Care of Professional Voice-Test 2 Flashcards Preview

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Flashcards in Care of Professional Voice-Test 2 Deck (41):
1

Pt hx: Hoarseness

Laryngitis
Mass lesions

2

Pt hx: Breathiness

Improper technique, Prevent full approximation
VF paralysis, Arthritis
Arytenoid dislocation, Unilateral scarring
Senile VC atrophy--singer getting older; aging & overworked VFs, never singing at right register, etc.

3

Aging Voice Characteristics

Breathiness and decreased range

4

What happens with aging voice?

Muscular tone decreases; Lungs lose capacity; Thorax loses dispensability; Mucosa of vocal tract atrophies; Mucosal secretions change
Nerve endings reduced in #; Laryngeal cartilages ossify; Joints may be arthritic & stiff

5

Myasthenia Gravis:

neuro problem; can fatigue anytime during day; short-period of time—immediate time; rest & it gets better; by end of day-thinking nodules

6

Fatigue Characteristics

Hoarse; Breaking into different registers; Losing range; Changing timbre

7

Possible Cause of Hoarseness related to Fatigue

Misuse of abdom.

8

Possible Cause of Breaking into Different Registers related to Fatigue

Singing too long (MG) & neck musculature

9

Possible Cause of Losing Range related to Fatigue

Over singing

10

Possible Cause of Changing Timbre related to Fatigue

Singing to loudly

11

Pt Hx: Volume Disturbance:

Hormonal changes, aging, neurological disease, SLN paralysis (monotone & minor swallowing problems), herpes infection, reflux (increased warmup time), voice limitations, technical errors

12

Pt Hx: Pain

Posterior (Intubation granulomas, contact ulcers, etc)
VC Lesions
Laryngeal Joint Arthritis
Infection
Gastric Irritation of Arytenoids
*Excessive Neck Muscular Activity

13

Pt Hx: Behavioral

Date of next important performance (can they do major performance, etc.)
Professional singing status & goals
Amount & nature of vocal training
Type of singing & environment
Rehearsal
Warm up/cool down

14

Pt Hx: Psychological

Pre-performance anxiety
Stage fright
Insecurity
Depression
Emotional disturbances
Dry mouth, cold clammy skin, thick secretions

15

Instead of throat lozenges:

Lozenges add to thickness of secretions
Cut up a lemon into small pieces & let it dry out; put in medicine bottle & suck on those

16

Pt General Health Problems

Overall physical condition
URI, post-nasal drip, coughing
Allergies
Infectious sinusitis (diffuse mucosal inflammation)
TMJ dysfunction: decreased range, vocal fatigue, change in quality, change in placement, posterior tongue placement, laryngeal hyperfunction

17

Pt Surgery

VF lesions
Tonsillectomy
Anesthesia (intubation)
Thyroidectomy (SLN & RLN)
Thoracic & abdominal surgery (Breathing)

18

Reflux Laryngitis

Arytenoid Irritant
Eating after a late performance
Bitter taste & halitosis upon awakening
Dry/coated mouth
Scratchy sore throat
Lump in throat
Prolonged warm up time

19

Foods irritating reflux

Affect amount & viscosity of mucosal secretions, irritating if aspirated:
Milk, nuts, ice cream, chocolate, highly spiced foods, coffee (caffeine)

20

Exposure to Irritants

Allergies to dust & mold in concert env't
Drying effect of cold air & dry heat (decreased lubrication): scratchy voice, tickling cough
Smoke-filled rooms
Smoking tobacco/marijuana
Alcohol abuse: muscular incoordination

21

Vocal Abuse in Speaking (some populations)

Cheerleading in teens
Conducting choirs
Teaching singing

22

Vocal Abuse in Singing/Common Technical Errors:

Excessive muscle tension in tongue, neck, larynx
Inadequate abdominal support
Excessive volume (singing through hoarseness)
Inadequate preparation, rehearsal, training
Improper range

23

When evaluating singers....

