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Flashcards in Exam 1 Deck (183):
1

What are functional voice disorders characterized by?

by tension, hyperfunction, larynx “riding high”, anxiety

2

How many cases of functional voice disorders are dysphonia cases?

10%

3

T or F: Most functional voice disorders are predominantly men.

False

4

What does URI stand for?

Upper Respiratory Infection

5

What are functional voice disorders caused by?

URI, stressful/traumatic event, psychosocial (mood, anxiety, adjustment), organic, idiopathic

6

T or F: No structural pathology is present unless an organic disorder develops

True (with the exception of organic causes

7

What are some examples of functional voice disorders?

Puberphonia/Falsetto/Mutational falsetto
Functional aphonia
Functional dysphonia
Paradoxical VF Movement (PVFM)/ PVCD/VCD

8

What is puberphonia?

“mutational falsetto”
Pitch control disorder (pitch too high, pitch breaks)

9

T or F: Puberphonia is due to anatomic immaturity of larynx.

False

10

What does the larynx do in puberphonia?

Larynx "rides high"

11

What causes puberphonia?

Emotional stress

12

What does functional aphonia sound like?

Whisper or shrill-sounding voice

13

What did functional aphonia used to be called?

“hysterical” syndrome and “conversion” symptom or “conversion hysteria”

14

How long does functional aphonia last?

May be temporary or intermittent

15

What do 80% of purberphonia cases coexist with?

Psychiatric disorders

16

What is functional dysphonia also called?

MTD Muscle Tension Dysphonia

17

What can you see/feel in functional dysphonia client?

Excessive tension of laryngeal/ extralaryngeal muscles (neck, shoulder)
“Clavicular breathing”/“Chest breathing”

18

What symptoms may clients have with functional dysphonia?

↑ vocal effort
Vocal fatigue

19

What is ↑ vocal effort & vocal fatigue due to in functional dysphonia?

Hyperfunction
Ventricular compression
Ventricular phonation
A-P press

20

What does PVFM stand for?

Paradoxical Vocal Fold Movement

21

What are the etiologies for PVFM?

Psychogenic, LPR, neurological

22

What does LPR stand for?

Laryngopharyngeal Reflux

23

What symptoms do you see with PVFM?

Dyspnea
Inspiratory stridor (vf’s adduct on inspiration)
May be exercise-induced
May or may not have dysphonia
May have chronic cough

24

What is PVFM frequently misdiagnosed with?

Asthma

25

What are organic disorders typically due to?

Abnormal anatomy, tissue changes
(purely organic)

26

T or F: Functional disorders can have organic factors OR be wholly functional.

True

27

T or F: Functional disorders have abnormal anatomy.

False-typically normal anatomy unless functional misuse leads to organic changes.

28

Give some examples of functional misuse.

Inadequate breath support, hard glottal attack, supraglottal squeeze

29

What are the classifications of organic disorders?

Congenital
Misuse/Abuse
Disease
Trauma

30

What is an organic disorder with the classification of congenital-web?

Laryngomalacia

31

What is an example of an organic disorder with the classification of Misuse/Abuse due to lifestyle diet?

Reflux

32

What is an example of an organic disorder with the classification of Misuse/Abuse due to lifestyle of smoking?

Reinke's edema

33

What is an example of an organic disorder with the classification of Misuse/Abuse due to lifestyle personality?

Nodules

34

What is an example of an organic disorder with the classification of Disease?

Cancer

35

What is an example of an organic disorder with the classification of Trauma

Cartilage Dislocation

36

List types of organic disorders.

Nodules
Polyps
Cysts
Papilloma
Granuloma
Contact ulcer
Sulcus vocalis
Congenital
Web
Hemmorhage
Laryngitis
Reinke’s edema
Leukoplakia
Cancer

37

What are vocal fold nodule(s)?

Benign mass(es) on medial vf surface(s)

38

What is the etiology of vocal fold nodule(s)?

