Exam 2 Flashcards
1
Q
What is the difference between Organic disorders and functional disorders?
A
Organic disorders have structural issues. The problem is with the anatomy.
Function disorders are related to how those structures function, not necessarily because of the structures.
2
Q
What are some of the most common organic disorders?
A
nodules and polyps
3
Q
True or false. Vocal nodules occur unilaterally.
A
FALSE. Vocal Nodules occur bilaterally, developing at the same time.
4
Q
Where are vocal nodules normally found in the VF?
A
at the junction of Anterior 1/3 and posterior 2/3 of the vocal folds
5
Q
What is the most common cause of nodules?
A
Engaging in consistent phonotrauma.
6
Q
Do polyps occur unilaterally or bilaterally?
A
Mostly unilateral, but can occur bilaterally. 90% are unilateral.
7
Q
T o F. Can polyps develop after just one instance of phonotrauma?
A
True.
8
Q
What is a pendunculated polyp?
A
A polyp that hangs from a peduncle or stalk, away from the VF.
9
Q
What is a sessile polyp?
A
A polyp that is attached to the VF. Not hanging.
10
Q
What are the two kinds of polyp?
A
Pedunculated and sessile.
11
Q
How are polyps treated? Surgery or therapy?
A
Primarily by surgery. Speech therapy may be necessary afterward.
12
Q
How are nodules treated? Surgery or Therapy?
A
Speech Therapy
13
Q
When someone has a nodule or polyp, how could their voice sound with respect to perceptual measures?
A
Pitch –> lowered
Loudness –> due to a lack of ability to achieve complete glottal closure, loudness will be below functional limits.
Quality –> breathiness, horseness/raspiness (because of poor mucosal wave.)
14
Q
When someone has a nodule or polyp, how could their voice sound with respect to acoustic measures?
A
Frequency –> will be decreased, a lower F0 (fundamental frequency.)
Intensity –> will be decreased
Noise –> increased NHR, increased VTI, and increased Jitter and shimmer.
15
Q
How will Vital Capacity be affected by the presence of a mass on the VF? (such as a polyp or nodules)
A
It won’t be. This is just regarding respiration
16
Q
How will MAFR (Mean Airflow Rate) be affected by the presence of a mass on the VF? (such as a polyp or nodules)
A
It will be deviant (higher than functional values) due to poor glottal closure causing air to escape at a quicker rate! (air/time when phonating.)
17
Q
How will PQ (Phonotory Quotient) be affected by the presence of a mass on the VF? (such as a polyp or nodules)
A
PQ = vital capacity/time
PQ will not be very useful when looking at a polyp or nodules. You already known that the laryngeal valving is poor.
18
Q
How will VSPL (Variable Sound Pressure Level) be affected by the of a mass on the VF? (such as a polyp or nodules)
A
The ability to change loudness will be poorer than in functional healthy individuals.
19
Q
How will Voicing Efficiency (VE) be affected by the presence of a mass on the VF? (such as a polyp or nodules)
A
Voicing efficiency measures the pressure at the level of the lips which is the assumed pressure at the level of the VFs. This will be affected because there isn’t complete closure of the VFs.
20
Q
T or F. Nodules have a blood supply.
A
False. Polyps have a blood supply.
21
Q
What is a nodule?
A
Bilateral vocal fold masses that occur as a result of consistent phonotrauma.
The voice may sound hoarse, with reduced pitch and reduced loudness.
They are likened to callouses on the VFs.
Can be treated by therapy, surgery may be necessary in some cases.
22
Q
Who is a professional voice user? A vocal Olympian?
A
Anyone who uses their voice for their living. Teachers, singers, etc.
23
Q
What is edema refer to?
A
Swelling
24
Q
What do newer nodules look like as opposed to older ones?
A
Newer nodules will look gelatinous but older nodules look more callous-like (fibrosis).
25
What is a polyp?
