Spindle-shaped glottis: Sulcus vocalis, presbilarynx and other causes

Year 2012, Volume: 39 Issue: 4, 614 - 622, 01.12.2012

Salih Bakır Vefa Kınış

https://doi.org/10.5798/diclemedj.0921.2012.04.0213

Abstract

Spindle-shaped glottal insufficiency may appear at any age. This disorder significantly affect the voice quality and hence the life quality. Degenerative, neuromuscular, inflammatory, functional, iatrogenic and psychogenic originated pathologies can lead to spindle-shaped glottal insufficiency. Sulcus vocalis, vocal scars and presbylarynx constitutes degenerative causes. The term sulcus vocalis is used to describe a groove at the free edge of the vocal folds resulting in an area of mucosal stiffness and giving the vocal folds a bowed aspect during phonation. It may involve all or any segment of the edge of the fold. The defect may be confined to the superficial layer of the mucosa or penetrate deeply in the vocal ligament and muscle. According to involvement, three types have been described. Etiology remains controversial and the authors present arguments for each theory, acquired or congenital. The term ‘presbylarynx\' denotes vocal changes due to aging of the larynx. Symptoms are characterized by poor vocal projection, shorter phonation duration and vocal roughness. Videolaryngostroboscopy is a highly effective diagnostic tool for spindle-shaped glottal insufficiency. The glottis is spindle-shaped during phonation and vibration is frequently asymmetrical and reduced in amplitude. Because of closing defects; median line air leakage is observed in the anterior two-thirds of the vocal folds during phonation. Treatment options include phonosurgery and speech therapy in spindle-shaped glottis. The aim of the present paper is to review the reasons of vocal fold curvature, particularly presbylarynx and sulcus vocalis, and the clinical features of spindle-shaped glottal insufficiency.

Keywords

Voice, vocal folds, dysphonia

İğ şekilli glotis: Sulkus vokalis, presbilarenks ve diğer nedenler

Abstract

İğ şekilli glotik yetersizlik, her yaşta karşımıza çıkabilir. Bu bozukluk, ses kalitesini ve dolayısıyla yaşam kalitesini bozar. Dejeneratif, nöromüsküler, enflamatuvar, fonksiyonel, yatrojen ve psikojen nedenli patolojiler iğ şekilli glotik yetersizliğe yol açabilir. Sulcus vocalis, skarlar ve presbilarenks dejeneratif nedenleri oluşturur. Sulcus vocalis, ses kıvrımında mukozal sertlik oluşturan bir alana neden olmakta, mukoza dalgalarının normal yayılımını engellemekte ve ses kıvrımında yaylanmaya neden olmaktadır. Sulkus vokalis, mukozanın yüzeysel tabakasına sınırlı olabilir veya derindeki vokal ligamanı ve kası penetre edebilir. Tutuluma göre üç tipi tarif edilmiştir. Etiyolojisi halen net değildir. Konjenital veya edinsel olduğuna yönelik tartışmalar devam etmektedir. Presbilarenks, ileri yaşlarda larenksin yaşlanmasına bağlı olarak gelişen, zayıf vokal projeksiyon (kısık, zayıf, hava kaçaklı) ve kısa fonasyon süresi semptomları ile karakterize değişiklikleri ifade eder. Videolarengostroboskobi, iğ şekilli glotis teşhisinde oldukça faydalı bir cihazdır. Fonasyon sırasında iğ şekilli glotise neden olan ses kıvrımlarının serbest kenarında kavislenmiş (yaylanmış, kıvrılmış) görünüm, en önemli fizik muayene bulgusudur. Ses kıvrımlarında kapanma defekti nedeniyle 2/3 ön kısmında hava kaçağı gözlenir. Amplitüt genişliğinde azalma vardır. Vibrasyon sıklıkla asimetriktir. İğ şekilli glotiste tedavi seçenekleri cerrahi ve ses terapisidir. Bu yazıda sulcus vocalis ve presbilarenks gibi sık olmakla beraber çoğunlukla atlanan patolojiler başta olmak üzere iğ şekilli glotik yetersizlik nedenleri literatür eşliğinde gözden geçirilmiştir.

