vocal cord summary
Introduction
Introduction to the vocal cord summary The vocal nodule (vocal nodule), also known as the singernodule or teacher nodule, occurs in children who are called a nodule. It is a special type of chronic laryngitis that is formed by inflammatory lesions. The most important clinical symptom is hoarseness. Clinical diagnosis can be performed by laryngoscopy. Treatment includes appropriate vocal cord rest, corrective vocal methods, and surgical treatment. The early degree is lighter, the sound is slightly rough or basically normal, mainly because the sound is easy to fatigue, when the sound is used for a long time, when the time is good or bad, it is intermittent hoarseness; often the snoring occurs when the treble is high, accompanied by the pronunciation delay, tone Change, etc.; some patients may not see obvious sound changes in daily conversation, but when singing, there may be more obvious manifestations such as narrower range and limited vocalization. The condition continues to develop, and the vocal weights increase, from intermittent to continuous, and also occur when lower sounds. The actor cannot sing because of the hoarseness or the teacher cannot teach. The degree of hoarseness is related to the size and location of the vocal cord nodules. basic knowledge The proportion of illness: 0.0025% Susceptible people: no special people Mode of infection: non-infectious Complications: vocal cord polyps congenital vocal dysplasia
Cause
Vocal cord nodules
Occupational factors (20%):
Excessive use of sound or improper use of voice, common in teachers, actors, singers and other professional voices, long-term continuous high-pitched speech, too high pitch or too long singing can lead to vocal nomination.
Disease factors (15%):
Upper respiratory tract infection, cold, acute and chronic laryngitis, rhinitis, sinusitis, pharyngitis, lung, trachea, bronchitis, etc. can all be the cause of the disease. If the sound is excessively used on the basis of the presence of upper airway inflammation, the vocal cord nodules are more likely to occur.
Body factor (10%):
Nasal, sinus and pharyngeal infections may spread directly due to inflammation, or inflammatory secretions flow into the throat, leading to disturbances in vocal resonance, resulting in improper vocalization and increased fatigue of the laryngeal muscles, leading to the disease. When the lungs, trachea, and bronchus are infected, the inflammatory secretions produced by coughing can be in contact with the throat for a long time, and the disease can be secondary.
Environmental factors (15%):
Contact with irritating pathogenic factors, such as high temperature operations, dust operations, chemical industry, etc. can produce a large amount of irritating substances, causing vocal cord nodules.
Endocrine disorders (15%):
The vocal cord nodules have gender differences in the incidence of children and adults, and those who are over 50 years old are rare. Therefore, some scholars believe that endocrine factors may have some association with vocal cord nodules.
Some systemic diseases (15%):
Such as heart, kidney disease, diabetes, rheumatism, etc., vasomotor function disorder, long-term congestion of the throat, can be secondary to this disease.
Hypopharyngeal reflux (5%):
Throat and pharyngeal reflux disease has received more and more attention in recent years, and the research on this disease has been deepened. Some scholars believe that chronic inflammation caused by reflux of gastric contents stimulates the laryngeal mucosa is also one of the causes of vocal cord nodules.
Pathogenesis
In 1866, the vocal cord summary was first described by Turck. In 1935, Tarmeaid explained the formation mechanism of the vocal cord nodules in a research report, and determined that the vocal cord nodules are a concept of dysfunctional vocal diseases. The formation of vocal cord nodules is on the one hand the vocal cord function is low, on the other hand is the influence of excessive exhalation airflow. Under the influence of the Bernouilli effect, the negative pressure of the glottis region will increase with the increase of the glottal airflow velocity. The force that attracts the closure of the vocal cords also increases as the airflow increases. Under the action of excessive airflow, the mucosa of the vocal cord membrane appears as an upward and inward arched protrusion, and the mucosal wave at the junction of the 1/3 of the vocal cords is the most obvious. When the vocal cords are closed each time, the mucosa at the mid-1/3 junction of the vocal cords is subjected to the Bernouilli effect.
