Test 2 Flashcards
(129 cards)
1
Q
What causes functional voice disorders?
A
Incorrect use of some aspect of the phonatory system
2
Q
What are the two types of functional voice disorders?
A
Muscle tension dysphonia-related to misusing the vocal mechanisms, producing a hypertension type of dysphonia
Psychogenic-result from emotional trauma or conflict that manifests itself in voice (aka conversion aphonia)
3
Q
Besides functional voice disorders, what are the other two kinds of voice disorders?
A
Organic-due to physiological abnormality in structure of function at various sites along the vocal tract
Neurological-due to problems with muscle control and innervation of the muscles of respiration, phonation,and resonance which may be impaired from birth or secondary to injury or disease of the peripheral or central nervous system
4
Q
What are types of functional voice disorders that are primarily muscle tension in cause?
A
contact ulcers (granulomas) muscle tension dysphonia reinke's edema traumatic laryngitis ventricular dysphonia vocal fold thickening vocal nodules vocal polyps
5
Q
What are types of functional voice disorders that have a psychogenic cause?
A
conversion aphonia (aka psychogenic aphonia) Functional dysphonia mutational falsetto paradoxical movement
6
Q
Describe Muscle Tension Dysphonia
A
functional voice disorder
hypertension
excessive use of muscles to phonate
most common voice disorder in adults and children
no organic pathologies
two types (primary and secondary–primary can lead to secondary)
7
Q
What is primary muscle tension dysphonia?
A
client has discomfort and hoarseness, but laryngeal structures are normal; increased tension, but no structural changes
8
Q
What is secondary muscle tension dysphonia?
A
with continued misuse, secondary tissue malformations may occur (e.g., vocal fold swlling (edema), vf thickening, polyps, nodules)
9
Q
What is ventricular dysphonia?
A
Dysphonia related to use of false folds aka false fold phonation
False folds interfere during phonation (either caused by approximation/vibration of false folds OR by abnormal vibration of true folds due to false folds riding on the true folds
Usually associated with severe muscle tension
10
Q
What are vocal nodules?
A
Fall under classification of secondary MTD
often result of continuous abuse of larynx and misuse of voice
typically bilateral, whiteish bulges; often occur at ant 1/3 and post 2/3 (place of greatest friction)
can progress to like a callous
11
Q
Describe vocal polyps
A
Fall under classification secondary MTD
more like a blister; usually unilateral; usually occurs from single vocal event
You can have nodules already and then develop polyps
12
Q
What is Reinke’s edema
A
Falls under secondary MTD
buildup of fluid under vf cover in Reinke’s space; strongly associated with smoking
13
Q
What is traumatic laryngitis
A
Falls under secondary MTD
“morning after voice”
vf swells as result of excessive or strained voice usage; can be related to chronic cough/habitual throat clearing/forceful singing
14
Q
what is vocal fold thickening
A
falls under secondary MTD
thickening of vf related to muscle tension
15
Q
What are voice characteristics associated with excessive tension?
A
falsetto
diplophonia
phonation breaks
16
Q
what is falsetto?
A
Tension exceeds that of normal stretching of vf
Posterior f are so tight that there is little vibration which results in higher pictch
You can have falsetto with primary or secondaray MTD
17
Q
What is diplophonia?
A
“double voice”
You have 2 distinct frequencies occurring simultaneously; typically when true and false folds vibrate at the same time; both true and false folds are approximating at the same tie
Can be related to functional or organic vf disorders
18
Q
What are phonation breaks?
A
temporary loss of voice; can be part of a word, whole word, phrase, or sentence
Usually related to increased muscle tension
19
Q
What is the difference between dysphonia and aphonia?
A
Dysphonia= person can phonate but it’s disordered in some way
Aphonia= complete lack of phonation
20
Q
What is functional dysphonia?
A
Falls under functional voice disorder with psychogenic cause
perceptural abnormality in the voice, but NO structural changes
21
Q
What is conversion aphonia (aka psychogenic aphonia)?
A
Functional with psychogenic cause
Nothing wrong with the person from a medical perspective but they are presenting symptoms sometimes
Only using a pure whisper; inadequate approximation of the folds, but no reason why that should be happening
Sometimes we see if they can cough (bc then we see if physically they CAN adduct vf)
22
Q
What is mutational falsetto?
A
functional with psychogenic cause
inappropriate use of high pitch voice (falsetto) beyond puberty in males
23
Q
What is paradoxical vf movement?
