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1
Q

What would objective measures would you find with nodules

A

Increased NHR, VTI, jitter and shimmer
Decreased fundamental frequency due to mass
Decreased intensity from less subglottal pressure
Increased MAR from loss of air in phonation
Lower VSPL and VE

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2
Q

How would you differentiate nodules from polyps

A

Nodules are bilateral, on anterior 2/3, posterior 1/3 of folds
Arise over time

Polyps are mostly unilateral and have a blood supply
Can form with one incidence of phonotrauma

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3
Q

What are the 2 types of nodules

A

Acute which are gelatinous in appearance. From hyperfunctional voice use

Chronic which are more fibrous and arise over time with repeated phonotrauma

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4
Q

How do you treat nodules

A

Voice rest and good vocal hygiene

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5
Q

How do you treat polyps

A

Surgery

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6
Q

What are the two types of polyps

A

Sessile which are on the fold

Pedunculated that hang from a stem

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7
Q

What is laryngitis

A

Inflammation of larynx

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8
Q

How do you treat laryngitis

A

Good vocal hygiene
Usually heals itself within a week
Medical treatment if an infection is present

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9
Q

What are the symptoms of laryngitis

A

Hoarseness
Fever
Cough
Lower pitch from edema

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10
Q

What is Reinke’s edema

A

Edema that forms in the superficial lamina propria

Associated with smoking

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11
Q

What objective measures would you expect to see in Reinkes edema

A 
Increased NHR
Increased jitter and shimmer
Reduced frequency
Reduced intensity, VSPL and VE
Increased MAR
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12
Q

What is a laryngeal cyst

A

Mucous mass found underneath mucosa in superficial lamina propria
Usually in transition area or vocal ligament
Can be anywhere
Need to make a differential diagnosis with contact ulcers

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13
Q

Describe intubation granuloma

A

Mass arising from arytenoid cartilage due to trauma from intubation
Iatrogenic

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14
Q

What causes contact ulcers

A

LPR

Laryngeal-pharyngeal reflux

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15
Q

What symptoms would you see with a contact ulcer

A

Hoarseness
Breathiness
Reduced pitch
Reduced loudness

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16
Q

What causes candida

A

Antibiotics
Illness
Chemotherapy

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17
Q

How would you identify candida

A

White spots on mucosa
Stiff irregular folds
Abnormal redness

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18
Q

What changes would you see in the voice with candids

A

Minimal to moderate changes due to swelling

Pressed, hoarse, or breathy

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19
Q

What is the viral infection that causes a mass in the supraglottal, glottal, or subglottal regions

A

Human papilloma virus 6 and 11

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20
Q

What is a papilloma

A

Mass due to HPV in the supraglottal, glottal, or subglottal regions

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21
Q

What objective measures would you find with a papilloma

A

Increased NHR
Reduced frequency
Reduced vital capacity

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22
Q

What is the primary symptom of a glottal web

A

Respiratory difficulties
Shortness of breath
Harsh and high pitched voice
Can be anterior or posterior

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23
Q

What causes a glottal web

A

75%congenital due to folds not separating during embryonic development in the 4th to 10th week
Acquired due to trauma usually iatrogenic