Unilateral masses on the VFs caused by phonotrauma.
They have a blood supply and come in two types: pedunculated and sessile polyps.
Polyps require surgery to remove.
Cause hoarseness, reduced pitch, and reduces loudness in one's voice.
26
What is the best way to make a differential diagnosis of a nodule versus a polyp?
Do a stroboscopic/laryngoscopic examination. You have to see it!
27
What is laryngitis?
```
Inflammation of the larynx
Can happen as a result of a fever or phonotrauma
Should resolve within a week.
Hoarseness, raspiness, and lower pitch
Loudness isn't affected
```
28
What is Reinke's Edema?
Thick, gelatinous material that accumulates in the superficial layer of the lamina propria (Reinke’s Space)
Mostly induced by smoking and sometimes by phonotrauma.
Hoarseness, poor mucosal wave, reduced pitch.
Corresponding acoustic measures impaired.
29
How will Reinke's Edema present in acoustic measures?
Frequency --> lower with decreased range
Intensity --> reduced
Noise --> hoarse; NHR: higher #; VTI: higher # ; possible presence of jitter and shimmer
30
How will Reinke's Edema present in aerodynamic measures?
```
Vital Capacity --> Unaffected
Max Phonation Duration --> reduced
MAFR --> unaffected (air expelled/time)
PQ --> reduced/lower (VC/MPD)
Voicing Efficency --> reduced
VSPL --> below functional limits
```
31
How will Reinke's Edema present in perceptual measures?
Pitch --> reduced in general. Range is reduced as well.
Loudness --> reduced
Quality --> hoarse, raspy
32
What is a laryngeal cyst?
a mass made up of material, usually mucus, that is surrounded by a membrane. Kind of like a boil.
33
Where are laryngeal cysts found? When would location affect voice?
Could be anywhere in the laryngeal area! If it is found in the superficial lamina, then it will affect voice.
34
How does a laryngeal cyst affect the acoustic measures of a voice?
Frequency --> reduced
Amplitude --> reduced
Noise --> hoarseness, impaired mucosal wave.
35
How are laryngeal cysts treated?
Medication or surgery. Possibly SLP therapy afterwards...
36
Describe granulomas/intubation granulomas.
Outgrowths due to intubation tubes usually in the mucosa of the vocal process.
37
How do granulomas affect perceptive measures?
Pitch --> reduced
Loudness --> reduction if glottal closure is affected
Quality --> breathiness, hoarseness
38
Where are intubation tubes normally go?
Through the *posterior* area of the vocal folds towards the lungs.
39
What is the difference between a laryngeal cyst and a larynocele?
Laryngeal cysts are FLUID filled.
| Larynoceles are AIR filled.
40
What is LPR? Describe it. What can it cause?
Laryngo-Pharyngeal Reflux
When stomach acids or liquids come back up to the esophagus and pass past the upper esophageal sphincter and spill into the airway and onto the VFs.
This can cause contact ulcers in the posterior aspects of the VFs.
41
What is common aspect unique about the *quality* of a female voice versus a male voice?
The female voice quality if statistically a bit breathier due to a small poster VF gap.
42
How to contact ulcers affect acoustic measures?
Frequency --> reduced
Amplitude --> can be reduced
Noise --> hoarseness, breathiness,
43
What do granulomas and contact ulcers have in common?
They both occur in the posterior aspect of the VFs.
44
Describe what candida looks like
White, peppered spots throughout, overall edema/erythema, and stiff/irregular vocal folds.
45
What is erythema?
superficial reddening of the skin, usually in patches, as a result of injury or irritation causing dilatation of the blood capillaries.
46
Why does candid occurr?
a weakened immune system due to antibiotics/medications, general illness, or use of chemotherapeutic agents.
47
What is candida's affect on the voice?
If it is only located in the laryngeal area then, there won't be must change.
But if the candida occurs on the VFs, the quality of the voice may be pressed, hoarse, or breathy. There isn't issue with glottal closure, so pitch and amplitude is likely unaffected.