A
Functional with psychogenic cause
Client is trying to adduct during inspiration
Can cause wheezing souds, difficulty maintaining regular breath pattern
3 subtypes associated with asthma, exercise, and psychological stress
most tx is related to breathing
24
Q
What are voice problems with an organic cause?
A
sulcus vocalis contact ulcer cancer leukoplakia endocrine change hypothyroidism granuloma hemangioma hyperkeratosis infectious laryngitis larngectomy papilloma pubertal changes webbing
25
What is an organic voice disorder?
results from physiological abnormality in structure of function at various sites along the vocal tract
26
What is sulcus vocalis?
organic voice disorder (OVD)
Congenital or acquired; person has long, oval shaped glottal opening during adduction OR has long line running longitudinally to glottis
Vocal qual is breathy
27
What is a contact ulcer?
Can be either functional (from hard glottal attacks, habitual coughing, hypertension, excessive use) or organic (usually associated with GERD)
28
How is cancer a VD?
OVD
Cancer in vocal tract causes voice changes (e.g. tumor on vf; laryngeal cancer, either subglottal, glottal, or superglottal)
29
What is leukoplakia?
OVD
White colored patches that are lesions to the surface of mucosal tissue (benign); but they are pre-cancerous lesions, so should be monitored closely
Perceptually, voice is normal
30
Endocrine changes as a voice disorder
OVD
Glands that produce hormones (e.g., pituatary); too much or too little can impact ones fundamental frequency of pitch
31
Hypothyroidism--what is it?
OVD
insufficient thyroxin by the thyroid gland
Can increase mass of vf over time, which could lower pitch
32
What is a granuloma?
OVD
When you have contact ulcer and tissue grows over it; usually related to GERD, but also can be related to hyperfunction
33
What is a hemangioma?
OVD
similar to contact ulcer or granuloma, but it is soft, blood-filled sac; relatively rare; can be either functional or organic in etiology; can be related to GERD or prolonged intubation
34
What is hyperkeratosis?
OVD
lesion related to conntinued tissue irritation; may be pinkish; could also be related to GERD; ex) girl got this from second hand smoke from parents
35
what is infectious laryngitis?
OVD
Viral, usually associated with upper respiratory infection and usually associated with edema (aka swelling)
36
What is a laryngectomy?
it is the removal of the voice box (larynx)
Often used to treat head and neck cancer (one of the surgical interventions)
37
What is a papilloma?
OVD
wart like growth; viral
Predominantly by dark, moist areas of airway; can be seen in kids or adults
ex) HPV
38
What are pubertal changes?
OVD
any changes with puberty associated with stormy mutation period would be organic in nature (BUT mutational falsetto is functional in nature)
39
What is webbing?
OVD
Can be congenital or acquired; acquired is typicaclly bc of other tracheal/laryngeal surgery
Growth across the glottis bt the 2 folds; makes pitch higher
40
What are examples of neurogenic voice disorders (NVD)?
essential tremor
spastic dysphonia
vocal fold paralysis
dysarthria secondary to....amyotophic lateral sclerosis, myastenia gravis, multiple sclerosis, huntington's disease, parkinson's disease
41
What is spastic dysphonia?
NVD
result from laryngeal dystonia (neurological dysfunction of motor movements); voice sounds strained; can have either adductor or abductor spasmodic dysphonia; can think of it as a spasm
42
What is essential tremor?
NVD
strongly connected with hyperkinetic dysarthria; can have essential tremor in body parts but also in voice; commonly seen in Parkinson's disease; repetitive, consistent tremor
43
what is vocal fold paralysis?
NVD
complete loss of nerve input to a muscle, which results in loss of muscle function
can be caused by damage to CN #10, stroke, trauma, and any damage to brain stem (especially medulla bc hthat's where CN# 10 rests)
can be bilateral or unilateral
44
What is vocal fold pareisis?
NVD
partial loss of nerve input to a muscle, which would result in muscle weakness
can be caused by damage to CN #10, stroke, trauma, and any damage to brain stem (especially medulla bc hthat's where CN# 10 rests)
can be bilateral or unilateral
45
What is dysarthria?
motor speech disorder that can affect respiration, phonation, resonance, and/or articulation
type of dysarthria is related to site of lesion
46
What are disorders related to dysarthria?
```
Amyotrophic lateral sclerosis (ALS)
Myasthenia gravis
multiple sclerosis
Huntington's disease
Parksinson's
```
47
What is ALS?
