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1
Q

What are the differences between misuse and vocal abuse Phonotrauma?

A

They do not differ a lot, more of behaviors on a continuum.
-Misuse: voice production behaviors that distort the normal behavior of the phonatory mechanism to work efficiently and effectively. High vocal demands, many people can misuse their voice frequently

-Vocal abuse: behavior that is harsher & that traumatizes the VF tissue sufficiently to cause tissue change

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2
Q

Examples of types of misuse versus vocal abuse

A
  1. Misuse: increased tension/strain (hard glottal attack, high laryngeal position, AR laryngeal squeezing), inappropriate pitch level, (puberphonia, persistent glottal fry, lack of pitch variability), excessive talking, ventricular phonation, dysphonia, and aphonia
  2. Vocal Abuse: excessive/prolonged loudness, excessive use/strain during tissue change (creating further VF damage), excessive coughing, excessive throat clearing, screamer/noise maker, exercise enthusiast
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3
Q

Who is most likely to present with puberphonia? How may this affect them socially with their communication?

A

Most common: males who went through puberty
It is perceived as unusual or inappropriate for a man to have a high-pitched voice instead of a low-pitch voice. It may make them feel embarrassed

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4
Q

Why do certain children exhibit phonotrauma?
What sort of vocal behaviors lead to this?

A

Because children are prime exhibitors of excessive talking, screaming, and noise making
These behaviors can cause vocal nodules, which are common in children & are often called ‘screamer’s nodules’ because of this

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5
Q

What are the histological differences between nodules and polyps?

A

-Polyp: BMZ thinning, decreased fibronectin, and presence of fibrin and iron. Greater central core of fibrous tissue with greater dentify than the LP. It is covered by normal or slightly hyperplastic epithelium

-Nodules: abnormal BMZ with altered anchoring fibers, increased fibronectin, and increased collagen

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6
Q

A person who reports voice changes following attendance at an LSU football game is most likely to be diagnosed with which benign lesion?

A

Nodules
They will most likely have lost their voice and have irritated VF mucosa (possibly edematous)

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7
Q

What is the difference between an acute and chronic nodule & what is the effect on voice

A

Acute: soft and pliable appearance. Mostly vascular and localized edema. Usually unilateral
With vocal rest, may get better.

Chronic: hard, fibroused, white, thick. Epithelium may show hypertrophy, rough surfaces. Not always symmetric in size
More stiff and cause more resistance to VF vibration
Usually bilateral
No improvement with vocal rest

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8
Q

How can the size and location of a polyp affect vibration?

A

If the polyp is bigger, it can interfere with glottal closure and cause breathiness
If found in the subglottis region, rather than the free margin of the VFs, they may cause little alteration to voice quality

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9
Q

If a benign lesion goes away with therapy, we can likely determine it was not what?

A

A cyst

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10
Q

What are some signs and symptoms of Reinke’s edema?

A

Symptoms: lower pitch, hoarseness, shortness of breath
Signs: lower findamental frequency, VFs appear fluid-filled, boggy-like structures. Greater excursion of the mucosal wave, incomplete glottal closure

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11
Q

What are the factors that can lead to the development of keratosis?

A

Smoking
Env pollutants

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12
Q

Why is surgery the primary treatment for Recurrent Respiratory Papiloma instead of voice therapy?

A

Because they tend to proliferate & can obstruct the airway

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13
Q

How would a laryngeal web affect vocal fold vibration

A

In a child it may result in stridor
In adults may result in hoarseness and high pitch

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14
Q

3 potential symptoms of inhalation trauma

A
  1. Swelling
  2. Inflammation
  3. Burns
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15
Q

What does the TNM system refer to

A

It is a system that evaluates the severity of malignancy: lower numbers indicate lesser involvement & higher numbers indicate severity

T= site of the primary tumor
N= involvement of lymph nodes
M= the spread of the lesion to other body parts (metastasis)

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16
Q

What are the potential treatments for malignant laryngeal tumors

A

-Surgery
-Radiation therapy
-Chemotherapy

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17
Q

What sort or incident would likely cause a hemorrhage?

