Exam 3 Flashcards
(87 cards)
1
Q
What professionals provide treatment/management of voice disorders?
A
Otolaryngologist, surgeon, neurologist, psychologist, SLP
2
Q
What is the goal of voice therapy?
A
To achieve a realistic level of adequacy which will meet the patient’s 1) occupational 2) emotional and 3)social needs
3
Q
What are the 3 general principles for Voice therapy?
A
- Progress results from patient’s response to clinician’s instruction/encouragement
- Auditory discrimination and feedback are important
- Therapy is designed for each individuals
4
Q
How is auditory discrimination and feedback done?
A
- Modeling voice disorders
- Audio recording
5
Q
What are the 4 steps of the general voice therapy outline?
A
- Discrimination and Feedback
- Facilitate change in the voice
- Practice Stabilization of the new voice
- Carry-over and habitualization
6
Q
The initial step, discrimination and feedback, is similar to _______________?
A
Van Riper’s articulation therapy
7
Q
What is negative practice?
A
Client says it right then says it wrong- hear the difference and feel the difference
8
Q
What is the most important segment of therapy?
A
Facilitate change in the voice
9
Q
What is the most time consuming component of therapy?
A
Facilitate change in the voice
10
Q
What is used to facilitate change in the voice?
A
Voice facilitating techniques (VFAs)
11
Q
What is the 3rd step of the voice therapy outline?
A
Practice and Stabilization of the new voice
12
Q
The new voice should be ____________ and ____________.
A
Readily produced and easily produced
13
Q
What is sometimes considered the most difficult step of voice therapy outline?
A
Step 4: Carry over and habitualization
14
Q
What is used to stimulate carryover?
A
Develop a hierarchy of situations
15
Q
What is hierarchy is used for carryover?
A
Wolpe’s reciprocal inhibition:
- relaxed responses to anxiety-evoking situations
- identify a hierarchy of anxiety-evoking situations
16
Q
What is vocal hygiene used to do?
A
- prevent vocal fold pathology
- to eliminate vocal fold pathology
- to eliminate a distracting vocal quality
17
Q
Vocal hygiene offers rules in:
A
- using the voice with greater ease
- avoiding laryngeal strain and excessive effort while vocalizing
- maintaining healthy vocal tract
18
Q
The voice therapy outline is used with what kind of voice disorders?
A
Any voice disorder that requires any type of behavioral voice therapy
19
Q
Suggestions for vocal hygiene
A
- reduce or eliminate vocal abuse
- avoid yelling and shouting
- avoid talking above the noise
- develop an easy glottal attack
- use an appropriate pitch level
- take an easy, relaxed breath when speaking
- avoid tightening the jaw or grinding the teeth
- drink plenty of water
- Avoid caffeine and alcohol
- avoid smoking or smoky environments
20
Q
What is a vocal nodule?
A
A tissue reaction to frictional trauma between the vocal folds
21
Q
There are ____ stages of vocal nodule development.
A
Three
22
Q
What are characteristics of stage 1 vocal nodules?
A
- localized, slight reddening on the free margin of VF
- nodules appear gelatinous and floppy
- nodules have not yet penetrated the underneath layers of the VF
- mucosal wave will be fairly normal
- can result from a few nights of vocal abuse and may resolve on their own
23
Q
What are characteristics of stage 2 vocal nodules?
A
- localized swelling or thickening on the edge of the VF
- nodules appear grayish, translucent thickenings
24
Q
What are characteristics of stage 3 vocal nodules?
A
- Definite nodule forms with fibrotic tissue replacing the thickening
- nodules are hard, white or gray
- prognosis for improvement decreases
- occurs from vocal misuse over a long period of time
- tend to be chronic and long-standing
25
What are 4 vocal characteristics of vocal nodules?
1. Harsh quality
2. Breathy voice
3. Limited pitch range
4. lower pitch
26
Describe prenodules
- pretty normal voice
- sometimes breathy
- mucosal wave is normal
- nodules are translucent
- hourglass configuration of the VF
27
If voice therapy is not successful in eliminating vocal nodules during stage 3, what happens?
Surgery and then voice therapy to follow
28
When will improvements from voice therapy be noted?
2-3 weeks with a compliant client
29
What will vocal nodule voice therapy plan include?
1. reduction/elimination of vocal abuses
| 2. elimination of hard glottal attack
30
What is one strategy to eliminate hard glottal attack?
H below the vowel
31
Hard glottal is more common w/ ______
vowels
32
What are some appropriate VFAs for vocal nodules?
1. confidential voice
2. place the voice
3. yawn/sigh
4. open mouth approach
5. relaxation
33
Why is placing the voice so important in cases of vocal nodules?
- The client needs to focus the resonance upward into the oral cavity
- use words that begin with nasals
34
What are 3 causes of polyps?
1. Upper respiratory infection
2. Contaminants in the air
3. vocal abuse
35
Where can polyps occur?
1. on the VF- bi or unilateral
2. above glottis
3. below glottis
36
When vocal polyps develop due to vocal abuse where do they occur
On the VF- anterior 1/3 posterior 2/3
37
2 types of polyps
1. pedunculated/stalk-like
| 2. sessile/broad-based
38
Voice characteristics of polyp
- hoarseness/harshness
- frequent throat clearing
- increased effort for phonation- talking becomes tiring
39
If the polyp interferes with the vibratory pattern, what may occur?
1. Diplophonia
2. sudden voice breaks
3. vocal shut-offs
40
How are vocal polyps treated?