Related to dysarthria
neurological disease that affects how nerves fire
example: bulbar (brainstem) ALS typically results in severe dysarthria
48
What is myasthenia gravis?
related to dysarthria
wekaness associated with rapid fatigue (any muscle under voluntary control); as length of task increases, voice gets more and more weak; weakness goes on and off
49
What is multiple sclerosis?
Related to dysarthria
chronic, evolving/progressive disease invovling damage to the sheath of nerve cells in the brain and spinal cord
symptoms: numbness, reduced muscle coordinnation; can affect speech and can be associated with severe fatigue
50
What is hungtington's disease?
Related to dysarthria
inherited, degenerative neurological disease; may star off with mild prosody (intonation) changes; can progress to sudden, jerky voice changes
51
What is parkinson's?
Related to dysarthria
Progressive disorder of the nervous system that affects movement; usually associated with hypokinetic dysarthria; significantly reduced vocal intensity; usually reduced awareness that they are speaking softly
52
Why do we classify by etiology?
If we understand the source of the voice disorder, helps us know how to go aboout tx
53
What are the classifications of voice disorders?
```
1. Functional
A. Muscle Tension
i. Primary
ii. Secondary
B. Psychogenic
```
2. Organic
3. Neurogenic
54
How do we classify by perceptual problems?
Pitch
Intensity
Quality
55
What is usually the cause of pitch changes?
Change in mass of the vocal folds
Higher: longer, thinner, and more tense
Lower: thicker, shorter, less tense
56
What is evidence of a pitch problem?
Modal frequency is too high or low
Narrow range (lack of inflection)
Excessive pitch breaks (caused by too much tension)
```
Pitch appropriate to the situation
Too high (puberphonia, mutational falsetto, webbing)
Too low (hypothyroidism)
```
57
Moore's criteria for pitch problem
higher than most voices of same age, gender, and culture
lower than most voice of same age, gender, and culture
voices that do not vary in the customary way
58
Intensity voice problems are defined as...?
voice is too loud or soft for demands of the situation
59
What personality is typically associated with loud and soft voices?
Loud-aggressive, egotistical, and assertive
| Soft-quiet, shy, withdrawn, insecure
60
What should you always check for when there are concerns with intensity?
Hearing loss!
61
What is a phonation break?
spontaneous loss in voice, due to spontaneous abduction
62
what is a pitch break?
sudden shift in fundamental freq, sudden change in pitch upward or downward
63
What are quality disorders?
Disturbances in laryngeal tone usually associated with sound generated at the level of the vf
64
Vocal quality depends on what?
Condition of the vibratory source
65
What does the condition of the vibratory source depend on?
Normmal structure
Normal physiology
Emotional state does not affet quality
Good vocal habits
66
What are phonatory based voice disorders?
Harsh (rough, unmusical sound due to excessive laryngeal tension; think of hard glottal attack and aggressive initiation of phonation)
Hoarse (rough, unmusical quality with diplophonia or voice breaks; combination of breathy characteristics and harshnness)
67
What are resonance disorders?
Strident (resonance problem which occurs in the pharynx; tight, hard sound; not due to structure, de to use; associated with TYPE A personality)
Thinness (small, childish voice cause by tension in the oral cavity; more noticeable in men than in women; usually results from forward tongue posture; ex) Michael Jackson)
68
What is breathiness?
folds do not have adequate closure, air escapes during phonation; could be functional in nature and may be related to neurological disease; seen a lot with unilateral vf paralysis/pareisis
69
What is dysphonia?
any alteration in normal phonation
70
What is aphonia?
Complete loss of voice
71
What is hypernasality?
Excessive nasality; related to velopharyngeal insufficiency; seen a lot with cleft palate
72
What is hyponasality?
nasal cavities are congested and there is a reduction in the nasal resonance; sound like this when sick
73
What is cul-de-sac?
pharyngeal focus of voice due to posterior tongue carriage "hollow sounding"; sounds like muffled voice, low in volume, sound is absorbed in a cavity (typically the pharynx) almost like a sponge
74
what does a thorough voice eval include?
Medical examination by ENT
Case history
Observation of the client
testing/evaluation of the client
75
What will laryngologist assess during medical exam?
```
Vf (color, position, shape, movement)
ventricular folds
laryngeal ventricle
pharynx
tonsils/adenoids
oral cavity
nasal cavities
velopharyngeal mechanism, congenital palatal insufficiecy
glands and muscles of tehe neck
```
76
Who provides diagnosis of the laryngeal pathology?
otolaryngologist
77
Who provides voice diagnosis?
SLP
78
What do you ask client when getting case history?
