A vallecular cyst is a mucus-containing cyst in the vallecula. Such cysts are relatively common. Vallecular cysts are almost always asymptomatic and found during examination for another issue, such as a voice problem.
Photos of Vallecular Cyst:
Vallecular Cysts don’t Disturb Swallowing—Except When They Do
Laser for A Type of Lesion Usually Left Alone
The transient, somewhat forceful exhalation of air against an intentionally blocked airway. In a common variant of this maneuver, a person blocks the exhaled air by sealing the lips and plugging the nose, which forces air up the Eustachian tube and “pops the ears”; this variant is often performed when on a plane that is descending for landing. In a second variant, a person blocks the exhaled air by closing the vocal cords; this variant is often performed sub-consciously when a person lifts a heavy weight. This second variant of the Valsalva maneuver is also sometimes elicited by a physician during a cardiac or neurological evaluation.
Verrucous carcinoma is a variant of squamous cell carcinoma (SCCA). In the head and neck, this uncommon subtype of SCCA is seen most often in the oral cavity or on the vocal cords. Visually, it tends to have an exophytic (outward-growing) and wartlike, irregular surface. This variant of SCCA is typically less aggressive than other squamous cell carcinomas. Local recurrence tends to be the issue more than distant metastasis. Surgery tends to be the most effective treatment, though of course every patient’s circumstance is individualized and considered in the light of three treatment options: surgery, radiation therapy, and chemotherapy.
Verrucous Carcinoma, Before and After Laser Treatment
In the voice, a pulsating effect produced by small variations of pitch, typically occurring five or six times per second. The opposite of singing with vibrato is to sing with straight tone.
Videoendoscopic Swallowing Study (VESS)
A method of evaluating a person’s swallowing ability by means of a video-documented physical examination, looking from inside the throat. Also called the fiberoptic endoscopic evaluation of swallowing (FEES). The videoendoscopic swallowing study (VESS) is to be distinguished from the videofluoroscopic swallowing study (VFSS), which is an x-ray-based assessment.
How it works:
To perform a VESS, a clinician uses a fiberoptic or distal-chip nasolaryngoscope. The clinician begins by examining the structure and function of the patient’s palate, tongue, pharynx, and larynx, including sensation, if desired. Next, to assess the patient’s swallowing capabilities and limitations, the clinician positions the tip of the nasolaryngoscope just below the nasopharynx and, looking downward into the throat, asks the patient to swallow a series of colored substances with a range of consistencies (e.g., blue-stained water, blue-stained applesauce, and orange-colored crackers).
As the patient swallows these substances, the clinician watches to see if any significant traces remain in or reappear in the space above, around, or within the larynx, rather than disappearing into the entrance to the esophagus. If significant traces remain in view, or if any material spills into the opening of the larynx or down the trachea, the patient may have presbyphagia. If significant traces initially disappear but then re-emerge upward from the esophageal entrance, the patient may have cricopharyngeal dysfunction, with or without a Zenker’s diverticulum.
Benefits of the videoendoscopic swallowing study:
This method has particular value for patients who are bedfast and cannot travel to the radiology suite, or for patients whose swallowing function is rapidly evolving (improving, usually), such as those recovering from a mild stroke. For clinicians experienced with this technique, VESS can also often be used with new patients complaining of dysphagia during the initial consultation as a robust and—depending on patient history—potentially stand-alone method of diagnosis and management. Sometimes, the VESS findings, along with a patient history of solid food lodgment at the level of the cricoid cartilage or cricopharyngeus muscle, will indicate when VFSS should also be obtained to assess for possible cricopharyngeal dysfunction. Even in this latter circumstance, when VFSS is called upon to confirm a suspected diagnosis, VESS will have already oriented the examiner to the nature and severity of the problem. In most follow-up circumstances other than after cricopharyngeal myotomy, VESS is generally more efficient and inexpensive than VFSS.
VESS Assesses Equipment, Secretions, then Swallowing Ability
Dysphagia / Delayed Swallow Reflex
Reflux Into Hypopharynx, Characteristic of Cricopharyngeal Dysfunction
Hypopharynx Pooling After Swallow
Zenker’s Diverticulum and VESS
Vallecular Cysts don’t Disturb Swallowing—Except When They Do
Pill Lodgment Due to Swallowing Disability
Delayed Swallow Reflex: Compare Blue Applesauce and Blue Water
Scarring Diverts Swallowed Materials Directly into the Larynx
Skull Base Fracture and Vagus Nerve Injury—Note Pharynx Contraction and Impact on Swallowing
VESS in 6 Still Photos
VESS (Videoendoscopic Swallow Study) Findings after Radiotherapy
Cervical Osteophytes do not by Themselves Seem a Major Impediment to Swallowing
Aspiration, and Fountain of Returned Aspirate after Coughing
Zenker’s Diverticulum Returns Its Contents Upwards to the Throat After Each Swallow
Three Views of the Entrance to the Esophagus from far Away to Close-up
Videoendoscopy is the coupling of video-documenting technology to an endoscope, so that the examination of the larynx, trachea, or esophagus, as the case may be, is permanently recorded for later review and possible comparison with prior endoscopy examinations.
