I- Definition :
Dysphonia is the achievement of voice related to abnormal morphology or function of vocal cords.
II- anatomy :
The vocal cords are shaped 2 ribbons moored to a fixed point in front and rear movable.
And symmetrical pairs, they are constituted by the speech muscle covered with a separate type of respiratory mucosa of the muscle by the space of Reinke.
The 2 vocal cords meet in front of a fixed anterior commissure timely. The rear part of each vocal muscle is moored sue a cartilaginous processes of the 2 arytenoid cartilages articulating with the upper edge of the cricoid kitten.
The mobility of cartilage is provided by the recurrent nerve, branch of the vagus nerve (X) innervating muscle dilators and constrictors of the glottis.
The vocal cords do not have lymphatic drainage.
III- positive diagnosis :
A- Examination :
It often allows an etiological.
It specifies the character dysphonia :
- Mode of occurrence
- Permanent or intermittent
- Occurring after a vocal effort
- Seniority and scalability.
Any dysphonia extending over 3 weeks requires an ENT examination of the vocal cords.
*It looks for associated signs preceding or following dysphonia :
- Odynophagie, dysphagie
*He appreciates the field :
- smoking and / or alcohol intoxication
- Professional voice : singers, teachers…
- infectious history : syphilis, tuberculosis
- Recent anesthesia with intubation
- cervical or thoracic surgery history
- Gastroesophageal reflux
- Chronic Sinus Infection
Any persistent dysphonia on alcohol and tobacco field has to fear cancer.
B-Clinical Examination :
It comprises :
- A l’inspection : looking for a low cervical scar beside the larynx or thyroid region
- Palpation cartilage research a skeletal deformity and palpation of the cervical lymph node areas to find possible lymphadenopathy.
- An examination of the larynx laryngeal mirror or with an endoscope to assess mobility and morphology of the vocal cords.
C- Additional tests :
They are made in the balance sheet phoniatric essential before any dysphonia :
- phoniatric appreciation of voice : singing voice, projected voice, spoken voice…
- Video endoscopy with Strobe allows a more precise approach lesions and vibration mucosal abnormalities that causes.
- Computer analysis of the voice to a pre-therapeutic objective assessment of the fundamental frequency laryngeal.
IV- etiological diagnosis :
A- Disorders of laryngeal mobility :
1- recurrent paralysis :
- United or bilateral
- in closing
→ The lesion may be located on the recurrent nerve route :
- thyroid surgery or esophageal history with cervical involvement
- mediastinal involvement or heart to the left recurrent.
→ On the path of the vagus nerve
- Atteinte tronculaire au niveau de cervical region, the jugular foramen or posterior fossa resulting in an immobilized vocal cord abduction.
2- Ankylosé crico-aryténoidienne :
Simulating paralysis, secondary to intubation
3- Dysphonie spasmodique :
Having to find a more general spastic reached : blepharospasm, facial spasm and neck muscles.
B- morphological with vocal cord :
1- inflammatory :
very common, they do find aggravating factors s (chronic sinusitis, gastroesophageal reflux) :
- Laryngites aigues occurring in a bacterial or viral context
- chronic laryngitis mainly due to tobacco abuse. They must fear the cancerous transformation of these lesions
– Red hypertrophic laryngitis
– Laryngitis white dyskeratotic with plates more or less in thickness can conceal carcinoma in situ or microinvasive.
- Laryngitis pseudo-myxomatous related to a significant edema of Reinke's space, transforming exceptionally cancer.
2- tumoral :
cancers : cancer of the vocal cord is the major fear before any persistent dysphonia
- Can be strictly limited to the vocal cord or extended to floors above and below glottal
- Can result in extended forms a decrease or loss of mobility of the larynx.
- Imposes a biopsy under general anesthesia by laryngoscopy.
Benign tumors :
- Amylose, chondrome
- Only histology allows diagnosis.
- laryngeal mobility disorders are rare in evolution.
3- infectious :
- Syphilis, TB where the context can guide diagnosis.
- Papillomatose laryngée : is occurring in childhood or appearing in adulthood and more pejorative prognosis for malignant potential.
4- birth defects :
Often diagnosed in indirect laryngoscopy :
- Sulcus glottidis = vocal muscle slot
- Kystes congénitaux intra-cordaux
5- secondary organic lesions to a functional voice disorder :
very common, they result in polyps, nodules, kissing nodules.
Any organic lesion of the vocal cords that are not its evidence, imperatively requires laryngoscopy under general anesthesia with histological specimen.
C- absence of morphological abnormality :
The diagnosis is then that a functional dysphonia require full balance phoniatric. The psychological field must be assessed, may occur or be at the origin of this functional disorder.
V- Treatment :
1- Treatment involves :
- The removal of risk factors : tobacco, alcohol.
- The treatment of aggravating factors : chronic sinusitis, reflux gastrooesophagien
- The processing of morphological lesions
2- Acute laryngitis :
- Are treated with antibiotics, antiinflammatory aerosols and.
- A remote control of the vocal cords should help control the restitution ad integrum of their anatomy.
3- Other organic pathologies :
- Will be treated according to their etiology but most often require a suspension laryngoscopy under general anesthesia.
- Speech therapy is often necessary to correct the malposition voice.
4- Treatment of disorders of laryngeal mobility :
- Unilateral recurrent laryngeal paralysis and ankylosis are treated mainly through mere speech therapy.
- Sometimes, need for injection of Teflon or collagen in the paralyzed vocal cord.
- In case of associated dyspnoea (bilateral paralysis), it may be necessary to perform a laser arytenoidectomy or chordwise posterior notch.
5- Treatment of functional dysphonia :
– removal of any organ damage : polyp, nodule
– Monitoring allows speech therapy rehabilitation :
- To verify the absence of recurrence
- Detect malignant transformation of certain injuries
- On objectify healing through a new evaluation of voice.
Dr M's course. Benchaoui – Faculty of Constantine