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24
Q

What is a laryngocele

A

Air filled dilation in ventricles

Congenital

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25
What causes subglottal stenosis
Congenital: malformed cricoid cartilage formed in utero. 3rd most common congenital Acquired: iatrogenic Idiopathic. More common middle aged women
26
What symptoms would you see in subglottal stenosis
Stridor | Dyspnea, cough, significant chest wall movement
27
What are the symptoms of presbylarynges
``` Sarcopenia:thinning of muscles Superficial layer of cord thins Collagen in cord becomes more dense Mucosal wave abnormalities Possible bowing of folds ```
28
What is sarcopenia
Thinning of muscles
29
What is sulcus vocalis
Groove in fold Bilateral and symmetrical May protrude into vocal ligament
30
What is varix
Enlarged and dilated vein in folds
31
What is ecstasia
Fused lesioning of blood vessels in folds | On superficial lamina oropria
32
What causes muscle tension dysphonia
Phonotrauma
33
What contributes to poorvocal health
``` Smoking Marijuana Alcohol Caffeine Sleep deprivation Vocal fatigue Inappropriate vocal use Obesity Allergies ```
34
What does improper voice use result in
Increased tension Inappropriate pitch Ventricular phonation Later-medial and posterior-anterior compression
35
What is the difference between primary and secondary dysphonia
Primary is direct result of disorder | Secondary is from compensation
36
What causes phonotrauma
Excessive loud talking Straining during laryngeal inflammation Coughing or throat clearing Sports cheering
37
What are symptoms of phonotrauma
``` Hosrseness Fatigue Strain Pain Loss of voice Poor projection Loss of pitch/ loudness range ```
38
What are good differential diagnoses between muscle tension and neurologic disorders
Usually worse at the end of the day | Varies throughout day
39
What does a larynoscopy reveal in strain
Compression (lateral medial or anterior posterior) Supraglottal strain Hyper adduction Elevated laryngeal position
40
What is a hard glottal attack
Rapid adduction of folds before a vowel | Increased subglottal pressure to overcome adductive forces which produces sudden explosive sounds
41
What happens when there is elevated laryngeal positions
Pitch increases | Perceive strain, hoarseness, and increased pitch
42
What are the symptoms of puberphonia
Hoarseness, breathiness Pitch breaks, inadequate resonance Shallow breathing, muscle tension Lack of variability
43
What is ventricular dysphonia
Vibration of false folds Secondary to vocal fold disorder Gives rise to diplophonia
44
What are the characteristics of ventricular dysphonia
Low pitch because of added mass Hoarseness Reduced intensity due to poor pressure below folds
45
What causes psychogenic dysphonia
Emotional trauma, stress or attention seeking
46
How can you tell if someone is faking
They can laugh, whisper
47
What are the types of assessment
``` Laryngoscope Perceptual Acoustic Aerodynamic Quality of life EMG ```
48
What are the 5 subsystems of motor speech disorders or dysarthria
``` Respiration Phonation Resonance Articulation Prosody ```
49
What do you call a lesion on a muscle
Myopathy
50
What do you call a lesion on a nerve
Neuropathy
51
What do you call a lesion at the junction of the nerve and muscle
Myoneural junction disease
52
What is loss of muscle mass called
Atrophy
53
What is muscle tension dysphonia
Any inappropriate use of voice | Overuse of laryngeal muscles
54
What are the two types of muscle tension dysphonia
Primary and secondary
55
What is the primary concern of muscle tension dysphonia
Airflow especially laryngeal resistance | More resistance = less airflow
56
What is hyperfunction
Compression of muscles that causes strain | On superior medial, lateral medial, or supraglottic
57
What assessment do you use for vocal fold paralysis
EMG
58
What can you expect to see in the assessments of muscle tension dysphonia
Auditory perceptual:strained, raspy Acoustic: noise etc Respiration: reduced airflow Laryngoscopy: lateral medial compression, anterios posterior compression, supraglottal tension, aperiodicity, asymmetry
59
What are the 3 parts of brain stem
Midbrain Pons Medulla
60
What are the two UMN fibers
Corticospinal | Corticobulbar
61
Where do the UMN originate
Precentral gyrus
62
Where do LMN originate
From coricobulbar fibers
63
What is dysarthria
Any speech disorder caused by neurological impairment
64
What are the aspects of speech that a motor speech disorder would affect
``` Respiration Phonation Articulation Resonance Prosody ```
65
What do LMN lesions cause
Flaccid dysarthria
66
What do UMN lesions cause
If bilateral they cause spasticity | If unilateral do not affect voice
67
What are the 7 types of dysarthrias
``` Spasticity Flaccidity Unilateral UMN Ataxia Hyperkinesia Hypokinesia Mixed ```
68
What is ataxia
Loss of coordination
69
What causes spasticity
Bilateral UMN
70
What causes flaccidity
Uni and bilateral LMN
71
What causes ataxia
Lesion in cerebellum
72
What is hyperkinesia
Too much movement
73
What is a classic disease with hypotonia
Parkinson's
74
What is a motor neuron disease
Disorder at the junction of LMN and UMN
75
What is the origin of the LMN
Motor neuron
76
What are the two braches of the Vegas nerve that innervate the voice production
Superior laryngeal | Recurrent laryngeal
77
What des the recurrent laryngeal nerve innervate
All intrinsic laryngeal muscles except the cricothyroid | Sensory information below the folds
78
What are the types of neurogenic voice disorders
Vocal fold paralysis Spasmodic dysphonia Organic voice tremor
79
What muscles are affected by abductor paralysis
Posterior cricoarytenois
80
What muscles are affected by adductor paralysis
Lateral cricoarytenoid | Interarytenoids
81
What are the problems associated with adductor paralysis
Phonation Aspiration Subglottal pressure
82
What is the primary concern of bilateral adductor paralysis
Aspiration
83