Keywords

Ses, ses telleri, disfoni

References

• Giovanni A, Chanteret C, Lagier A. Sulcus vocalis: a review. Eur Arch Otorhinolaryngol 2007;264(4):337-44.
• Ford CN, Inagi K, Khidr A, et al. Sulcus vocalis: a rational approach to diagnosis and management. Ann Otol Rhinol Laryngol 1996;105(2):189-200.
• Bouchayer M, Cornut G, Witzig E, Loire R, Roch JB, Bas- tian RW. Epidermoid cyst, sulci, and mucosal bridges of the true vocal cord: a report of 157 cases. Laryngo- scope.1985;95(9):1087- 94.
• Ishii H, Baba T, Kawabata I. Clinical observations in the sul- cus vocalis. J Otolaryngol 1967;70(7):911-9.
• Shin Y. Clinical and pathological investigations of sulcus vo- calis. Otologia (Fukuoka) 1976;22(7):819-35.
• Nakayama M, Ford CN, Brandenburg JH, et al. Sulcus vo- calis in laryngeal cancer: a histopathologic study. Laryngo- scope. 1994;104:16-24.
• Hsiung MW, Woo P, Wang HW, et al. A clinical classifica- tion and histopathological study of sulcus vocalis. Eur Arch Otorhinolaryngol 2000;257(4):466-68.
• Sunter AV, Yigit O, Huq GE, et al. Histopathological char- acteristics of sulcus vocalis. Otolaryngol Head Neck Surg 2011;145(2):264-9.
• Monday LA, Bouchayer M, Cornut G, et al. Epidermoid cysts of the vocal cords. Ann Otol Rhinol Laryngol 1983;92:124- 7.
• Itoh T, Kawazaki H, Morikawa I, et al. Vocal fold furrows. A 10-year review of 240 patients. Auris Nasus Larynx 1983;10(Suppl.):S17-26.
• Hirano M, Tanaka S, Yoshida T, et al. Sulcus vocalis: func- tional aspects. Ann Otol Rhinol Laryngol 1990;99(6):679- 83.
• Sato K, Hirano M. Electron microscopic investigation of sulcus vocalis. Ann Otol Rhinol Laryngol 1998;107(1):56- 60.
• Lindestad PA, Hertegard S. Spindle-shaped glottal insuf- ficiency with and without sulcus vocalis: a retrospective study. Ann Otol Rhinol Laryngol 1994;103(5):547-53.
• Jacobson BH, Johnson A, Grywalski C, et al. The Voice Handicap Index (VHI) development and validation. Am J Speech Lang Pathol 1997;6(1):66-70.
• Rosen CA, Lee AS, Osborne J, et al. Development and validation of the voice handicap index-10. Laryngoscope 2004;114:1549-56.
• Kılıç MA, Okur E, Yıldırım İ, et al. Ses Handikap En- deksi (Voice Handicap Index) Türkçe versiyonunun gü- venilirliği ve geçerliliği. Kulak Burun Bogaz Ihtis Derg 2008;18(3):139-47.
• Tanaka S, Hirano M, Chijiwa K. Some aspects of vocal fold bowing. Ann Otol Rhinol Laryngol 1994;103(3):357-62.
• Mallur PS, Rosen CA. Vocal fold injection: review of indi- cations, techniques, and materials for augmentation. Clin Exp Otorhinolaryngol 2010;3(4):177-82.
• Ford CN, Staskowski PA, Bless DM. Autologous collagen vocal fold injection: a preliminary clinical study. Laryngo- scope 1995;105(8):944-48.
• Dailey SH, Ford CN. Surgical management of sulcus vo- calis and vocal fold scarring. Otolaryngol Clin North Am 2006;39(1):23-42.
• Hsiung MW, Kang BH, Su WF, Pai LU, Lin YH. Combina- tion of fascia transplantation and fat injection into the vocal fold for sulcus vocalis: long-term results. Ann Otol Rhinol Laryngol 2004;113:359-66.
• Molteni G, Bergamini G, Ricci-Maccarini A, Marchese C, Ghidini A, Alicandri-Ciufelli M, et al. Auto-crosslinked hy- aluronan gel injections in phonosurgery. Otolaryngol Head Neck Surg 2010; 142(4):547-53.
• Isshiki N, Shoji K, Kojima H, et al. Vocal fold atrophy and its surgical treatment. Ann Otol Rhinol Laryngol 1996;105(2):182-8.
• Zeitels SM, Mauri M, Dailey SH. Medialization laryngo- plasty with Gore-Tex voice restoration secondary to glottal incompetence: indications and observations. Ann Otol Rhi- nol Laryngol 2003;112(2):180-84.
• Gerek M. Larengeal Çatı Cerrahisi (Larengoplastik Ses Cer- rahisi). Turkiye Klinikleri J E.N.T. 2002;2(3Suppl1):55-65.
• Su CY, Tsai SS, Chiu JF, et al. Medialization laryngo- plasty with strap muscle transposition for vocal fold at- rophy with or without sulcus vocalis. Laryngoscope 2004;114(10):1106-12.
