Speech Disorders FINAL TEST Flashcards
(149 cards)
1
Q
Papilloma
A
- Benign, viral neoplasm/tumor
- Stippled mass, like a wart
- Caused by exposure to HPV
- Juvenile or adult papilloma
- May occur in the pharynx, trachea and larynx
- Benign, but may be precancerous
2
Q
Carcinoma
A
- Malignant tumor
- Life-threatening
- Smoking is a major cause of laryngeal cancer
- risk increases substantially when alcohol is combined with smoking
- Voice changes may be an early detection of disease
- Vs. papilloma & nodules & polyp
3
Q
Edema
A
- Reinke’s edema: swelling (fluid fills the superficial layer of the lamina propria, aka Reinke’s space)
- Translucent, sac-like
- Smoking, reflux, chronic vocal abuse
4
Q
Laryngeal Web
A
- Membrane
- Congenital or scar tissue from trauma
- Consequences
- stridor
- hoarseness
- aphonia
5
Q
Spasmodic Dysphonia
A
- Disorder affecting motor control of the larynx
- Hallmark symptom: Intermittent voice stoppage
- Strained voice, pitch breaks, worsens with stress
- Thought to be psychogenic at one point; now considered a form of focal dystonia
6
Q
Focal Dystonia
A
Involuntary muscular contractions and abnormal postures
7
Q
Laryngectomy: What kind of surgeries should you have if you caught it early on?
A
If it is caught early on, may only need chemotherapy or simpler surgery:
- Cordectomy
-Hemilaryngectomy
8
Q
What do you do if you did not catch laryngectomy early on?
A
You will have to remove the larynx completely
9
Q
Speech After Laryngectomy:
Mechanical
A
Artificial larynx
10
Q
Speech After Laryngectomy:
Surgical
A
- TEP (Tracheo-Esophageal Puncture)
- Most frequently used method of laryngeal speech
11
Q
Cysts
A
Glandular duct blockage (glob of fat or fluid-filled growth) contained within membrane
12
Q
Neurogenic Voice Disorders
A
- Disruption in structure or function at CNS or PNS level
- Dysfunction of Vagus Nerve (Cranial Nerve X)
13
Q
Neurological Diseases
A
Parkinson’s disease
ALS
MS
among others
14
Q
What is spasmodic dysphonia?
A
Disorder affecting motor control of the larynx
15
Q
Hallmark symptom of Spasmodic Dysphonia
A
Intermittent voice stoppage
16
Q
What kind of voice do you have with spasmodic dysphonia?
A
Strained voice, pitch breaks, worsens with stress
17
Q
Is Spasmodic Dysphonia psychogenic?
A
At one point it was considered, but now it’s a form of focal dystonia.
Involuntary muscular contractions and abnormal posturs
18
Q
A
19
Q
A
20
Q
A
21
Q
A
22
Q
Vocal Fold Paralysis Phonation
A
Normal phonation, but may progress to complete respiratory obstruction
23
Q
Is bilateral abductor vocal fold paralysis life-threatening?
A
Bilateral abductor vocal fold paralysis is life threatening and requires prompt management
24
Q
What is vocal fold paralysis caused by?
A
Caused by thyroidectomy, neurological disorders, congenital
25
Medialization Thyroplasty
Place implant through thyroid behind vocal, fat injections can also be used
26
Types of Functional Voice Disorders
Functional aphonia, muscle tension dysphonia, puberphonia, psychogenic voice disorders
27
Types of Organic Voice Disorders
Voice Nodules, Polyps, Cysts, Carcinoma, Reflux laryngitis, Reinke's edema
28
Types of Neurological Voice Disorders
Vocal fold paralysis; degenerative diseases; spasmodic dysphonia; stroke
29
Characteristics of Voice/Voice Disorders
Pitch, Loudness, Quality, Resonance
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31
S/Z Ratio
Obtain 3 trials at comfortable pitch and loudness.
Measure of phonation efficiency vs. respiratory efficiency
32
S/Z Ration Score
1 = normal vocal fold functioning
>1.4= Possible problems with glottal valving
33
Acoustic Measure Instruments
Sound level meter
Computer software, apps
Spirometer
34
examples of Voice Therapy: Medical
Surgery, Radiation, Medication
35
Environmental Voice Therapy
Adjust goals to environment
Modify environment to meet goals
36
Behavioral Therapy Goals
Voice therapy/training
Direct behavior modification
37
Flow Phonation
Flow phonation is a voice therapy technique that emphasizes steady airflow and relaxed phonation to reduce laryngeal tension and promote efficient voice production. It encourages a balance between respiratory support and vocal fold vibration.
38
Flow Phonation Examples
A client practicing flow phonation may blow through a straw into water (semi-occluded vocal tract exercise) to feel continuous airflow while gently voicing. They might say "ho-ho-ho" softly while keeping the airflow smooth and uninterrupted.
