1
Q
What does the voice carry information about?
A
- emotions / emotional state
- physical status
- meaning behind the words we speak
2
Q
What do we include in a psychosocial interview?
A
- Address psychosocial history as well as current status
- Identify how the client uses their voice to maintain relationships in their day to day life?
- Life events or emotional difficulties that may be related or precipitated voice issues
- Profiles e
3
Q
When talking with your client who has non organic voice disorders, what are some things to discuss?
A
- Educate client re: voice disorder issue
- explain relationship between stress and laryngeal muscle contraction
- Discuss that problem is not in their head; not their fault
- Address questions re: onset and stress
4
Q
What are some family or social/cultural things we should look for when dealing with voice disorders?
A
- Family life / stage of their life
- Patient’s aspirations
- Communication issues with family; employment; coworkers; other professionals
- How is the voice affecting their everyday life?
5
Q
Skipped PPT slide 6…do you think we need it?
A
.
6
Q
In regards to cultural aspects between males and females, what is perceived in a male’s voice vs. a female’s voice?
A
- low pitch (male)
- strength, control, assurance, authority, relaxation, naturalness
- low pitch (female)
- grade, charm, gentleness, softness
males (report talk- vying for knowledge and skill)
females (rapport talk- making connections and negotiating relationships)
7
Q
In regards to self concept & voice, feelings about self are communicated by what?
A
paralinguistic aspects of communication:
- stance
- eye contact
- vocal behaviors
- signal the level of comfort
- anxiety, confidence
- knowledge
- degree of emotionality conveyed
8
Q
In regards to self concept & voice, what may result from fear / anxiety?
A
The laryngeal sphincter opens widely to allow maximal respiratory flow for running- thus voice becomes weak, breathy; may be temporary or perpetuated over time.
9
Q
In regards to self concept & voice, what could conversely happen when compared to feelings about self, fear and anxiety?
A
Individuals who decide to stand their group or “fight” may lock the laryngeal sphincter or “combat,” thus creating over adduction, constriction or acoustic rube resulting in effort and strain
10
Q
T/F: General body tension or specific intrinsic/extrinsic laryngeal musculature WILL NOT result in difficulties with vocal mechanism functioning?
A
False
11
Q
What is compensation in regards to voice?
A
- Loud voice to shore up their feelings of inadequacy
- Loud bullying voice may mask a fragile self esteem
12
Q
What is pitch variability or lack of in regards to voice?
A
- Signal psychosocial issues
- depressed patients may show little affect or monotone; slow rate
- extreme tension of and constriction of the laryngeal striations may result in elevation of the larynx and abnormally high pitched voice
- Males who want to portray themselves in a more masculine image may adopt an inappropriate low pitch which is stressful to the voice mechanism
13
Q
What is expected of SLPs in regards to counseling?
A
- extreme cases need to be referred out (not our job)
- we can build effective relationship with each client and address issues that are relevant to the voice disorder
14
Q
What are some things we as SLPs can build with our clients that are relevant to their voice disorder?
A
- enhancing clients’ self esteem
- help client gain insights re: social communicative interactions, as well as help with producing and habituating more appropriate vocal behaviors
15
Q
What are some clinical therapeutic considerations?
A
- Be encouraging
- personal distance issues
- utilize coping strategies- role playing
- stress reduction- exercise
- loss and grief: health /function; employment issues; altered life; allegation from others (i.e., elderly clients, spasmodic dysphonia)
- anger/denial/fear/anxiety: uncertainty of future, loss of control, costly medical care
16
Q
What might interventions include?
A
- problem clarification
- feelings clarification
- concept correction
- skills inventory
- mobilizing support/services
17
Q
What is problem clarification in regards to intervention?
A
Exploring discussing the psychosocial changes with the person/family
18
Q
What is feelings clarification in regards to intervention?
A
Allowing feelings to surface without judgement
19
Q
What is concept correction in regards to intervention?