Before the formation of the vocal cord nodules, it is often observed that the anterior middle part of the vocal cords, that is, the inflammatory edema of the mucosa at the formation of the vocal cord nodules, has secretions attached to the surface during the vocalization, and the patient frequently clears the secretions to try to clear the secretions. At this time, if the vocalization continues, the negative pressure attraction of the Bernouilli effect will further aggravate the vocal cord mucosal damage, which may cause a chronic inflammatory reaction of the vocal cord mucosa. Long-term strong negative pressure will lead to thickening of the vocal cord mucosal epithelium, and finally form a small knot-like protrusion at the middle 1/3 junction of the vocal cords.
Pathophysiology
The vocal cord nodules are caused by excessive vibration of the vocal cords, causing tissue damage, which is manifested as damage to the mucosal epithelial layer and the basement membrane. Wang (1996) found that the epithelium on the lower surface of the vocal cord nodules is more pronounced than the epithelial hyperplasia on the upper surface, and that this may be more intense with the lower surface vibration during vocalization and is directly related to the direct impact of the high pressure airflow under the glottis. Therefore, it is impossible for a single injury to cause a vocal cord nodule, but a repeated injury.
The vocal cord nodules are inflammatory reactions caused by repeated mechanical damage, and the vocal cord nodules of different textures are formed according to the process of inflammation development. Early or early vocal cord nodules are soft and red, covered with normal squamous epithelium, edematous matrix, and may have vascular hyperplasia, vasodilation or hemorrhage; more mature or mid-term vocal cord nodules are more solid, fibrotic or transparent The mature or advanced vocal cord nodules are pale, with epithelial thickening and keratinization.
Prevention
Vocal cord nodules prevention
Vocal cord rest and vocal training can prevent the occurrence of the disease to a certain extent. At the same time, smoking, drinking, eating spicy food and other irritating virulence factors should be avoided. Attention should also be paid to preventing upper respiratory tract infections such as colds and reducing the incentives for vocal cord nodules.
Complication
Vocal cord nodules complications Complications, vocal cord polyps, congenital vocal dysplasia
1. In the early stage of vocal cord nodules, the treble was broken, the sound was easy to fatigue and not long-lasting, and the bass was unchanged. Later, it gradually increased, and most of the sounds ruptured and hoarse.
2. If the vocal cord nodules are larger, there is a significant hoarseness. From intermittent development to persistence, the patient is difficult to sing and cannot speak loudly.
3. Severe vocal cords can be severely hoarse or aphasia, unable to communicate in language, affecting work, study and life.
4. The vocal cord nodules can make the vocal cords incompletely audible, which leads to hoarseness, and the vocal cords will increase the weight of the vocal cords, resulting in fatigue. If the treatment is not timely, the vocal folds will gradually increase and persist, and the sacral belt may also appear. Symptoms such as blood and neck lymph node metastasis, vocal cord nodules may also have cancerous changes without knowing it.
Symptom
Vocal cord nodules Symptoms Common symptoms Sound abnormalities Deaf Children's vocal cords Damage glottic edema
The main symptom is hoarseness. The early degree is lighter, the sound is slightly rough or basically normal, mainly because the sound is easy to fatigue, when the sound is used for a long time, when the time is good or bad, it is intermittent hoarseness; often the snoring occurs when the treble is high, accompanied by the pronunciation delay, tone Change, etc.; some patients may not see obvious sound changes in daily conversation, but when singing, there may be more obvious manifestations such as narrower range and limited vocalization. The condition continues to develop, and the vocal weights increase, from intermittent to continuous, and also occur when lower sounds. The actor cannot sing because of the hoarseness or the teacher cannot teach. The degree of hoarseness is related to the size and location of the vocal cord nodules.