48
What causes papillomas?
The Human Papilloma Virus (HPV) strains 6 and 11
49
What is a papilloma?
A viral infection leading to wart-like lesions in supraglottal, glottal, and subglottal regions.
50
How are papillomas treated?
Surgical excision is required
51
How do papillomas affect voice?
Hoarseness, reduced pitch, and respiratory difficulties will be observed.
52
What are the two types of laryngeal webbing? Describe them.
Congenital (75% of cases): occurring due to the failure of the vocal cords separating during embryonic development (recanalization, 4th-10th week)
Acquired: Trauma, typically from intubation or surgery complications
53
What are the primary symptoms of laryngeal webs?
respiratory difficulties and shortness of breath.
54
How to laryngeal webs affect the voice?
Voice is harsh and high pitched.
55
What is stridor?
Noisy breathing
56
What is Stenosis?
The narrowing of any structure.
57
There are 3 kinds of sub-glottal stenosis. List and describe.
Congenital: malformed (smaller) cricoid cartilage formed in utero; 3rd most common congenital disorder
Acquired: intubation or trach
Idiopathic: more common in middle-aged women, 25-50
58
What is sub-glottal stenosis?
The narrowing of the trachea below the VFs.
59
What are some symptoms of sub-glottal stenosis?
Stridor, dyspnea (difficult or labored breathing), cough, significant chest wall movement
60
Define dyspnea.
Difficult or labored breathing
61
Define Idiopathic refer to?
An unknown cause of something.
62
Define iadrogenic.
relating to illness caused by medical examination or treatment.
63
What is prebylarynges?
Age-related voice disorder in the elderly.
Superficial layer of the cord thins, and collagen deeper in the cord becomes more dense.
Can also see bowing of the VFs.
64
What is sarcopenia?
thinning of all muscles, including skeletal muscles. This can be seen in presbylarynges.
65
What is sulcus vocalis?
Groove or furrow in the VF which is usually bilaterally symmetrical.
66
What is the cause of sulcus vocalis?
Causes are relatively unknown. Speculated to be LPR (Laryngo-pharyngeal reflux) or phonotrauma.
67
What is Varix?
superficial, prominent vein that is enlarged and dilated
68
What is ectasia?
fused lesioning of the blood vessel (more involved throughout the VF where varix is more focused)
69
Varix and ectasia are *BLANK* related lesions.
Blood related lesions
70
What are the 15 organic voice disorders discussed in class?
Nodules, polyps, Laryngitis, Reinke's Edema, laryngeal cysts, granulomas, contact ulcers, candida, papillomas, laryngeal webbing, sub-glottal stenosis, presbylarynges, sulcus vocalis, and varix and ectasia.
71
What is a functional voice disorder?
Disorders of the voice where the structure is intact but the functions of laryngeal structures is compromised in the absence of any known organic/neurological pathology.
72
What is the primary cause of a functional voice disorder?
Phonotrauma
73
List some contributors to poor vocal health or phonotrauma?
```
Cigarette smoking
Use of marijuana
Tobacco
Alcohol
Caffeine
Sleep deprivation
Vocal fatigue
Inappropriate vocal use
Obesity
Allergies
```
74
What is Muscle Tension Dysphonia (MTD)?
"Anything that you are doing extraneous or doing more to your muscles" in both the extrinsic and intrinsic muscles of the larynx.
```
"An umbrella term for any kind of inappropriate use of laryngeal muscles."
(Baliaji, class 7)
```
75
What are the two broad types of muscle tension?
Primary: using muscles inappropriately (just being an outgoing person and talking too loudly too often!)
Secondary: usually as a response to something else. (Vocal fold paralysis could result in an attempt to vibrate the false vocal folds.)
76
Improper voice use results in: (4)
Increased tension/strain
Inappropriate pitch level
Ventricular phonation (Use of false vocal folds)
Lateral-medial/Anterior-posterior compression.
