Journal Reading

Adviser :
dr. Agus Sudarwi, Sp.THTKL
dr. Afif Zjauhari, Sp.THT-KL
Presented by :
Annisa Aulia
Christine Nathalia
Indra Kurniawan

ABSTRACT
Background
Hoarseness earliest signal of local and
systemic disease.
Not a disease but a symptom of disease or
disturbance of larynx or laryngeal innervation.
Aim of the study analyse various causes
and conditions associated with hoarseness of
voice.

Methods
150 patients prospective randomised study

Results
In the present study of 150 cases, 87 were
males and 63 were females with M:F ratio of
1.4:1 and age ranged from 1090 years with
majority of cases in 4th and 6th decade of their
life.
All patients had history of hoarseness of voice
with most of patients having duration of disease
between one month to one year.
On flexible fibreoptic laryngoscopy 27% of cases
showed normal study.
Bilateral lesion (72.6%) predominated overall.

Conclusions
Flexible
fibreoptic laryngoscopy is an effective
alternative for diagnosis of laryngeal lesions and
various causes of hoarseness of voice.
Vocal nodule has been found as the commonest cause
of hoarseness of voice followed by vocal cord palsy
and laryngopharyngeal reflux disease.

Hoarseness is one of the first and only signal of serious

local and systemic disease.
commonest symptoms in ENT practice.
earliest manifestations of conditions directly or indirectly
affecting the voice apparatus as voice being the primary
means of communication socially and professionally.
defined as perceived, rough, harsh or breathy quality of
voice.
In children vocal abuse as one of the most widely quoted
factor associated with hoarseness.

METHODS

Prospective randomized study, 150 patients

were selected with inclusion criteria of
hoarseness of voice, attending otolaryngology
outpatient department of Dayanand medical
college and hospital. No exclusion criteria were
applied
Duration of study was of 14 months (20152016).
Larynx was examined by flexible fibreoptic
laryngoscopy followed by biopsy if suspicious
looking area was seen.
Statistical method used was SPSS version 17.

RESULTS
Gender distribution

Males

42%
58%

Females
Rasio M : F = 1,4:1
N: 150

Protective
Respiratory
Deglutition
Vocalization

LARYNX
How Is The Sound Of Your Voice Produced???

SOUNDS air flow from the lungs

vibrates the vocal cord epithelium.
fluctuations in air pressure sound
waves.

Arytenoid cartilages & attached

muscles
are
responsible
for
movement and tension of the vocal
cords.

HOARSNESS
Various lesions of vocal cords causing hoarseness
include pathologic changes from ;
Allergies
Irritants And Inflammatory Processes
Neuromuscular
Systemic Disorder
Neoplasma
Increase In Age

DISCUSSION

Banjara Et Al

This
study

DISCUSSION
Ghosh et al
(2001)

Banjara Et al

Baitha(2004)

Recent
Studies

1. Vocal
Nodule

1. Funcional lession
(16.33%)

1.chronic
nonspecific
laryngitis
(43.63%)

1.vocal
nodule in
20% of
cases

2. vocal nodule
(11.95%),

2.acute
laryngitis
(23.63%),

2.10%
vocal cord
palsy a

3.vocal palsy
(11.16%),

3.carcinoma
larynx
(14.54%),

3.10% had
aryngopha
ryngeal
reflux
disease.

4. cancer and chronic

laryngitis (9.56%
each)

4.vocal cord
palsy(9.09%)

5.tubercular
laryngitis
(5.45%).

CONCLUSION

LAMPIRAN

NORMAL VOCAL CORD

Vocal Cord Paralysis

Bilateral vocal cord immobility (BVFI) absent movement of

the vocal folds.
Reduced or absent function of the vagus nerve , laryngeal
nerve (RLN).
mechanical derangement of the laryngeal structures, such
as the cricoarytenoid (CA) joint.

