Vocal Cord Disorders 聲帶疾病(英文)
Vocal Cord Disorders 聲帶疾病(英文)
Generally speaking, vocal cord disorders include acute or chronic chorditis, vocal cord nodules, vocal cord polyps, vocal cord malignant tumors, degenerative vocal cord atrophy, vocal cord incompetence, and the causes include vocal cord atrophy, vocal cord paralysis, etc, which are described as follows:
Acute and Chronic Chorditis
Vocal cord oedema is caused by upper respiratory tract infection. It is called acute chorditis because of the symptoms of sore throats, cough, itching or hoarseness. Usually after one to two weeks, the sound can be restored to its original state. Chronic chorditis is often induced by frequent speech, erroneous vocal habits, excessive consumption of irritating foods (e.g. spicy food and spirits), or heavy smoking, as well as gastroesophageal reflux and gastritis. The patient's vocal cords are irregularly thicker and hoarseness usually lasts for a long time, along with a sense of tightness in the throat or an urge to clear phlegm.
In addition to reducing phlegm and antagonizing gastroesophageal reflux, or drug therapy for gastritis and gastric ulcer, it is important to have a normal life habit, rest and eating habits and avoid satiety before bed. However, it should be noted that anti-acid reflux or drugs for gastritis and gastric ulcer are hydrogen ion pump inhibitors, which can improve symptoms by inhibiting gastric acid secretion, with a few users likely to have side effects of a headache or gastrointestinal discomfort.
Vocal Cord Nodules
Long-term excessive speech and incorrect vocal habits may initially only cause chronic chorditis, which is prone to fatigue. Gradually, epidermal thickening and irreversible changes of subcutaneous tissue occur in front of the vocal cord, leading to the formation of vocal nodules. Nodules are mostly found at the midpoint of the anterior two-thirds of the vocal cords on both sides. Most of the patients are women.
When it is found that the voice starts to be hoarse or the throat is uncomfortable, we should rest more and use cough medicines and swelling-reducing drugs when necessary to avoid the occurrence of vocal nodules. The sooner vocal nodules are found, the sooner speech therapy is carried out, such as changing speech habits and training to produce sound through Dantian, the smaller or even disappearing vocal nodules will be. If speech therapy is ineffective for more than three months, laryngeal microsurgery should be considered.
Laryngeal microsurgery is the main treatment for vocal cord nodules as the effect of pharmacotherapy is not good. At present, endoscopy combined with steroid injection through the cervical vocal cords is available, but the effect remains to be evaluated. A week of keeping quiet is required after operation to make the wound heal completely.
Vocal Cord Polyps
After a loud roar or severe cough, the vocal cord mucosal vessels rupture and bleed, but the blood clots are not fully absorbed. The hoarseness lasts for more than two weeks to several months and the condition is becoming worse, which is more common in men (smoking can aggravate symptoms).
In the treatment of vocal cord polyps, slight and newly appeared vocal cord polyps may disappear due to less talk and medication, but if the symptoms have lasted for one or two months, the possibility of polyps disappearing is unlikely. Especially where after recuperation or conservative treatment with medications for more than 3 months, it still does not disappear, local steroid injection or laryngeal microsurgery can be considered, which is the same as vocal nodules.
Under general anesthesia, the vocal cords are fixed by a laryngoscope, the surgical site of larynx is magnified by microscope, and the vocal cords nodules or polyps are removed by laryngeal microinstruments. A week of keeping quiet is required after operation to make the wound heal completely.
Vocal Cord Leukoplakia
Some patients believe that hoarseness is only caused by nodules of vocal cords, but if they have the habit of smoking and drinking, they should be careful about the symptoms of hoarseness. In addition to vocal nodules, they may also develop leukoplakia of vocal cords.
Leukoplakia of the vocal cord is 50% more likely to deteriorate into vocal cord cancer, and may be combined with hypopharyngeal cancer or secondary primary esophageal cancer. Therefore, patients with hoarse voices who smoke are advised to seek medical treatment as soon as possible.