39
Resonant Voice Therapy (RVT)
Resonant Voice Therapy is a voice therapy method designed to achieve a strong, clear voice with the least amount of vocal effort. It focuses on feeling vibration (resonance) in the face, especially the lips, nose, and cheeks, indicating efficient vocal fold closure and optimal resonance.
40
Resonant Voice Therapy (RVT) Example
A clinician might guide a client to hum “mmm” and then say “mmmmmm-me,” focusing on the buzz felt in the facial mask area. The goal is to speak with ease and a forward-placed resonance.
41
Vocal Function Exercises (VFEs)
Vocal Function Exercises are a systematic series of exercises developed to strengthen and balance the laryngeal musculature, improve vocal fold vibration, and increase vocal endurance. They are often likened to "physical therapy for the voice."
42
Vocal Function Exercises (VFEs) Examples
A typical VFE set includes:
Sustaining the vowel /i/ for as long as possible at a soft volume.
Gliding from lowest to highest pitch on “knoll.”
Gliding from highest to lowest pitch on “knoll.”
Sustaining musical notes (C-D-E-F-G) softly on “oll.”
43
Laryngeal Massage
Laryngeal massage (also known as manual circumlaryngeal therapy) involves manual manipulation of the muscles around the larynx to reduce tension and lower a high laryngeal position, commonly seen in voice disorders related to muscle tension dysphonia.
44
Laryngeal Massage Examples
A speech-language pathologist may use their fingers to gently massage a client’s neck muscles, including the sternocleidomastoid and thyrohyoid space, while the client phonates vowels or hums. The technique often results in immediate improvements in voice quality.
45
LSVT Loud
LSVT LOUD is an evidence-based voice therapy program specifically developed for individuals with Parkinson’s disease and other neurological conditions. It aims to increase vocal loudness by training individuals to speak with more effort and intention.
46
Tracheoesophageal Puncture
One way valve allowing exhaled air to pass into pharynx. This airstream vibrates the mucosa of the upper PE segment.
47
Speech After Laryngectomy: Mechanical
Artifical Larynx
48
Speech After Laryngectomy: Surgical
TEP: Most frequently used method of alaryngeal speech
49
Esophageal Speech
Air is injected into upper esophagus and released in a controlled manner to create sound source for speech
50
Polyps and Nodules Location
Midpoint or anterior
51
Polyps and Nodules
Unilateral or bilateral
P: Is usually unilateral
N: Usually bilateral
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Polyps and Nodules Definitions
Polyps: soft blister
Nodules: callus
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Polyps and Nodules Causes
Polyps: Acute focal misuse
Nodules: usually chronic abuse
54
What are vocal polyps caused by?
Trauma to the vocal folds associated with vocal misuse or abuse
55
How do polyps develop?
When blood vessels in the vocal folds rupture and swell, developing fluid-filled lesions
56
Polyps tend to be unilateral, larger than nodules and vascular prone to hemorrhage?
57
Can polyps result from a single traumatic incident such as yelling at a sporting event?
yes
58
What vare the two types of polyps?
sessile, pendunculated
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Sessile Polyp
It is close or attached to a vocal fold tissue can cover up to 2/3 vocal fold
60
Penduculated Polyps
appears to be attached to the vocal fold by means of stalk and can be found on the free margins of the vocal folds as well as on the upper and lower folds
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What are the primary symptoms of polyps?
Hoarseness, breathiness or diplophonia or the perception of two different pitches during phonation
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When does diplophonia occur?
Because of the increase in mass of one vocal fold as a result of the polyp.
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What else do individuals who have vocal polys report?
Sensation of something in their throat
64
What are some effective ways to treat polyps?
The combination of the surgical removal of the polyps and voice intervention to eliminate vocal misuse or abuse is effective.
65
How can voice therapy help with polyps?
alone it can improve for some individuals, but not fully eliminate
66
What are contact ulcers?
Small reddened ulcerations that develop on the posterior surface of the vocal folds in the region of the arytenoid cartilages
67
Are contact ulcers like vocal nodules bilateral? Unlike nodules they can be what?
Yes and unlike nodules they can be painful
68
Is pain for contact ulcer unilateral or bilateral? Where can it radiate to?
Pain is either unilateral OR bilateral and it may radiate into the ear.
69
What is a granuloma?
As contact ulcers heal they are replaced by granulated tissue
70
GERD (Gastroesophegal reflux disease could be a huge cause of it). What is it?
Granuloma
71
Contact Ulcers and granulomas can be developed form what kind of trauma?
- Surgical intubation of the larynx.
72
Risk is greater for trauma that leads to contact ulcers and granulomas for which groups of people
Women and children who have smaller airways
73
What are the voice symptoms for ulcers:
- Vocal hoarseness
- Breathiness
-Throat clearing/Vocal Fatigue
74
How do you manage ulcers best?
