-Contact ulcers(granulomas)-Reflux-Webbing

Cause/etiology Hard glottal attack along with throat

clearing and coughing Laryngopharyngeal reflux (most common

cause) Postnasal drip Endotracheal intubation Surgery on the VFs

Teflon granuloma of the larynx Removal of cysts

Segmentation of VFs The anterior two - thirds

Muscle - vocalis portion of the thyroarytenoids Menbrane

Posterior third Arytenoids Menbrane

Location Medial aspect of the vocal processes of

the arytenoid cartilages Bilateral (mostly)

Typical symptoms Vocal fatigue - after prolonged

vocalization Hoarseness or roughness

Pain in laryngeal area or/and one ear

Contact ulcers with granulomas

Treatments

Treatments

The focus of voice therapy Elevate pitch Greater mouth and jaw relaxation Lower level of volume Eliminate all traces of excessively hard

glottal attack

Attention If surgical revision of the larynx has

resulted in a better voice, and then months or years afterwards the voice deteriorates, the larynx should be reexamined using endoscopy or stroboscopy in order to identify possible reactive granuloma

Location Lower esophageal sphincter Upper esophageal sphincter

Types GERD - Gastroesophageal reflux disease LPR or EER- Laryngopharyngeal reflux or

Extraesophageal reflux

Symptoms

Examinations

Treatments

Behavioral therapy Elevating the head of the bed Remaining upright at least 60 mins after

meals Avoid spicy food No exercise after eating Cutting down caffeine, carbonated drinks

and alcohol, esp afternoon and evening

Behavioral therapy Don’t drink too much water right before

bed No activities that compress the abdomen Weight loss Wearing looser clothing around the waist Eliminating smoking

Pharmacy PPI (proton - pump inhibitor 质子泵抑制剂 ) Prokinetic agent 胃肠蠕动促进剂

Surgery Surgical laparoscopic fundoplication (腹腔镜下胃底折叠术 )

Types Congenital Acquired

Cause/etiology Chromosome 22q deletion - Congenital Bilateral trauma of the medial edges of

the VFs – Acquired Bilateral surgery (laryngeal or tracheal) External trauma

Location Anterior one-third of VFs (mostly)

Typical symptoms High - pitched rough sound

Shorter length of VFs Shortness of breath

Seriously compromising the open glottis

Webbing

Examinations

Treatments