Laryngeal microsurgery for leukoplakia resection should be prioritized as the effect of pharmacotherapy is not good. Laryngeal microsurgery is indispensable for the treatment of vocal cord leukoplakia in smoking patients. In addition to the effective removal of leukoplakia, pathological confirmation can rule out vocal cord cancer. Further, it can be combined with laryngeal laser therapy to reduce the chance of vocal cord leukoplakia recurrence.
Malignant Tumors of the Vocal Cords
Vocal cord malignancies are closely connected with long-term smoking. Heavy smokers finding that their voices are hoarse in the early stage should be examined by an otolaryngologist immediately. Generally, an early stage sees only laryngeal epithelial hyperplasia, but repeated smoking and stress stimulation such as inappropriate speech or cough can trigger cellular canceration. Most of the lesions occur in the first third of the vocal cords, and there is a possibility of bleeding.
Early treatment with radiotherapy and late treatment with chemotherapy can achieve good therapeutic effect and preserve laryngeal organs. However, if it is found to be advanced or malignant cells not responding or sensitive to radiotherapy and chemotherapy, surgery is recommended as the initial therapy. In addition to reducing postoperative complications caused by radiotherapy and chemotherapy, the disease control rate and five-year survival rate are also promising.
Currently, with the advancement of surgical methods and surgical instruments, many patients with early laryngeal cancer can also receive laryngeal laser organ preservation surgery, which can effectively remove the lesion, preserve the function of the larynx, and reduce the sequelae of radiotherapy and chemotherapy.
Vocal Cord Atrophy and Paralysis
Long-term overuse of vocal cords often leads to hoarseness, but no lesions such as vocal nodules or polyps have been found in laryngeal examination. On closer inspection, fine and atrophic vocal cords are often the main cause of hoarseness.
Vocal cord paralysis can also cause hoarseness. Besides laryngeal trauma, cerebral apoplexy, viral infection and unknown factors, vocal cord paralysis has been found clinically to be associated with thyroid cancer, upper esophageal cancer, lung cancer, thoracic mediastinal lesions, and even type A aortic dissection complicated by hypertension.
To treat patients with vocal cord atrophy, after excluding organic lesions, if silent recuperation is ineffective, speech therapy and cardiovascular training can be considered. If there are still hoarseness symptoms and choking, besides autologous fat injection and hyaluronic acid injection for vocal cords (i.e. injection of hyaluronic acid into the vocal fold), laryngeal muscle transposition or thyroplasty can also be considered.
Autologous fat injection into the vocal cords is performed by first extracting 2-3 c.c. autologous fat from the patient's abdomen and then injecting it from the throat to the lateral side of the muscular layer of the vocal cords with a fine needle with the assistance of a microscope. Thyroid chondroplasty is a method of adjusting the laryngeal skeleton such as thyroid, annular or arytenoid cartilage through the neck incision under local anesthesia to improve laryngeal sound or swallowing function.
For patients with unilateral vocal cord paralysis after thyroid surgery who have not improved after six months of follow-up, injection of autologous fat or hyaluronic acid into the vocal fold may be considered as the initial treatment. Patients with severe unilateral vocal cord paralysis can undergo further laryngeal muscle transposition or thyroplasty, which can achieve a more lasting effect.
For the patients with bilateral vocal cord paralysis, it is suggested that under the protection of the safe airway by temporary tracheotomy, the operation of resecting unilateral laser arytenoid cartilage and partial posterior vocal cords should be performed under the condition that cardiopulmonary function is confirmed to be able to withstand laryngeal surgery by up to half a year of observation, which can greatly increase the chance of breathing out of tracheotomy and retain the function of speech.
In short, to have a pleasant voice, it is necessary to protect your throat from time to time. Once the symptom of hoarseness lasts for a period of time, be sure to see a doctor for the cause of the disease and symptomatic treatment.