1. Description of problem and causal factors
2. Onset and duration of the problem
3. Variability of the problem
4. Description of vocal use
5. Other information (previous tx and attitude toward it; family history; health history; use of tobacco or caffeine; use of medication; Sicca Syndrome--dryness of exocrine glands...can irritate the larynx, can cause throat clearing/coughing)
6. Observe client's social history, motivation, and general mental status
79
When you get a description of problem, who do you ask? What information do you get in addition to the description?
Ask client and other people involved in the client's life such as spouse, parents, and teachers; also get information about the patient's attitude toward the problem and his/her motivation to change
80
What do you find out about the onset and duration of the problem?
1. How long has problem been going on?
| 2. What was the onset like? Sudden (a few minutes or hours)? Gradual?
81
What might a sudden onset indicate?
1. Onset with emotional or traumatic event
2. Vocal trauma
3. Functional aphonia/dysphonia
4. Changes associated with stroke (sudden neurological change)
82
What might a gradual onset indicate?
1. Slow developing mass/lesion
2. Degenerative neurological disease
3. Ongoing vocal abuse
83
What voice disorders are aggravated by fatigue and stress?
ALL of them!!!!!
84
What would variability of problem look like for person with hyperfunction? What about for person with voice problem due to allergies/post nasal drip?
Hyperfunction: better voice earlier in day, which deteriorates as vocal use continues
Allergies/Post-Nasal Drip: voice improves as day progresses
85
True or False: Case history also includes observations in different settings to observe for vocal abuse.
True; You want to observe at playground, school, office, theater, home, choir, etc. to monitor for vocal abuse
86
What is xerostonia?
Dryness of mouth
87
What do allergies have to do with voice disorders?
Can cause swelling of mucosa; 25% of children with dysphonia have family history of allergies
88
What do medications have to do with voice disorders?
1. Antihistamines: dry out nasal passage and vocal folds
2. Expecterants: thin secretions
3. Psychotopic: can cause some dryness
89
What are you looking for in oral peripheral examinationn?
1. Any indication of neural impairment/asymmetry
2. Any neck tension-strap muscles visible
3. Any mandibular restriction
4. Unusual movements of the larynx
90
What are you looking for in respiration testing?
1. Lung volume
2. Airflow pressure
3. Airflow rate
4. Measure of motions of the torso (different types of breathing patterns)
91
What is the name of the capacity we are measuring when evaluating lung volume? What do we measure lung volume with?
Vital capacity (maximum amount of air that can be expelled from the lungs following a maximum inspiration); We measure with a wet (large container filled with water; type used for research) or dry spirometer (looking at how much air we can blow in the spirometer)
92
If person's vital capacity is below norms, are we concerned?
Not necessarily. Do a perceptual judgment. Do they have enough lung volume to have normal phrasing for speech? If so, don't worry about this.
93
What is airflow pressure related to? Where do we measure it at? How do we measure it? Why is it important?
1. Related to intensity
2. We measure it at the mouth bc we cannot measure it at the larynx
3. We measure it with pressure gauges or with a manometer.
4. It is important for measuring velopharyngeal adequacy.
94
How do we perceptually measure airflow pressure?
Can patient produce normal loudness? Can they vary loudness? Can they vary loudness based on the situation?
95
What is airflow rate related to? What does airflow rate measure? Changes in quality bc of airflow rate may be related to what kind of voice disorder?
1. Related to quality
2. Measures the volume of air passed through the glottis during a fixed period of time
3. Abnormal rate may be due to functional, organic (nodules, growth), or neurogenic (paralyzed vf) voice disorder
96
What is normal airflow rate? What does a greater air flow indicate? What does a lower air flow indicate?
1. Normal is 100 cc of air/second flow through the glottis in the production of a vowel
2. Greater air flow=more air escaping (breathy voice); could be due to polyps, nodules, tumors, or paralyzed vf
3. Less air flow=excessive closure; could be due to spastic dysphonia (would cause strained voice; we would work on relaxation in therapy
97
True or false: Instruments used for measuring air flow typically aren't available to clinicians.
True
98
What does maximum phonation time measure?
The ability to maintain a steady phonation sufficient for communication; there is a lot of variability in this measure...it is better used as a baseline for future comparison
Example: Take a deep breath and say /a/ for as long as possible
99
What does the s/z ratio measure? What does /s/ measure? What does /z/ measure?
S/Z measure is a screening measure for how long a patient can sustain a prolonged /s/ phoneme as compared to a /z/.
/s/ is a measure of expiratory control.
/z/ is a measure of phonatory expiratory control.
