Common voice disorders Flashcards
Whar is functional voice disorder?
Associated with vocal misuse and phonotrauma
Vocal misuse - voice production behaviours that prevent the vocal mechanism from working smoothly and efficiently
Eg.
MTD
Ventricular dysphonia
Psychogenic voice disorders
How does vocal misuse develop?
Periods of increased personal tension
Greater than usual demands on voice
Laryngitis
Periods of voice difficulty that resolve spontaneously
Increase in episode of voice difficulty
Altering vocal behaviour and being unaware of the change
What are the features of vocal misuse?
Increased tension and strain
- Hard glottal attack
- High laryngeal position
- Anteroposterior laryngeal squeezing
Inappropriate pitch level
- Puberphonia
- Persistant glottal fry
- Lack of pitch variability
Excessive talking
- Vocal fatigue
- Complaints correlate with patterns of excessive talking
Ventricular phonation
- Ventricular VF move towards midline and cover true VF
- Low pitch, hoarse, diplophonia
What is phonotrauma/vocal abuse and what are the signs/symptoms?
Harsher than vocal misuse Excessive prolonged loudness Strained and excessive voice use when there is already swelling, inflammation and tissue change present. Excessive coughing/throat clearing Screaming/noise-making Over-enthusiasm in sports/exercise
Signs/symptoms: Harsh/strident Hoarse Breathy Hard glottal attack High volume Vocal fatigue Frequent throat clearing Pitch breaks Tissue changes/laryngeal pain
What is the aetiology/pathophysiology of vocal nodules?
Functional voice disorder
Aetiology:
Tissue reaction to frictional trauma between VF
Excessive laryngeal tension
Pathophysiology:
Small, white/greyish protuberance on free margin of VF
Located at junction of anterior 1/3 and posterior 2/3
Usually bilateral and symmetrical
What are the stages of vocal nodules?
Early stages - localised capillary haemorrhage swelling and redness.
Later stage - fibrosis of epithelium, rough, semicircular, nodule.
Increase mass and stiffness of VF due to hard nodule.
If caught early while still soft they can resolve but when harder they may have to get surgery.
What are the speaker characteristics of people with vocal nodules?
Incessant talker, socially aggressive, tense, loud, teachers, singers, lawyers, autioneers, actors.
What are the perceptual and physiological signs of vocal nodules?
Hoarseness, breathiness
Habitual cough and throat clearing
Airflow may be increased
Increased subglottal pressure - while VF can still be closed because of the extra air required for vibration.
With large nodules there will be a decrease in subglottic air pressure as more air in allowed to escape.
What is the management of vocal nodules?
If nodules are immature and non-fibrous - voice therapy.
If nodules are fibrous - surgical removal and voice therapy.
Voice therapy:
Program of decreased vocal use/vocal rest.
Program of vocal hygiene.
Elimination of abusive behaviours
What is the aetiology and pathophysiology of vocal polyps?
Functional voice disorder
2 types: sessile/broad based or pedunculated
Usually unilateral
Located on junction of anterior 1/3 and posterior 2/3
What are the perceptual and physiological signs of vocal polyps?
Diplophonia, sudden voice breaks, hoarseness, roughness, breathiness.
Increased airflow and increased subglottal pressure (to overcome glottal incompetence)
What is the management of vocal polyps?
Medical: Pedunculated and large sessile are surgically removed.
Small sessile - voice therapy.
Voice therapy:
Similar to vocal nodules.
2 - 6 months before improvements in quality
What is Reinke’s oedema and what is the aetiology and pathophysiology?
Functional voice disorder
Polypoid degeneration
Build-up fluid in first layer of lamina propria in Reinke’s space.
Aetiology:
VF trauma and misuse
Smoking
More frequent in females if long term smokers.
Pathophysiology:
VF full of fluid, boggy
Oedema full length of VF bilaterally.
Oedema disturbs elasticity of VF - increased stiffness.
What are the perceptual and physiological signs of Reinke’s oedema?
Low pitch, hoarseness and shortness of breath.
Increased airflow.
What is chronic laryngitis and what is the aetiology and pathophysiology?
Functional voice disorder
Long-standing inflammation of laryngeal mucosa secondary to phonotrauma.
Aetiology:
Smoking - most common
Vocal abuse/misuse - coughing, throat-clearing
Overuse of mouthwashes and gargles
Pathophysiology:
VF red, irregular, thick, rounded.
Small dilated blood vessels on surface.
Oedema in supraglottic area.
What are the perceptual and physiological signs of chronic laryngitis?
Hoarseness, high or low pitch, non-productive cough, sore throat.
Increased air flow and subglottal pressure.
What is the management of chronic laryngitis?
Medical management: Surgical stripping if voice therapy unsuccessful.
Voice therapy: Program to reduce vocal abuse and misuse.
What is muscle tension dysphonia and what is the aetiology and pathophysiology?
Functional voice disorder
Very common type of voice disorder
Vocal muscle misuse
Aetiology:
Excessive musculoskeletal tension in head and neck.
Intrinsic and extrinsic muscles sensitive to emotional stress.
Hypercontraction of muscles - common denominator in functional dysphonias.
What is the symptomatology of MTD?
Aphonia/dysphonia Breathiness Hoarseness Excessive high pitch (could be low too) Pain in laryngeal area Referred pain to ears and chest Sensation of lump or tightness in larynx or pharynx Pain in response to pressure on larynx. Often worried that they may have polyps or cancer which can increase tension.
What is the physiological basis of MTD?
Usually normal larynx.
May demonstrate abnormal function.
Secondary mucosal changes may occur.