A

-Single episode of traumatic voice use or laryngeal trauma
-Combination of heavy voice use + anticoagulants and salicylates
-Extended use of inhaled steroids

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18
Q

What can cause fixation of the cricoarytenoid joint?

A

Arthritis, trauma, or joint disease

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19
Q

Do we expect to see tissue changes with mass and stiffness of the VFs with contact granulomas?

A

There is an irregularity shaped mass of tissue at the vocal process of the arytenoids

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20
Q

What is a common way one can develop a laryngeal granuloma?

A

Intubation

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21
Q

What are the two types of spasmodic dysphonia?

A
  1. Adductor SD
  2. Abductor
    or a mix
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22
Q

What type of adduction do the VFs engage in during Myasthenia gravis?

A

Hypoadduction

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23
Q

What type of true VF vibratory behavior do you expect to see with myasthenia gravis

A

Weakness resulting in True VFs not adducting completely
Breathy voice

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24
Q

How is someone’s pitch affected by parkinsons disease

A

The rigidity and stiffness causes monopitch

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25
What type of adduction do the VFs engage in with Parkinsons Disease
Hypoadduction
26
Why is the left VF more often involved in cases with unilater VF paralysis compared to the right VF
The left recurrent laryngeal nerve travels further in the body than the right recurrent laryngeal nerve does As a result the left side has more opportunity for lesions
27
How do voice symptoms change over the course of the degenerative disease (Amyotrophic Lateral Sclerosis: ALS)?
The early symptoms are hoarseness or harshness with slurred speech As the disease progresses, all symptoms increase in severity and their debilitating factors
28
Why is unilateral VF paralysis more common than bilateral VF paralysis
Differing lengths of the RLN on each side
29
How do the tissue makeup of the VFs differ for a child versus adult?
Infants VF histology is more uniform Adults are layered and distinct
30
2 types of congenital anomalies in children
-Laryngomalacia -Laryngeal paralyese
31
What is the free radical theory about aging voice
Free radicals are by products from normal cellular metabolism that have one extra electron Free radicals attack, damaging DNA and protein because the free electron has a strong attraction to be attached to molecules
32
What changes to the VF tissue structure increases stiffness in the lamina propria
Loss of collagen fibers Increased fibers Increased fibronectin Diminished extracellular spaces Decreased hyaluronic acid
33
What muscular changes do we see with VFs due to aging?
The muscles atrophy and get weaker They stiffen and decrease in surface density Decreased ratio of satelite cells to myonuclei
34
What physiologic changes could we expect to see through laryngeal imaging with presbyphonia (aging voice)
Thinning VFs Edema Posterior glottal gap
35
Based on the changes due to presbyphonia, older individuals are most likely to show what auditory-perceptual signs?
-Pitch rises in men and falls in women -Breathiness -hoarseness -Long pauses
36
How might quality of life be related to perceptions of voice quality in older individuals
Voice problems with aging may be improved through lifestyle, diet, and physical condition. Exercise can maintain blood pressure and strengthen as well as increase bone mass. & it can benefit the VFs
37
What is the goal of voice therapy?
Restore functional communication Resolve within feasible bounds of structural physiology
38
Difference between indirect and direct therapy
Indirect: aspects we modify in an external fashion & how they use their voice and certain environments (condition in which the voice is used in) Direct: modify voice and vocal patterns themselves. Home implementation (changing voice behaviors)
39
Recommendations for patients enduring vocal hygiene therapy?
1. drink more water 2. Rest voice 3. Reduce amount of talking 4. Reduce loudness of talking 5. Avoid throat clearing/coughing 6. Modify external environment 7. Avoid whispering 8. Humidifier 9. Voice amplification (microphone/FM system) 10. Reduce alcohol/smoking/vaping 11. Treat GERD/acid reflux