Videofluoroscopic Swallowing Study (VFSS)
An x-ray-based method of evaluating a person’s swallowing ability. The videofluoroscopic swallowing study (VFSS) is also sometimes called the modified barium swallow, or the “cookie swallow.”
In a radiology suite under fluoroscopy (which creates moving rather than still x-ray images), the patient is asked to swallow barium in thin liquid and paste consistencies, and then in paste on a cookie or cracker. The barium bolus is followed radiographically through the mouth, throat, and into the esophagus. Both lateral and anterior–posterior views are recorded and, depending on the facility, a simple screening sequence of the subsequent movement down the esophagus is also recorded.
Cricopharyngeal dysfunction, before and after myotomy: Series of 2 photos
Cricopharyngeal dysfunction, before and after myotomy: Series of 2 photos
Infection or inflammation of the vocal cord mucosa, caused by viral infection. The mucosa becomes pink or red, and the normally thin mucus blanket increases in volume and can become more viscous. If the mucosa becomes sufficiently inflamed and edematous, an individual can lose his or her voice transiently (for one to three days, typically). An analogy for these tissue and secretional changes in the larynx is viral “pink-eye.” For treatment, antibiotics are of no benefit; instead, as the patient waits for the infection to pass, supportive measures such as voice rest and hydration are suggested.
A vocal event or phenomenon that is unexpected and abnormal. It is “something the voice does that it shouldn’t.” These sorts of findings, in combination with vocal capabilities and vocal limitations, are listened for during the vocal capability battery.
Vocal capabilities refer to the full extent of the voice’s abilities in terms of loudness, range, steadiness and control, rapid repetitive sound-making, high soft singing, and so forth. Understanding of any voice’s capabilities (and limitations) requires much elicitation by the examiner. Also required is an understanding of expected capabilities for sex and age, so that an individual’s capabilities can be compared with what is expected.
Vocal capability battery
The vocal capability battery is a variable set of vocal tasks that the clinician elicits from the patient in order to understand the individual’s vocal capabilities and vocal limitations. During the vocal capability battery, the clinician might assess average/anchor pitch, maximum range, ability to add loudness, sustained phonation (for stability), swelling checks of mucosal injury, maximum phonation time, and response to brief trial therapy.
Events or circumstances that permit, invite, or demand much voice use. A person’s vocal commitments could include his or her occupation, childcare, rehearsals and performances, hobbies or even volunteer activities to which a person is highly committed, sports, and so forth. Heavy vocal commitments and innative talkativeness are the two potential sources of vocal overuse and, unsurprisingly, are often seen together.
Vocal Cord Bowing
“Bowing” is a descriptive term to specify that the vocal cords are not matching in a straight line, with only a thin dark line between them at the moment of pre-phonation. Instead, the cords become gently concave or bowed outwards. At the moment of pre-phonation, there is a wider, oval slit between the cords.
Bowing can be physiologic, asymptomatic, and a genetic “given.” In this physiologic type, the bowing will be subtle to mild and there will be good vibratory pattern. When moderate or severe, bowing may more likely be the result of aging, vocal disuse, Parkinson’s disease, or other conditions. Moderate and severe bowing correlate with a degree of vocal cord atrophy and the vibratory pattern can be more flaccid. The voice tends to have a soft-edged quality, a little higher in pitch than normal, and can fade with use. Voice building is the primary treatment, but very occasionally severe bowing is treated with bilateral vocal cord implants.
Vocal Cord Bowing
Bowing of vocal cords and effect of pitch
Four views of vocal cord bowing in the same person
Red herring capillary ectasia and mucosal injuries
Glottic furrow—not just bowing and not glottic sulcus
Voice Building (shorter version):
Vocal Cord Bruising
The rupture of one or more capillaries in the vocal cords, so that blood leaks into the tissue. This vocal cord bruising occurs as a result of excessively vigorous mucosal oscillation, usually during extensive or vigorous voice use, aggressive coughing, or even a very loud sneeze, and it can make the voice hoarse or otherwise limited.