77
What are the three patterns of muscle tension as discussed in class?
Lateral medial constriction
Superior medial constriction
Supraglottis constriction
78
List some examples of Phonotrauma.
Excessive loud talking
Straining during a laryngeal inflammation.
Coughing, throat clearing
Sports enthusiasts, cheer leaders.
79
# Define "hard glottal attack" and explain how it makes sounds more explosive.
Is this a functional or organic voice disorder?
Rapid adduction of the vocal folds usually seen just before a vowel sound.
Increased subglottal pressure is required to overcome the adductive forces which produces sudden explosive sounds.
80
Describe "Elevated Laryngeal Position"
Is this a functional or organic voice disorder?
Accompanied by pitch increase.
Perceive strain, hoarseness, increased pitch.
Can be assessed by observation and palpation (you can feel the muscles of the neck tensed.)
81
Singers often use this as a strategy to increase pitch incorrectly, to the detriment of their voice.
an elevated laryngeal position
82
Define Puberphonia/Mutational Falsetto.
| Is this a functional or organic voice disorder?
Unusual high pitch that persists beyond puberty
83
What are some symptoms of puberphonia/mutational falsetto?
hoarseness, breathiness, pitch breaks, inadequate resonance, shallow breathing, muscle tension, lack of variability
84
What are some common causes of puberphonia/mutational falsetto?
Desire not to ‘grow up’.
Over identification of a male with his mother.
Social Immaturity.
Desire to maintain soprano singing voice.
Muscle incoordination/dysfunction with no known etiology.
85
Describe ventricular disphonia. How does it often come about?
Vibration of the false VFs independent or with the true VFs.
Usually secondary to a vocal fold disease where the false vocal folds compensate for the impaired true vocal fold vibration. (Gives rise to diplophonia)
86
Describe the acoustic measures of a voice with ventricular disphonia.
Frequency --> lower than normal due to the thickness of the false VFs.
Amplitude --> Reduced due to poor pressure below the false VFs.
Noise --> hoarse, crackling voice
87
Define psychogenic dysphonia. (Is this functional or organic?)
loss of voice where there is insufficient structural or neurological pathology to account for the nature and severity of the dysphonia, and where loss of volitional control over phonation seems to be related to PSYCHOLOGICAL PROCESSES such as anxiety, depression, conversion reaction, or personality disorder.
Functional voice disorder because the structures are still intact.
88
What measures could aide in making a differential diagnosis with psychogenic dysphonia?
If a person can cough, laugh, whisper, and use the VFs in other reflexive behaviors, then it is likely psychogenic dysphonia.
89
Regardless of if a disorder is functional or organic, what 5 voice assessment procedures should be conducted?
Perceptual Assessment
Acoustic Evaluation
Laryngoscopy - Visual perceptual evaluation
Aeordynamics - both subjective and objective measures of respiration.
EMG (Electromyography) - assess muscle function
90
Generally, in a patient with a muscle tension disorder, how would they do in an audio perceptual evaluation?
Clinician would note significant deviance in their voice quality. Raspy, breathy, strained, etc.
91
Generally, in a patient with a muscle tension disorder, how would they do in an acoustic evaluation?
Usually noise related measures are maximally affected. Other measures are affected too.
92
Generally, in a patient with a muscle tension disorder, how would they do in a respiratory (aerodynamic) evaluation?
Depending on the strain, airflow can be impaired. Usually, airflow is reduced.
93
Generally, in a patient with a muscle tension disorder, how would they do in a laryngoscopic evaluation?
lateral medial compression, anterior posterior compression, supraglottal tension, aperiodicity, asymmetry etc.
94
Define Paradoxical Vocal Fold Movement (PVFM).
Inappropriate adduction of the vocal folds during inhalation. Often occurs as a result of hypersensitivity.