40
Why are vocal rehabilitation techniques so difficult to study?
-The therapeutic pieces are not obvious -Clinician actions have direct and indirect effects on multiple overlapping patient functions
41
What are 3 major obstacles in improving descriptions of behavioral based voice therapy interventions
1. The critical pieces of treatment are unclear, making it difficult to replicate treatment and determine its effectiveness 2. Effectiveness of comparing research is difficult. Different protocols and different targets 3. It is difficult to piece together similar treatments for a meta-analysis
42
What is the tripartite structure for treatment?
It helps a clinician directly affect singular treatment targets The clinician chooses one method or multiple methods for each target. Each target must have a mechanism of action which is how the method will affect the target All of the targets must result in an overall aim
43
5 examples from the final list of RTSS voice targets and voice ingredients
Supraglottal phonation Vocal fry Voice quality- breathiness Voice quality- roughness Voice quality-strain
44
VanStans example of target, ingredient, and dose for MTD
Ingredient: Practice purposefully tensing your vocal folds followed by releasing that tension while speaking. Then maintain that relaxed manner. Dose: Practice releasing tension ten times twice a day. Maintain the relaxed manner for ten seconds of speaking. MoA: Release excess tension and feel the change of voice quality while progressively relaxing. Target: Decrease tension.
45
Define vocal function exercises
Series of systematic voice manipulations to aid return to healthy voice by strengthening and coordinating laryngeal masculature and improving efficiency of the relationship of airflow, VF vibration, and supraglottic treatment of phonation
46
Tasks for vocal function exercises
1. Warm up: Sustain 'ee' 2. Stretching: from low to high 'knoll' 3. Constricting: high to low on 'knoll' 4. Power exercise: sustain 'knoll' (goal dependent on patient)
46
Tasks for vocal function exercises
1. Warm up: Sustain 'ee' 2. Stretching: from low to high 'knoll' 3. Constricting: high to low on 'knoll' 4. Power exercise: sustain 'knoll' (goal dependent on patient)
46
Tasks for vocal function exercises
1. Warm up: Sustain 'ee' 2. Stretching: from low to high 'knoll' 3. Constricting: high to low on 'knoll' 4. Power exercise: sustain 'knoll' (goal dependent on patient)
46
Tasks for vocal function exercises
1. Warm up: Sustain 'ee' 2. Stretching: from low to high 'knoll' 3. Constricting: high to low on 'knoll' 4. Power exercise: sustain 'knoll' (goal dependent on patient)
47
Define Semi-occluded Vocal Tract Exercises
Focus on impedance matching, the proportion of cricothyroid vs cricoarytenoid muscle activation during vocing, VF kinematics, or contact patterns during phonation
48
Tasks in SOVT (semi-occluded Vocal Tract) exercises
Humming Trills Semivowels Anterior fricatives Bilateral plosives Nasals
49
Goal of semi-occluded vocal tract exercises
Reduce tension
50
Define resonant voice therapy
Uses humming and nasal consonants to teach easy voice production through a natural approach
51
Tasks in resonant voice therapy
Produce a hum and feel the resonance/vibration of the hum in the nose and cheeks Sustain the hum and practice until the target sound is produced without difficulty
52
In resonant voice therapy, continuous humming promotes what?
Sustaining vocalization
53
Define laryngeal manual therapy
Designed to reduce musculoskeletal function and hyperfunction by gently rubbing the larynx
54
Tasks in Laryngeal Manual Therapy
-Push back maneuver -Pull down maneuver -Medial compression and downward traction
55
What is the push back maneuver in the laryngeal manual therapy?
Forefinger on thyroid cartilage pushes back to change shape of the glottis
56
What is the pull down maneuver in laryngeal manual therapy
Thumb and forefinger are placed in the thyrohyoid space and then pull the larynx downward
57
What is medial compression and downward traction in the laryngeal manual therapy
Thumb and forefinger in the thyroid space with medial compression
58
Define confidential voice
Therapy technique used for patients who present with excessive loudness, teaching them to use a breathy voice
59
Task in confidential voice