Misuse/abuse

39

What are signs/symptoms of vocal fold nodule(s)?

hoarseness, rough voice, ↑ vocal effort, vocal fatigue/strain, loss of upper range, voice variability, vf edema, hourglass closure, ↓ vf vibration, “strong” personality, hearing loss

40

What are VF polyps?

Generally soft mass

41

T or F: VF Polyps are usually unilateral

True

42

What is the etiology of VF polyps?

Misuse/abuse

43

What are the different types of VF polyps?

fibrous, hemmorhagic, pedunculated

44

What are signs/symptoms of VF polyps?

hoarseness, rough voice, ↑ vocal effort, vocal fatigue/strain, breathing problems (depending on size), voice variability (especially if pedunculated), vf edema (reactive swelling), throat clearing

45

What is a VF cyst and where is it located?

Benign opaque mass originating below vf surface

46

What is the etiology of a VF cyst?

entrapment of vf lining (under the lining) or plugged mucous-secreting gland, vocal misuse/abuse

47

What are signs/symptoms of VF cysts?

hoarseness, rough voice, ↑ vocal effort, vocal fatigue/strain, vocal fold edema, throat clearing

48

What is edema?

reactive swelling

49

What is a laryngocelle?

cyst in laryngeal cavity

50

What does HPV stand for and what is it?

Human Papilloma Virus
Wart-like benign growths of the larynx

51

What is papillomatosis?

Papilloma in the larynx

52

What are the etiologies of Papilloma?

acquired at birth, oral sex, unknown

53

What are the signs and symptoms of papilloma?

hoarseness, rough/scratchy voice, cough/throat clear, globus sensation, breathing problems, ↓ vf vibration, scarring (recurrent)

54

How many strains of HPV causes laryngeal papillomatosis?

60 Strains

55

What is a granuloma?

Benign polyp on vocal process

56

What is the difference between a granuloma and a polyp?

Location-granuloma is located on the vocal process of the arytenoids.

57

What is the etiology of granulomas?

LPR and Intubation

58

What are signs and symptoms of granulomas?

globus sensation, heartburn/indigestion (reflux-type), excessive throat clearing, dry cough, post-nasal drip, breathing problems (size-dependent), may be pedunculated

59

What are contact ulcers?

Raw sores on mucous membrane overlying vocal process of arytenoid

60

What are the etiologies of contact ulcers?

Misuse/abuse, LPR, smoking, intubation

61

What are signs and symptoms of contact ulcers?

hoarseness, globus sensation, mild pain when voicing or swallowing, throat clearing, erythema

62

What is sulcus vocalis?

Thinning or absence of superficial lamina propria
> "ditch"

63

What does "sulcus" mean in Latin?

cleft, furrow

64

What are the etiologies of sulcus vocalis?

unknown – developmental? genetic? post hemmorhage/cyst?

65

What are signs and symptoms of sulcus vocalis?

may not have voice probs, harsh voice, hoarseness, higher pitch, abnormal vf vibration

66

T or F: Sulcus vocalis is seen in children.

False-never seen in children

67

What is Laryngomalacia?

When the cartilage fails to stiffen.

68

What are signs and symptoms of laryngomalacia?

Epiglottis collapses into the airway,
Stridor

69

What is subglottal stenosis?

Narrow subglottal space

70

What causes subglottal stenosis?

Arrested deviation of cricoid cartilage (usually doesn't form);
Intubation trauma

71

What is esophageal atresia?

occlusion of the esophagus

72

When does esophageal atresia occur?

When the esophagus hasn't formed all the way or if something is occluding it.

73

What is a tracheoesophageal fistula?

Openings between the trachea and esophagus

74

What may a tracheoesophageal fistula occur with?

Esophageal pouch

75

What does a web look like and where is it located?

Tissue across larynx, usually anterior

76

What is the etiology of a web in the larynx

Congenital, post-surgical

77

What are signs and symptoms of a web?

May not have voice problems; usually no problems breathing

78

What is a deterrent for webs?