A
problems and their implications are discussed realistically and put into perspective
20
Q
What is skills inventory in regards to intervention?
A
problem solving/coping strategies/role playing
21
Q
What is mobilizing support/services in regards to intervention?
A
outside referrals, resources, possibly communication aids
22
Q
What are some other treatment considerations?
A
- working with and education family members
- working as part of a comprehensive team (physicians, OTs, PTs, Mental Health workers, social workers, etc.)
23
Q
What is a treatment option for voice disorders following Traumatic Stress and the goals?
A
- take a team approach with Mental Health professionals
- goals may include:
- regain voice
- identify emotions
- attend to whole person
- vbe aware of aspects of social communication
- use of relaxation exercises to reduce stress
- reduce muscular tension
24
Q
how can emotional outburts effect the voice?
A
- Excessive emotional outbursts/crying or shouting- sometimes result in phonotrauma
- Excessive crying or emotional vocal outbursts are usually accompanied with high lung volumes which causes extreme increase in subglottic pressure resulting in possible phonotrauma.
- Vocal fold hemorrhage can occur - symptoms result in sudden changes in voice quality and vocal fatigue
25
do males or females have a higher likelihood of having functional dysphonias?
females
26
t/f
vocal nodules are more prevalent in males?
False. Females
27
does Cancer, papilloma, and granuloma occur more in males or females?
males
28
what are some counseling/treatment options for children?
- group therapy beneficial
| - role playing valuable- to minimize yelling, anger, use other behaviors rather than yelling etc…
29
what are some counceling/treatment options for the transgender community?
- use pronouns to match gender the person is currently expressing
- promote education among peers, colleagues, students re: value of diversity
- refer to other professional help as needed.
30
what are some counceling/treatment options for older clients?
- discover their legacy
- deal with the loss of control in their lives--- such as: failing health
- peers dying
- authority diminishes
- strength wanes
- fewer people talk with them
- loss of their identity/role
- financial independence may erode
31
what are some general suggestions for counseling/treatment?
- Be genuine
- Provide them a sense of control (offer choices)
- checking statements (e.g., “tell me if this is awkward”, “I am sensing you are tired”, “am I rushing you” etc..)
- Give time for their life review- “When I was young…”
- Reinforce previous skills/occupation
- Use of repetition/clarifying
- Repair communication breakdowns- be patient, don’t take negatively, consider timing, drop problem subjects
32
what is Phonotrauma/Misuse hyperfunction defined as (Dysphonias Related To Tension, Habits, and Trauma)?
inappropriate pitch and loudness and vocal abuse as inappropriate and injurious vocal practices-- inappropriate laryngeal muscle activity
33
what are some causes of Vocal Fold Irritation and Injury?
- excessive musculoskeletal tension-may be a function of as related to compensations to deal with organic issue
- elevation of the larynx
- hyperadduction of the folds and supraglottal structures
- use of inappropriate pitch level or loudness
- singing with poor technique
- excessive coughing/throat clearing;
- gastroesophageal reflux
- smoking, alcohol, drug use
- inhalation of airborne irritants
- dehydration of folds
- sudden cheering/yelling; intubation injury
- bulimia spasms and acidity
34
what are treatment options for phonotrauma/misuse?
- address appropriate vocal hygiene
- probe psychosocial aspects
- work to reduce tension and lower laryngeal position in neck to elicit normal phonation
- chewing therapy, progressive relaxation, biofeedback, yawn sigh and increased airflow approaches.
35
what are the disorders related to hyperfunction?
l. Muscle Tension Dysphonia (MTD)
2. Benign Lesions of the Lamina Propria
- Vocal Fold Nodules
- Vocal Fold Cysts
- Reactive Vocal Fold Lesions
- Fibrous masses of Lamina Propria
3. Contact Ulcers
4. Reflux Issues
5. Laryngeal Hyperkeratosis
6. Laryngeal Leukoplakia
7. Prolonged Ulcerative Laryngitis
8. Other Conditions: Laryngoceles
36
What are the two types of Muscle Tension Dysphonia (MTD)?
