funtional voice disorders Flashcards
(18 cards)
What is Muscle Tension Dysphonia?
A voice disorder that is accompanied by observable tension of the neck, shoulders, jaw, and throat
Often related to psychosocial stress
Hyperfunctional, no observable lesion, tm tension happening in the muscles with voice
Tx= voice therapy and relaxation
What are some postures of the head and neck?
neutral, extension, flexion
check to see patients posture
if there is tm tension or something wrong extrinsically, can affect intrinsically
What is generalized tension phonation?
When ALL laryngeal muscles are engaged during phonation, including the abductor ones (PCA)
Activity of the PCA leads to posterior glottic gap! which can lead to nodules, polypoid degen and chronic inflammation ):
What is vocal fatigue?
Effortful, inconsistent and ineffective phonation
Symptoms= deteriorating voice quality, endurance, pitch, loudness range, less resp support; may have nodules, muscle tension
Some people are just more prone to this bc of dispositional differences
More symptoms= xerostomia, pain at throat base, laryngeal globus
DIFF FROM MYASTHENIA LARYNGIS
Ax= stroboscopic examination, there will be a decreased amplitude, phase asymmetry, anterior gap may be seen
Tx= physiological voice therapy (sustaining sounds for as long as they can)
What is phonotrauma?
Also known as vocal abuse, this is when there are prolonged maladaptive behaviours, such as being super loud or aggressive, or maneuevers such as throat clearing and coughing
At risk situations= loud ambient noise, talking for a long time, unhealthy demands on speaker, poor training and breath support
Tx for phonotrauma?
Voice therapy and counselling, if needed phonosurgery and therapy, expected to go away itself though
What is ventricular phonation?
Also called false/mixed phonation; when too much supralaryngeal tension causes an approximation and vibration of the false folds
can be because of muscle tension or stress
need therapy
How is ventricular phonation assessed?
Phonation may be confused with supraglottic squeezing
Important to verify that the false folds are actually the sound source!!
VENTRICULAR PHONATION HAS NO PITCH MODULATION
TX= voice therapy and vocal reduction
What is puberphonia?
A voice drop during pubery happens, an octave for males and 2-3 semitones in females
For males; Puberphonia= post-mutational falsetto
Females= Juvenile voice
Tx for both= voice therapy
What is post-mutational falsetto?
Possible causes: Feminine self-identification, resistance towards adulthood, embarrassment about the voice change, muscular incoordination.
Males go higher
Perceptual signs:Elevated larynx,high pitch,soft breathy voice, cul-de-sac resonance.
Habitual cricothyroid hyperfunction.
Because of this habitual lengthening of the vocal folds, the compression that is necessary for loudness increases cannot be achieved and patients may find it difficult to raise their voices.
Emotional investment may exist as well, introducing the new vocal change can be different
What is juvenile voice?
Possible causes: Resistance towards adulthood, muscular incoordination.
Perceptual signs:Child-like pitch,elevated larynx, high pitch, soft breathy voice, cul-de-sac resonance.
Habitual Cricothyroid Hyperfunction.
Decreased Loudness.
Less recognized in females, imp to be nice to them :)
What is psychogenic conversion dysphonia and aphonia?
Related to a psychological effect
Severe aphonia or dysphonia even with intact vocal anatomy/physiology
Sudden onset, seen in adult women
Induced by life stress and tension
The voice disorder may allow patient to avoid dealing w the true conflict
The patient may get secondary gains from the voice disorder
Tx=Voice therapy and psychotherapy
What is irritable larynx syndrome?
A hyperkinetic laryngeal dysfunction that happens because of several causes because of a triggering stimulus
Criteria= tension symptoms, dysphonia, laryngospasm, chronic cough
Palpable and visible tension= in cricothyroid and thyrohyoid spaces
Sensory trigger= airborne/esophageal irritant
What is the severity spectrum of irritable larynx syndrome?
- Chronic throat clearing
- Chronic cough
- Paradoxical vocal fold motion (vocal fold that should open to inhale are now closing, and if the closing persists it becomes a laryngospasm)
- Laryngospasm
Why does the larynx become irritable?
Altered neuronal control; larynx is overly excited and sensitive
Laryngopharyngeal reflux sometimes thought to be culprit
Some acid bothering posterior larynx
What is idiopathic paradoxical VF motion?
AKA vocal cord dysfunction
This is when there is an inappropriate adduction of the VF, usually happens w inspiration constricting airway causing stridor
Episodes of shortness of breath
Scary for the affected person
Severe cases req. trachetomy
What are findings linked with paradoxical VF motion?
Esophageal reflux (which constantly irritates the larynx)
Anxiety or panic disorder
Neuromuscular dyskinesia
What is treatment of paradoxical VF motion?
Usually behavioural treatment like exersize training, respiration training to restore a normal pattern, if needed anti reflux meds