95
What are the two physiological variants of PVFM (Paradoxical Vocal Fold Movement)?
Two physiological variants:
1. Adduction of true and false folds throughout the breathing cycle
2. Adduction during deep inspiration and slight abduction on expiration
96
What is the etiology of PVFM?
Can occur as a result of:
- Poor breathing habits while working out (often seen in swimmers) (exercise induced asthma)
- Coexistent with asthma
- Precipitated by emotional events
- Occurring with or without organic conditions
97
List some signs and symptoms of PVFM.
```
Sensation of throat being closed
Dramatic episodes of breathing difficulty
Stridor
Pt. struggles to inspire
Shortness of breath
‘Wheezing’
Cough (chronic cough)
```
98
What would you see in a laryngoscopic evaluation of a client with PVFM?
VF adduction of anterior two-thirds during inspiration
Posterior glottal gap during closure on inspiration
50% will have normal VF motion when asymptomatic (meaning the voice symptoms aren't significant, just respiration difficulties)
99
What is a neurogenic disorder?
Caused by disruption to the neural supply to the larynx.
100
Describe an upper motor neuron and it's pathway.
They are the main source of voluntary movement. They are located inside the brain and within the nervous system.
The upper motor neurons begin in the motor strip (Area 4, the primary motor cortex, or the pre-central gyrus), descending into the subcortical structures for inhibition and other regulatory functions. When they reach the level of the brainstem, they either continue down the spinal cord as cortico-spinal fibers or stay within the brain as cortico-bulbar fibers. After this, they go to specific muscles via the lower motor neurons.
101
All motor neurons are ascending or descending?
Descending. They are taking the motor messages from the brain to the muscles for motor movement.
102
What are the two types of upper motor neurons?
Cortico-spinal fibers
| Cortico-bulbar fibers
103
What cranial nerves originate at the level of the brainstem?
Cranial Nerves 3-12.
| They are the LMNs associated with the corticobulbar fibers!
104
What is another name for the LMNs associated with the corticobulbar tracts?
Cranial nerves
105
What is another name for the LMNs associated with the corticospinal tracts?
Spinal Nerves
106
True or False. A lesion in a UMN will be similar to that of a lesion in an LMN.
FALSE!!
107
What are the 5 aspects or subsystems of speech?
```
Articulation
Resonance
Respiration
Phonation (Voice)
Prosody
```
108
What is the main result of an LMN lesion?
Flaccidity. (The lesion can be unilateral or bilateral. Both result in flaccidity.)
109
Compare flaccidity vs spasticity.
Flaccid: loss of muscle tone. Limp. Hypo- or Atonic.
Spactic: Increases tone. Not necessarily tight. Hypertonicity.
110
What type of lesion causes spasticity?
***BILATERAL*** UMN lesions.
111
What is dysarthria?
Neuro-motor speech disorders that affect the five sub-systems of speech.
112
True or false: Cranial nerves are UMNs.
False. CNs are LMNs because they arise from the Corticobulbar tracts of UMNs.
113
Describe ataxic dysarthria.
A lesion in the cerebellum, resulting in "drunken speech," The inappropriate stress of words. (Cerebellum is associated with balance.)
114
Describe flaccid dysarthria.
Causes by lesions to the LMNs and are characterized by hypotonicity (reduced tone).
115
Describe flaccid dysarthria.
Causes by lesions to the LMNs and are characterized by hypotonicity (reduced tone).
116
Describe Spastic dysarthria.
Caused by bilateral UMN lesions, resulting in spacticiyt.
117
How many kinds of dysarthrias are there?
7
118
What is hyperkinesia?
Too much movement, extraneous, or rapid movements, such as what can be seen in spasmodic dysphonia.
119
What is Hypokinesia?
Reduced movement, predominately caused by Parkinson's disease. A lesion occurs in the substantia nigra, causing a reduction in movement.
120
What disease is associated with hypokinesia?