- Primary Muscle Tension Dysphonia
| - Secondary Muscle Tension Dysphonia
37
Describe Primary Muscle Tension Dysphonia?
- hyper functional vocal production
- weak voice
- lacking intensity and variation
- rough
- hoarse or thin quality
- dysphagia and vocal fatigue
38
When is the onset of primary muscle tension dysphonia?
- During mid-adult years; sometimes after acute laryngitis related to reflux
- a result of upper respiratory tract infections
- vocal fry
- painful voicing
- vocational limitations
39
t/f
MTD patients have the same amount of dysphonia when they sustain vowels, but patients with AD-SD (Adductor Spasmodic Dysphonia) exhibit less severe dysphonia during sustained vowels?
True
40
Describe Secondary Muscle Tension Dysphonia
Hyperfunctional behaviors occur in response to glottal incompetence documented by flexible nasoendoscopy
41
What are the contributing factors for secondary muscle tension dysphonia?
- reflex
- high stress levels
- excessive voice use
- excessive loudness in voice production
- poor breath support
- inappropriate low pitch
- visible cervical neck tension
42
What is needed to dx benign lesions of the lamina propria?
videostroboscopy to dx bw nodules, cysts, reactive lesions, and fibrous masses of the lamina propria
43
What 4 categories fall under the benign lesions of the lamina propria?
- Vocal fold nodules
- vocal fold cysts
- reactive vocal fold lesions
- fibrous masses of the lamina propria
44
Describe vocal fold nodules (benign lesions of the lamina propria)
- not symmetrical
- occur at the junction of the anterior 1/3 and the posterior 2/3 of the entire folds where maximum excursion of the folds occur and greatest impact during phonation
- severity of dysphonia increases in proportion to size of the nodules
45
What are the predisposition factors for vocal nodules (benign lesions of the lamina propria)?
- high sub glottal pressure
- hyper adduction of folds
- vocal lengthening high pitch
- dehydration of the vocal folds
- inflammatory conditions (allergies)
- infectious issues
- laryngopharyngeal reflux
46
What are the assessment results of vocal nodules (benign lesions of the lamina propria)?
- quality deviation (hoarseness)
- loss of vocal control
- increased phonatory effort
- restricted pitch range
- phonatory fatigue
- voice improves as loudness increases
- voice breaks
47
Describe vocal fold cysts (benign lesions of the lamina propria)
- usually unilateral
- decrease mucosal wave
- located within the lamina propria at the junction of the anterior 1/2 and posterior 2/3 of the entire length of the folds
- decreases mucosal wave
- vocal fatigue may be severe and voice quality weak
- deteriorates with prolonged use
48
Describe reactive vocal fold lesions (benign lesions of the lamina propria)
- occur opposite another lesion such as a cyst, polyp, or fibrous mass
- result of the effect of the other lesion causing impact stress on the previously unaffected opposite fold
49
Describe fibrous masses of the lamina propria (benign lesions of the lamina propria)
- located at the junction of the anterior 1/2 and posterior 2/3 of the entire folds
- can occur allowing vocal fold scarring or when polyp material hardens
- impedes vocal vibration
50
What are the factors relevant to the development of benign lesions?
- Physiological
may include:
-compensatory muscular tension of the paralaryngeal and suprahyoid muscles;
- faulty posture;
- increased abdominal pressure force through constricted folds
- Medical Factors
- allergies
- environmental irritants
- dehydrated folds
- chronic cough
- laryngopharyngeal reflux
- Psychological
- attitude
- coping skills
- lifestyle implications
- Treatment
- education of vocal hygiene
- analysis of patterns of phonotrauma
- vocal re-education
- symptom modification
- improve respiration
- frontal tone focus
- elimination of hard glottal attack
51
Describe Contact Ulcers
- Either intubation or nonintubation type ulcers/granulomas
| - essentially an ulcerated area on the medial surface of the arytenoid cartilage
52
What are granulomas?
