Flashcards in Exam 2 Deck (92):
What are functional voice disorders the result of?
Incorrect use of some aspect of the phonatory system.
What are two types of functional voice disorders?
Muscle tension dysphonia and psychogenic voice disorders
What are muscle tension dysphonias?
Voice disorders related to misusing the vocal mechanisms
What are the two types of muscle tension dysphonia?
Primary and secondary
What do primary muscle tension dysphonias result from?
Incorrectly using the voice due to some type of hyperfunction/too much muscle tension
What do secondary tissue changes result from?
Develop related to the vocal hyperfunction (vocal nodules or polyps occurring because of vocal abuse)
What are psychogenic voice disorders?
Disorders resulting from emotional trauma or conflict that manifests itself in voice (aka conversion aphonia)
What are organic voice disorders?
Voice disorders due to a physiological abnormality in structure or function at various sites along the vocal tract.
What are neurological voice disorders?
Voice disorders due to problems with muscle control and innervation of the muscles of respiration, phonation, and resonance, which may be impaired from birth or secondary to injury or disease of the peripheral or central nervous system
What are some voice problems with a psychogenic cause?
Functional dysphonia, conversion aphonia, and mutational falsetto
What are the 3 categories of classification by perceptual problems?
Pitch, intensity, and quality
What are pitch changes due to?
Mass changes of the vocal folds
What are some things that might indicate a person is having a pitch problem?
Modal frequency that's too high or too low, a narrow pitch range, excessive pitch breaks, or a pitch that is inappropriate to the situation
When is intensity considered a problem?
If the voice is too loud or too soft for the demands of a situation.
Vocal quality depends on the condition of what?
The vibratory source
What are quality disorders?
Disturbances in laryngeal tone, usually associated with sound generated at the level of the VF
For a NORMAL VOICE, the condition of the vibratory source depends on what four factors?
1. Normal structure
2. Normal physiology
3. Emotional state does not affect quality
4. Good vocal habits
If a voice has a rough, unmusical sound due to excessive laryngeal tension, what quality disorder might we classify that as?
If a voice has a rough, unmusical quality with diplophonia or voice breaks, what quality disorder?
What is a resonance quality problem which occurs in the pharynx and results in a tight, hard sound?
What is a small, childish voice caused by tension in the oral cavity? Usually has a forward tongue carriage.
How would we describe a person's voice is their VF do not have good closure, and a lot of air escapes during phonation?
What is a general term that describes any alteration in normal phonation?
What is it called when a voice has excessive nasality?
What is it called when the nasal cavities are congested and there is a reduction in nasal resonance?
What is it called when there is a pharyngeal focus of voice due a posterior tongue carriage and the voice is very "hollow sounding"
A thorough voice evaluation should include what four things?
1. Medical examination
2. Case history
3. Observations of the client
4. Testing and evaluation of the client
Who does the medical examination of your voice client?
What four things will the ENT assess the VF for?
What are some of the key components of the case history?
Description of the problem and causal factors, onset and duration of the problem, variability of the problem, and description of vocal use
Why is it important for us to know the onset and duration of the problem?
It might give us an indication of the etiology
When observing the client, what are 3 important things to consider?
Their social history, motivation, and general mental status
What is one of the first informal evaluations we may do to our patients?
Oral peripheral examination, especially looking for any asymmetry, neck tension, or unusual movements of the larynx.
What 4 types of information are we looking for during respiration testing?
1. Lung volume
2. Air pressure
4. Measures of motions of the torso
What do we measure lung volume with?
A dry (or wet) spirometer
What is vital capacity?
The maximum amount of air that can be expelled from the lungs following a maximum inspiration
What is the standard vital capacity, in mL, for males and females?
Males = 4600 mL
Females = 3565 mL
What might we measure to answer the question "does the patient have sufficient expiratory control for normal speech?"
Greater ______ of speech requires greater airflow pressure.
Greater ______ of speech requires greater airflow rate.
Under normal conditions, how many cc of air/second flow through the glottis in the production of a vowel?
If airflow rate is greater than 100 cc/sec, what does that mean? How will the voice sound?
Indicates inadequate closure; voice sounds breathy
If airflow rate is less than 100 cc/sec, what does that mean?
There is excessive closure (likely AD-ductor spastic dysphonia)
What is maximum phonation time?
A measurement of the ability to maintain steady phonation sufficient for communication.
What is the average MPT for a child? Young adult?
Child = 10 sec.
Young adult = 23 sec.
What is the S/Z ratio?
How long a patient can sustain a prolonged /s/ phoneme as compared to a /z/.
The "S" in the S/Z ratio is a measure of what? What is the "Z" a measure of?
"S" = measure of respiratory expiratory control
"Z" = measure of phonatory expiratory control
What is the normal S/Z ratio for normal speakers?
Should be 1!
If an SZ ratio is greater than what, there is a vocal pathology?
What is the most inefficient type of respiratory pattern?
Give 2 reasons why clavicular breathing is unsatisfactory.
1. Only the upper part of the lungs are expanding, which doesn't provide an adequate respiration
2. It causes a strain in the neck accessory muscles
What is the preferred method of respiration?
What are 3 things we need to determine in a pitch evaluation?
1. Frequency range
2. Best pitch
3. Habitual pitch
What is habitual pitch?
