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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 © 2008 Bastian Voice Institute.
La belle indifference:
A French term that indicates a peculiar lack of concern on
the part of a patient about the problem for which they have
come to be evaluated, even when one would think the average
person would be distressed by it. Sometimes such individuals
do not seem that interested in options for recovery as well.
Observation of la belle indifference should cause the clinician
to think about possible nonorganicity.
This phenomenon in a patient may be magnified by certain elicitation
techniques on the part of the clinician.
Laryngeal dystonia:
A benign neurological condition affecting the larynx associated
with either voice disturbance or much less commonly breathing
disturbance, and yet more infrequently with both. The voice
disturbance is referred to as spasmodic
dysphonia. The breathing manifestation is called
respiratory dystonia.
Laryngeal electromyogram
(LEMG): See electromyogram.
Laryngeal examination:
The process of visualizing the interior of the larynx or voicebox.
This is part three of the integrative
diagnostic model. Screening examination can be completed
with the time-honored laryngeal mirror
examination. The flexible fiberoptic scope or laryngeal
telescope can also be used. Examination is further enhanced
through use of strobe illumination to provide apparent slow
motion views of vocal fold vibration, and also via videodocumentation
of the examination to allow review and collaboration with
other clinicians. See laryngeal mirror
examination and laryngeal
videostroboscopy.
*Laryngeal image biofeedback
(LIB): A technique first described to our knowledge
by Dr. Bastian, in which videoendoscopy
is performed and shown to the patient in real time, rather
than being recorded and reviewed with the patient. The purpose
of LIB is to allow the individual to modify his or her laryngeal
behavior (and the vocal sound that results) using not only
auditory and kinesthetic feedback, but also visual feedback.
Laryngeal mirror examination:
A time-honored method for visualizing the interior of the
larynx and pharynx, and especially the vocal folds. This method
was originally described in the 19th century by famed singing
teacher Manuel Garcia. An angled “dental” mirror
is held against the soft palate and over the base of the tongue,
and illuminated, typically by head mirror or headlight. The
larynx is then visualized in this mirror while the patient
phonates on the /i/(eee) vowel.
Laryngeal videostroboscopy:
A technique of examining the larynx that includes special
endoscopes coupled to both
continuous and strobe light, a video system, a TV monitor,
and a computer. This technique produces highly magnified views
of the larynx that are videodocumented for later study/review
with patient, speech pathologist, family, and so forth. In
normal light the vibration of the folds would appear as a
blur; the strobe light allows assessment of apparent individual
cycles of vibration.
Laryngologist:
A sub-specialized otolaryngologist
(ear, nose and throat physician), who focuses on disorders
of the throat, including those involving the functions of
voice, swallowing, and airway. As one might expect, laryngologists
come in varying types. Some do not do cancer work that involves
open operations on the larynx, nor do they do neck dissections.
Some do not have much involvement with swallowing. BVI laryngologists
practice what we informally term full service laryngology.
This means that our practice encompasses microsurgery on the
vocal folds as a large part on one end of the spectrum, up
to and including the big operations of larynx cancer
and larynx and tracheal reconstruction, on the other end of
the spectrum.
Laryngopharynx:
Refers to the anatomical region that begins roughly at the
base (back) of the tongue and goes down to the level of the
upper part of the trachea/esophagus
low in the neck. The laryngopharynx comprises an area in which
both breathing and swallowing functions are shared. When one
reaches the larynx/esophagus, separate and dedicated airway
and foodway passages begin.
Laryngoscopy:
The process of looking into the larynx. See laryngeal videostroboscopy,
laryngeal mirror examination
and microlaryngoscopy.
Laryngopharynx acid reflux disease
(LPRD):
Laryngospasm:
A sudden reflexive closure of the larynx occurring when the
individual is trying to breathe. Occurs more frequently in
persons who have vocal fold paralysis
or in those experiencing sensory neuropathic
cough; also seen as an aftermath of an upper respiratory
infection. Typical episodes begin abruptly and last approximately
one minute. The individual often makes loud inspiratory noises
whose loudness abates gradually over the first minute or two.
The voice may be choked off during the same time, making it
difficult to speak. Laryngospasm is terrifying not only to
the person experiencing it but also to family, friends, or
strangers observing the episode. May awaken its victim from
sound sleep. Rarely, an individual will experience a series
of laryngospasms, making it appear that they are having one
much longer spasm.
