American Medical Association Family Medical Guide - American Medical Association [386]
Diagnosis
If, after examining your throat, your doctor rules out inflammation from laryngitis, he or she will refer you to an otolaryngologist (an ear, nose, and throat specialist) for a more thorough examination of your larynx. If the otolaryngologist sees signs of a growth, he or she will probably schedule an outpatient procedure called endoscopy. During the endoscopy, he or she will insert a viewing tube (laryngoscope) through your mouth to the larynx and will take a sample of cells from the larynx for examination under a microscope to determine if the growth is cancerous.
Treatment
Voice-retraining therapy can help relieve pressure on the vocal cords, sometimes causing nodules to shrink enough to stop causing symptoms such as hoarseness. Polyps and nodules can go away on their own, but sometimes a surgeon may need to remove them. If you have surgery, you will be given general anesthesia. The doctor uses an operating microscope to magnify the area, making it easier for him or her to see and remove the abnormal tissue. Papillomas can recur after surgery and may need to be removed several times.
Malignant tumors that are detected early can be successfully treated either with radiation therapy (see page 23) or by removing part of the larynx. With either of these treatments, total loss of voice is rare (the voice is usually preserved at least partially). In advanced cancer, the entire larynx may be removed or the person may be given chemotherapy (see page 23) along with radiation therapy (called chemoradiation) to eliminate the cancerous cells. Even in relatively advanced cases, the chances for a cure are good.
If the surgeon removes your entire larynx, different types of therapies are available to help you regain your speech. With the help of a speech therapist, you may learn how to use your esophagus to speak. Or you may be able to learn to use a special vibrating device that you manipulate with your tongue and teeth to produce the sounds of speech. In some cases, a surgeon implants a valve between the trachea and esophagus (see illustration below) to divert air from the lungs into the esophagus to produce the sounds of speech.
Speaking without your larynx
Surgery can enable you to speak after having your larynx removed by creating a system to produce speech sounds. The surgeon makes a small hole in your neck into your trachea. He or she then implants a valve between the trachea and esophagus. When you want to speak, you place a finger over the hole in the trachea. Blocking the opening in the trachea allows air from your lungs to pass through the new valve, which makes the pharynx vibrate to produce sound.
The Lungs and Chest
Your two lungs lie on either side of the central cavity of the chest. The upper tips of the lungs are slightly above the collarbone. The bottom surfaces of the lungs rest on the diaphragm, a sheet of muscle that arches up into the chest cavity and completely separates the chest cavity from the abdomen.
The bronchi are the main airways that branch into each lung from the trachea. They divide into smaller and smaller airways called bronchioles. Each bronchiole ends in a cluster of tiny air sacs called alveoli. Each lung contains about 150 million alveoli. Each alveolus contains several minute blood vessels called capillaries. The walls of the capillaries are thin enough to allow oxygen and carbon dioxide (a waste product from body processes) to move between the air and the blood. The alveoli transfer oxygen from the air you