-Model the breathy voice for the patient & instruct them to use that voice -Patient focuses on making voice breathy This means they also reduce loudness, reduce rate, reduce hyperfunction, and become aware of the expiratory airflow
60
What respiratory function is drawn attention to in confidential voice therapy?
Expiratory airflow
61
The rational of confidential voice is use of a breathy voice causes...
The glottis to remain open Reduced the force of contact Reduced force of medial compression of the VFs
62
What is the stretch and flow (flow therapy) technique
Used for functional dysphonia or aphonia Helps patients with breath holding tendencies to manage their airflow
62
What is the stretch and flow (flow therapy) technique
Used for functional dysphonia or aphonia Helps patients with breath holding tendencies to manage their airflow
62
What is the stretch and flow (flow therapy) technique
Used for functional dysphonia or aphonia Helps patients with breath holding tendencies to manage their airflow
62
What is the stretch and flow (flow therapy) technique
Used for functional dysphonia or aphonia Helps patients with breath holding tendencies to manage their airflow
63
What is the stretch and flow (flow therapy) technique
Used for functional dysphonia or aphonia Helps patients with breath holding tendencies to manage their airflow
63
What is the stretch and flow (flow therapy) technique
Used for functional dysphonia or aphonia Helps patients with breath holding tendencies to manage their airflow
63
What is the stretch and flow (flow therapy) technique
Used for functional dysphonia or aphonia Helps patients with breath holding tendencies to manage their airflow
63
What is the stretch and flow (flow therapy) technique
Used for functional dysphonia or aphonia Helps patients with breath holding tendencies to manage their airflow
63
What is the stretch and flow (flow therapy) technique
Used for functional dysphonia or aphonia Helps patients with breath holding tendencies to manage their airflow
63
What is the stretch and flow (flow therapy) technique
Used for functional dysphonia or aphonia Helps patients with breath holding tendencies to manage their airflow
63
What is the stretch and flow (flow therapy) technique
Used for functional dysphonia or aphonia Helps patients with breath holding tendencies to manage their airflow
64
What is the stretch and flow (flow therapy) technique
Used for functional dysphonia or aphonia Helps patients with breath holding tendencies to manage their airflow
65
Tasks in stretch and flow therapy
-Patients instructed to produce a steady outflow of air during exhalation Biofeedback methods are used (tissue in front of mouth, hand in front of mouth) -Patient monitors air flow -After continuous airflow is mastered, voicing is introduced -Words and phrases are introduced
66
Who was LSVT developed to treat? How does it benefit them
Patients with Parkinsons Patients increase effort and focus on putting forth maximum effort to produce a loud voice, which improves their respiratory support
67
What is LSVT (Lee-Silverman Voice Treatment)
Technique that maximized phonatory and respiratory function through various tasks
68
Tasks in LSVT
Patients produce a loud voice with maximum effort and then monitor the loudness of their voice while they speak
69
What is PhoRTE (Phonation Resistance Training Exercise)
Similar to LSVT Uses pitch in addition to loudness to improve vocal outcomes
70
Who has PhoRTE been developed to treat?
Hypofunctional voice disorders Presbyphonia
71
Tasks in PhoRTE
Sustain /a/ loudly Produce /a/ with pitch glides across their pitch range Say a phrase in a loud, high pitch voice Say the same phrase but in a loud, low pitch voice
72
Define total laryngectomy & cordectomy
Complete removal of the larynx Partial or total cordectomy is the removal of part of the VFs through surgical or radiation therapy
73
Name types of alaryngeal speech
1. Electrolaryngeal speech 2. Esophageal speech 3. Tracheoesophageal speech
74
What is a tracheoesophageal prosthesis?
One way silicon valve
75
Different types of prostheses available to patients
Valves that automatically occlude in response to certain tracheal air pressure levels Prosthesis comes in variety of lengths and diameters Indwelling prosthesis
76
SLPs role in voice therapy with a TEP patient
Selecting and fitting the prosthesis Helping the patient manage its ongoing use and care Troubleshooting and assisting patients with issues

Voice (5 decks)

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