Ig sekilli glotis: Sulkus vokalis, presbilarenks ve diger nedenler/Spindle-shaped glottis: Sulcus vocalis, presbilarynx and other causes

ÖZET. Ig sekilli glotik yetersizlik, her yasta karsimiza çikabilir. Bu bozukluk, ses kalitesini ve dolayisiyla yasam kalitesini bozar. Dejeneratif, nöromüsküler, enflamatuvar, fonksiyonel, yatrojen ve psikojen nedenli patolojiler ig sekilli glotik yetersizlige yol açabilir. Sulcus vocalis, skarlar ve presbilarenks dejeneratif nedenleri olusturur. Sulcus vocalis, ses kivriminda mukozal sertlik olusturan bir alana neden olmakta, mukoza dalgalarinin normal yayilimini engellemekte ve ses kivriminda yaylanmaya neden olmaktadir. Sulkus vokalis, mukozanin yüzeysel tabakasina sinirli olabilir veya derindeki vokal ligamani ve kasi penetre edebilir. Tutuluma göre üç tipi tarif edilmistir. Etiyolojisi halen net degildir. Konjenital veya edinsel olduguna yönelik tartismalar devam etmektedir. Presbilarenks, ileri yaslarda larenksin yaslanmasina bagli olarak gelisen, zayif vokal projeksiyon (kisik, zayif, hava kaçakli) ve kisa fonasyon süresi semptomlari ile karakterize degisiklikleri ifade eder. Videolarengostroboskobi, ig sekilli glotis teshisinde oldukça faydali bir cihazdir. Fonasyon sirasinda ig sekilli glotise neden olan ses kivrimlarinin serbest kenarinda kavislenmis (yaylanmis, kivrilmis) görünüm, en önemli fizik muayene bulgusudur. Ses kivrimlarinda kapanma defekti nedeniyle 2/3 ön kisminda hava kaçagi gözlenir. Amplitüt genisliginde azalma vardir. Vibrasyon siklikla asimetriktir. Ig sekilli glotiste tedavi seçenekleri cerrahi ve ses terapisidir. Bu yazida sulcus vocalis ve presbilarenks gibi sik olmakla beraber çogunlukla atlanan patolojiler basta olmak üzere ig sekilli glotik yetersizlik nedenleri literatür esliginde gözden geçirilmistir. Anahtar kelimeler: Ses, ses telleri, disfoni. ABSTRACT. Spindle-shaped glottal insufficiency may appear at any age. This disorder significantly affect the voice quality and hence the life quality. Degenerative, neuromuscular, inflammatory, functional, iatrogenic and psychogenic originated pathologies can lead to spindle-shaped glottal insufficiency. Sulcus vocalis, vocal scars and presbylarynx constitutes degenerative causes. The term sulcus vocalis is used to describe a groove at the free edge of the vocal folds resulting in an area of mucosal stiffness and giving the vocal folds a bowed aspect during phonation. It may involve all or any segment of the edge of the fold. The defect may be confined to the superficial layer of the mucosa or penetrate deeply in the vocal ligament and muscle. According to involvement, three types have been described. Etiology remains controversial and the authors present arguments for each theory, acquired or congenital. The term 'presbylarynx' denotes vocal changes due to aging of the larynx. Symptoms are characterized by poor vocal projection, shorter phonation duration and vocal roughness. Videolaryngostroboscopy is a highly effective diagnostic tool for spindle-shaped glottal insufficiency. The glottis is spindle-shaped during phonation and vibration is frequently asymmetrical and reduced in amplitude. Because of closing defects; median line air leakage is observed in the anterior two-thirds of the vocal folds during phonation. Treatment options include phonosurgery and speech therapy in spindle-shaped glottis. The aim of the present paper is to review the reasons of vocal fold curvature, particularly presbylarynx and sulcus vocalis, and the clinical features of spindle-shaped glottal insufficiency. Key words: Voice, vocal folds, dysphonia.

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