Usually surgery
41
If the polyps are caused by vocal abuse...
Postpone surgery and begin voice therapy
42
After a patient undergoes surgery to remove a polyp- what must happen post-surgery?
Vocal rest is essential
43
Voice therapy for polyps
1. Consider vocal rest
2. vocal hygiene
3. reduce vocal use
4. reduce hard glottal attacks
5. increase breath support
6. facilitating techniques
44
What is a contact ulcer?
Benign lesions that develop on the vocal processes of the arytenoid processes and erosion of the mucosa between the arytenoids
45
What are causes of a contact ulcer?
- Vocal abuse
- gastro-intestinal disorders and esophageal reflux
- irritation from intubation during surgery
46
Contact ulcers are one of the few VF lesions characterized by ______.
pain
47
Symptoms of contact ulcers
1. pain
2. usually described as radiating toward the neck or ear
3. may also indicate a throat tickle
4. need to clear the throat
5. aching or dryness of the throat
48
Are contact ulcers bilateral, unilateral, or both?
Can be bilateral or unilateral
49
Characteristics of adult males with contact ulcers
1. hypertonic laryngeal musculature
2. habitual use of very low pitch
3. explosive stress patterns
4. sharp, abrupt glottal attack
5. restricted pitch variability
6. phonation w/ high intra glottal pressure
50
Contact ulcers have ___ stages of development.
3
51
Characteristics of stage 1 contact ulcers
1. vocal fatigue and hoarseness
| 2. recovery overnight
52
Characteristics of stage 2 contact ulcers
1. continued hoarseness
2. fatigue and some apin
3. inflammation and loss of mucosal covering
53
Characteristics of stage 3 contact ulcers
1. severe and constant hoarseness, fatigue, and pain
2. rest does not help
3. formation of granulated tissue in effort to heal the wound
4. lack of mucosal covering
54
Vocal characteristics of contact ulcers
1. low pitch
2. hoarse
3. persistent glottal attacks
3. loud voice
55
What is a papilloma?
A wart-like growth in the larynx
| Appears as a gray-pink, berry shaped projections
56
What causes papillomas?
DNA virus
57
Papillomas usually occur in ___________ and are more common in _________.
Children
| Males
58
When is there a higher incidence of papillomas?
1. Lower socioeconomic status
| 2. in children whose mother's had genital warts at the time of birth
59
Why are papillomas dangerous?
1. Can become so large that they obstruct the airway
| 2. May be pre-malignant
60
Describe the appearance of papillomas
Gray-pink, berry shaped projections
61
What are vocal characteristics of papillomas?
Hoarseness, aphonia, stridor, shortness of breath, croupy-like cough
62
What is stridor?
Stridor is the sound you head on inhalation or exhalation
63
What is the treatment for papillomas?
Surgery
| -may reoccur as soon as two weeks post surgery
64
What are two alternative treatments for papillomas?
Infereron injections
| Autogenous vaccines
65
When is voice therapy used in cases of papillomas?
If hoarseness persists past surgery
| DO NOT do therapy when papillomas are present
66
Describe a tracheostomy
Inserted below the level of the VF and the tube bypasses the airway. The air does not reach the VF to vibrate for phonation.
67
What is a laryngeal web?
Tissue web covering all or part of the glottis
68
How do webs normally grow and why?
Grow anterior to posterior because the VF are closest together at the anterior commissure
69
What are etiologies of laryngeal web?
1. Congenital
- 10th week of embryonic development
2. Acquired from trauma
3. Infection
4. Secondary to surgery of nodule or papilloma removal
70
Vocal characteristics of cases of laryngeal web
1. Higher than normal pitch
- restricted vibratory surface
2. Harsh quality
3. Shortness of breath
4. Stridor
5. Cough consistent with voice
71
What is treatment for webbing?
Surgery
- heat laser
- keel inserted so VF do not fuse back together
72
Is voice therapy required after surgery for webbing?
Not usually, if so, will be minimal
73
VF paralysis describes......
What the VF CANNOT do
74
What is VF paralysis?
The inability of one or both VF to move due to lack of innervation of intrinsic muscles of the larynx
75
Unilateral adductor VF paralysis...
One VF cannot close (adduct)
76
Etiologies of VF paralysis
10% due to CNS disorders
| 90% due to damage to vague nerve or it's branches
77
The superior laryngeal nerve innervates _____
cricothyroid muscles
78
If there is damage to the superior laryngeal nerve, what will be present?
Problems with pitch
Unilateral- may hear diplophonia
Bilateral- monotone
79
The recurrent laryngeal nerve innervates...
All other intrinsic muscles
80
If there is damage to the recurrent laryngeal nerve, it will affect,,,?
the VF's ability to adduct or abduct
81
Causes of unilateral adductor paralysis (UAP)
-Trauma to RLN (surgical injury or trauma)
| Trauma- compression of nerve by tumors, englarged glands, strangulation
82
VF paralysis is sometimes __________
temporary
| -may recover in first 9 months post injury
83
Vocal characteristics of UAP
Dysphonic (harsh or hoarse), weakness (soft voice), breathiness, loss of fine motor control for pitch change
84
What type of VF is more rare?
Bilateral Adductor Paralysis (BAP)
85
Describe BAP
Both folds in the peri-median position and unable to close
86
BAP is usually caused by ______
stroke
87
Vocal characteristics of BAP
no voice- paralytic aphonia