With post-surgery medication
75
What are two types of laryngitis?
Acute and chronic
76
Laryngitis are inflammation of the vocal folds that can result from exposure to noxious agents (tobacco smoke, alcohol)
77
What is chronic laryngitis?
Is a result of vocal abuse during period of acute laryngitis and it can lead to deterioration of vocal fold tissue.
78
What are papillomas?
Laryngeal papillomas are small wart-like growths that cover the vocal folds and the interior aspects of larynx.
79
What are these papilloma lesions caused by?
They are caused by papillomavirus (HPV)
80
What are the ost common abnormal laryngeal pathology group?
Children younger than 6
81
Are papillomas cancerous? Can they obstruc the airway?
No they are noncancerous. Yes they can obstruct the airway and hinder breathing.
82
How are papillomas removed?
They are surgically removed.
83
When papillomas are surgical removed is it gone forever?
No they have a strong tendency to reappear multiple operations that may damage vocal fold tissue.
84
Children with this disorder exhibit what for papillomas?
Exhibit inspiratory stridor or noisy breathing during inhalation, indicative of a narrowing in the airway.
85
What are laryngeal webs?
The result of connective tissue growing between the vocal folds. They can be congenital or acquired as the result of trauma or prolonged infection.
86
What aspects do laryngeal webs form on?
The anterior aspects of the vocal folds and can interfere with breathing causing inspiratory stridor and shortness of breath.
87
How do you get rid of laryngeal webbing?
Must be removed surgically.
88
Webs produce what kind of voice quality?
a high-pitched hoarse voice quality, aphonia, or ocmplete absence of voice depending on the severity of the web
89
What is the most seroius organic disorder?
Laryngeal cancer is the most serious organic disorder of the voice.
90
What laryngeal cancer linked to?
Cigarette smoking
Excessive use of alcohol
91
What are some other risk factors for laryngeal cancer?
- HPV infection
- Poor nutrition
- Age
-Race
-Family
-History
- GERD
92
What is an early sign of cancer that is persistent?
Hoarseness in the absence of colds or allergies
93
What must one do with the larynx when cancer is diagnosed?
You must remove the entire larynx to prevent the spread of the cancer to other parts of the body.
94
What happens to the trachea when the larynx is removed?
It is repositioned to form a stoma (mouthlike opening) on the anterior aspect of the throat for breathing purposes.
95
What is esophageal speech?
It is a way to talk after larynx removal which uses the esophagus as a vibratory source.
You speak in burps as a substitute for actual voice production.
Some cannot produce esophageal speech
96
What is another device that helps with speech after larynx removed?
Electropharynx - battery powered. It has a vibrating diaphrag tha tis placed on the lateral aspects of the neck. The vibration excites the air in the vocal tract and thus serves as an alternate form of voicing.
97
How does TEP work?
Surgery-wise there is the TEP which directs air from the trachea into the esophagus allowing the speaker to use the respiratory air from the trachea into the esophagus, allowing the speaker to use respiratory air and muscle of the esophagus, the cricopharyngeous muscle for voice production.
98
What are neurologic voice disorders?
It is the second major group of organic voice disorders that is caused by damage to the CNS or PNS.
99
What is the CNS comprised of?
The brain and spinal cord and area of the brain such as the primary motor cortex in the frontal lobe control activation of muscles that intiate speech and voice production via connections with PNS
100
What is PNS?
It consists of 12 cranial nerves that activate the muscles responsible for speech and voice after receving signals from the CNS; cranial nerve innervates the muscles of the larynx and is responsible for voice production
101
What can disorders of the CNS or PNS result in?
Characterized by muscle weakness, paralysis discoordination or involuntary movements
102
What do most of these disorders generally dysarthria involve?
Generalized neurological damage resulting in comple pattern of speech and voice symptoms
103
What happens when cranial nerve is damaged?
Unilateral and bilateral vocal fold paralysis result from damage to the 10th cranial nerve or the vagus nerve which controls the laryngeal muslces for phonation, specificallly the recurrent laryngeal nerve of the vagus i the nerve supply for most of the laryngeal muscles associated with voice production
104
What are the voice symptoms for unilateral vocal fold paralysis?
Hoarse and breathy voice quality
Reduced loudness
Monoloudness
Pitch Breaks
Sudden uncontrolled upward or downward changes in pitch
105
Is a paralyzed vocal fold flaccid?
Yep
106
When both recurrent laryngeal nerves are damaged the result is ________ vocal fold paralysis.
Bilateral
107
What happens with the voice when it is bilateral paralyzed vocal fold?
The voice is breathy, weak or totally absent.
108
Why would bilateral vocal fold paralysis be life-threatening?
