11 - Functional Voice Disorders Flashcards by Jamie Bevill

What are Organic Voice Disorder?

Something is wrong with the anatomy of the laryngeal structures

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What are Functional Voice Disorders?

Something is wrong with the physiology of the laryngeal structures

No organic or neurological pathology

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What are eight things that contribute to poor vocal health?

Cigarette/Tobacco Use

Marijuana Use

Alcohol

Caffeine

Sleep deprivation

Vocal fatigue/Inappropriate vocal use

Obesity

Allergies

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How do Tobacco and Marijuana products contribute to poor vocal health?

They can cause lesions

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How do Alcohol and Caffeine contribute to poor vocal health?

They can cause dehydration

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How does sleep deprivation contribute to poor vocal health?

It can cause muscle weakness (asthenia)

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What is Muscle Tension Dysphonia?

1+4

An umbrella term for improper use of voice that creates the following four symptoms:

Increased tension/strain
Inappropriate pitch level
Ventricular phonation (Use of false vocal folds)
Lateral-medial/Anterior-posterior compression.

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Is Muscle Tension Dysphonia primary or secondary?

Either

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What happens in laryngeal resistance?

Usually when resistance increases, airflow decreases (or when resistance decreases, airflow increases)

Can be paradoxical for those with voice disorders

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What is Phonotrauma?

Straining during a laryngeal inflammation.

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What causes Phonotrauma?

Excessive loud talking

Coughing, throat clearing

Sports enthusiasts, cheerleaders.

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Why does excessive coughing and throat clearing cause Phonotrauma?

Hyperadduction

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What are the usual complaints in Phonotrauma?

Hoarseness

Fatigue

Strain

Pain

‘Loss of voice’

Poor projection

Loss of pitch and loudness ranges

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Where is Increased Strain?

Strain in the laryngeal and extralaryngeal musculature

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What does a patient’s voice sound like with Increased Strain?

(2)

Raspy

Hoarse

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What is seen in a Laryngoscopy for a patient with Increased Strain?

(5)

Lateral medial compression

Anterior posterior compression

Strain of supraglottal structures

Hyperadduction

Elevated laryngeal position

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What is a Hard Glottal Attack?

Rapid adduction of the vocal folds usually seen just before a vowel sound.

(Increased subglottal pressure is required to overcome the adductive forces producing sudden explosive sounds.)

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What is an Elevated Laryngeal Position?

The raising of the larynx accompanied by an increase in pitch

Who often uses Elevated Laryngeal Positions?

Untrained singers may tend to use it as a strategy to increase pitch which is incorrect and is detrimental to voice.

What may be perceived in a patient with Elevated Laryngeal Position?

(3)

Strain

Hoarseness

Increased pitch

How can we assess Elevated Laryngeal Position?

Can be assessed by observation and palpation.

What is Puberphonia (Mutational Falsetto)?

Unusual high pitch that persists beyond puberty

Males are said to have mutational falsetto; females are said to have childlike or juvenile voice

What are other symptoms of Puberphonia (Mutational Falsetto)?

(7)

Hoarseness

Breathiness

Pitch breaks

Inadequate resonance

Shallow breathing

Muscle tension

Lack of variability

What are common causes of Puberphonia (Mutational Falsetto)?

Desire not to ‘grow up’.

Over identification of a male with his mother.

Social Immaturity.

Desire to maintain soprano singing voice.

Muscle incoordination/dysfunction with no known etiology.

Does Puberphonia (Mutational Falsetto) become more psychological because of the stigma?

Yes

What is Androphonia?

Excessively low pitch in females?

What is Ventricular Dysphonia (Plica Ventricularis)?

Vibration of the false vocal folds by themselves or with the true vocal folds.

Is Ventricular Dysphonia (Plica Ventricular) a primary or secondary disease?

Usually secondary to a vocal fold disease where the false vocal folds compensate for the impaired true vocal fold vibration.

What are symptoms of Ventricular Dysphonia (Plica Ventricular)? (4)

Diplophonia (voice has two pitches) Voice is low in pitch because of increased mass of the ventricular folds. Hoarse, crackling voice. Reduced intensity due to poor pressure below the false vocal folds.

What is Psychogenic Dysphonia?

Functional status is altered because of psychological reasons.

What can cause Psychogenic Dysphonia? | 3

Emotional trauma Stress Attention seeking behaviors

What will be normal in Psychogenic Dysphonia?

Usually, reflexive behaviors such as laughing or whispering They will show mobile vocal folds.

How do we assess voice? | 4

Perceptual and acoustic analyses of voice. Laryngoscopy Subjective and objective measures of respiration. EMG

What should you expect in Perceptual Measures from a patient with a Functional Voice Disorder? (3)

Strained quality Breathiness Raspiness

What should you expect from Acoustic Measures in a patient with a Functional Voice Disorder?

Usually noise related measures are the most affected. | Other measures are affected too.

What should you expect from Respiration Measures in a patient with a Functional Voice Disorder? (2)

Depending cause, airflow can be impaired. Usually, airflow is reduced.

What should you expect from a Laryngoscopy in a patient with a Functional Voice Disorder? (5)

Lateral medial compression Anterior posterior compression Supraglottal tension Aperiodicity Asymmetry

What is Paradoxical Vocal Fold Movement (PVFM)?

Inappropriate adduction of the vocal folds during inhalation

What are the two physiological variants of Paradoxical Vocal Fold Movement (PVFM)? (2)

Adduction of true and false folds throughout the breathing cycle Adduction during deep inspiration and slight abduction on expiration

What is coexistent with Paradoxical Vocal Fold Movement (PVFM)?

Asthma

What can precipitate Paradoxical Vocal Fold Movement (PVFM)?

Emotional events

Does Paradoxical Vocal Fold Movement (PVFM) occur with or without organic conditions?

Both

What are the Signs and Symptoms of Paradoxical Vocal Fold Movement (PVFM)? (7)

Sensation of throat being closed Dramatic episodes of breathing difficulty Stridor Difficulty inspiring Shortness of breath ‘Wheezing’ Cough

What might we see in a Laryngoscopy for a patient with Paradoxical Vocal Fold Movement (PVFM)? (3)

VF adduction of anterior two-thirds during inspiration Posterior glottal chink during closure on inspiration Half will have normal VF motion when asymptomatic