4 Funct VD

Question 1

what is muscle tension dysphonia

Answer 1

voice disorder accompanied by observable tension of the neck, shoulders, jaw, and throat; often related to psychosocial stress

Question 2

therapy for muscle tension dysphonia

Answer 2

voice therapy, relaxation

Question 3

true or false: palpation of the larynx on patients with muscle tension dysphonia will not make them jump.

Answer 3

false; patients may jump during palpation

Question 4

true or false: posture is important for voice

Answer 4

true; over activation of supra and infra-hyoidal muscles can affect voice

Question 5

what is generalized tension phonation?

Answer 5

All laryngeal muscles are engaged during phonation, including the abductor muscle (causing to a posterior glottic gap)

Question 6

true or false: generalized tension phonation can lead to nodules, polypoid degeneration, and chronic inflammation

Answer 6

true

Question 7

what is an example of generalized tension phonation?

Answer 7

a toddler throwing a tantrum trying to be loud

Question 8

what is lateral hyderadduction?

Answer 8

vocal folds come to medial position, but on top of one another

Question 9

what is anterior-posterior hyperadduction

Answer 9

shortening of the VFs to speak in lower pitch

Question 10

true or false: shortening the VFs to speak lower won’t cause stress to the larynx

Answer 10

false

Question 11

what is hyperadduction of the ventricular folds?

Answer 11

when the ventricular folds are brought to the medial position and vibrating
may have this phonation without vocal fold vibration

Question 12

what is vocal fatigue?

Answer 12

• patients may report losing voice
• symptoms: deteriorating voice quality, endurance, pitch and loudness ranges, inefficient respiratory support
• associated symptoms; xerostomia, pain at base of tongue, throat and larynx, laryngeal globus

Question 13

true or false: laryngeal massage can’t relax the larynx

Answer 13

false

Question 14

what is laryngeal globus?

Answer 14

persistent sensation of a bump in the throat without any obstruction or difficulty swallowing

Question 15

what is myesthenia gravis?

Answer 15

autoimmune disorder in which affects communication between nerves and muscle, causing weakened muscles

Question 16

true or false: myesthenia gravis is reversible with voice therapy?

Answer 16

false; reversible by meds

Question 17

ax and tx of vocal fatigue

Answer 17

Ax: Stroboscopic examination: Vocal folds appear normal at rest; decreased amplitude and phase asymmetry with anterior gap

Tx: Physiological voice therapy (strengthening exercises)

Question 18

what can cause phonotrauma?

Answer 18

• Prolonged maladaptive behaviours
• Excessively loud and aggressive phonation
• Hard voice onset
• Poor shouting or singing technique
• Aggressive or repetitive laryngeal vegetative maneuvers (coughing, throat-clearing, grunting).

Question 19

Other names for phonotrauma?

Answer 19

• vocal abuse
• vocal misuse
• vocal stress
• repetitive strain injury

Question 20

Who is at-risk for phonotrauma?

Answer 20

• Loud ambient noise (e.g., factory, classroom).
• Talking for long periods of time (e.g., teacher, preacher).
• Unhealthy demands placed on the speaker (e.g., acclamation vendor, drill instructor).
• Poor training, insufficient breath support and excessive laryngeal tension (e.g, rock singer).

Question 21

true or false: patients will have higher self of control if you tell them that their vocal folds have sustained a traumatic injury, as opposed to telling them they have abused them

Answer 21

true

Question 22

tx for phonotrauma

Answer 22

voice therapy and counselling
may need phonosurgery followed by voice tx

Question 23

what is ventricular phonation

Answer 23

Excessive supra-laryngeal tension causes an approximation and vibration of the ventricular folds.
– May be caused by muscle tension or emotional stress

Question 24

true or false: ventricular phonation can’t be used to compensate for dysphonia

Answer 24

false; can use ventricular phonation to compensate (e.g., after partial laryngectomy)

Question 25

ax and tx of ventricular phonation

Answer 25

Ax: During imaging, ventricular phonation may be confused with supraglottic squeezing - crucial to verify the ventricular folds are the source of sound. – Glottal or mixed glottal-ventricular phonation: Patient can change pitch – Ventricular phonation: No pitch modulation Tx: Voice therapy, vocal re-education

Question 26

What is puberphonia?

Answer 26

* Voice drop during puberty: – About an octave (12 semitones) lower in the male. – About two to three semitones lower in the female. * Puberphonia in males: Post-mutational falsetto * Puberphonia in females: Juvenile voice

Question 27

possible causes of post-mutational falsetto

Answer 27

Feminine self-identification Resistance towards adulthood Embarrassment about the voice change Muscular incoordination

Question 28

perceptual signs of post-mutational falsetto

Answer 28

Elevated larynx high pitch soft breathy voice cul-de-sac resonance

Question 29

what is post-mutational falsetto?

