Healthy vocal folds -Answer- pearly white in color , may sometimes appear grayish or pinkish in men the surrounding tissue is a healthy pink color Straight, smooth edges with no lesions or other abnormality The mucosal wave is robust and symmetric Histology: Inflammation/laryngitis - define what laryngitis is, what erythema and edema are -Answer- Inflammatory response when your vocal folds get irritated consistently. Mucosal surface causes blood vessels to dilate, erythema (bloody appearance, can see capillaries) and Edema (swelling of the vocal folds). Causes/risk factor of laryngitis: is it specific etiology? What are two groups of causes? - Answer- Non-specific with various etiologies, which are: - Infectious causes (bacterial, viral, fungal, etc.) - Traumatic causes (phono trauma, environment, laryngopharyngeal reflux, not warming up voice, talking too much or too harshly) Features of laryngitis (morphology, appearance, location, etc.) -Answer- bloody and/or swollen appearance, capillaries swollen Increased throat clearing and coughing Pain , mucosa is thicker because it is trying to protect itself, primary symptom is hoarseness Demographics (age, sex, race) of laryngitis -Answer- Non-specific Voice quality with laryngitis - how does the voice sound? what is the voice quality like? What happens if it is severe? -Answer- typically the mass has increased bc inflammation, hoarseness, altered voice quality: rougher, breathier, pitch can change, if laryngitis is severe the individual will lose their voice. Laryngitis: patient complaints -Answer- Same as features: voice is rough or lower, lots of throat clearing and pain, discomfort or dryness in the throat Differential diagnosis for laryngitis: What is it confusable with? -Answer- Prior to endoscopy: nodules, polyps, cysts, strep throat, keratosis, etc. many confusable etiologies Image of laryngitis and appearance - how do the vocal cords look? Laryngoscopy vs. stroboscopy? -Answer- The vocal cords are red, irritated, and have a bloodshot appearance. small dilated blood vessels may be visible on the inflamed folds. Asymmetry and aperiodicity with reduced mucosal waves and reduced amplitude Histology of Scarring -Answer- Damage to the deep layer of the lamina propria/ vocal ligament of the vocal fold. Damage does not heal correctly and there are increased amounts of disorganized extra-cellular matrix proteins of lamina propria Causes and risk factors of scarring -Answer- Chronic long term and possibly severe phonotrauma (misuse) ruptured cyst or polyp; hemorrhage; chronic LPRD iatrogenic (surgery, radiation, etc) Features of scarring -Answer- reduced or absent mucosal wave at the lesion site, no lump or bump, aperiodic vibration because of the scar tissue Demographics : scarring -Answer- Non- specific Voice quality with scarring -Answer- Voice will present as rough with asthenia and may have reduced intensity and range, altered pitch, voice breaks, and may have Diplophonia or pitch instability Patient complaints with scarring -Answer- Rough voice, increased effort, asthenia, weak voice, breathiness, altered pitch or pitch changes and breaks, instability on holding a pitch Differential diagnosis with Scarring - what does it get confused with? -Answer- These symptoms could be just about anything prior to endoscopy - however they are very closely confused symptomology wise with: Sulcus vocalis, Sulcus vergeture No lump or bump - there will be a loss of tissue so you will be able to see it is not confusable with a lump on endoscopy Image of vocal fold scarring -Answer- Irregularities on the vocal fold, inconsistencies in mucosal layer Histology of sulcus vocalis/sulcus vergeture -Answer- Reduction and deficiency, and absence of the extracellular metric proteins of the lamina propria, appear as a crease or groove on the phonatory margin, lateral to it, or on the surface of it, but always parallel to phonatory margin Difference between sulcus vergeture and sulcus vocalis -Answer- Sulcus vergeture's histology is that its usually along most or all the length of the vocal fold, and the epithelium is not bound to ligament. Often bilateral Sulcus vocalis is much shorter but also deeper, and binds with the vocal ligament Causes and risk factors: Sulcus vocalis/Vergeture -Answer- Sulcus vergeture: usually congenital, caused by atrophic changes in the epithelium or lamina propria Sulcus vocalis: caused by an injury secondary to ruptured mass lesion or post surgical scarring that creates a groove or trough