Many patients have a history of upper respiratory tract infection before the onset of the disease, followed by a vocal cord nodules, so that the hoarsein still can not completely relieve after the infection has healed. The whole process may cause the patient to think that the hoarseness is caused by the infection, and ignore the adverse effects of the daily use of excessive sound and improper use of the sound on the vocal cords.
Examine
Vocal cord summary check
Laryngoscopy (indirect laryngoscope, direct laryngoscope, fiber laryngoscope, electronic laryngoscope, stroboscopic laryngoscope, etc.): Diagnosis can be performed by various laryngoscopy combined with clinical symptoms.
A typical vocal cord nodule is a symmetric nodular bulge at the mid-1/3 junction of the bilateral vocal cords. In the early stage, the middle 1/3 of the vocal cords were separated from the rim, and secretions were attached during the vocalization. When the vocal cords were abducted, the secretions were filiform across the glottic fissure. Thereafter, the mucosa at the vocal cords is edematous, soft and reddish. In the late stage, it gradually becomes a grayish white small bulge, and the surface is smooth and has a firm feeling. It is about half a grain size and becomes a distinct summary. The nodules generally occur bilaterally symmetrically, with either one side being larger and the other side being smaller or only one side visible. The vocal cord nodules can be limited to small protrusions, and can also be broad-spindle-shaped thickening. The former is more common in vocal singers, while the latter is common in other professionals who use excessive sound. The knots on both sides of the sound are placed together so that the glottis cannot be completely closed, in the shape of an "hourglass".
Indirect laryngoscopy observation is not satisfactory for direct laryngoscopy, fiber laryngoscopy, electronic laryngoscopy, stroboscopic laryngoscopy, etc., stroboscopic laryngoscopy can observe the vocal cord morphology, but also observe the vocal cord movement. In addition, various acoustic acoustic assessments and aerodynamic evaluations can be performed to understand the extent to which the vocal cords and the airflow through the glottis are affected by the lesions.
Diagnosis
Vocal cord nodules diagnostic identification
diagnosis
Mainly based on clinical symptoms, that is, a long history of hoarseness, combined with laryngoscopy, can make a clinical diagnosis.
Differential diagnosis
Vocal cord polyp
The vocal cord polyps and vocal cord nodules are mainly identified by clinical macroscopic morphology. Mostly soft, translucent new creatures in the middle 1/3 of the vocal cord edge, white or pink, smooth surface, can be pedicled, or wide base.
Vocal cord cyst
Including retention cysts, epidermoid cysts and so on. The cyst is hemispherical, with a smooth surface, grayish white, yellowish or reddish. The wall of the capsule is generally thin and can be fluctuating. It can be distinguished by stroboscopic laryngoscopy.
Laryngeal papilloma
It is the most common benign tumor in the throat. It is generally thought to be caused by a viral infection. It can be single or multiple. The mass is pale, reddish or dark red. The surface is often mulberry-like or rough and uneven, such as fluff. The pedicles often move up and down with the respiratory airflow and can be identified by pathological examination.
Throat nodules
Mostly located in the posterior part of the larynx, manifested as pale, edema of the laryngeal mucosa, accompanied by multiple superficial ulcers, such as worm-like. One side of the vocal cords can also be hyperemia and thickening. Can be associated with low-heat, cough and other systemic symptoms, chest X-ray, tuberculin test, sputum culture, etc. to help identify.
Laryngeal cancer (glottic type)
It occurs mostly in older men and usually has a long history of smoking, and the symptoms of hoarseness are progressively worse. Laryngoscopy can be seen in the vocal cords of the cauliflower pattern or nodular mass, the surface is not smooth or rough, can be attached to the pseudo-membrane or ulcer formation, the touch is brittle, easy to appear, can infiltrate the surrounding tissue, continue to develop The sound belt is fixed. In the advanced stage, dyspnea may occur, metastatic neck lymph nodes may be enlarged, and systemic symptoms such as dyscrasia may occur at the end.