Parkinson's disease.
121
What disease is associated with hyperkinesia?
Spasmodic Dysphonia.
122
What is the disorder called when the lesion is on the muscle itself?
Myopathy.
123
What is it called when the lesion is on the nerve?
Neuropathy.
124
What is it called when the lesion is at the junction of the nerve to the muscle?
A myoneural junction disease.
125
If the lesion is on the motor neuron it is called...
A motor neuron disease.
126
What is the only LMN lesion we will see as SLPs?
Vocal Fold Paralysis.
127
List the 7 types of Dysarthria.
```
Spasticity (Bilateral UMN lesions)
Flaccidity (LMN Lesions)
Ataxia (Cerebellar lesion)
Hyperkinesia (Too much movement)
Hypokinesia (Too little movement)
Mixed
Unilateral UMN
```
128
What are the branches of the vagus nerve?
Superior laryngeal nerve (SLN)
| The recurrent laryngeal nerve. (RLN)
129
What are the branches of the superior laryngeal nerve (SLN) and what are their functions?
External Branch - motor to the cricothyroid for pitch changes.
Internal Branch - sensory
130
What is the purpose of the Recurrent laryngeal nerve?
It innervates all of the intrinsic laryngeal muscles except for the cricothyroid. It is important for both adduction and abduction.
131
Is vocal fold paralysis unilateral or bilateral?
It can be either.
132
What are some possible causes of vocal fold paralysis?
May be caused by peripheral involvement of the recurrent laryngeal nerve or the superior laryngeal nerve
```
Surgery
Neurological disease
Head/neck trauma
Viral infections
Tumors
(May affect adductor or abductor muscles)
```
133
What are some symptoms of VFP (Vocal fold paralysis)?
Breathiness
Low intensity
Low pitch
Intermittent diplophonia
134
Describe bilateral abductor paralysis and what the first intervention can be.
When the VFs are paralyzed in the closed position, cannot abduct sufficiently for respiration.
A critical condition that requires surgical establishment of the airway
Sometimes remove arytenoid or suture it in an open position
135
Describe bilateral adductor paralysis.
The vocal folds do not come together or adduct. They aren't completely open but instead are in a paramedian position.
136
What is a primary concern in adductor paralysis?
Airway protection is an important issue
| May require tube feedings
137
What is the voice quality like of a person with adductor paralysis?
Very dysphonic (secondary muscle tension)
Breathy
Weak
138
Describe unilateral abductor paralysis.
1 paralyzed fold remains at the midline, failing to abduct completely.
Airway protection remains intact
139
What is the voice quality like in unilateral abductor paralysis?
Mildly dysphonic with possible difficulty elevating loudness levels
Usually no difficulty with airway; however, may demonstrate stridor upon inhalation
140
Which is the most common type of VF paralysis that we will see?
Unilateral Adductor Paralysis.
141
Describe unilateral adductor paralysis and describe the voice quality.
Vocal fold usually paralyze in a paramedian position
The affected fold fails to adduct to the midline.
Voice Quality will vary depending on the position of cord and size of the glottal gap during phonation.
142
What are the effects of a lesion on the external branch of the superior laryngeal nerve (SLN)?
You will have cricothyroid (pitch) dysfunction.
143
What are the effects of a lesion on the internal branch of the superior laryngeal nerve (SLN)?
Problems with respect to sensation or any bolus near the VFs. You should see a lot of mucus.
144
Can spasmodic dysphonia be theraputically treated?
No. You will likely need to have some kind of botox injections that will reduce the spasm.
145
What are some symptoms of spasmodic dysphonia?
strained, strangled, and effortful voice production
146
Does spasmodic dysphonia occur in men or women more often?
in women
147
What disorder can spasmodic dysphonia seem like? What is a strategy for differential diagnosis?
Muscle Tension Dysphonia.
Because Spasmodic dysphonia affects vowels more, you can have the patient read a sentence that has many vowels. If there is more struggle, then it is likely spasmodic dysphonia.