Answer 29

In males Hanging onto the high pitched voice even after puberty Habitual cricothyroid hyperfunction

Question 30

true or false: it is easy to achieve a great amount of loudness with post-mutational falsetto?

Answer 30

false; Because of this habitual lengthening of the vocal folds, the compression that is necessary for loudness increases cannot be achieved and patients may find it difficult to raise their voices.

Question 31

what is juvenile voice?

Answer 31

In females Habitual cricothyroid hyperfunction Decreased loudness

Question 32

possible causes of juvenile voice

Answer 32

Resistance towards adulthood muscular incoordination

Question 33

perceptual signs of juvenile voice

Answer 33

Child-like pitch elevated larynx high pitch soft breathy voice cul-de-sac resonance

Question 34

true or false: puberphonic voice disorders are less frequently recognized in males

Answer 34

false; less recognized in females

Question 35

true or false: puberphonia can have psychosocial consequences

Answer 35

true

Question 36

Tx for puberphonic voices

Answer 36

voice therapy

Question 37

MTF transgender voice?

Answer 37

– The majority of cases. – Phonosurgery can help to permanently lengthen the vocal folds (can cause laryngeal web) – Voice therapy (difficult)

Question 38

FTM transgender voice?

Answer 38

– Less frequent (but not less difficult). – Prolonged testosterone therapy causes a pitch drop – Voice therapy (vocal tract is still female-sized, teach configuration for vowels)

Question 39

Psychogenic conversion dysphonia and aphonia

Answer 39

* Severe aphonia or dysphonia despite intact vocal anatomy and physiology * Sudden onset, often related to a cold with a sore throat * Highest frequency in adult women but males and children may also be affected * Induced by life stress and tension: – The voice disorder may allow the patient to avoid dealing with the true conflict – The patient may get secondary gains from the voice disorder – The patient could be bullied at school, or stressed at work (causing the dysphonia)

Question 40

how does psychogenic muscular tension dysphonia sound?

Answer 40

raspy, somewhat breathy

Question 41

Therapy for psychogenic voice disorders

Answer 41

voice therapy & psychotherapy

Question 42

what is irritable larynx syndrome

Answer 42

A hyperkinetic laryngeal dysfunction resulting from an assorted collection of causes in response to a definitive triggering stimulus

Question 43

criteria of irritable larynx syndrome

Answer 43

– Symptoms of tension: Dysphonia and/ or laryngospasm with/ without globus sensation; chronic cough – Palpable and visible tension: Palpable in the cricothyroid and thyrohoid spaces and in the supralaryngeal muscles – Sensory trigger: Airborne or esophageal irritant

Question 44

true or false: patients with irritable larynx syndrome are often irritated by palpation

Answer 44

true

Question 45

The irritable larynx syndrome as a severity spectrum

Answer 45

(least severe) Chronic throat clearing --> Chronic cough --> Paradoxical vocal fold motion --> Laryngospasms (most severe)

Question 46

How do larynges become irritable?

Answer 46

- Altered central neuronal control: Larynx becomes overly excitable and sensitive - Changed sensitivity threshold. - Laryngopharyngeal is sometimes suspected as the culprit.

Question 47

Role of the SLP (in irritable larynx syndrome? or overall? *check*)

Answer 47

* Educate and counsel (caused by behaviours) * Optimize vocal hygiene and minimize irritants. * Teach strategies to better control cough. * Encourage sense of control.

Question 48

What is the idiopathic Paradoxical vocal fold motion

Answer 48

VFs closing during inhalaltion (should be open) Respiratory distress, inhalatory distress similar to asthma Episodes of shortness of breath, often during exercise

Question 49

another name for idiopathic Paradoxical vocal fold motion?

Answer 49

vocal cord dysfunction exercise-induced laryngeal obstruction (EILO)

Question 50

true or false: some severe cases of idiopathic Paradoxical vocal fold motion require a tracheotomy

Answer 50

true

Question 51

true or false: sniffing can allow for VFs to open more during idiopathic Paradoxical vocal fold motion

Answer 51

true; due to negative pressure in lungs

Question 52

Findings associated with paradoxical vocal fold motion

Answer 52

* Esophageal reflux * Anxiety or panic disorder * Neuromuscular dyskinesia

Question 53

Tx for paradoxical vocal fold motion

Answer 53

* Behavioural treatment, often involving exercise training. * Respiration training to restore a normal respiratory pattern. * If necessary, anti-reflux medication and psychotherapy.