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Syphilis Of The Larynx

It is a rare condition now. Only gumma of tertiary stage is sometimes seen. It may occur in any part of the larynx and present as a smooth swelling which may later ulcerate. Diagnosis is only on biopsy and serological tests. Laryngeal stenosis is a frequent complication.

Voice and Speech disorders

  1. Dysphonia plica ventricularis ( ventricular dysphonia)
    1. Causes:
      1. Functional [psychogenic]
      2. Organic
        1. Voice production is by false cords or ventricular band   
        2. Quality of voice: Rough, low-pitched and unpleasant
        3. Treatment: functional type: speech therapy & psychological counseling Organic type: treatment of the cause and speech therapy

MCQ . Broyle’s ligament. Small ligament which connects both vocal cords at the anterior commissure to the thyroid cartilage.
MCQ. Gutmann’s pressure test. It is done in puberphonia. Pressing on the thyroid prominence in a backward and downward direction relaxes the over stretched vocal cords and new low-pitched voice can be produced.
MCQ. Mouse-nibbled appearance of vocal cords is caused by tuberculosis.
MCQ. Vocal nodules occur at the junction of anterior with middle third of vocal cords as this is the maximum vibra­tory area during speech.


  1. Functional aphonia (hysterical aphonia)                                                    
    Emotionally labile females (15-30 yrs)
    Vocal cords : Abducted position when trying to phonate
    Adduct only on coughing
    Treatment : Psychotherapy
    Speech therapy
    Type III thyroplasty in non responding cases to conservative management
  2. Puberphonia: (mutational falsetto voice)
    Features: Persistence of the high-pitched childhood voice after puberty
    Seen in emotionally immature insecure boys
    Gutmann’s pressure test: Backward and downward pressure on the thyroid cartilage helps produce a low-pitched voice due to relaxation of the over stretched cords.
    Treatment: Psychotherapy
  3. Phonasthenia
    Definition: Weakness of voice due to fatigue of phonatory muscles- Thyroarytenoid and interarytenoid or both may be affected
    I/L finding:
    1. Elliptical space b/w the cords
      1. Weakness of thyroarytenoid
    2. Triangular gap near the posterior commissure:
      1. Weakness of interarytenoid
    3. Key-hole appearance
      1. Weakness of thyroarytenoid and the interarytenoid
        Treatment: Voice Rest and speech therapy
  4. Hypo nasal voice : (Rhinolalia clausa)
    Due to blockage of the nose and nasopharynx
    - Common cold - Nasal polyp
    - Nasal growth - Adenoids
    - Nasopharyngeal mass
  5. Hyper nasal voice (rhinolalia aperta)
    Cause: failure of the nasopharynx to cut off from the oropharynx or due to acquired perforation of the palate (velopharyngeal insufficiency)
    - Submucous cleft - Paralysis of the soft palate
    - Cleft of the plate - Oroantral fistula
    - Velopharyngeal insufficiency

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