entrance to the upper esophagus at the junction of the throat and esophagus. This video provides an example of this disorder.


Straight tone

Sustaining the voice on a steady pitch and loudness, without any vibrato. In the vocal capability battery, straight tone is elicited during a sustained tone to assess the stability of the voice, and to discover whether or not there are any neurogenic findings of lack of control, “involuntary glitches,” tremor, or the like.



Stridor

Stridor is a harsh, wheezy, or rough respiratory sound most often heard on inspiration to indicate laryngeal, subglottic, or tracheal partial obstruction or stenosis. Compare with involuntary inspiratory phonation.



Stripping of vocal cords

An older term in the lexicon of laryngology, now passing out of use. The idea of stripping the vocal cords is to grasp the mucosa superficially, and then to “peel” it, along with whatever pathology might be present. The thought was that the mucosa would re-grow and be more normal. With more modern concepts of the crucial importance of the mucosa and, particularly, the need for it to be loosely attached to underlying layers of the cords, the practice of stripping has been discredited in favor of more precise removal of otherwise irreversible lesions.



Stroboscopy

To look at something using strobe rather than continuous illumination. At our practice, we use strobe lighting to allow apparent slow motion videodocumentation of the vibration of the vocal folds. When, for example, the vocal folds produce the pitch of “middle C,” they vibrate at 252 hertz, or cycles, per second; hence, under ordinary illumination, this rapid vibration of the vocal folds is a blur. Under a common setting for the stroboscope, however, the vocal folds appear to be vibrating at just 2 cycles per second, regardless of the actual rate of vibration, which allows the vibratory dynamics to be observed.



Subglottic stenosis

Subglottic stenosis is narrowing just below the vocal cords, in the lowest part of the larynx and immediately above the first tracheal ring. Examples of causes include scarring from a breathing tube used during a long ICU stay, Wegener’s Granulomatosis (aka Granulomatosis with polyangiitis), and idiopathic subglottic stenosis (aka limited Wegener’s Granulomatosis).


Photos of subglottic stenosis:










Subglottis

The lower part of the larynx, from just below the free margin of the vocal cord to the upper end of the trachea.



Submucosal fibrosis

A disorder in which the attachment of the mucosa to the underlying vocal ligament appears to thicken and toughen, yet without creating any protrusion, such as one sees with nodules or polyps. The mucosa thereby becomes less flexible. Think of satin turning into canvas of a similar thickness.


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Superior

Toward the upper end of a person’s body. For example: the head is superior to the feet. The opposite of inferior.



Superior laryngeal nerve (SLN) paralysis

Paralysis of one of four main nerves serving the larynx, and two of the four if the paralysis is bilateral. SLN paralysis may be idiopathic or perhaps the result of neck surgery. The SLN internal branch supplies sensation to the interior of the upper part of the larynx; the external branch supplies motor innervation to the cricothyroid muscle.

Individuals with SLN paralysis, whether unilateral or bilateral, seem to compensate for the sensory deficits, provided that motor swallowing abilities are intact. On the other hand, they have symptoms of loss of upper voice and poor vocal projection. These two symptoms are easily verified by clinician elicitation and judgment of response.



Supportive treatment

Supportive treatment is treatment aimed at providing comfort or reducing the problem, but not necessarily curing it.



Supraglottic cyst

A retention-type cyst of the supraglottic structures not manifesting as either an anterior or lateral saccular cyst. With a supraglottic cyst, the duct of a single gland is thought to become obstructed and to thereby retain secretions. By contrast, with a saccular cyst, the mouth of the laryngeal saccule becomes obstructed.

Photos:




Supraglottic laryngectomy

Supraglottic laryngectomy is one type of partial laryngectomy, in which the upper part of the larynx is removed, for a tumor that does not involve the vocal cords. The ventricles are the dividing line between glottic and supraglottic tumors. Due to the higher risk of metastasis to neck nodes, supraglottic laryngectomy as primary treatment is usually combined with neck dissection.



Supraglottic phonation

Making voice by means of supraglottic vibration rather than glottic (true vocal cord) vibration. The supraglottic tissues used for vibration can vary between individuals. Vibrating tissue can be the false vocal cords (false cord phonation), aryepiglottic cords, or apical arytenoid mucosa.

Supraglottic phonation may become necessary if the vocal cords are absent or scarred to the point of being unable to vibrate. Examples might include larynx trauma, partial laryngectomy with loss of one or both vocal cords or an inability to bring them close enough together to be entrained into vibration, or progressive radiation damage (radiation fibrosis), usually many years after treatment for cancer.


Photos:


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Supraglottic swallow

A swallowing technique in which a person coughs right at the end of a swallow to help prevent any swallowed food or liquid from going down into the airway. This technique is especially useful for individuals who have undergone a supraglottic laryngectomy, because the upper part of the larynx (epiglottis, aryepiglottic cords, false cords, etc.) has been removed and can no longer help to shield or divert swallowed material.

For each and every swallow, the person will do as follows: first, finish chewing; then, hold the food or liquid in the mouth and fill the lungs with air; then, with the food or liquid still in the mouth, hold his or breath; then, swallow forcefully and, without hesitation, cough immediately on the tail end of the swallow. At our practice we call this technique a “swallowcough,” to signify that the cough occurs using pent-up air from the lungs, and not air drawn in between the swallow and the cough.



Supraglottic web

When either the false folds or aryepiglottic folds adhere to each other. This supraglottic web narrows the laryngeal vestibule and distorts the normal contours of the larynx. This is an uncommon diagnosis, and is usually either a complication of cancer-treating radiation therapy or else is the result of trauma, such as from a gunshot wound or severe blunt trauma to the larynx that causes fracture and tears the mucosa.

See also: glottic web.


Photos:




Supraglottis

The upper part of the larynx, from just above the vocal cord to the tip of the epiglottis.



Surgical results: before and after photos

Vocal polyps:








For more info: Vocal polyps


Vocal nodules:








For more info: Vocal nodules


Cancer:









For more info: Cancer


Capillary ectasia:





For more info: Capillary ectasia


RRP:





For more info: Recurrent Respiratory Papillomatosis


Vocal cord paralysis/paresis:








For more info: Paralysis or Paresis


Stenosis:






For more info: Stenosis


Other:















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