If the ruptured capillary is extremely superficial, like the capillaries seen on the white of the eye, then a “thin suffusion” kind of bruise occurs, and there is no deformity of the vocal cord margin; within a few days, the voice recovers. If the vessel is a few cell layers deeper into the cord, then a small “puddle” of blood like a micro-hematoma may collect and create a kind of “blood blister.” Although a superficial bruise resolves quickly and doesn’t seem to cause permanent damage, the “blood blister” type can become a hemorrhagic polyp and require surgery; with state-of-the-art surgery, however, the voice can virtually always be restored to its original capabilities.
Vocal Cord Bruise / Hemorrhage, Before and After Rest and Surgery
Vocal Cord Bruise / Hemorrhage
Vocal Cord Bruise / Hemorrhage, Before and After Rest
Bruise Caused by Cough
Bruising from Sensory Neuropathic Cough
Vocal Cord Bruising From Coughing
The Evolution of Vocal Cord Bruising and Emergence of a Vulnerable Capillary
Vocal cord dysfunction (VCD)
Vocal cord dysfunction (VCD). We refer to this disorder as nonorganic breathing disorder, laryngeal (see that entry for a fuller definition), which should be distinguished from nonorganic breathing disorder, tracheal.
Nonorganic Breathing Disorder, Laryngeal
Vocal Cord Paralysis, Bilateral
A neurological disorder in which the nerve supply to both vocal cords is absent. This may be as the result of injury through external trauma, thyroid surgery, or blunt or penetrating trauma to the neck. Sometimes vocal cord immobility due to scarring—from an endotracheal tube, for instance—is mistaken for vocal cord paralysis, though the distinction is usually easy to determine, provided that an appropriately intense and directed workup is done. In particular, this workup must include topical anesthesia to the larynx so as to enable an extremely close visualization of the posterior commissure and subglottis, which may uncover evidence of scarring.
Bilateral Vocal Cord Paralysis
Mucosal Indrawing with Inspiration
Vocal Cord Paralysis, Unilateral
Neurogenic inability of one vocal cord to move. Unilateral vocal cord paralysis is associated with weak voice of a degree that can vary between individuals. Symptoms may include one or more of the following: weak, air-wasting dysphonia; inability to be heard in noisy locations; a tendency of the voice to be somewhat stronger in the morning but to “fade” with use; and a tendency to cough when drinking thin liquids.
See also: vocal cord paralysis, bilateral.
Injection Laryngoplasty with Temporary Gel
Vocal Cord Paralysis
Vocal Cord Paralysis, Before and After Medialization
Extrusion of Vocal Cord Implant
Voice Gel for Immediate Help
TA + PCA-only Paresis
55 Years of Paralysis with Every Classic Finding
Medialization Laryngoplasty Typically Doesn’t Fix the LCA “Finding.”
Voice Gel Injection for Vocal Cord Paralysis
Posterior Commissure Synechiae
Vocal Cord Paresis
Vocal cord paresis is the partial loss of voluntary motion for one or more of the muscles that move the vocal cords. Paresis is to be distinguished from paralysis, which refers to a complete loss of motion. Sometimes, however, the terms “paralysis” or “paralyzed” are used less precisely to encompass any kind of loss of motion, partial or complete. But we prefer the term “paresis” whenever it applies, and below we suggest a way to use this term when describing more complicated cases of vocal cords with reduced or no mobility.
Paresis or paralysis of a muscle or muscle group is caused by damage to its nerve supply. In other words, the underlying cause of a paretic or paralyzed muscle’s immobility is not a disorder of that muscle per se, but a disorder of the nerve supplying that muscle. Perhaps for this reason, it is common to speak of paralysis according to the nerve involved, rather than the muscle or muscles; in the world of laryngology, for example, we speak of “paralysis of the recurrent nerve.” However, it seems more logical to describe paralysis or paresis according to what is actually immobilized: the muscles. For example: if in a given case only the posterior cricoarytenoid (PCA) muscle is immobilized, then instead of calling that “paralysis of the recurrent nerve,” we would call it “PCA-only vocal cord paresis.”
In that example, though, some might wonder if it would be better for us to say “paralysis” instead of “paresis.” In other words, should we describe the nature of the immobility of the PCA muscle alone (so that, if the PCA is totally immobile, we would say “PCA-only vocal cord paralysis”) or that of the vocal cord’s entire set of muscles (which as a group is only partially immobile, so we would stick with “PCA-only vocal cord paresis”)? We think that, in general, it is more helpful to do the latter. To illustrate, here is an imaginary conversation: “Is this vocal cord paralyzed or paretic?” “Paretic.” “Which kind of paresis is it?” “PCA-only.”
It is surprisingly easy to diagnose the different variants of vocal cord paresis with a straightforward visual examination. Click on a particular variant to learn more:
- Vocal cord paresis, TA + LCA
- Vocal cord paresis, TA-only
- Vocal cord paresis, LCA-only
- Vocal cord paresis, PCA-only
- Vocal cord paresis, IA-only