Videostroboscopic and morphological aspects of voice disturbances in patients with larynx atrophy and coexisting hypopharynx cancer

Abstract

Vocal folds play a crucial role in voice production. The physiological vibrations of vocal folds depend on the unchanged multilayered structure of the vocal folds mucosa. Morphological changes of mucosa are the cause of voice quality disorders -dysphonia. The aim of this study was to determine the morphological base of dysphonia in patients with vocal folds atrophy. A group of 24 patients with larynx atrophy confirmed by endoscopic (VLS) and stroboscopic (VLSS) examination of the larynx was included in the study. The morphological assessment of the larynx mucosa was carried out with the use of the transmission electron microscopy (TEM). Ultramorphological examinations revealed changes in the epithelium, basal membrane and lamina propria of the vocal folds mucosa. An increased number of collagenous fibers, fibroblasts with signs of vacuolar degeneration inflammatory cells and a decreased number of blood vessels and pericytes were observed. Morphological changes found in the epithelium, basal membrane and lamina propria of the vocal folds mucosa were the cause of disorders of vocal folds vibrations registered in the stroboscopic examination of the larynx (VLSS).

Morphological aspects of the euphonic voice

“…Atrophy of vocal fold mucosa, a process that occurs with age, results in disorders of voice quality called presbyphonia. Kosztyła-Hojna, Sato et al [2,12] have described thinning of the paraepidermoid epithelium and partly multistratified epithelium with infiltrations from plasmatic cells and lymphocytes in patients over the age of 65. In ultramorphological examinations, a large number of collagenous fibers (C), inflammatory cells and fibroblasts (F) with signs of vacuolization and small folds occurring in the basal membrane have been observed.…”

“…Laryngeal edemas are often seen in older female patients, but atrophy is seldom observed. Laryngeal edemas are characterized by keratosis of the paraepidermoid epithelium with enlarged blood vessels and infiltrations from plasmatic cells and lymphocytes [2]. The intensified destruction of epithelial cells with vacuolization, small folds of the basal membrane, the occurrence of fibroblasts (F) with enlarged cisterns of the granular endoplasmatic reticulum in branches and an increased number of collagenous fibers (C) observed in ultramorphological assessment suggest the presence of edematous changes of the vocal fold mucosa.…”

“…This was the cause of the voice quality disorder known as dysphonia. Morphological changes occurring in the mucosa have been described in patients with the clinical form of edema and atrophy of the larynx and in patients in the senile age [2,[8][9][10][11][12][13][14][15]. Atrophy of vocal fold mucosa, a process that occurs with age, results in disorders of voice quality called presbyphonia.…”

“…The multilayered, flat epithelium, without signs of keratosis of the vocal fold mucosa, is situated on the basal membrane. In young people, the folds of the basal membrane are pronounced [2][3][4][5]. The lamina propria of the mucosa consists of a superficial layer, an intermediate layer and a deep layer [6].…”

“…The vocal muscle forms the main mass of the vocal folds. Pathological voice quality -dysphonia -may be the result of functional or organic pathology [2,3]. Organic changes may refer to the epithelium or lamina propria of the laryngeal mucosa.…”