Laser: An acronym for
“light amplification by stimulated emission of radiation.”
Rather than producing light of varying wavelengths that scatters
in every direction, as a lightbulb does, the laser apparatus
creates light that is coherent – meaning that only one
wavelength is created and every photon (“packet”)
of light travels in precisely the same direction. Somewhat
confusingly, “laser” may be used to designate
both the machine that produces the laser beam, and the beam
itself.
Laser surgery: Surgery
that uses a beam of laser light, rather than other instruments,
to cut, dissect, remove, and so forth. The beam of light has
advantages over other cutting instruments, such as scalpel
or scissors. First, at the same time that it cuts, it tends
to seal off tiny blood vessels and reduce bleeding. Second,
it may be especially useful in endoscopic surgery, where there
is not a lot of room for instruments. Third, it is very precise.
Both the microspot carbon dioxide laser and the RevoLix laser
used at BVI have minimum spot sizes of about 1/5 of a millimeter.
Laryngitis:
See also candida laryngitis,
nonorganic voice disorder,
ulcerative laryngitis, laryngopharynx
acid reflux disease (LPRD)
Laryngopharynx reflux
disease: A constellation of symptoms and findings
caused by reflux (backwards flow) of stomach acid into the
throat or larynx, typically during sleep. May be seen with
or without the heartburn, acid belching, etc., commonly associated
with GERD. The classic symptoms
of LPRD may be exaggerated in the morning and include one
or more of the following: dry throat, rawness or scratchy
sensation, increased mucus production and attendant throat
clearing, husky voice quality or low-pitched morning voice,
irritative cough, and, if one is a singer, the need for prolonged
warm-up. For appropriate treatment measures, see GERD.
Latency (of voice
production): During vocal capability/limitation
elicitation, a patient may
seem to pause an inappropriate amount of time before complying
with a requested vocal task. May be a sign of introversion/vocal
inhibition/embarrassment, but much more often may be an indicator
of nonorganicity, especially
if it accompanies la belle indifference.
LEMG:
Laryngeal electromyogram. See electromyogram.
Leukoplakia:
Literally, a “white patch,” most often seen on
the vocal fold of longstanding smokers, or in those with some
other cause of chronic inflammation. Leukoplakia is the descriptive
term for what, on biopsy,
may be keratosis, carcinoma
in situ (CIS), or carcinoma.
Lidocaine: The chemical
name for the most common topical and local anesthetic used
at BVI. When applied topically, lidocaine numbs the mucosa
for between 15 and 30 minutes; when infiltrated via injection,
the duration is about the same, unless a small amount of epinephrine
is added, in which case the numbing effect may last 1 ½
hours or so.
Local anesthesia:
As compared with general anesthesia,
in which the entire body is rendered unconscious and asensate,
local anesthesia “numbs” a local area, most commonly
with lidocaine injected into
the tissues to be operated upon.
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 some part of the upper part of the voice, anything
from a few notes to 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 voice
to go flat against the person’s will.
Lower esophageal
sphincter (LES): A circular band of muscle surrounding
the esophagus at its lower end. This muscle should be in a
state of continual contraction, relaxing only momentarily
to allow food to pass into the stomach. Given that the muscle
should immediately contract again once food/liquid has passed
through, it serves as a “one-way valve” to allow
food and liquid to pass into the stomach, but not backwards
from stomach into the esophagus. When the LES fails to remain
adequately contracted, it can allow for acid
reflux leading to gastroesophageal
reflux disease (GERD) and laryngopharynx
reflux disease (LPRD). If the muscle fails to relax
appropriately when the food/liquid bolus reaches it in its
travel toward the stomach, the person has a condition called
achalasia.
LPRD:
See laryngopharynx reflux disease.
*Luffing:
Refers to the flaccid, flapping sound that occurs when more
than the normal amount of air is passed between vocal folds
at least one of which is flaccid by virtue of a vocal
fold paralysis or functional (non-organic)
flaccidity of the folds. A breathy, diplophonic,
unstable kind of vibration occurs that is characteristic of
this laryngeal state. Luffing may not be heard if the individual
is speaking very softly. It may often be elicited
by asking the patient to phonate loudly. Luffing is a quality
easy to identify, once heard and defined for the uninitiated
clinician.
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