5.1 Functional Voice Disorders

Question 1

Functional Voice Disorder

Answer 1

-Primarily related to the way the voice is used

-Phonotraumatic Behaviors

Question 2

Phonotraumatic Behaviors

Answer 2

Vocal Misuse and abuse

Question 3

Phonotraumatic Behavior Examples

Answer 3

1. Hard Glottal Attack
2. Laryngeal Squeezing
3. Persistent Glottal Fry
4. Excessive Talking/Talking too loudly
5. Excessive Coughing/Throat Clearing
6. Yelling/Screaming/Making Unusual Sounds

Question 4

Functional Voice Disorders Predisposing Factors

Answer 4

1. Vocal Demands
2. Allergies, GERD (LPR)

Question 5

Are structural changes secondary to phonotraumatic behaviors?

Answer 5

Yes

Question 6

Muscle Tension Dysphonia Definition

Answer 6

1.Excessive laryngeal musculoskeletal tension of extrinsic or intrinsic muscles

2. Hyperfunctional disorder

Question 7

MTD Contributing Factors

Answer 7

1. Anxiety
2. GERD
3. Infection
4. Edema

Question 8

Primary MTD vs. Secondary

Answer 8

Primary has no other underlying cause, Secondary has an organic underlying cause

Question 9

MTD Auditory-perceptual & acoustic characteristics

Answer 9

1. Strained Voice
2. Decreased loudness level and range
3. Pitch variable but decreased range (High pitch has an elevated laryngeal position and increased VF tension)

Question 10

MTD Aerodynamic characteristics

Answer 10

Increased laryngeal resistance

Question 11

MTD Laryngeal Imaging Characteristics

Answer 11

1. Supraglottic hyperfunction

*Increased medial compression of true and false VFs
*Anterior-posterior compression

Question 12

MTD Management

Answer 12

1. Behavioral Voice Therapy
2. Voice Hygiene

Question 13

Vocal Nodules

Answer 13

-Most common benign VF lesion (adults and kids)

-Callous-like swellings on inner margin of VFs

-Inflammatory degeneration of superficial layer of LP

-Basement membrane zone

-Usually bilateral and symmetrical

-Caused by phonotraumatic behaviors

Question 14

Vocal Nodules Auditory-perceptual & acoustic characteristics

Answer 14

1. Roughness & Breathiness
2. Difficulty producing high pitched sounds & reduced pitch range
3. Reduced pitch: Increased mass -> slower vibration -> decrease in F0
4. Vocal Fatigue
   a. increased voice use
   b. Associated tension as compensation → strained voice quality

Question 15

Vocal Nodules:
Laryngeal imaging characteristics

Answer 15

1. Early or acute nodules: soft, pliable, reddish
2. Chronic nodules: hard, white, thick, fibrotic

3.vLaryngeal and VF edema

4. Hourglass closure patterns
5. Decreased vibratory amplitude
6. *Asymmetrical vibration

Question 16

Vocal Nodules:
Aerodynamic characteristics

Answer 16

1. Increased airflow
2. Decreased subglottal pressure

Question 17

Vocal Nodules: Management

Answer 17

1. Behavioral voice therapy
2. Vocal hygiene
3. *Surgery

Question 18

Vocal Polyp

Answer 18

1. Small to large fluid-filled sacks
2. Usually unilateral
3. May create contralateral reaction
4. Anterior 1/3 of VFs

Question 19

Vocal Polyp Etiology

Answer 19

1. phonotrauma

a. Gradual course

b. Can result from single event: yelling

c. Highly associated with smoking

Question 20

Vocal Polyp
Auditory-perceptual & acoustic characteristics

Answer 20

1. Roughness and breathiness
2. Decreased pitch and pitch range
   a.Diplophonia

3.Decreased loudness
a.Strained voice quality

5. Vocal fatigue
   a.Increased voice use

Question 21

Vocal Polyp
Laryngeal imaging characteristics

Answer 21

1. Sessile: closely adhering to mucosa, broad base
2. Pedunculated: attached by a slim stalk
3. Vascular, edematous, inflamed
4. Hourglass closure pattern
5. Aperiodic vibration and asymmetry
6. Reduced vibratory amplitude and mucosal wave

Question 22

Vocal Polyp:
Aerodynamic characteristics

Answer 22

1. Increased Airflow
2. Decreased subglottal pressure

Question 23

Vocal Polyp Management

Answer 23

1. Behavioral Voice Therapy
2. Vocal Hygiene
3. Surgery

Question 24

Reinke’s Edema

Answer 24

1. Buildup of fluids in Reinke’s space
   a.Generalized edema
2. Highly associated with smoking (90% of cases)
   a.Chronic mucosal irritation
3. Other terms: polypoid degeneration, chronic polypoid corditis

Question 25

Reinke’s Edema Auditory-perceptual & acoustic characteristics

Answer 25

1. Roughness & Breathiness 2. Very low pitch voice a. Decrease stiffness b. Bilateral increase in mass

Question 26

Reinke's Edema Aerodynamic Characteristics

Answer 26

Increased laryngeal resistance

Question 27

Reinke’s Edema: Laryngeal imaging characteristics

Answer 27

1.Bilateral edema in membranous portion of VFs 2. Complete or incomplete VF closure 3. Asymmetry and aperiodicity of vibration

Question 28

Reinke’s Edema Management

Answer 28

1. Surgery: drainage of fluid 2. Quit smoking 3. Behavioral voice therapy after surgery

Question 29

Puberphonia

Answer 29

1. Significant growth and hormonal changes in boys ages 12-16 a. Increase in VF length and mass b. Decrease in pitch 2. Changes gradual, but greatest VF mass increase occurs in last 6 mo 3. Puberphonia: adolescent raises pitch to or above puberty level a. Voice in falsetto range (mutational falsetto) 4. Psychological failure to accept new and lower pitched voice

Question 30

Puberphonia Auditory-perceptual and acoustic characteristics

Answer 30

1. High pitch voice a. Voice instability: pitch swings and downward pitch breaks b. Poor vocal projection 2. Increased effort associated with phonation a. Strained voice quality

Question 31

Puberphonia Aerodynamic characteristics

Answer 31

1. Increased subglottal pressure a. Excessive tension

Question 32

Puberphonia Laryngeal imaging characteristics

Answer 32

1. Increased tension in VFs 2. Posterior gap closure pattern

Question 33

Puberphonia Management

Answer 33

1. Behavioral Voice Therapy 2. * Surgery