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Glossary
Note: Within a definition, words in italics are defined elsewhere in the glossary. Words beginning with * were coined or brought into the language of voice disorders by Dr. Bastian, or to our knowledge are used primarily by BVI physicians and Bastian-trained fellows. Please note that we may be adding terms to this list from time to time. Copyright © 2009 Bastian Voice Institute.
Cancer:
Refers to any malignant growth or tumor caused by abnormal
and uncontrolled cell division. The hallmarks of cancer (the
majority of those in the head and neck may also be called
carcinoma are its (eventual)
ability to invade neighboring tissue and/or to spread (metastasize)
to other parts of the body through the lymphatic system or
the bloodstream. Early cancers may have done neither, remaining
localized to the tissue of origin.
Candida albicans: A fungal
organism, normally part of human upper aerodigestive tract
flora. It may become pathogenic (creating a disease state)
when there is a disturbance in the balance of other normal
organisms. Such an imbalance may occur due to use of steroids,
either taken by mouth or inhaled, as for asthma. Other causes
of candida albicans overgrowth include use of broad-spectrum
antibiotics, and/or immunosuppression. The resulting disease
state in the upper aerodigestive tract may cause hoarseness
or an outbreak of thrush.
Candidiasis: Infection
with candida albicans, a ubiquitous
commensal organism in the
upper aerodigestive tract. While this organism normally causes
no problem, under certain circumstances it can overgrow. These
circumstances include (1) when other normal flora are killed
through administration of antibiotics, (2) if surface immunity
of the mucosa is decreased via inhalation of steroid medication,
and (3) if the individual is immunosuppressed by disease or
other drugs. Typical symptoms of candidiasis in the upper
aerodigestive tract include slight sore throat and hoarseness.
Candida laryngitis:
Infection/inflammation of the surface tissue, or mucosa, of
the vocal folds caused by overgrowth of the commensal
organism candida albicans.
Overgrowth of the organism is potentiated by use of steroid
inhalers, as for asthma; by use of broad-spectrum antibiotics;
by diabetes or other mechanisms of immunosuppression on the
part of the patient; or by some combination of these factors.
Treatment may consist of reducing or withdrawing listed potentiators,
or through use of an antifungal agent such as fluconazole.
See also candidiasis.
Capillary ectasia
(CE): Enlargement or dilation of capillaries
on the surface of the vocal folds. Some believe this to be
an estrogen effect similar to “spider veins” that
one might see on the legs, for example. At BVI we think of
these as mainly being another manifestation of overuse of
the voice, and a response to ongoing injury of the vocal folds.
Once established, capillary ectasia may cause symptoms of
reduced vocal endurance and exaggerated premenstrual huskiness.
CE may also increase the risk of vocal fold bruising (hemorrhage)
and hemorrhagic polyp formation.
Many affected individuals, however, may “coexist”
with their capillary ectasia when armed with appropriate information
about this disorder and through carefully managing amount
and manner of voice use. When indicated, capillary ectasia
is easily corrected via vocal fold microsurgery.
Carcinoma:
A malignancy originating in the tissues that line the surfaces
and cavities of the body. See also the synonym cancer.
Carcinoma in situ
(CIS): A lesion comprised of “cancer cells,”
but with those cells limited to the lining mucosa
and without evidence of extension to adjacent structures.
In other words, there is no sign of invasion beyond the mucosa.
CIS is typically a localized and highly curable precursor
to invasive cancer. CIS is
sometimes called intraepithelial carcinoma. In laryngology,
this entity is found primarily on the vocal folds themselves,
where a tiny, early lesion can change the quality of the voice.
In other locations, CIS would ordinarily be “silent.”
*Ceiling effect:
Synonym for lowered vocal ceiling.
This is a type of vocal phenomenology most often seen in the
perimenopausal voice. It
may also be seen in cases of superior
laryngeal nerve paralysis, or cricothyroid joint
ankylosis. The individual
with this problem may note that he or she cannot access a
part of the upper voice, be that a few notes or an octave
or more. As the individual approaches the ceiling of the voice,
whether normal or lowered, one begins to hear muscular effort,
and often a tendency for the pitch to flat against the person’s
will.
