A 47-year-old professional operatic soprano noted sudden breathiness and loss of qual

Discussion in 'Plab 1 and 2 forum' started by Neha Gupta, Jul 21, 2013.

  1. Neha Gupta

    Neha Gupta Active Member

    Q. A 47-year-old professional operatic soprano noted sudden breathiness and loss of quality and projection in voice. Laryngoscopy was normal. She was treated with steroids and intensive anti-reflux therapy but persisitent dysphonia caused by her condition was so severe that she felt her career was over. The next best test is

    a) Computed tomography of the brain

    b) strobovideolaryngoscopy

    c) thyroid levels

    d) barium meal

    e) allergy evaluation
  2. Neha Gupta

    Neha Gupta Active Member

    b is the answer

    The vocal cords typically vibrate during speech, singing or humming at a rate of 80 to 400 times per second. These vibrations are too fast for the unaided eye to see and, therefore, cannot be completely evaluated with indirect mirror laryngoscopy. Stroboscopy may be used to evaluate vocal cord vibrations. Stroboscopy allows the examiner to view the vocal cords in slow motion. Strobovideolaryngoscopy is done using a 70 degree rigid telescope or a flexible nasopharyngoscope. Vocal cord vibration involves high-speed, minute vibrations; thus, a subtle change in the muscosa or tension of the vocal cord--that results in hoarseness--may be observed. Strobovideolaryngoscopy is especially important in the evaluation of subtle lesions affecting the vibration of the cords. This mode allows for the discovery of small lesions such as a vocal cord scar, hemorrhage or cyst. In this paient\'s case strobovideolaryngoscopy revealed varicosities on the superior surface of the vocal cords which were vaporized using a CO2 laser. The patient recovered well

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