• Kocak I, Dogan M, Tadihan E, et al. Window anterior com- missure relaxation laryngoplasty in the management of high-pitched voice disorders. Arch Otolaryngol Head Neck Surg 2008;134(12):1263-9.
• Kendall K. Presbyphonia: a review. Curr Opin Otolaryngol Head Neck Surg 2007;15(3):137-40.
• Hagen P, Lyons GD, Nuss DW. Dysphonia in the elderly: diagnosis and management of age-related voice changes. South Med J 1996; 89(2):204-07.
• Kandoğan T, Olgun L, Gültekin G. Causes of dysphonia in patient above 60 years of age. Kulak Burun Bogaz Ihtis Derg 2003; 11(5):139-43.
• Takano S, Kimura M, Nito T, et al. Clinical analysis of pres- bylarynx-vocal fold atrophy in elderly individuals. Auris Nasus Larynx 2010;37(4):461-4.
• Ramig LA. Effect of physiological aging on vowel spectral noise. J Gerontol 1983;38(2):223-5.
• Ramig LA, Ringel RL. Effects of physiological aging on se- lected acoustic characteristics of voice. J Speech Hear Res 1983;26(1):22-30.
• Pontes P, Brasolotto A, Behlau M. Glottic characteristics and voice complaint in the elderly. J Voice 2005;19(1):84- 94.
• Tanaka S, Hirano M, Chijiwa K. Some aspects of vocal fold bowing. Ann Otol Rhinol Laryngol 1994;103(3):357-62.
• Sato K, Hirano M. Age-related changes of the macula flava of the human vocal fold. Ann Otol Rhinol Laryngol 1995; 104(7):839-44.
• Paulsen FP, Tillmann BN. Degenerative changes in the human cricoarytenoid joint. Arch Otolaryngol Head Neck Surg 1998; 124(8):903-6.
• Sato K, Hirano M. Age-related changes in the human laryn- geal glands. Ann Otol Rhinol Laryngol 1998; 107(4):525- 29.
• Morrison M, Gore-Hickman G. Voice Disorders in the El- derly. J Otolaryngology 1986; 15(2):231-4.
• Sato K, Hirano M, Nakashima T. Age-related changes of collagenous fibers in the human vocal fold mucosa. Ann Otol Rhinol Laryngol 2002;111(1):15-20.
• Bloch I, Behrman A. Quantitative analysis of videostrobo- scopic images in presbylarynges. Laryngoscope 2001; 111 (11 Pt 1):2022-7.
• Piccirillo JF, Painter C, Fuller D, et al. Multivariate analy- sis of objective vocal function. Ann Otol Rhinol Laryngol 1998;107(1):107-12.
• Omori K, Slavit DH, Matos C, et al. Vocal fold atrophy: quantitative glottic measurement and vocal function. Ann Otol Rhinol Laryngol 1997;106(4):544-51.
• Makiyama K, Yoshihashi H, Park R, et al. Assessment of phonatory function by the airway interruption meth- od: agerelated changes. Otolaryngol Head Neck Surg 2006;134(3):407-12.
• Remacle M, Lawson G. Results with collagen injection into the vocal folds for medialization. Curr Opin Otolaryngol Head Neck Surg 2007;15(3):148-52.
• Hirano S, Nagai H, Tateya I, et al. Regeneration of aged vocal folds with basic fibroblast growth factor in a rat model: a preliminary report. Ann Otol Rhinol Laryngol 2005;114(2):304-8.
• Kim SH, Kearney JJ, Atkins JP. Percutaneous laryngeal col- lagen augmentation for treatment of parkinsonian hypopho- nia. Otolaryngol Head Neck Surg 2002;126(6):653-6.
• Mao VH, Abaza M, Spiegel JR, et al. Laryngeal myasthenia gravis: report of 40 cases. J Voice 200;15(1):122-30.
• Bakker KK, Ramig LO, Sapir S, et al. Control of vocal loudness in young and old adults. J Speech Hear Res 2001; 44(2):297-305.
• Connor NP, Suzuki T, Lee K, et al. Neuromuscular junc- tion changes in rat thyroarytenoid muscle. Ann Otol Rhinol Laryngol 2002; 111 (7 Pt 1): 579-86.
• Suzuki T, Connor NP, Lee K, et al. Age-related alterations in myosin heavy chain isoforms in rat intrinsic laryngeal muscles. Ann Otol Rhinol Laryngol 2002; 111(7):962-7.
• Kılıç MA. Ses bozuklukları: yeni bir sınıflandırma sistemi. Ç.Ü. Tıp Fakültesi Arşiv Tarama Dergisi 1999;8(3):321-37.
• Kılıç MA, Bakır S. Organik hastalıklar ve travmaya bağlı ses bozuklukları. Turkiye Klinikleri J E.N.T.-Special Topi- cs 2011;4(2):24-31.