148
Is spasmodic dysphonia considered hyper- or hypokinetic?
Hyperkinetic.
149
Which type of spasmodic dysphonia (SD) is more common?
Adductor Spasmodic Dysphonia.
150
What is the voice quality like of someone who has adductor spasmodic dysphonia?
Pressed
Strained
Strangled
Effortful
151
What occurs during adductor spasmodic dysphonia?
Involuntary adductor spasms during phonation, although, intermittent periods of normal phonation may occur.
*Note: Normal vocal fold structure.
152
Describe abductor spasmodic dysphonia.
Involuntary abductor spasms during phonation
Vocal quality:
Intermittently breathy with phonation breaks and short periods of aphonia
Folds appear normal
Intermittent normal periods of phonation
153
What is the primary treatment for spasmodic dysphonia? How does it work?
Botox. It is actually poison and causes paralysis. So, in a specified dosage to a specific area, it will paralyze the area of the VF to prevent the spasms.
154
True or False: singing, laughing, coughing, throat clearing, and humming are affected in Spasmodic Dysphonia.
False. Those sounds remain unaffected. (This can assist in making a differential diagnosis.)
155
What were the three important neurogenic voice disorders spoken about in class?
Vocal Fold Paralysis
Spasmodic Dysphonia
Organic/Essential Voice Tremor
156
Describe an organic/essential tremor.
central nervous system disorder that results in involuntary, regular tremors in the limbs, head, larynx, or other oral structures.
When it is localized to the larynx = Organic Voice Tremor
157
Is organic voice tremor more prevelant in males or females?
Males
158
Around what age do we see the most cases of organic voice tremor?
40-60 years
159
Describe the symptoms of an organic voice tremor.
Regular modulating tremor of pitch and intensity when producing pitches ranging from 4Hz to 7Hz, discernable during vowel prolongation
"Shaky" or "wobbly" voice quality.
Periodic voice breaks can be heard in severe forms.
160
Does Botox help with organic voice tremors?
Yes, but it is limited. Not a lot of SLP activities to help just yet. Mostly medication based treatments...still researching.
161
What is the difference between SD and Organic Voice tremors?
SD is much more inconsistent. In Organic voice tremors, it's much more consistent throughout.
162
List some examples of neurologic conditions that can cause voice disorders.
```
Myasthenia Gravis
Gullain-Barre’
Parkinson’s Disease
Huntington’s Disease
ALS
Multiple Sclerosis
Traumatic Brain Injury
```
163
What is myasthenia gravis?
My = Muscle
Asthenia = Weakness
An autoimmune neuromuscular disorder that results in weakness/atrophy of muscles.
This can manifest in weakness/atrophy of the VFs. (A person may speak for 5-6 minutes, lose their voice, rest it, then be able to speak again.)
164
Describe how the VFs look of someone with myasthenia gravis.
VF are sluggish and atrophied.
| Mucosal wave abnormalities will exist, which may make the voice sound breathy, hoarse and weak.
165
Where in the body system does myasthenia gravis occur?
At the myoneural junction.
| Where the nerve meets the muscle.
166
What are the four disorders within the LMNs? (Think location.)
1. Myopathy (on the muscle)
2. Neuropathy (on the neuron)
3. Myo-Neural Junction
4. Motor neuron disease (on the motor neuron)
167
What is Parkinson's Disease?
Depletion of dopamine (responsible for inhibition of nerve signals) in the substantia niagra region of the basal ganglia, causing hypokinesia.
168
What are the symptoms of PD?
Tremors. Predominantly the "pill rolling" tremor, which only occurs at rest (think of a person rolling a pill between their fingers.) Rigidity due to hypokinesia.
169
What is the most important/apparent symptom of PD with regards to voice?
Their loudness is so decreased! They also have a poor sensory understanding of their lack of loudness.
