Disorder of local abuse impact in public

This ppt is know about local abuse disorder and the think that we ignore about local abuse in day to day life Local abuse" can refer to different situations depending on the context. It might involve physical, verbal, or emotional abuse that occurs in a specific community or geographic area. This could be related to:

Domestic violence: Abuse within households or relationships.
Workplace abuse: Harassment or unfair treatment in a local work environment.
Community-level abuse: Discriminatory practices, mistreatment, or exploitation happening within a community.

1. Disorders of voice abuseDisorders of voice abuse
Dr. Abhinav Srivastava
Professor and Head
Dept. of ENT

2. Vocal nodulesVocal nodules
Syn: Singer’s nodules, teacher’s nodules,
screamer’s nodules, juggler’s nodules,
etc.
Defined as disorder of voice abuse
commonly seen in professional voice
users, characterized by hoarseness, vocal
fatigue and presence of pin head sized
raised lesions on both the vocal cords at
the junction of its anterior I/3 and
posterior 2/3.

3. EtiopathologyEtiopathology
‘Hyperkinetic voice’
Voice abuse- ‘professional voice
users’
–Increased intensity
–Altered pitch
–Long duration
Chronic cough
Reflux laryngitis (GERD)

4. Hyperkinetic voice
Maximum vibration at the junction of
anterior 1/3 and posterior 2/3
Trauma leading to odema and submucosal
microhaemorrhage
Epithelial hyperplasia and subepithelial
hyalinization and fibrosis
Bilateral vocal nodules in the free edge of
the cords

5. SymptomsSymptoms
Professional voice users
Hoarseness
Improves initially with voice rest
Voice fatigue (Phonesthenia)
Strained speech- pain in the neck/
throat

6. SignsSigns
Indirect laryngoscopy
Pin-head sized pearly white
projections on the free edge of the
vocal cords at the junction of
anterior 1/3 and posterior 2/3
Vocal cord movements are normal
Congestion of the cords +/-

8. InvestigationsInvestigations
Diagnosis usually made clinically
If ILS is difficult
–Flexible laryngoscopy
–Rigid angled laryngeal endoscopy (70°/
90°)
–Stroboscopy

10. Treatment- ConservativeTreatment- Conservative
Voice rest- ‘Absolute’
Treatment of local sepsis, cough,
reflux, etc.
Speech therapy
–Vocal hygiene
–Relaxing exercises
Early lesions may disappear

11. Surgical treatmentSurgical treatment
MICROLARYNGOSCOPY (MLS) AND
PRECISE EXCISION under GA
Advantage of microscope
–Hands free
–Illumination
–Magnification
Speech therapy and vocal hygiene should
be continued following excision- prevents
recurrence

14. Vocal polypVocal polyp
Defined as a disorder of voice abuse
commonly seen in professional voice
users, characterized by hoarseness
and presence of a sessile or
pedunculated mass usually arising
from one of the vocal cords

15. EtiologyEtiology
Hyperkinetic voice
–Professional voice users
–Sudden shouting
Allergy
Smoking/ other irritants
Reflux laryngitis
Chronic cough

16. PathogenesisPathogenesis
Hyperkinetic voice
Submucosal
hemorrhage
Bernoulli's
phenomenon
Hemorrhagic
polyp
Mucosal edema and
polyp formation
Organized, hyperplasia,
hyalinization- Vocal polyp

17. Pathological typesPathological types
Hemorrhagic polyp
Hyperplastic polyp
Hyaline polyp
Sessile
Pedunculated

18. SitesSites
Usually unilateral
Common site: Junction of anterior
1/3 and posterior 2/3
Can be seen in other areas like
anterior commisure
Free edge or under surface

19. SymptomsSymptoms
Common in females and between 30-
50 years
Professional voice users
Hoarseness
Phonesthenia
Diplophonia (double voice)
Very rarely, a large polyp may give
rise to choking spells/ stridor

20. SignsSigns
Indirect laryngoscopy
Sessile/ pedunculated mass
Smooth reddish/ whitish mass
Unilateral
Junction of anterior 1/3 and posterior 2/3
Polyp may move up and down during
respiration or may pop up during
phonation
Vocal cord movements- normal

25. InvestigationsInvestigations
Diagnosis usually made clinically
Flexible laryngoscopy
Rigid angled laryngeal endoscopy
Stroboscopy

26. DDDD
Laryngeal papilloma
Laryngeal carcinoma

27. TreatmentTreatment
Small/ sessile polyp- try
Voice rest
Speech therapy
Steroid inhalers
Large polyp
MICROLARYNGOSCOPY AND PRECISE
EXCISION under GA
Continue speech therapy and observe
vocal hygiene

28. Reinke’s odemaReinke’s odema
Syn:
–Bilateral diffuse polyposis
–Polypoid degeneration of vocal cords
Defined as benign condition of the vocal
cords, commonly seen in professional
voice users and is characterized by
diffuse odema of the entire length of both
vocal cords in the Reinke’s space
Reinke’s space: Subepithelial space in the
vocal cords

