Vocal fold nodules, Polyps and Cysts
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Definition and Symptoms
One of the primary conditions treated by laryngologists are benign lesions of the vocal folds. These include conditions such as vocal fold nodules, polyps, vocal fold cysts and sulcus. These benign lesions can occur in the context of heavy vocal use or in efficient vocal technique, but there are also gender and ethnic associations.
Benign lesions of the vocal fold can present with symptoms such as voice change, hoarseness, vocal fatigue, limited projection, loss of reliability, and altered pitch. Vocal fold nodules, previously called singer's nodules, are benign, symmetric swellings in the middle of the vocal fold. Polyps are discrete lesions that can involve both the surface and underlying layers of the vocal fold. Vocal fold cysts are discrete lesions that sit underneath the lining of the vocal cord (epithelium).
Diagnosis and Treatment
Diagnosis of polyps, cysts and nodules involves visualising the larynx with a small camera. Videostroboscopy allows accurate assessment of the structure and function of the vocal folds. Treatment for benign vocal fold lesions typically involves voice therapy with a speech pathologist to maximize vocal efficiency and alter maladaptive behavioural voice patterns. In some cases, surgical treatment of the lesions is required when conservative measures fail. Surgery is typically reserved for those who are concerned regarding their voice limitations.
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Definition and Symptoms
Laryngeal cancer is a type of cancer that arises from the tissues of the larynx. Laryngologists care for patients with early cancers of the larynx. The biggest risk factor for laryngeal cancer is smoking.The symptoms of laryngeal cancer are often indistinguishable from benign vocal fold lesions in their early stage, and hence it is critical for anyone with persisting voice change.Symptoms may include persistent voice change, difficulty swallowing, pain with talking or swallowing, and a lump in the neck. In more advanced stages, the cancer can cause cough and breathing difficulties.
Diagnosis and treatment
Diagnosis involves a combination of nasal endoscopy as well as biopsies and imaging. Treatment options vary depending on the stage and location of the cancer, but may include surgery, radiotherapy, and chemoradiotherapy. Treatments can be used in combination. Early detection and treatment are crucial for improving outcomes and preserving laryngeal function.
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Laryngeal Cancer
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Vocal Cord Paralysis and Paresis
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Definition and Symptoms
Vocal cord paralysis is a condition where one or both of the vocal cords do not move. Vocal cord paresis is a partial weakness of the vocal fold. As the function of the larynx involves voice, swallowing, and breathing, any of these domains can be impacted. Causes of vocal cord paralysis can include nerve damage following intubation or surgery, viral infections, tumours and neurologic disorders.
Diagnosis and treatment
Vocal cord paralysis and paresis are diagnosed with using nasoendoscopy or videostroboscopy. Treatment depends on the severity and underlying cause of the paralysis, but some people are at risk of aspiration. Options include speech pathology treatment to maximize vocal efficiency and maintain safe swallow and surgical procedures to bulk up or reposition the paralysed cord. Vocal fold paresis may be managed in a similar way. On rare occasions, a tracheostomy may be required to secure the airway in an emergency if both vocal cords are paralysed and breathing is compromised.
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Definition and Symptoms
Laryngopharyngeal reflux is a condition where stomach acid flows back into the larynx and the throat causing irritation and inflammation. Unlike gastroesophageal reflux (GERD), which primarily affects the esophagus, laryngopharyngeal reflux impacts the pharynx and larynx. Symptoms of laryngopharyngeal reflux may include chronic cough, throat clearing, hoarseness, throat irritation, regurgitation of stomach juice and a sensation of a lump in the throat.
Diagnosis and treatment
Diagnosis is based on a combination of history findings and nasal endoscopy. However, without further testing, it can be difficult to determine whether the inflammation seen relates to reflux or other laryngopharyngeal conditions.
Treatment for laryngopharyngeal reflux involves lifestyle and dietary modification and a trial of sodium alginates to reduce stomach to control volume reflux or medication to reduce stomach acid production. On occasion, surgical interventions can be performed to prevent reflux.
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Laryngoharnygeal reflux
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Chronic Cough
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Definition and symptoms
Chronic cough is a cough that has lasted for more than 8 weeks and can present following a preceding illness or out of the blue. Chronic cough can be caused by heart and respiratory conditions, sinusitis or allergies with post-nasal drip, reflux, swallow disorders and neurological problems. Chronic cough can have a significant impact on day-to-day wellbeing and represents a major health issue worldwide.
Diagnosis and treatment
Prior to seeing an ENT for cough lung disease should be excluded or managed. Laryngologists will ensure the drivers of chronic cough are treated and visualise the upper airway with a nasoendoscope. Treatment includes cough desensitisation therapy with a speech pathologist, neuromodulator medication and Botulinum neurotoxin injections.
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Definition and symptoms
ILO is a breathing condition where the larynx becomes incoordinated and can close down, restricting breathing and sometimes causing stridor (a high-pitched throat -ocused noise). The most severe form of ILO is laryngospasm, where the larynx can completely close and a person may pass out. ILO can often mimic or occur with asthma.
Diagnosis and treatment
ILO is diagnosed based on a strong history of ILO symptoms and nasoendoscopy which confirms abnormal movement of the vocal cords. Often if there are no symptoms at the time of the examination, treatment is commenced on the basis of a clinical suspicion for ILO. Treatment involves breathing exercises with a speech pathologist or physiotherapist, medication and Botulinum neurotoxin for severe cases.
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Inducible Laryngeal Obstruction / Vocal Cord Dysfunction
ILO / VCD
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Airway Stenosis
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Definition and symptoms
Airway stenosis or narrowing of the airway is an uncommon but important condition managed by laryngologists. This narrowing can occur at various levels, including the supraglottic, glottic, or subglottic regions. Causes of airway stenosis include prolonged intubation, trauma, infections, autoimmune diseases, and congenital abnormalities. Symptoms can be variable in severity and may include difficulty breathing, stridor (a high-pitched wheezing sound), and recurrent respiratory infections.
Diagnosis and treatment
Airway stenosis can be difficult to diagnose without an ENT surgeon looking at your airway with a nasoendoscope. It is not uncommon for patients to have undergone multiple tests of breathing before their referral to a laryngologist. Treatment options are moving towards awake minimally-invasive procedures, including steroid injections, but also include endoscopic procedures to dilate and remove the stenotic segments, laser surgery, and open surgical reconstruction of the airway.
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Definition and symptoms
Laryngologists manage patients with a wide variety of swallowing disorders which present with dysphagia or difficulty swallowing. Symptoms of swallowing disorders include difficulty chewing, food sticking, choking, discomfort or pain on swallowing and regurgitation. Dysphagia can result from various conditions, including neurologic disorders, structural abnormalities, and sensory dysfunction.
Diagnosis and treatment
Laryngologists work closely with speech pathologists to assess and treat swallowing disorders and may use investigations such as nasoendoscopy, video fluoroscopy, and manometry. Adequate investigation prior to surgical consideration, particularly with respect to permanent procedures, is crucial. Treatment of swallowing disorders depends on the underlying cause but includes swallow therapy, diet modifications, office-based procedures including botulinum neurotoxin and surgical interventions. These interventions are designed to improve swallow function and prevent aspiration, but despite this swallow disorders can be both challenging and progressive.
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Swallowing Disorders
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