170
What is the best voice treatment method for patients with PD?
LSVT - Lee Silverman Voice Treatment
171
Sentences with a lot of consonants will be more difficult for someone with ABSD or ADSD?
ABSD (Abductor Spasmodic Dysphonia
Abductor SD is spasms when the VFs are moving apart, like for voiceless consonants. Thus, consonant-heavy sentences can assist in making a differential diagnosis.
172
Sentences with a lot of vowels will be more difficult for someone with ABSD or ADSD?
ADSD (Adductor Spasmodic Dysphonia)
Adductor SD is spasms when the VFs are moving together to create voice. All vowels are voiced, thus, a vowel-heavy sentence can assist in making a differential diagnosis.
173
Why do patients with PD struggle with loudness? (2 main reasons)
They have reduced respiratory support (physiological)
| They develop a sensory calibration issue (they perceive themselves as talking loud enough.)
174
Why could someone have a congenital (prenatal and perinatal) voice disorder?
Prenatal:
Poor embryologic developmental Issues
Maternal alcohol/drug abuse
```
Perinatal:
Hypoxia
Traumatic Births
Breech delivery
Delayed birth cry
Forceps can be used incorrectly
Jaundice
```
175
What are some postnatal causes of a voice disorder as discussed in class?
Trauma, seizures, jaundice, etc.
176
What are the 5 congenital voice disorders discussed in class?
VF Paralysis
Laryngeal stenosis – narrowing of the lower airway
Laryngomalacia – flaccid epiglottis obstructing the airway. ‘Omega-shaped’ epiglottis
Laryngocele – air filled dilation of the laryngeal vestibule.
Webbing
177
What is the difference between a laryngocele and a layrngocyst?
A cyst is filled with fluid or mucus by a laryngocele is filled with air.
178
What is a laryngeal web?
A skin or tissue that grows and partially fuses the VFs together depending on where the web is.
179
What are some symptoms to listen/look for in children who may have a voice disorder?
Dysphonia, a hoarse, breathy, or rough voice, may have excessive glottal fry
Intermittent aphonia, recurring temporary loss of voice.
Voice breaks, fleeting interruptions in voice during singing or speech.
Pitch breaks, abrupt changes in pitch of voice, usually when going from lower to higher pitch.
An excessively loud voice for no reason
An inability to sustain a note when singing
An effortful or strained voice, voice sounds as if it takes special effort to produce and is not efficient.
180
What is the leading cause of childhood voice disorders?
Phonotrauma
Rare to find just “one” abusive behavior.
Most common habits – Talking too long, too loudly, and with too much effort.
181
What are some examples of how a child could develop nodules or vocal strain?
Talking and singing in excess, for example in a school play, concert, choir; shouting in the playground against background noise; overusing the voice when sick; cheerleading; overusing voice when emotionally upset or tired.
Glottal attack.
Children who do not rest voice when they have a sore throat, asthma, or post nasal drip.
Crying, laughing, loud and long outbursts of emotions, tantrums, inability to cope properly with negative emotions, related to loud, forceful use of voice.
Shouting, cheering, and screaming
182
What are some common anatomical changes associated with aging that could affect the VFs?
Vocal fold thinning due to atrophy.
Bowing of vocal folds.
Discoloration of the vocal folds.
Edema of superficial lamina propria.
Ossification of cartilages.
Decreased blood supply.
183
How is pitch affected as we age?
Pitch increases for men (the muslce mass drops and ossification) and decreases for women (due to hormones).
Although the pitches never meet
184
What are some perceptual measure changes that occur in the aging voice?
Altered pitch
Roughness
Breathiness
Weakness
Hoarseness
Tremulousness/instability
185
What are the two groups of organic disorders?
Neurogenic (problems in neurology) and structural (something physically wrong)
186
What is a functional voice disorder?
A functional disorder means the physical structure is normal, but the vocal mechanism is being used improperly or inefficiently.
