Midterm - Voice Disorders

Question 1

Muscle Tension Dysphonia

Answer 1

• caused by vocal hypertension - too much effort to phonate Primary - dysphonia Secondary - in presence of organic/phycogenic/neurologic problem, as compensatory strategy Treatment: head/neck relaxation, chant talk, chewing, digital manipulation, laryngeal massage, yawn-sigh

Question 2

Ventricular Dysphonia

Answer 2

• interference of false vocal folds during phonation, usually a symptom of another problem - false folds shouldn’t approach midline

Question 3

Psychogenic Dysphonia

Answer 3

• hoarseness that has no physical cause appears after emotional distress

Question 4

Puberphonia

Answer 4

Voice doesn’t reflect development of secondary sex characteristics in puberty characteristics: pitch breaks, falsetto, strain treatment: masking, digital manipulations, glottal fry - hierarchy approach

Question 5

Somatization Dysphonia

Answer 5

Shows symptoms beyond dysphonia (e.g., laryngeal pain, shortness of breath). 􏰂Presents like a physical etiology, but there isn’t one. 􏰂Features can include whisper voice or aphonia, very high or very low pitch, voluntary muteness. 􏰂Treatment is centred around identification and reduction of the emotional and psychological factors.

Question 6

Vocal Cord Nodules

Answer 6

• whitish growths on one or both of the vocal cords - callous-like growths

Question 7

Answer 7

Vocal Cord Nodules

Question 8

Answer 8

Vocal Cord Polyps

• one or both cords
• appear as fluid filled sacks
• larger than nodules
• blister like
• cord abuse over time or short term

Risks: hoarseness, 􏰁breathiness or air wastage, 􏰁decreased pitch range and loudness range, voice and body fatigue, Shooting pain from ear to ear

Question 9

Treatments for Nodules & Polyps

Answer 9

medically, surgically, and/or behaviorally

Surgical intervention involves removing the nodule or polyp from the vocal cord. This approach only occurs when the nodules or polyps are very large or have existed for a long time.

This includes treatment for gastroesophageal reflux disease (GERD), allergies, etc. Medical intervention to stop smoking or to control stress is sometimes needed.

behavioral intervention/voice therapy from SLP/CDAs

Question 10

Answer 10

Laryngitis

􏰁 Hoarseness, Breathiness, 􏰁Harsh voice, 􏰁Strained voice, 􏰁Low pitch

Treatment: rest, no whispering

Question 11

Organic Voice Disorders

Answer 11

Related to structural deviations of the vocal tract, or to diseases of specific structures of the vocal tract

Question 12

Laryngomalacia

Answer 12

Congenital Abnormality

• inward collapse of subglottic structures
• treatment - outgrown or surgery (5%)

Question 13

Answer 13

Subglottal Stenosis

• narrowing of subglottal space
• congenital OR acquired (caused by repeated intubations at birth)
• treatment: close monitoring OR surgical intervention

Question 14

Esophageal Atresia/Tracheoesophageal Fistula

Answer 14

• EA: esophagus ends in blind pouch
• TF: abnormal opening between eso and trac
• often occur together
• surgery immediately after birth followed by feeding therapy

Question 15

Answer 15

Cancer

• carcinoma in vocal tract
• Tongue, palate, velum: Effects on articulation, vocal resonance, swallow.
• 􏰁Larynx: Effects on voice, consequences for airway adequacy.
• treatment: surgery, radiation

Question 16

Acid Reflux

Answer 16

Gastroesophageal Reflux Disease (GERD) is the passage of gastric juices from the stomach into the esophagus.

􏰁Laryngopharyngeal Reflux Disease (LPRD) is the passage of contents superiorly into the pharynx

treatment: meds and diet

Question 18

Answer 18

Granuloma

Granulated tissue that forms over contact ulcers on the arytenoid cartilages.

􏰁 Causes:
􏰂 Hard glottal attack, LPRD, intubation

Treatment: voice therapy; lower strain, jaw relaxation, lower volume (Confidential Voice), easy attack

Question 19

Answer 19

Leukoplakia/Hyperkeratosis

Reactive epithelial tissue growth.
􏰁Thickened patches that are red (keratosis) or white (leukoplakia). 􏰁Unilateral or bilateral. 􏰁Causes: Smoking
􏰁Treatment: Monitor as a pre-malignant condition. 􏰂 Eliminate sources of irritation.

Question 20

Answer 20

Papilloma

Wart-like growths, viral in origin (associated with certain strains of HPV).

􏰁Affects adults and children.

􏰁Treatment: Medical/surgical management to protect airway.

Question 21

Answer 21

Laryngeal Webbing

Abnormal tissue forms between the VFs.

􏰁Can be congenital or acquired.

􏰁Signs and Symptoms: 􏰂 High-pitched cry/voice 􏰂 Stridor

􏰁Treatment: Surgical removal (sometimes grows back)

Question 22

Neurogenic Voice Disorders

Answer 22

Related to damage or disease within the nervous system

Question 23

Answer 23

Vocal cord paralysis (uni, bi)

• damage to CNX through head and neck injuries, tumors, disease, surgery, or stroke.
• Unilateral more common than bilateral.
  􏰁- The paralyzed vocal cord does not move to vibrate with the other cord but vibrates abnormally or does not vibrate at all
• surgery or injections
• head turn (toward paralysed side), digital manipulation, pitch shift

Question 24

Spasmodic Dysphonia

Answer 24

Adductor type (more common)

• cords spasm closed during speech, sounds strained/strangled

Abductor type

• cords spasm open during speech, sounds breathy
• neurologic disorder
• cause unknown - trauma, viral infection, random

Question 25

Parkinson’s Disease

Answer 25

hypokinetic dysarthria

• reduced loudness, breathy, monotone, intermittent

Treatment: Lee Silverman Voice Treatment (LSVT:LOUD)