Unilateral vocal fold paralysis (UVFP) symtom;

-breathy voice
-swallowing disabilty
- a weak cough
This is a common cause of neurogenic hoarseness.
When this paralysis is properly evaluated and treated,
normal speakingvoiceis typically restored.

Vocal cord Polyps

Vocal cord lesions are benign (noncancerous)

growths that include nodules, polyps, and cysts.
Polyps :
+ more vascularized than nodules,
+ larger than nodules and resembleblisters.
+ caused by overuse or misuse of the voice
+ polypoid corditis (Rienkes edema), is associated
almost exclusively withsmoking.

Vocal Cord Nodule

Vocal cord nodules = singers nodules

result from repetitive overuse or misuse of the voice.

These callous-like growths develop in the midpoint of the

vocal folds.

Vocal Cord Cyst

+ Repeattraumafrom vocal misuse benign lesions that arise

within the lamina propria of the vocal fold. types of cysts are found ;
mucus retention cysts
epidermoid cysts.

LARYNGOPHARINGEAL REFLUX

End of your esophagus sphincter Stomach acid backs up into

(pharynx,larynx), or into the back of your nasal airway inflammation
unprotected areas
The most common symptoms include:
+Excessive throat clearing
+Persistentcough
+Hoarseness
+A "lump" in the throat:
+A sensation ofpostnasal drip

VALLECULAR CYST

Valleculae cyst = retention mucus epiglottis : benign, usually appearing

on the lingual surface of the epiglottis and were classified;
+ cystic ductal obstruction and retention of mucus in the collectical
ductus of glands in submucosal.
major theories that these cysts occur due to obstruction or
malformation emberyologi.

Carcinoma Larynx

leading cause of death in the US squamous cell carcinoma

study by Zhao et al suggest that there is an association between
overexpression of compounds histone deacetylase 1 (HDAC1) and
SCC.
potential risk factors associated :
tobacco use
Excessive use of ethanol
Male gender
Infection of human papillomavirus
increasing age
A diet low in vegetables

Subglottic mass

Uncommon in children.
A case of benign fibrous histocytoma (BFH) respiratory
distress and stridor in an eight year old female child.
Management:
confirmation
of
diagnosis
by
videolaryngoscopy and CECT neck, relieving of respiratory
distress and treatment of underlying cause.

Supraglottic cancer

SCC of the supraglottis is seen less frequently thancancer of the

glottis
treated differently from tumors of the glottis or subglottis
the disease and its treatment can affect the function of the larynx,
including speech, swallowing, and breathing.
Etiology
tobaccoand alcohol use. ( the international occurrence of SCC)

Laryngitis

the larynx becomes

swollen and inflamed.
commonly
manifests
quickly symptoms
lasting for no more
than 2 weeks.
Cases
of
acute
laryngitis are often best
treated
with
rest,home remedies,
and self-care measures
that
can
relieve
symptoms

Symptoms

Cold or upper respiratory tract infection

Dry cough (as well as bloody saliva in

non-infectious laryngitis)

Difficult or painful swallowing

Feeling of fullness, tickling, or rawness

in throat

Fever

Runny nose

Shortness of breath

Sore or dry throat

Swollen lymph nodes in the neck

Vocal weakness or loss of voice

Bacterial Laryngitis
Physical Findings:
Purulent secretions can be
seen in the entire larynx
and also in the trachea.
These
secretions
frequently get caught on
the cords and the patient
has
frequent
throat
clearing.
Notice
the
secretions on both vocal
cords.

Fungal Laryngitis
Physical Findings:
seen on the vocal cords, false
cords, and the mucosa of the
supraglottic larynx (above the
vocal cords).
These
are
thickened
white
patches that involve the entire
area. Sometimes they are less
extensive as in the last figure
below which shows fungus on the
true cords only, sometimes seen in
patients with inhales steroids.

Viral Laryngitis
Physical Findings:
erythema of the entire larynx.
The vocal cords, the false cords and the
surrounding
tissues
there
is
hypervascularity and edema.

