Specific Voice Disorders

Question 1

What is a tissue reaction to frictional trauma between the vocal folds?

Answer 1

Vocal nodules

Question 2

What are the 3 stages of nodule development?

Answer 2

Stage 1, 2, and 3

Also prenodules

Question 3

Describe Stage 1 of nodule development

Answer 3

Only on the free margin of the VF

Nodules are gelatinous and floppy

Question 4

Describe Stage 2 of nodule development

Answer 4

Localized swelling or thickening on the edge of the vocal folds
Nodules appear grayish and translucent

Question 5

Describe Stage 3 of nodule development

Answer 5

Nodules are hard, white, or gray; these nodules are chronic and longstanding.

Question 6

What are the vocal characteristics associated with vocal nodules?

Answer 6

Harsh quality, breathy voice, limited pitch range, and lower pitch

Question 7

Where do nodules most commonly occur?

Answer 7

Juncture of the anterior 1/3 and posterior 2/3 of the VF

Question 8

What is the clinical management for nodules in Stage 1 or 2?

Answer 8

Voice therapy that may include counseling

Question 9

What is the clinical management for Stage 3 nodules?

Answer 9

Therapy, counseling, may need surgery

Question 10

With a ______ client, improvement should be noted within 2-3 weeks

Answer 10

Complaint

Question 11

Where do we want to “place the voice”?

Answer 11

High in the facial mask instead of low in the throat

Question 12

Placing the voice is trying to change the focus of what?

Answer 12

Resonance

Question 13

What is the purpose of the yawn sigh?

Answer 13

To facilitate an easy onset

Question 14

What are the causes of polyps?

Answer 14

URI, contaminants, vocal abuse or a single traumatic event

Question 15

If polyps are due to vocal abuse, where might they be located?

Answer 15

Junction of the anterior 1/3 and the posterior 2/3 of the VF

Question 16

What two types of polyps are there?

Answer 16

Pedunculated and sessile

Question 17

What is the difference between pedunculated and sessile polyps?

Answer 17

Pedunculated are stalk-like and sessile are more broad-based.

Question 18

Where all could polyps occur?

Answer 18

On the VF, supra- , and sub-glottally

Question 19

What are the most common voice complaints for polyps?

Answer 19

Hoarseness, frequent throat clearing

Question 20

What is the management protocol for polyps?

Answer 20

Surgery if they’re large; after surgery you can begin voice therapy

Question 21

What are contact ulcers?

Answer 21

Benign lesions that develop on the vocal processes of the arytenoid cartilages

Question 22

What are the most common causes of contact ulcers?

Answer 22

Vocal abuse, GERD, and irritation from intubation during surgery

Question 23

What are the symptoms of contact ulcers?

Answer 23

**Pain, throat tickle, need to clear throat, aching or dryness in the throat

Question 24

What are the 3 stages of development of contact ulcers?

Answer 24

1 - vocal fatigue & hoarseness, recovery overnight; redness and swelling between arytenoids
2 - continued hoarseness, fatigue and occasional pain; severe inflammation and early loss of mucosal covering
3 - severe and constant hoarseness, fatigue, and pain; mucosa is completely stripped, starting to see formation of granuloma

Question 25

What are the vocal characteristics of a contact ulcer?

Answer 25

Low pitch, hoarseness, persistent glottal attacks, and loud voice

Question 26

Treatment for contact ulcers?

Answer 26

Refer for gastrointestinal eval; vocal rehabilitation

Question 27

What is a papilloma?

Answer 27

Wart-like growth in the larynx

Question 28

What is a papilloma caused by?

Answer 28

DNA virus

Question 29

What is the primary concern of papillomas?

Answer 29

Constriction of the airway because they grow so fast

Question 30

What population do papillomas typically occur in?

Answer 30

Children; typically do not persist after adolescence

Question 31

Vocal characteristics of papillomas?

Answer 31

Hoarseness, aphonia, stridor, shortness of breath, and croupy-like cough

Question 32

What is the primary treatment for papillomas?

Answer 32

Medical - need surgery to preserve the airway

Question 33

What is a tissue web covering all or part of the glottis?

Answer 33

Laryngeal web

Question 34

How does a laryngeal web grow?

Answer 34

Anterior to posterior

Question 35

What might cause a laryngeal web?

Answer 35

It can be congenital or acquired (trauma or infection)

Question 36

What are the vocal characteristics of laryngeal web?

Answer 36

Higher than normal pitch (b/c of the shortened vibratory surface) Harsh quality Shortness of breath Stridor

Question 37

What is the treatment for laryngeal web?

Answer 37

Always surgery!

Question 38

What is vocal fold paralysis?

Answer 38

The inability of one or both VF to move due to a lack of innervation of intrinsic muscles of the larynx

Question 39

In regards to VF paralysis, what does the label refer to?

Answer 39

It refers to what the affected VF CANNOT do

Question 40

In unilateral adductor paralysis, what is wrong with the VF?

Answer 40

One VF cannot adduct

Question 41

What are 90% of VF paralyses due to?

Answer 41

Damage to the vagus nerve or its branches (superior laryngeal or recurrent laryngeal)

Question 42

What is the difference between the superior laryngeal and recurrent laryngeal?

Answer 42

The muscles innervated - the superior laryngeal innervates the cricothyroid muscles, and the recurrent laryngeal innervates all other intrinsic muscles of the larynx.

Question 43

What happens to the VF/voice if the cricothryoid muscles are not innervated?

Answer 43

Can't tense them or make pitch adjustments.

Question 44

If the recurrent laryngeal nerve is damaged, what difficulty will you have with the VF?

Answer 44

Ability to AD-duct and AB-duct

Question 45

If an individual has AD-ductor paralysis, what's wrong the VF?

Answer 45

They can't close/AD-duct

Question 46

What is usually the cause of unilateral adductor paralysis?

Answer 46

Trauma to the recurrent laryngeal nerve (surgical injury or trauma)

Question 47

What are the voice characteristics of unilateral adductor paralysis?

Answer 47

Dysphonic (harsh or hoarse) Weakness Breathiness Loss of fine control for pitch change - may be monotone

Question 48

How would the voice sound in bilateral AD-ductor paralysis?

Answer 48

Would be completely breathy (because neither VF could AD-duct!) - it's called paralytic aphonia

Question 49

What position are the VF in in bilateral AD-ductor paralysis?

Answer 49

Both folds are in the paramedian position and are unable to close

Question 50

What is the management of vocal fold paralysis?

Answer 50

Surgery, some sort of injection into the VF, a repositioning of the arytenoids, maybe some voice therapy

Question 51

What are some ways to increase the AD-duction of the VF? (think facilitating techniques)

Answer 51

Pushing technique (not well supported), head positioning, or lateral digital pressure

Question 52

What is the problem of the VF in AB-ductor paralysis?

Answer 52

The VF are almost primarily AD-ducted/stuck in the midline position; will not AB-duct to a full lateral position for full inspiration

Question 53

What is the primary problem associated with AB-ductor VF paralysis?

Answer 53

Breathing - the VF won't open all the way!

Question 54

What does bilateral AB-ductor paralysis require?

Answer 54

An immediate tracheostomy because the person won't be able to breathe!