Voice Disorders Related to Phono-Trauma

Question 1

phono-trauma

Answer 1

any vocal behavior that can have a traumatic effect on the vfs

Question 2

2 ___ types

Answer 2

1. edema
2. hemotoma

Question 3

edema

Answer 3

acumulation of fluid in the vfs

Question 4

hemotoma

Answer 4

localized swelling caused by a ruptured blood vessel

Question 5

phono-trauma encompasses both

Answer 5

vocal abuse and vocal misuse

Question 6

difference between vocal misuses and vocal abuses

Answer 6

• all forms of vocal misuse could be considered vocal abuse
• but not all vocal abuses are vocal misues

Question 7

some __ __ phono-trauma, but others ___ __ phono-trauma

Answer 7

come from, result int

Question 8

etiology of phono-trauma

Answer 8

• have a predictable cycle
• first stage of reaction to phono-trauma is edema
• threshold can be crossed

Question 9

first stage of reaction to phono-trauma is edema

Answer 9

• accumulation of the fluid in the vfs
• they get irrated and swell up
• spontaneous healing kicks in and the vfs are fine if given the opportunity

Question 10

threshold can be crossed

Answer 10

• once crossed, spontaneous healing can no longer occur
• pushed where it can come back, or enough damaged occurred that can’t heal (lasting changes in vfs)
• voice can either remain stable or get worse

Question 11

phono-traumatic behaviors

Answer 11

• in some way connected to vocal hyperfunction
• normal to increased loudness and pitch as well as straining

Question 12

laryngeal saccules: people wit head and neck cancer frequently have issues with vfs

Answer 12

• typically due to radiation
• salivary glands and laryngeal saccules can get fried out
• most likely will have voice changes

Question 13

each person’s point at which spontaneous healing is no longer possible is…

Answer 13

different, but everyone reaches it at some point

Question 14

type of voice: if going with the anatomy, it is…

Answer 14

hypofunction

Question 15

type of voice: if compensating for the anatomy, it is…

Answer 15

hyperfunction

Question 16

therapy regimen, multi-pronged plan

Answer 16

• prongs are the establishment of good vocal hygiene
• as needed, a program of direct vocal intervention
• establishment of a program of vocal rest

Question 17

prongs are the establishment of good vocal hygiene

Answer 17

• having the patient target elimination in the reduction of the abuses and misuses that they use
• has to be specific to the individual
• target these behaviorally using programs of vocal abuse/misuse production

Question 18

as needed, a program of direct vocal intervention

Answer 18

teach the patient to use strategies that promote a less effortful, more healthy/hygenic form of phonation

Question 19

establishment of a program of vocal rest

Answer 19

• not always needed
  1. complete vocal rest
  2. modified vocal rest

Question 20

in other instances, not treatment of choice

Answer 20

may require medical interveniton or surgery

Question 21

you are on a team

Answer 21

• always requires a medical doctor because they call the shots
• SLP cannot provide treatment until/unless the doctor sees the patient and tells us to complete treatment

Question 22

2 steps with the team

Answer 22

1. doctor diagnosis of the status and changes of anatomy to the vfs
2. treatment

Question 23

SLP’s role is to…

Answer 23

evaluate and treat the voice

Question 24

who is the ideal professional for patient to see?

Answer 24

otolaryngologist with experience in voice disorders (ENT)

Question 25

can a patient be recommended from any doctor?

Answer 25

yes, as long as they have looked at the patient's vfs

Question 26

treatment types

Answer 26

1. therapy only 2. therapy -> medical 3. medical -> therapy 4. therapy -> medical -> therapy 5. medical only

Question 27

therapy -> medical

Answer 27

- SLP sets the stage to reduce the size of the lesion if possible - then SLP teaches the patient what they need to know so that after the surgery, the lesion doesn't return

Question 28

medical -> therapy

Answer 28

- surgeon decides to complete surgery - then SLP teaches techniques to prevent recurrence

Question 29

therapy -> medical -> therapy

Answer 29

- therapy first to reduce size of lesion - then, lesion is removed by doctor - then SLP retrains to prevent recurrence

Question 30

medical treatment only

Answer 30

very rare, old style

Question 31

advantages of voice therapy over surgery

Answer 31

- there is less time loss from work (vocally demanding jobs especially) - can be an effective non-traumatic treatment option - more cost effective (depends on insurance)

Question 32

disadvantage of surgery over therapy

Answer 32

nonremoval of the behavior that caused the lesion or cause of lesion to reoccur

Question 33

vocal misuse defined

Answer 33

the incorrect use of pitch, tone, focus, quality, volume, breath support, and/or rate that distorts the normal propensity of the phonatory mechanism to work effectively and efficiently

Question 34

tone focus

Answer 34

use of the entire resonatory tract

Question 35

problems with tone focus

Answer 35

only using the voice at the level of the throat/larynx

Question 36

vocal misuse is directly related to voice production

Answer 36

screaming, whispering, loquaciousness (talking all the time/excessively), talking in a strained manner, etc.

Question 37

vocal abuse defined

Answer 37

mistreatment of the laryngeal or voice producing mechanism

Question 38

examples of vocal abuse

Answer 38

smoking, drinking/eating excessive dairy products, constant throat clearing, yelling, singing inappropriately, eating spicy foods, etc.

Question 39

treat each patient individually

Answer 39

- plan accordingly - what might be detrimental to one person may not be for another person - physically and psychologically different - also not blanket for the individual