Have them bring guitar if they use it, stand if that’s how they sing, etc.
Speaking voice & singing voice should match

24

When working with excessive volume in tx:

Make them do it softly in therapy (harder to sing softly than loudly)-soft is retraining neuromuscular coordination

25

Age vs. Training

Near puberty female
After puberty male
Children: mainly vocalize without strain
Avoid vocal abuse

26

Drugs Leading to Dryness, Possible Tremor, Coughing, Clearing

Vitamin C (5-6 g/day), antihypertensives, bronchodilators, antiviral agents, hormones (birth control), antihistamines, diuretics, anticoagulants, antitussives, antacids, antidiarrheal agents, beta blockers, aspirin, tranquilizers

27

Physical Exam of Professional Voice

Nasal cavity status
Bruxism, TMJ dysfunction
Neck scars/trauma
Laryngeal vertical mobility
Gag reflex
Palatal deviation
Tongue, hand, or motor tremor
Post-viral infection neuropathy: decreased SLN fx (can also affect RLN)--paresis/paralysis of nerve

28

Evaluation of Singer's Voice Measures of Phonatory Ability

MPT, Frequency Range of Phonation (vocal fry to falsetto)
Musical frequency range of phonation (lowest to highest acceptable notes)
Vocal register (fry, modal, falsetto)
Speaking fundamental frequency
Intensity range of phonation

29

Eval of Singing Voice

Posture
Sing a 5 note scale on /a/
Sing entire range
Compare singing vs. speaking voice

30

Sign that there might be a Vocal Cord Mass:

Pitch break at a certain frequency
Voice will sound good except at certain pitches were the voice breaks
In some tx: Relax and work into mid- and high-ranges; more flexibility; reduce hard contact

31

Eval of Singer's Voice: Observations

Contraction of neck muscles; jaw jutting
Retraction of upper lip; retraction of lower lip
Retraction of tongue
Position of larynx w/ pitch changes
Facial grimacing/forehead tension

32

Other Assessments: Eval of Singing Voice

Pulmonary Fx studies
Laryngeal airflow measures
Visi-pitch analyzer
Sona-graph
EMG

33

Antibiotics for Vocal Dysfunction

High doses for 7-10 days course
Erythromycin/tetracycline
Amoxicillin before a performance w/ intramuscular injection

34

Antihistamines for Vocal Dysfunction

Causes dryness, thick mucous, dry cough x before a performance
Rec: corticosteroids
Seldane between performances

35

Mucolytic Agents for Vocal Dysfunction

Helps liquefy viscous mucous, decrease throat clearing, reduce post nasal drip
Organidin, Extex, Humibid

36

Corticosteroids for Vocal Dysfunction

Anti-inflammatory for acute laryngitis
Do not recommend overuse
Recorded high dosage for short period of time 3-6 days of decadron or Medrol
Dosepak one intra-muscular injection if acute

37

Diuretics for Vocal Dysfunction

Premenstrual period bound fluid retention in Reinke's space
Do not mobilize bound fluids; they cause dehydration & thicken secretions

38

Analgesics for Vocal Dysfunction

Aspirin predisposes to VC hemorrhage
Acetaminophen is best substitute
Ibuprofen may interfere with clotting

39

Dehydration

Dry lining of VC's and larynx
Dried mucus
Mucosal wave nearly absent

40

Sprays, Mists, Inhalants

Contain analgesia's; Propellant inhaler may be damaging
Prolonged steroid use in asthmatics causes muscle atrophy
Afrin, Propylene glycol, water or saline via a vaporizer

41

Singer's First Aid Kit

Tylenol for headache
Prylosec or Gaviscon for reflux
Ampicillin, erythromycin, tetracycline for URI
Afrin for nasal congestion
Sudafed for mild allergy
Entex, Organidin, Robitussin, Humibid for post-nasal drip
Steroids prescribed in limited dosage by physician