- Airway blockage results when the folds are paralyzed in the adducted or midline position usually requiring a tracheostomy
109
Does the risk of aspiration during swallowing increase or decrease when the fold are paralyed? In what position?
Increaseds when in the abducted or open position
110
If nerve regeneration and improved function are not observed in how many months? What will happen?
9-12 months
After the injury surgical treatment may be required to facilitate vocal fold closure
111
What can soft tissue fillers such as fat be used for?
It can be injected into a paralyzed vocal fold to build its mass; surgical procedures to move the paralyzed fold into the midline position can be promote vocal fold contact
112
What does voice treatment following surgery aim to increase?
Vocal fold closure and loudness
113
What does Parkinson's disease result form?
From degeneration of dopaminergic neurons in the substantia, interfering with the function of basal ganglia circuitry.
114
what are some other symptoms of Parkinson's Disease?
- Muscle rigidity
- Reduced range of movement
- Tremor at rest
-Overall slowness of movement or hypokinesia are characteristics of parkinsons disease
115
What is the facial appearance of someone with Parkinson's disease?
Unemotional and masklike
116
What are some voice symptoms of Parkinson's diseae?
Reduced loudness, monopitch, monoloudness, hoarseness, harshness and breathiness
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How is it usually treated? Is it serious?
Yes it's serious and is usually treated aggressively with a variety of drugs and in some cases surgical procedures such as deep brain stimulation
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What are some things with neuropharmacological and surgical treatments that have positive effect on limb movements that are not consistently improved?
Speech and voice symptoms
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Intensive voice treatments aimed at what is successful?
Improving speech intelligibility and vocal loudness
120
What is ALS?
It is a neurodegenerative disease caused by damage to multiple areas of the CNS. ALS is a motor neuron disease characterized by degeneration of both the upper and lower motor neurons causing flaccid and spastic weakness and ultimately paralysis.
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ALS Voice Symptoms
Breathiness
Harshness
Strained voice
Reduced loudness
Monoloudness
Inspiratory stridor
Abnormally high or low pitch
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What kind of device can be helpful for people with ALS?
Amplifier
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Is direct voice treatment recommended for ALS?
No because it is degenerative.
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What are some compensatory strategies that ALS use as well?
Gestures or an alphabet board
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What kind of device is eventually needed for someone with ALS?
AAC Device
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What is spasmodic dysphonia?
It is a neurological voice disorder that reflects damage ot basal gangla and cerebella control circuits
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What kind of movements does spasmodic dysphonia involve?
It involves abnormal, involuntary movements of the larynx with adductor-type SO occurring in the majority of cases
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What is the average age onset of spasmodic dysphonia? Does it affect women or men more?
45 to 50 years of age.
It affects women more than men
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What is the neurological origins for SD?
From an abnormal adductor laryngospasm that causes a strained effortful tight voice and intermittent voice stoppages
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What is SD associated with?
A voice tremor that is best heard during prolongation of the /A/ vowel.
131
What is the preferred method of treatment for neurological or idiopathic SD?
Botox injection into specific laryngeal muscles to cause incomplete paralysis
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How do functional voice disorders come about?
Result from misuse, abuse or overuse of the voice or psychological or stress factors without causing physical changes to the larynx muscle tension dysphonia
133
Does surgery for cleft palate help with improving function?
No, just with appearance.
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Cleft palate function improvement requires what?
Speech language treatment
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What is a way to rate VPD?
CPAP
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What is the CPAP?
It is a resistance exercise treatment program. It is an 8-week muscle resistance home-training program designed to strengthen the muscles of the soft palate
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What does CPAP stand for?
Continuous positive airway pressure
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The CPAP device that people use is like what other device?
Obstructive sleep apnea
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What is treatment like with CPAP?
It involves production of 50 unspecified words and 6 sentences while pressure is delivered through the nose
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What happens with the practice time each week for CPAP?
It progressively increases
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What does the CPAP procedure attept to strengthen?
Muscles of the velopharyngeal mechanism by having the velar musculature work against systematic increases of the weight because it would be quite impractical and probably impossible for little weights
142
CPAP uses air pressure in the _______ as a substitute.
Nasal cavity
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What works as the weight that the velopharyngeal works against with a CPAP?
Heightened air pressure in the nasal cavity
144
What are individuals with clefts at a high risk for?
Disordered articulations
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When should direct intervention by an SLP for speech-sound development begin by for cleft palate?
Before the first palatal surgery and as early as 5 to 6 months of age before the onset of babling
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What should the early speech-language intervention focus on?
Increasing the child's consonant inventory especially pressure consonats and on increasing airflow
147
What is it useful to teach for cleft palates?
The difference between nasal and oral sound, as well as how to direct the air stream through the mouth
148
what is EPG - Electropalatography?
This technique uses an artifical palatal palte containing electrodes that are connected to the computer.
149
Where is the palatal plate fitted?