Cidofovir:
Also known as Vistide™. This is a newer anti-viral drug
originally developed for a different indication and now appearing
to have value in the treatment of laryngeal papillomatosis.
It is increasingly used as an adjunctive, off-label treatment
for human papilloma virus
infection in the larynx (aka recurrent respiratory papillomatosis
(RRP) aka laryngeal papillomatosis).
*Classic variant
spasmodic dysphonia: Typical, easy-to-diagnose
spasmodic dysphonia in which
there are noticeable phonatory arrests – a momentary
“cutting out” or “dropping out” of
the voice so that a sound of speech or a syllable or word
is choked off, in the case of adductory
SD, or drops out to a whisper, in the case of abductory
SD.
Combined modality
treatment: Used particularly in reference to
cancer treatment, where there
are two or more treatment options. For example, a patient
may undergo combined modality treatment, where the tumor is
first removed with the laser (primary
treatment is surgery) and then the tumor bed and
neck are irradiated. In this case, combined modality treatment
would mean surgery + radiation therapy.
Commensal:
Refers to an organism that lives within a host and derives
benefit from so doing without either harming or helping the
host – in a sense, an organism that is a harmless freeloader.
See also candidiasis.
Conservation surgery: A
strategy and philosophy of larynx cancer
surgery that focuses not only on radicality with respect to
removal of cancer, but also
on being conservative concerning sparing of normal laryngeal
structures, so as to preserve voice, swallowing, and breathing,
and to avoid total laryngectomy and/or chemotherapy and radiation.
Special training and experience are required especially for
advanced conservation operations, both laser (through the
mouth) and non-laser (through an incision on the neck).
Creaky voice:
The quality of a voice that sounds like a door creaking on
its hinges. Creaky voice is normally produced in the mid to
upper part of the range, and not typically at high levels
of loudness. It also tends to be a low glottal airflow condition
of phonation. Contrast with the related phenomenon of vocal
fry.
Cricopharyngeus dysfunction
(CPD): Refers to failure of the tonically contracted
upper esophageal sphincter
(UES) to relax and open when one swallows. Cause is usually
unknown. The UES comprises
the cricopharyngeus muscle
and is located at the lower level of the voicebox or larynx.
Typically, individuals with CPD first notice that pills or
solid food begin to lodge at the level of the larynx. The
problem tends to progress inexorably, though often slowly,
as the years pass, until the individual must limit himself
or herself to liquid and soft foods. This condition is fully
resolved through a straightforward surgical procedure performed
through the mouth with the laser and only occasionally through
a neck incision. See also Zenker’s
diverticulum.
Cricopharyngeus muscle:
The name of the muscle comprising the upper
esophageal sphincter (UES), and which is subject
to one of two disorders: cricopharyngeus
dysfunction (CPD) or cricopharyngeus
spasm (CPS).
Cricopharyngeus myotomy
(CPM): A procedure in which the cricopharyngeus
muscle, or upper esophageal
sphincter, which makes a “ring” around
the upper esophagus, is divided or cut across in order to
break its grip. This is done in cases where the muscle fails
to relax when one swallows, resulting in a functional obstruction.
Symptoms that follow include solid greater than liquid dysphagia.
Cricopharyngeus spasm
(CPS): A syndrome arising from the same muscle
that is implicated in cricopharyngeus
dysfunction, with or without Zenker’s
diverticulum. In the case of CPS – and in contrast
to cricopharyngeus dysfunction – swallowing is normal.
Instead, one experiences a choking or lump-in-the-throat sensation.
Typically, symptoms are better while eating meals. Treatments
include behavioral and medical options.
Cymetra™:
This is a human collagen product. The collagen is micronized
(ground into tiny particles, and treated to remove any possibility
of contamination with bacteria or viruses). It is then made
into a dry powder. Before use, it is reconstituted to create
a paste consistency that can be injected through a relatively
fine needle. Commonest use is to fatten and firm up a paralyzed
vocal fold. Duration of benefit varies between six
weeks and six months. Consequently, this procedure is used
when only temporary assistance is needed – as when it
is believed that the vocal fold’s function will recover.
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