Mitomycin C

79

What is a hemmorhage of the vocal folds?

Bleeding into superficial lamina propria

80

What are the etiologies of a hemmorhage of the vocal folds?

misuse/abuse, medications (Coumadin, aspirin: blood thinners)

81

What are the signs and symptoms of a hemmorhage of the vocal folds?

hoarseness, vf erythema, vf edema, ↓ vf vibration, loss of pitch range, varix (varices)

82

What does erythema mean?

Redness

83

What does varix (varices) mean?

Blood spot/blood vessel on vf

84

What is the #1 cause of vf hemmorhage?

VF edema due to stiffening up from fluid causing hoarseness

85

What does a hemmorhage also look like on other places of the body?

A bruise: starts off bright red, pale red, then plaquey yellow

86

What is laryngitis?

Inflammation of the vocal folds

87

What are the etiologies of laryngitis?

Infection, LPR, allergies

88

What are signs/symptoms of laryngitis?

hoarseness, sore throat, cough, fever, vf edema, erythema

89

What is Reinke's Edema?

Swelling of he entire superficial lamina propria (Reinke’s layer)

90

What is another name for Reinke's Edema?

polypoid corditis

91

What is the etiology for Reinke's Edema?

Smoking

92

What are signs and symptoms of Reinke's Edema?

gravelly voice, low pitch, vf edema, impaired breathing

93

What is leukoplakia?

White patches/growths on epithelium

94

What is leukoplakia a precursor for?

Pre-cancerous

95

What are the etiologies of leukoplakia?

smoking, chemical exposure

96

What are signs and symptoms of leukoplakia?

hoarseness, ↓ vf vibration, vf edema

97

What is the #1 sign/symptom of Reinke's Edema?

VF Edema (swelling) due to taking on a lot of fluid due to the carcinogens going through the system causing the larynx to swell

98

Why do those with Reinke's Edema have a lower pitch?

Due to increased fluid production creating greater mass for vf's.

99

What does COPD stand for?

Chronic Obstructive Pulmonary Disease

100

What is the next step from Reinke's Edema?

Leukoplakia

101

What is an occupation that is at risk for leukoplakia?

Janitor due to mixing cleaning supplies.

102

What is the next step after leukoplakia?

Cancer

103

Where is cancer typically located in the larynx?

Glottic (larynx-vocal folds) & supraglottic-(above VF's in the false VF's, epiglottis, and tongue base)

104

Where is cancer rarely located in the larynx?

subglottic in proximal trachea

105

What are the etiologies of cancer?

smoking, heavy alcohol consumption, asbestos or chemical exposure

106

What are signs and symptoms of cancer?

hoarseness, rough voice, pain, strain, difficulty/pain swallowing

107

What is the main sign/symptom of cancer?

Pain

108

What are the etiologies of laryngeal trauma?

Hit in the neck, weight lifting, foreign bodies

109

What does paradoxical mean?

The reverse of how it should work.

110

What is different in the breath patterning of a client of PVFM?

Breath patterning opposite of what should be. They're adducting on inspiration instead of abducting.

111

What does aphonia mean?

No voice

112

T or F: a full whisper uses less muscles than a regular voice.

False-uses more muscles

113

T or F: a client with PVFM may not have voice issues when speaking.

True

114

Which one sounds more stressed? A client with funtional dysphonia (MTD) or aphonia?

Functional Dysphonia (MTD)

115

What is a globus senstation?

The feeling like something is there

116

What is dyspnea?

Trouble breathing

117

What things affect good vocal hygiene?

-64 oz. water/day
-caffeine (is a diuretic) for every 8oz, need 6 oz water
-alcohol
-Reflux
-Cigarettes
-Enough sleep/rest
-Misusing voice

118

What does diuretic mean/do?

Causing increased passing of urine from where it takes water from cells and voids it out.

119

What causes heartburn & reflux?

spicy/acidic foods, caffeine, obesity, eating too close to sleeping, exercising too soon after eating, eating meals 3-4 hours before lying down, smoking, elevate had of bed-LPR

120

Who is laryngomalacia typically associated with?

