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Flashcards in Organic Voice Disorders Deck (15)
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1
Q

Contact Ulcers

A

Inflammatory Disease

Small ulcerations that develop on the medial aspect of the vocal process of the arytenoid cartilage due to irritation

Caused by: deterioration of voice after prolonged vocalization or vocal fatigue, low pitch phonation with hard glottal attack, or status post endotracheal intubation

accompanied by pain in the laryngeal area, or may lateralize o one ear

hoarseness, throat clearing, hard glottal attacks, coughing, LPR

respond to therapy status post surgery

2
Q

Cysts

A

usually unilateral, soft and pliable

occur on the inner margin, superior or inferior surface of the true vocal fold, or anywhere on the ventricular folds

may be acquired or congenital

refer back to ENT for surgical intervention as systs do not respond to voice therapy

otolaryngologists use a small superficial incision along the superior edge of the vocal fold to excise the cyst

3
Q

endocrine changes

A

individual voices are either too low or too high due to endocrine dysfunction

pituitary problems: there is not the normal development of progesterone by the ovaries for girls or testosterone for males

hypothyrodism causes increase mass of the vocal fold which results in lower pitch

premenstrual vocal syndrome: vocal fatigue, reduced pitch range, hypophoni, loss of harmonics

menopause: women experience lower fundamental frequencies. excessive androgenic hormones resulting in the glottal membrane thickening, increase size-mass of the vocal folds. Hormonal therapy is beneficial for this.

4
Q

Hyperkeratosis

A

Oral or pharyngeal lesions discovered by the dentist or ENT.

Lesions are biopsied to malignant (cancerous) or nonmalignant (benign).

Hyperkeratosis : pinkish, rough lesion which is nonmalignant but maybe a precursor for malignant tissue change. Therefore, it is watched closely.

Locations: under tongue, on the vocal folds at the anterior commissure, or on the arytenoid prominences.

Chronic irritants: secondhand smoke, LPR

Voice Disorder: Mild-Severe depending on the site and extent of lesion. Surgery, Vocal Hygiene, PPI, Cessation of irritant to the tissue improves the phonation.

5
Q

Leukoplakia

A

Whitish-colored patches

Location: lesions to the surface membrane, in the subepithelial space which occur under the tongue and on the vocal folds

Benign precancerous tumors that are watched closely as it often leads to squamous cell carcinoma.

Cause: Heavy smoking, LPR, human papilloma virus (HPV)

Voice: Hoarse, Lower Pitch, & at times, Hypophonic

If located on the glottal margins then vocal fold closure is affected with a breathy voice

Voice Therapy is important to restore normal voice status post surgery

6
Q

Recurrent Respiratory Papillomatosis

A

Most common benign laryngeal neoplasm in children

Wartlike growths that occur in dark, moist caverns

Majority are due to Human Papilloma Virus (HPV)

May occur in extralaryngeal sites: oral cavity, trachea, & bronchi.

Can be a serious threat to the airway

Voice: hoarse, shortness of breath

Most papillomas stop recurring with puberty, 20% persists into adulthood

Surgical treatment which is palliative , not curative

Voice Therapy is conducted status post therapy with work on respiration control

7
Q

Infectious Laryngitis

A

URI=upper respiratory infections

Severe headache, chest cold, fever, sore throat, cough, odynophagia,
dysphonia

Most are Viral in origin

Bacterial infection associated with high fever & very sore throat

Which responds to antibiotics?

Medication, Amantadine fights off influenza; however, has side effects such as xerostomia & xerophonia

8
Q

Infectious Laryngitis Treatment Approaches

A

Voice rest (no whispering) for 2-3 days to be sure the vocal fold tissue does not touch or vibrate when irritated or swollen

Humidifcation, hydration, reduced activity, analgesics

9
Q

Puberty

A

Occurs on average of over 4-5 years

Females tend to start at age 9

Males tend to start at ages 11-12

Noticeable laryngeal growth & change in Fundamental Frequency (Hz) occur in the LAST YEAR of puberty

Male voices drop one full octave, Female voices drop almost half an octave

This occurs over 3-6 months, and up to a year

Middle School Years are not optimal for choirs or Glee Clubs

Vocal fatigue, not trained for proper techniques in singing and not aware of physical limitations

Should avoid attempting optimum pitch or modal- pitch because of rapid changes

10
Q

Sulcus Vocalis

A

Congenital or Acquired

Sulcus=furrow or indentation

Furrowed medial edge of the vocal fold, bilaterally symmetrical

Spindle configuration= all or any edge of the vocal fold

Involve the superficial layer or penetrate down into the vocal ligament and muscle

11
Q

Diagnosing Sulcus Vocalis

A

Videostroboscopy has improved the ability to examine sulcus vocalis as compared to laryngeal mirror examinations

Vocal Folds are abducted: identify the fold furrow

Vocal Folds are adducted: reduced mucosal wave, stiff lamina propria, glottal incompetence, air leakage through the midline of anterior 2/3 of the folds

Vocal Quality: little variability in pitch, strained quality, low intensity, fatigue when attempting to be louder

Periods of Aphonia & Increased Laryngeal Muscle Tension

12
Q

Treatment of Sulcus Vocalis

A

Therapy: Glottic Closure, Pitch/Loudness, & Quality

Severe Sulcus: Sulcusectomy where an incision is made above the sulcus; upper & lower borders of the sulcus are sutured together

Mucosal slicing: microvertical slices across the sulcus

Injecting collagen or fat into the sulcus; into the the deep layers of the lamina propria

Replace the scar tissue with implanted atelocollagen sheets into the lamina propria to regenerate vocal fold mucosa and its tissue (gradual improvements over a year time period)

Medialization thyroplasties & strap muscle transpositions

13
Q

Voice Therapy

A

Pitch Shifts

Loudness Changes

Lateral Digital Pressure

Firmer Glottal Closure

Auditory feedback with real time amplification

Easy onset of phonation

14
Q

Webbing

A

Laryngeal web grows across the glottis between the 2 vocal folds,
congenitally or acquired

Reduces fold vibration, high-pitched, rough sound

Congenital Web: glottal membrane failed to separate in embryonic development

Hear stridor, syncope, high-pitched squeal

Immediate surgery, temporary tracheostomy, recovery over 4-6 weeks

Acquired Webs: bilateral trauma of medial edges of vocal folds

Prolonged infection or prolonged surface tension cause the inner margins of the folds to grow together at the level of the anterior commissure since the folds are so close together at that point to begin with

1/3 the distance from the anterior commissure

Infection, bilateral surgery (laryngeal or tracheal), papilloma, nodules can form a web

Surgery: web is cut, vertical keel is placed between the folds to prevent approximation of the vocal folds

Voice Rest

Voice Therapy

15
Q

Hemagiomas

A

similar to contact ulcers and granulomas

however, it is a soft, pliable, blood-filled sac

Location: infantile hemangiomas are in the subglottis, adult hemangiomas are found in the supraglottis.

Associated with vocal hyperfunction, LPR, or intubation trauma

Surgical intervention first, vocal hygiene, and voice therapy next