29. EtiopathologyEtiopathology
Same as chronic laryngitis

30. Clinical featuresClinical features
Symptoms
–Same as chronic laryngitis
Signs
–Diffuse odema of both vocal cords
–‘Spindle’ shaped swelling on the cords
–Vocal cords are mobile

32. TreatmentTreatment
Conservative
–Voice rest
–Speech therapy
–Treat etiological factors, if any
–Steroid inhalers
Surgical
–Microlaryngoscopy
–Vocal cord stripping
–One cord at a time to prevent adhesions
–Avoid injury to vocal ligament

33. Contact ulcer/ granulomaContact ulcer/ granuloma
Defined as disorder of voice abuse
characterized by hoarseness and
pain in the throat on speaking and
presence of of an ulcer on the vocal
process of one arytenoid and
granuloma on the vocal process of
other arytenoid

34. EtiologyEtiology
Hyperkinetic voice
Same as chronic laryngitis

35. PathologyPathology
Chronic trauma at the vocal process
of arytenoids—ulceration on one
side and granuloma on the other

36. SymptomsSymptoms
Hoarseness
Pain on speaking- throat/ neck
Phonesthenia
Sticky/ FB sensation in the throat

37. SignsSigns
Indirect laryngoscopy
Characteristic granuloma on the
vocal process of one arytenoid and
ulcer on the other
Granuloma fits into the ulcer on
phonation
DD: Malignancy of larynx

38. TreatmentTreatment
Microlaryngoscopy and excision
biopsy of the granuloma
Voice rest
Vocal hygiene
Speech therapy
Treat etiological factors, if any

39. ClassificationClassification
Benign
PAPILLOMA
Hemangioma
Glomus
Chondroma
Fibroma
Lymphangioma
Adenoma
Malignant
SQUAMOUS CELL
CARCINOMA
Adenocarcinoma
Carcinosarcoma
Small cell
carcinoma
Chondrosarcoma

40. PAPILLOMA OF THE PAPILLOMA OF THE
LARYNXLARYNX
Types
Juvenile laryngeal papillomatosis
(Children)
Solitary laryngeal papilloma (Adults)

41. Juvenile laryngeal papillomatosisJuvenile laryngeal papillomatosis
Syn: Recurrent respiratory
papillomatosis
Benign neoplasm of the larynx,
commonly seen in children and is
characterized by presence of
multiple warty lesions on the larynx
which may give rise to fatal
respiratory obstruction

42. IncidenceIncidence
Most common benign tumor of the
larynx in childhood
Approximately 1500 new cases
reported annually

43. EtiologyEtiology
Human papilloma virus 6 and 11- tissue specific-
targets stratified squamous epithelium of the
oropharynx, larynx, and anogenital region but not
epidermis
? Genetic predisposition
80-90% of cases present before 3 years of age
May get infected during birth if mother has genital
condylomata (Genital warts)- 50% of cases have
mothers with this!
But delivery by caesarian section does not prevent
it- ? Transplacental spread/ postnatal infection

44. PathologyPathology
Gross: Multiple pinkish white warty
lesions on the supraglottis and vocal
cords- may obstruct the airwary
Can occur anywhere in the respiratory
tract- but common glottis and
supraglottis
Microscopy: Finger like projections of
epithelial tumor cells with central
fibrovascular core

45. SymptomsSymptoms
Hoarseness
–‘Any child with hoarseness of more than
1 month duration should be diagnosed
as JLP until otherwise proved’
‘Asthma-like’ features
Stridor

46. SignsSigns
Hoarse voice/ harsh weak cry
ILS: Multiple pinkish warty lesions,
airway may be obscured
Inspiratory/ biphasic stridor +/-

47. InvestigationsInvestigations
X-ray lateral/ AP view of the neck
Chest X-ray
Flexible/ rigid laryngoscopy
Microlaryngoscopy and excision-
Biopsy
Bronchoscopy to r/o
tracheobronchial lesions

48. TreatmentTreatment
Various methods of treatment described
Microlaryngoscopy and excision with
microcautery- common method of treatment
Avoid trauma to adjacent areas- seeding
into raw areas can result in recurrence?
Recurrence rates very high
May need repeated such procedures to clear
the airway
Spontaneous regression may occur after
puberty

49. Other methods of treatment:Other methods of treatment:
Inconsistent success reportedInconsistent success reported
Cryosurgery
Ultrasonic destruction
Laser vaporization
MLS and application of podophyllum
Interferon therapy
Autogenous vaccines
Long term antibiotics have been tried
Antiviral treatment

50. If stridor +If stridor +
Tracheostomy if intubation is not
possible
Tracheostomy should be avoided
because recurrence in the
tracheastoma site can occur- more
difficult to treat

51. PrognosisPrognosis
High recurrence rates
Death due to respiratory obstruction
If survives till puberty- prognosis is
good
NOT PREMALIGNANT

52. SOLITARY PAPILLOMASOLITARY PAPILLOMA
Occurs in adults
Clinical presentation is similar to vocal
polyp- commonly occurs on membranous
vocal cord
Etiology: Human papilloma virus
Treatment: Microlaryngoscopy and
excision
PREMALIGNANT CONDITION
Prognosis is good if completely excised-
recurrence rates very low compared to
Juvenile papillomatosis

53. Thank you