Children

121

What are children typically dx with?

VF nodules or laryngomalacia

122

What is the most prevelant voice disorder?

Vocal Fold Nodule(s)

123

T or F: It's rare to see polyps grow bilaterally

True (they do not cause another to form like nodules)

124

What makes up the CNS?

Motor cortex, primary motor strip, midbrain, brainstem – motor control of larynx

125

What does Broca's Area do?

Voice response (preplanning)

126

What does the insula do?

Motor planning for voice

127

What does the precentral gyrus do?

Voice production

128

What does the basal ganglia/thalamus do?

Sensory info for vocalizing (motor)

129

What do the temporal lobes do (Heschyl's gyrus)

Audition

130

What makes up the PNS?

Cranial and spinal nerves

131

What are the cranial nerves of phonation/voice?

IX, X, XI, XII

132

What does the Glossopharyneal (IX) nerve do?

Motor to stylopharyngeus muscle
Function: elevates larynx

133

What does the Vagus (X) nerve do?

Superior Laryngeal Nerve (SLN), Recurrent Laryngeal Nerve (RLN): sensory & motor to larynx, motor to thorax

134

What does the Spinal Accessory (XI) nerve do?

Neck accessory muscles (Sternocleidomastoid/SCM & trap), levator veli palatini & uvula

135

What does the Hypoglossal (XII) nerve do

Depression/elevation of larynx (via tongue muscles), neck strap muscles

136

What does the SLN branch of the Vagus do?

Sensory: (internal branch) mucous membrane supraglottal larynx
Motor: (external branch) cricothyroid muscle

137

Where does the RLN branch of the Vagus run?

Right: Loops behind R carotid and R subclavian
Left: Loops around aortic arch (male)

138

What does the RLN branch of the Vagus do?

Motor: TA of VF, PCA (abductor), LCA (adductor), transverse arytenoids (adduction), oblique arytenoids (adduction), and all other laryngeal muscles

139

If there is Left VF paralysis, where is the lesion?

Immediately think Left RLN (LMN) ipsilateral damage

140

What are etiologies of neurogenic voice disorders?

Congenital (Huntington's)
Lesion/tumor/disease (dysarthrias, stroke, cancer)
Trauma (TBI, n. trauma)

141

What is the sensory function of the Superior Laryngeal Nerve (SLN) of the Vagus?

(internal branch) mucous membrane supraglottal larynx

142

What is the motor function of the Superior Laryngeal Nerve (SLN) of the Vagus?

(external branch) cricothyroid (CT) m.

143

Where does the LEFT Recurrent Laryngeal Nerve (RLN) of the Vagus travel to?

loops around aortic arch

144

Where does the RIGHT Recurrent Laryngeal Nerve (RLN) of the Vagus travel to?

loops behind Right carotid & Right subclavian

145

What is the motor function of Recurrent Laryngeal Nerve (RLN)?

TA of vf, PCA (abductor), LCA (adductor), transverse arytenoids (adduction), oblique arytenoids (adduction) + all other laryngeal m.’s

146

What are examples of LMN Neurogenic Voice Disorders?

Myesthenia Gravis (MG), Guillaine-Barré, Flaccid dysarthria

147

What are examples of UMN Neurogenic Voice Disorders

Spastic dysarthria, Hypokinetic dysarthria (PD), Hyperkinetic dysarthria (Spasmodic dysphonia, essential tremor Huntington’s), Ataxic dysarthria

148

What are examples of Mixed Neurogenic Voice Disorders

ALS, TBI, MS

149

What are symptoms of LMN Neurogenic Voice Disorders?

Flaccidity: weakness, reduced muscle contraction, reduced ROM

150

What are symptoms of UMN Neurogenic Voice Disorders in Spastic dysarthria?

Spasticity/hypertonicity, strain/strangle, short phonation time, monopitch

151

What are symptoms of UMN Neurogenic Voice Disorders in Hypokinetic dysarthria?