Inflammatory tissue arising from perichondritis (inflammation of the connective tissue around a cartilage) or arytenoid cartilage
53
What are the causes of contact ulcers?
- Laryngopharyngeal reflux
- gastroesophageal reflux
- compensatory hyper adduction of the vocal processes
- vocally demanding activités
- talking across distances
- coughing and throat clearing
- medial compression of the folds
- alcohol consumption and smoking
- intubatino trauma
- excessive gargling- mouthwash
- sinus allergies
- infections from post nasal drip
- inappropriate low pitch
54
What is the treatment for contact ulcers?
- educate on risk factors to determine possible causes
- vocal hygiene strategies
- initially focus on easy breathy vocal pattern
- shape vocal behaviors
- modify low pitch- raise habitual pitch level
- eliminate hard glottal attack
- reduce muscle tension-progressive relaxation, biofeedback
55
What are the two types of reflux?
1. Gastroesophageal reflux disease (GERD)
| 2. Laryngopharyngeal reflex disease (LRPD)
56
Describe GERD
- stomach acid passes through lower esophageal sphincter and stays in the esophagus.
- Heartburn
- indigestion
57
Describe LRPD
stomach acid passes through the upper esophageal sphincter (UES) and spills onto the more delicate laryngeal tissue.
58
What are the results of GERD and LRPD? And what age group are GERD and LRPD found in
- hoarse/rough voice
- bad taste or odor in oral cavity
- large number of cases in the 25 to 44 age group (GERD) and in the 45 to 64 age group (LRPD)
59
What is the treatment for GERD and LRPD?
- changes in diet/sleeping habits
- medications for limiting stomach acid
- sometime more serious cases require surgery to tighten sphincter.
60
What is Laryngeal Hyperkeratosis?
- plaque like thickening of the laryngeal mucosa caused by abnormal growth of the epithelium.
- May be malignant
- needs biopsy and avoidance of irritants
61
What are the causes for Laryngeal Hyperkeratosis? And when is the onset?
- laryngopharyngeal reflux
- cigarette smoking
- heavy alcohol use
- long term strained speaking habits
- hyperadduction to compensate for glottal incompetence
- throat clearing, coughing, post nasal drip chronic to sinus infections
- injury to tissues/radiation
- raspy voice present
- Keratin deposits are thick covering of vocal fold on one or both sides
- located anywhere on the folds
- onset between 40 and 60 years of age.
62
Describe Laryngeal Leukoplakia
- white patches on laryngeal mucosa and may reveal pre malignancy
- hoarseness is present
- precursor to carcinoma
- chronic irritation of tissues
63
What is the treatment for laryngeal leukoplakia?
- Cessation of cigarette smoking is primary importance
- surgery
- voice therapy to assist the patient to be compliant with suggestions
64
Describe Prolonged Ulcerative Laryngitis
- result of prolonged inflammation and ulceration of the vocal folds.
- Patients did not smoke or alcohol in histories
- respiratory infection was reported
- some had asthma, allergies and cold sores
- lesions were white to pink, often raised, and ulcerated.
65
What is the treatment for laryngeal leukoplakia?
- Voice rest
- steroids, antibiotics, and anti-reflux medications
- including voice therapy concentrating on vocal hygiene, and prevention of compensatory hyperfunction.
66
Describe Laryngoceles
- air sacs that connect to the larynx and cause a balloning in the neck tissue during coughing.
- Might be seen in brass instrument players.
67
What is the treatment for laryngoceles?
surgery
68
What is laryngeal chondromas?
rare cartilaginous tumors
Fall '13- 123 (Exam 4)
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