What would be the voice quality of someone with bilateral adductor paralysis
Dysphonic with secondary muscle tension Bresthy Wesk
84
What would the voice quality be like with unilateral abduction paralysis
Mildly dysphonic | Possible loudness issues
85
What is the most common form of vocal fold paralysis
Unilateral adductor paralysis
86
What type of dysarthria is spasmodic dysphonia
Hyperkinetic
87
What is the origin of spasmodic dysphonia
Disruption in extrapyramidal fibers in CNS
88
What are the symptoms of spasmodic dysphonia
Pauses in phonation Effortful voice production Strain Uncontrolled spasms
89
What voice qualities would you expect in adductor spasmodic dysphonia
Strain Effortful Vowels more affected Intermittent normal phonation
90
What voice qualities would you expect in abductor spasmodic dysphonia
Intermittent breathiness Short breaks of aphonia Intermittent normal phonation Can affect consonant production
91
What is essential tremor
CNS disorder | Results in involuntary regular tremors in limbs, head, larynx
92
What is organic voice tremor
Essential tremor limited to larynx | Based on frequency deviations of 4 to 6 hz
93
What is myasthenia gravis
``` Neuromuscular disorder Autoimmune Causes weakness and atrophy in muscles Occurs at myoneural junction Disruption of ACH receptors at myoneural junction ```
94
How does myasthenia gravis affect voice
Weakness after 5 -6 minutes | Mucosal wave abnormalities
95
Where are 4 places that you might see a LMN disorder
Motor neuron Myopathy Neuropathy Myoneural junction
96
What is the function of dopamine
Inhibitory
97
What type of dysarthria is parkinsons
Hypokinesia
98
What voice qualities would you expect in parkinsons
Monopitch Monoloudness Loudness biggest symptom Dont have sensory info that they are too soft
99
What is the voice treatment for parkinsons
Lee Silverman Loud | LSVD
100
What would happen to reflexes if in the LMN
Reduced
101
What would happen to reflexes if the lesion is in the UMN
Hyperactive reflex
102
What are the different types of paralysis
Abductor or adductor | Both unilateral or bilateral
103
What is a passymuir valve
A valve that redirects air through the folds for speech when there is a stoma
104
What are possible causes of vocal fold paralysis
``` Surgery Neurologic disease Head or neck trauma Viral infection Tumor ```
105
What are general symptoms of of paralysis
Breathiness Low intensity Low pitch Intermittent diplophonia
106
What is botox
A toxin that temporarily paralyzes the folds
107
How can you provide biofeedback for a parkinsons patient
Sound level meter
108
What are some examples of congenital neuroligic disorders in children
``` VF paralysis Laryngeal stenosis Laryngomalacia Laryngocele Webbing ```
109
What are some prenatal reasons for congenital voice disorders
Maternal substance abuse | Poor embryonic development
110
What are some perinatal reasons for congenital voicedisorders
Birth trauma Delayed birth cry Hypoxia
111
What is laryngocele
Air filled sac in the vestibule
112
What are postnatal causes of congenital voice disorder
Neonatal jaundice Seizures Encephalitis
113
What is laryngomalacia
Epiglottis is flaccid and obstructs airway. | Concern is swallowing and aspiration
114
What are signs of pediatric voice disorder
``` Dysphonia Intermittent aphonia Voice breaks in singing or speech Excessively loud voice Inability to sustain a note Effortful or strained voice ```
115
What is the primary acquired disorder in children
Muscle tension dysphonia
116
What is the leading cause of acquired voice disorder in children
Phonotrauma
117
What are actities in kids that may cause vocal nodules
``` Excessive use Glottal attack Not resting voice when ill Crying, laughing, outbursts Shouting, screaming ```
118
What should you consider when working with children
Laryngeal development Psychological/emotional development Language speech General development
119
What are some anatomical changes in geriatric patients
``` Atrophy Vocal fold thinning Bowing Discoloration Edema of superficial lamina Ossification Decreased blood supply ```
120
What are perceptual voice changes in geriatric patients
``` Altered pitch Roughness Breathiness Hoarseness Tremor Weakness ``` Quality. Pitch. Loudness
121
Why would loudness be affected in geriatric patients
Less air support | Less subglottal pressure
122
What are the essential elements of a report
``` Background/case history Laryngoscopy Auditory perceptual analysis Acoustic analysis Aerodynamic analysis Quality of life ``` Both subjective and objective
123
What info is in a case history
``` The problem verbatim Effect of problem on their life Onset and duration Variability or constancy Other symptoms present Medical history/ list of procedures etc Medications Vocal habits Psychological issues ```
124
What are components of a subjective aerodynamic assessment
Observe type of breathing Number of words per breath S/z ratio Max phonation duration
125
What are objective measurements for phonation
``` Habitual loudness and pitch Loudness variability (contrastive stress) Pitch variability, range Tremor Voice quality with severity ```
126
What is LPR
Laryngeal-pharyngeal reflux
127
What is LSVT
Lee Silverman Voice Treatment
128
What is MTD
Muscle tension dysphonia
129
What term is used describe functional disorders
Muscle tension dysphonia
130
Why is throat clearing destructive
Increased subglottal pressure required to overcome adductive forces to produce a sudden explosive sound
131
How does unilateral UMN present
Contralateral lower facial weakness
132
What contributes to PVFM
``` Reflux Exercise upper airway inflammation Exposure to irritants Environmental allergens Stress Change in temp Vocal maneuvers ```
133
How do you diagnose PVFM
Observe neck muscles Visualization of folds Symptoms Thorough history
134
How do you treat PVFM
Direct: relaxed throat breathing, panting, biofeedback Indirect: education, relaxation, reassurance, hygiene

Voice (2 decks)

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