Typically ration is about 1. If over 1.2, could be indicative of a pathology (like growth on vf).
100
What are the types of breathing?
Clavicular
Thoracic
Diaphragmatic-abdominal
101
Tell 3 things about clavicular breathing:
1. Most inefficient type of breathing
2. Easiest to ID bc shoulders are elevated
3. Shoulders are elevated on inhalation, neck accessory muscles as the primary muscles of inhalation
4. Unsatisfactory because when only the upper end of the lungs are expanded, they do not independently provide adequate respiration
5. Unsatisfactory because the strain in using the neck accessory muscles in counter-productive in trying to achieve greater relaxation in the upper thoracic area
102
What is the preferred method of respiration?
Diaphragmatic-abdominal breathing
103
What three things do we need to determine when doing a pitch evaluation?
1. Frequency range
2. Best pitch
3. Habitual pitch
104
What is frequency range?
Range of lowest to highest pitch
105
What is best pitch?
Easiest and most compatible pitch; the frequency that is slightly louder and clearer in quality
106
What is habitual pitch?
Most frequently occurring or modal pitch level used by the patient
107
Diagnostically, what do pitch measurements tell us?
Some vf pathologies cause changes in the pitch bc of increased weight and mass of the vf.
Some functional pitch problems may be the result of the person trying to sound more authoritative and adopting a lower pitch.
Higher pitch is usually indicative of tension and difficulty in relaxation of the laryngeal area.
If pitch variation is impossible, vf paralysis, virilizing drugs or glandular-metabolic conditions are suspected
108
What does high intensity tell us?
usually related to hyperfunction; assertive personalities also are likely to speak loudly
109
What does low intensity tell us?
May be due to vf paralysis; feelings of inadequacy, inferiority, or poor self-esteem; cultural attitudes that require it
110
What is there is lack in intensity variation?
May be indicative of depression, deafness, or neurological disorders.
111
How do we evaluate intensity?
1. Begin with assessment of hearing.
| 2 Use sound level meter to measure intensity.
112
Evaluate intensity in different situations/environments:
1. During differing levels of physical activity
2. During differing levels of background noise
3. In a large room
4. Standing close to the speaker and moving 10-15 feet away
[Does person adapt voice?]
113
What is breathiness?
The periodicity of the voice is reduced and aperiodicity, or noise, is increased.
114
What is harshness?
Often described as rough, unmusical, unpleasant, hard glottal attacks. Appears to have increased aperiodicity, a reduction in fundamental frequency and abrupt glottal attacks.
115
What is hoarseness?
A combination of breathiness and harshness (typical voice of someone with laryngitis).
116
What is glottal fry?
Slight hoarseness/harshness at the lower end of the pitch range. Often heard when inhalation is about to be restored.
117
What are pitch breaks?
Usually occur in voice that is too low or too high. As the person is talking, the pitch suddenly breaks upward or downward, often one octave above or below the pitch level the person was using.
118
What are phonation breaks?
Temporary losses of voice in part words, words, phrases, sentences. It is spontaneous abduction due to vocal fatigue, tension, or muscle spasm.
119
What voice qualities does the CAPE-V assess?
1. Overall severity
2. Roughness
3. Breathiness
4. Strain
5. Pitch
6. Loudness
120
True or false: The CAPE-V is a perceptual measurement.
True
121
What is CAPE-V good for?
Use for baseline to show growth (or lack of) after an intervention. Should be the same person giving at the beginning and at the end.
122
What are the three tasks that the CAPE-V does?
1. Sustained vowels
2. Sentences
3. Running speech
123
How do you score it?
Tick line for each task on each of the six lines that are 100 mm long. Then you physically measure the distance, in mm, to the tick mark to get the number score (0-100)
124
what else does the CAPE-V allow you to do?
Comment on resonance and additional features (e.g., asthenia)
125
What is the Voice Handicap Index (VHI)?
1. Commonly used Quality of Life instruments
| 2. Measure of patient's perception of their voice disorder
126
Who fills out the VHI?
The patient; it is a self-rating
127
What categories of impact does the VHI measure?
Functional: ipact of one's voice disorder on daily activities
Emotional: probes affective (e.g., feeling) responses in relation to one's voice disorder
Physical: self-perceptions of voice output characteristics (i.e., effort to speak, reduced breath support, vocal strain)
128
How do you score VHI:
Score each response 0-4
Calculate sum of entire VHI and each subscale
Compare patient's values to published norms
129
How can you use the VHI?
As a pre- and post- treatment quality of life outcome measure