Rigidity, bradykinesia, limited ROM, resting tremor

152

What are symptoms of UMN Neurogenic Voice Disorders in Hyperkinetic dysarthria?

Uncontrolled movements, strain/strangle

153

What are symptoms of UMN Neurogenic Voice Disorders in Ataxic dysarthria?

Cerebellar lesion, prosodic slowdown, resonance changes, inarticulation, “intoxicated”

154

What is the most common type of Mixed dysarthria?

Flacid/Spastic

155

What type of damage is ALS?

UMN & LMN

156

What type of damage is MS?

myelin sheath degeneration

157

T or F: TBI is a type of Mixed dysarthria.

True-it can be. Damage is variable

158

List what we do in a voice evaluation.

Patient history
Voice sample –sustained & connected
Perceptual analysis (subjective)
Acoustic analysis (objective)
Stroboscopic assessment
Respiratory assessment
Resonance/vp assessment
Recommendations/POC

159

What evaluation is objective?

MDVP

160

What do we use for perceptual analysis?

VHI & CAPE-V

161

What do we use for acoustic analysis?

MDVP

162

What do we use for respiratory assessment?

Spirometry, manometry, pneumotachometry

163

What do we use for resonance/vp assessment?

nasopharyngoscopy, nasometer

164

What additional assessments may we do in a voice eval?

Oral-facial exam
Hearing assessment
EGG
EMG

165

What does an EMG stand for and do?

Electromyography
records the electrical activity produced by skeletal muscles (volts)

166

What does an EGG stand for and do?

Electroglottograph
mean flow rate (MFR) of airflow at glottis

167

What do we need to ask in patient hx form?

Hx of the problem (Origin, Duration, Severity)
S/S: voice quality, pitch, resonance, loudness, reflux?
throat clear? cough? swallow probs? pain?
Social hx – how do they use their voice?
Related medical hx (surgeries, allergies, URI/resp,
psych/depression, medication list)
Vocal hygiene: caffeine? smoke? hydration?

168

What are the parameters rated in a videostroboscopic examination?

1. Focal Fold Edge
2. Glottal Closure
3. Phase Closure
4. Vertical level of vf approximation
5. Amplitude of vibration
6. Mucosal Wave
7. Vibratory Behavior
8. Phase Symmetry
9. Periodicity
10. Hyperfunction

169

When do we rate glottal closure? Add or Ab duction?

Adduction

170

What is phase closure?

The degree to which the vocal folds move together during vocal fold closure during phonation.

171

What is Vertical level of vf approximation?

The degree to which the vocal folds meet on the same vertical plane during phonation .

172

What is the assessment of amplitude of vf vibration?

The degree of movement from the medial to the lateral aspects of the vocal fold during phonation.

173

What is the assessment of mucosal wave?

The assessment of the degree of traveling wave that is present on the superior surface of the vocal fold during phonation.

174

What is the assessment of vibratory behavior?

The identification of portions of the vocal fold that are non-moving during phonation.

175

What is the assessment of phase symmetry?

The degree to which the vocal folds move symmetrically during vocal fold closure during phonation.

176

What is the assessment of periodicity?

The regularity of successive cycles of vibration during phonation.

177

What is the assessment of hyperfunction?

The extraneous activity in the form of ventricular compression/phonation and/or A-P press.

178

What does a spirometer measure?

flow, volumes, and lung capacities

179

What does a manometer measure?

air pressure
Maximum inspiratory pressure (MIP)
Maximum expiratory pressure (MEP)

180

What does a manometer measure?

cough strength (peak flow), inspiratory muscle phase, laryngeal compression (of vf’s) phase

181

What does a nasometer measure?

Nasalance

182

What does nasopharyngoscopy assess?

Assesses vp closure

183

What Recommendations/Point of Care (POC) do we give?

Patient education
Modified voice rest
Voice home exercises
Reflux management
Vocal hygiene
Voice therapy and/or re-eval
Referral