voice disorders

Question 1

What is a Hyperfunctional client?

Answer 1

muscle tension dysphonia, pressed voice, lesion

Question 2

What is a hypofunctional client?

Answer 2

bretahy

Question 3

Classifications of Voice Disorders

Answer 3

• Phonotrauma
• Organic
• Functional
• Psychogenic
• Neurological

Question 4

Phonotrauma definition

Answer 4

results from misuse or abuse of the vocal mechanism

Question 5

Organic definition

Answer 5

results from a disease process or may be congenital, i.e., cancer, acid reflux, laryngeal web etc.

Question 6

Functional definition

Answer 6

Muscle tensions dysphonias

Question 7

Psychogenic definition

Answer 7

results from an underlying psychological issue and presents no identifiable vocal pathology

Question 8

Neurological definition

Answer 8

results from damage to the RLN or SLN, disease processes that affect these nerves, or brain injuries or lesions

Question 9

Leukoplakia and Hyperkeratosis

Pre-cancerous lesions

Answer 9

• range from flat plaque-like whitish patches (leukoplakia) to warty lesions (keratosis).
• Increases VF mass and stiffness, decreases mucosal wave and amplitude, irregular glottic closure, aperiodicity ,
• VFs are asymmetric

Question 10

Sulcus vocalis

Answer 10

• A longitudinal groove or indentation in the upper edge of the VFs that parallels the free margins
• may be caused by phootrauma, smoking, congenital

Question 11

Laryngeal Cancer

Answer 11

• Globus sensation – ‘full feeling’ in throat
• May observe inhalatory stridor
• Throat pain, painful swallowing, problems swallowing, shortness of breath, halitosis

Question 12

Three categories of phonatory dysfunction:

Answer 12

Adduction / Abduction problems

Stability problems

Coordination problems

Question 13

Stability phonatory dysfunction

Answer 13

Parkinson’s, ALS

Essential Tremor

Question 14

Coordination phonatory dysfunctio

Answer 14

Abductor Spasmodic Dysphonia

Question 15

Adduction / Abduction problems

Answer 15

Vocal Fold Paralysis
Vocal Fold Paresis
SLN Paralysis
Pseudobulbarpalsy
Adductor Spasmodic Dysphonia
Huntington’s Chorea

Question 16

Paralysis in the adducted position causes

Answer 16

• Strained/strangled, monotone, low pitched, low volume voice w/ possible hypernasality
• Respiratory compromise due to decreased airway and stridor may be heard

Question 17

Paralysis in the abducted position causes

Answer 17

• Aphonia.

* Lack of airway protection for swallowing

Question 18

Management of Bilateral VF Paralysis

Abductor paralysis

Answer 18

1. If airway is acceptable, wait and see if nerves spontaneously recover
2. Cordectomy, Arytenoidectomy or VF lateralization

Question 19

Causes of Bilateral VF Paralysis

Abductor paralysis

Answer 19

PCA is paralyzed

VFs in medial or paramedian position

Question 20

Causes of bilateral Adductor paralysis

Answer 20

TA, LCA & IA are paralyzed

-VFs in abducted position

Question 21

Management of Bilateral VF Paralysis

Answer 21

1. Tracheostomy for safe swallow

2. AC medial rotation

Question 22

Unilateral VF Paralysis Causes:

Answer 22

• Unilateral RLN injury
• idiopathic
• tumor, trauma, etc

Question 23

SLN paralysis:

Effect on phonation:

Answer 23

inability to raise pitch
decreased pitch range
decreased VF closure

Question 24

SLN Perceptuall charactersitics

Answer 24

decreased habitual pitch
breathiness
decreased pitch and intensity ranges

Question 25

Vocal Fold Paresis causes....

Answer 25

inadequate VF closure

Question 26

Signs of Presbyphonia or Presbylaryngis

Answer 26

- decreased innervation - muscle atrophy = hypotonicity - stiffer, thinner mucosa in males - thicker, edematous mucosa in females - ossification of cartilages - loss of collagen & elastin fibers - submucus glands atrophy

Question 27

Cause of Presbyphonia or Presbylaryngis

Answer 27

aging

Question 28

Spasmodic Dysphonia: causes

Answer 28

CNS lesion – possibly basal ganglia and supplementary motor areas

Question 29

Spasmodic Dysphonia Effects on phonation

Answer 29

Irregular, uncontrollable muscle movements disrupt VF vibration

Question 30

Spasmodic Dysphonia Types

Answer 30

Adductor Abductor Mixed

Question 31

In adductor SD, what happens?

Answer 31

- VF adductors spasm periodically causing undesired hyperadduction. - Result is harsh, strained, strangled sound with obvious effort. - Most common.

Question 32

In abductor SD, what happens?

Answer 32

VF abductor spasms and abduct causing a breathy, hoarse, weak voice, decreased loudness is a problem

Question 33

Treatment of SD

Answer 33

Botox

Question 34

Essential Tremor causes

Answer 34

CNS lesion, likely extrapyramidal system

Question 35

Essential tremor is __________ in sustained phonation but___________ in speech

Answer 35

always present can also be present

Question 36

Perceptual characteristics of Essential tremor

Answer 36

Tremor, frequency & intensity modulations Voice stoppages Strain – struggle Harshness, monopitch

Question 37

Treatment of essential tremor

Answer 37

- Voice therapy – Barkmeier-Kramer approach - Remediate muscle tension if present - Breath support - Pharmacological

Question 38

Differential Diagnosis of DS and vocal temror and MTD.

Answer 38

1. Laryngeal palpation 2. Laryngeal massage and teach supraglottic relaxation exs. - --If MTD, voice will improve significantly - --If tremor, tension / strain-strangle quality will decrease and only tremor will be present - ---If SD, very little change will be observed.

Question 39

In differentiating between MTD and SD, MD is __________, SD is ______.

Answer 39

consistent not.

Question 40

Cause of Pseudobulbar Palsy

Answer 40

Bilateral lesions in corticobulbar tract at level of internal capsule, midbrain or pons.

Question 41

Effects of Pseudobulbar Palsy on phonation

Answer 41

- Laryngeal muscle weakness causing incomplete VF closure | - Laryngeal hyperactivity causing hyperadduction

Question 42

Treatment for Psedubulbar Palsy

Answer 42

- easy onset phonation | - flow phonation, aspirated onsets, frontal tone focus, -adequate breath support.

Question 43

Perceptual Characteristics of Pseudobulbar Palsy

Answer 43

- Breathiness - Strain / struggle - Harshness - Monopitch - Monoloudness

Question 44

Amyotrophic Lateral Sclerosis – ALS voice problems

Answer 44

hoarseness, harshness, strain/struggle, hypernasal, breathy

Question 45

Lesions to Basal Ganglia or other parts of extrapyramidal system:

Answer 45

Hyperkinesias | Hypokinesia