Granuloma/Contact Ulcer

highly vascular lesions that develop as the

result of tissue irritation in the back part
larynx at a place called the vocal process of
the arytenoid cartilage.

These lesions are often associated with 3

predisposing conditions:
1.

2.
3.

Esophageal reflux - which is thought to

irritate the tissues of the posterior larynx
and predispose this area to injury or
ulceration (e.g., contact ulcer).
Laryngeal intubation injury following surgery
or for long term airway ventilation.
Associated with persistent voice misuse,
especially the use of a pressed, low-pitched
voice quality.

Arytenoid Ulcers with Sloughs

Posterolateral ulceration with thick

fibrin
and
inflamed
adjacent
mucosa. Vocal fold edema present
bilaterally.

Similar ulceration with covering fibrin

(ellipse). Right vocal fold palsy present.
[RVF - right true vocal fold, LVF - left vocal
fold, E - epiglottis]

Injuries
complicating
endotracheal
intubation. The true vocal folds were
oedematous. (T - true vocal fold, F - false
vocal fold, [+] - granulations, [x] - fibrin
exudates, arrows - mucosal ulcerations)

Congested arytenoids

Vocal fold congestion (1 day after

extubation).

Leukoplakic patch

Leukoplakia is a white patch on the

vocal cords. The area may look like a
swollen white, gray, or lacy spot. The
white patch cannot be wiped off the
vocal cords.

Leukoplakia can be caused by a yeast

(fungal) infection, or could be a precancerous or cancerous condition.

Leukoplakic patch

Leukoplakia adalah "patch putih" pada pita suara.

Daerah mungkin terlihat seperti bengkak putih,
abu-abu.
Patch putih tidak dapat di lepaskan dari pita suara.
Leukoplakia dapat disebabkan oleh infeksi jamur ,
atau bisa menjadi lesi pra-kanker atau kondisi
kanker. Bila Anda memiliki leukoplakia, Anda
mungkin memiliki perubahan suara karena pita
suara Anda tidak menggetarkan cara yang benar.
https://patienteducation.osumc.edu/Documents/Leu
koplakia.pdf
http://laryngopedia.com/leukoplakia/

False vocal cord

Hypertrophy

Harus nya Cuma terlihat edem aj, tp gak

dapet jg.
Konsulin aj nnti sma dr afif

Laryngopharyngeal reflux disease

Laryngopharyngeal
reflux disease (LPRD) is
the backflow of stomach
contents (acid or non
acid) into the voice box
(larynx) or the throat
(pharynx).
LPRD can occur during
the day or night, in an
upright position, or
while lying down.

laryngopharyngeal reflux (LPR) mirip dengan kondisi lain GERD - bahwa hasil dari isi perut back up (refluks). Tapi
gejala LPR sering berbeda daripada yang khas dari
penyakit gastroesophageal reflux (GERD).

Dengan LPR, Anda mungkin tidak memiliki gejala klasik

GERD, seperti rasa panas di dada bagian bawah Anda
(heartburn). Itulah mengapa bisa sulit untuk mendiagnosa
dan mengapa kadang-kadang disebut silent reflux.
Laryngopharyngeal (la-RING-go-fa-RIN-gee-al) penyakit
refluks (LPRD) adalah aliran balik isi lambung (acid atau
non-asam) ke dalam kotak suara (laring) atau tenggorokan
(faring). LPRD dapat terjadi pada siang hari atau malam, di
sebuah tegak posisi, atau sambil berbaring.

Phonatory gap

Gak dapet gambar

nya
Hemmm.

A phonatory gap may be seen in

patients who have muscle tension
dysphonia, vocal cord paresis or
paralysis, loss of tissue, or vocal cord
flaccidity.

Sebuah gap phonatory dapat dilihat pada

pasien yang memiliki muscle tension
dysphonia, vocal cord paresis /paralysis, loss
of tissue/ vocal cord flaccidity.

Laryngitis

Laryngitis is an inflammation of your

voice box (larynx) from overuse,
irritation or infection.