The most frequently occurring or modal pitch level used by the patient during speech
What is best pitch?
The frequency that is slightly louder and clearer in quality, and also the pitch at which the thyroarytenoids and other intrinsic muscles can produce adduction with minimal muscular effort.
What is a higher pitch usually indicative of?
Tension and difficulty in relaxation of the laryngeal area.
If a voice is not loud enough, what could that be due to?
Vocal fold paralysis
What is the average adult intensity in conversation?
What are phonation breaks?
Temporary losses of voice in part words, words, phrases, or sentences. It's a spontaneous AB-duction due to vocal fatigue, tension, or muscle spasms.
What 6 vocal qualities/features does the CAPE-V assess?
Overall severity, roughness, breathiness, strain, pitch, and loudness
What do the C and I on the CAPE-V stand for?
Consistent and intermittent
Is the CAPE-V good for inter- or intra-rater reliability?
What are the 3 different tasks on the CAPE-V?
Sustained vowels (/a/ and /i/), sentences (6 different sentences), and running speech
How do you score the CAPE-V?
Make a tick mark on a line based on your perception of that specific quality, and then measure the tick mark in millimeters; correlates to severity rating
What does VHI stand for? Measures what?
Voice handicap index; tells us the functional impact of a patient's voice disorder and how it affects their every day life
What are the 3 categories that the 30 test items are broken down into?
Physical, functional, and emotional
What are 5 instrumental assessments of the voice we make?
Maximum phonation time, s/z ratio, pitch range, vital capacity, habitual pitch, etc. (think VisiPitch)
What is ventricular dysphonia?
Talking with false vocal folds
What is muscle tension dysphonia?
Using too much intrinsic muscular tension or extrinsic muscular tension that's resulting in a change in the voice
What could cause vocal fold thickening?
It's a secondary tissue change due to vocal hyperfunction; excessive muscle tension could cause it
What is diplophonia?
Production of voice at two pitches; using their true and false VF at the same time
What is Reinke's edema?
Accumulation of fluid under the VF cover in Reinke's space. VF become thick and floppy
What is traumatic laryngitis?
Generally because of excessive yelling; being hoarse from overuse of VF; usually resolves in a few days if behavior is discontinued
What are phonation breaks?
Voicing cuts out
What is a pitch break?
When the pitch of the voice suddenly jumps up an octave or down an octave in pitch; we hear this with mutational falsetto
What are vocal polyps?
Mass changes that occur on the VF because of vocal abuse; tend to have a much different look than nodules. Either broader or have a stalk to them and tend to hang down in the VF.
What is sulcus vocalis?
Organic voice disorder characterized by a long, oval-shaped glottal opening during AD-duction, or by a line running longitudinally, parallel to the glottis, down one or both vocal cords
What is a contact ulcer?
Tend to occur in the area of the cartilaginous glottis; see it in males who do a lot of excessive throat clearing or coughing. Due to vocal abuse, then it's functional cause. If it's a result of chronic GERD, then it's organic.
What is leukoplakia?
What patches that occur on the VF (or in the mouth); usually because of some type of environmental irritation (smoking, alcohol). Leukoplakia is benign, but it is a pre-cancerous condition.
How can endocrine changes impact the voice?
May cause an excess in FF so that the voice is too high or too low. If the appropriate hormones aren't secreted when they should be, the larynx won't grow as it's supposed to.
What is hypothyroidism?
Thyroid doesn't secrete as much hormone as it should. Can cause voice changes
What is a granuloma?
Where there is a lesion and the body tries to repair itself by growing tissue over it
What is hyperkeratosis?
Oral or pharyngeal lesion that could be cancerous or non-cancerous. Caused by continuous tissue irritation (chewing tobacco)
What is infectious laryngitis?
Same as viral laryngitis; swells up the vocal folds. "itis" = inflammation. Caused by some kind of virus.
What is a laryngectomy?
Partial or total removal of the larynx due to laryngeal cancer.
What is a papilloma?
Wart-like growths that are viral in origin and they frequently develop in the larynges of young children. Because the larynx is moist, these viruses sometimes grow. May affect the voice; could grow and obstruct the airway. If removed, they could return.
What is laryngeal webbing?
Can occur between the VF - can be congenital or acquired. Much less mass available for vibration.
What is a paradoxical VF movement?
It's a breathing problem, not a voice problem. These individuals AD-duct on inspiration. Often see in athletes or other people who have some psychological concerns/stress about breathing. Sometimes confused with asthma. Symptoms are typically seen as wheezing and difficulty maintaining a regular breathing pattern.
What is spastic dysphonia?
Laryngeal stuttering; sometimes associated with muscle tremors. The VF will spasm closed, giving voice a characteristic tight or strangled quality. Most common type is AD-ductor dysphonia where they spasm shut, could also be AB-ductor dysphonia where the VF spasm open.
What is essential tremor?
Benign tumor that individuals develop; not progressive necessarily. Not associated with a neurologic degenerative disease. See it in older individuals.
What is vocal fold paralysis? What are the 2 types?
One or both VF are completely or partially paralyzed. There is AB-ductor paralysis - VF will not close. Will open for breathing but will not come together for approximation so voice is primarily affected. Also AB-ductor dysphonia - VF will not completely open. Individual will have difficulty breathing and their voice may sound normal.