Voice Tx

Question 1

Puberphonia/FD

Answer 1

Voice therapy- holding larynx-should be at mid 100’s

Laryngeal manipulation
Circumlaryngeal massage
Laryngeal relaxation-laryngeal sigh
Neck stretches
Pitch control- Visipitch (videogames for loudness pitch) & vocal function exercises.

symptoms?

Question 2

Functional Aphonia/FD

Answer 2

Voice therapy

Breathing
Laryngeal manipulation
Circumlaryngeal massage
Laryngeal relaxation/yawn-sigh voice = laryngeal sigh
Neck stretches

symptoms?

Question 3

Functional Dysphonia-Muscle tension dysphonia/FD

Answer 3

Voice therapy- same as functional aphonia

Breathing
Laryngeal manipulation
Circumlaryngeal massage
Laryngeal relaxation/yawn-sigh voice (this is especially useful for MTD)
Neck stretches

symptoms?

Question 4

Paradoxical VF/FD

Answer 4

Paradoxical VF- the vf adduct on inspiration-
Respiratory training- “rescue breathing
Inhale/exhale through a straw
Deep nasal sniff with /f/ on exhalation

Laryngopharyngeal reflux management
Voice therapy: breathing patterning, laryngeal relaxation/yawn-sigh voice

symptoms?

Question 5

Vocal fold nodules/OD

Answer 5

Voice tx is the same for Vocal fold nodules/Polyp & Cyst

Modified voice rest
Low impact voice

Voice therapy:
Laryngeal relaxation/laryngeal sigh
Resonant voice therapy
Vocal function exercises

symptoms: hourglass closure, strong personality & hearing loss

Question 6

Polyp/OD

Answer 6

Modified voice rest
Low impact voice

Voice therapy:
Laryngeal relaxation/laryngeal sigh
Resonant voice therapy
Vocal function exercises
SURGICAL REMOVAL- SOMETIMES THEY DONT RESPOND TO VOICE THERAPY

symptoms: edema, voice variability, breathing problems depending on size.

Question 7

Cyst/OD

Answer 7

Modified voice rest
Low impact voice

Voice therapy:
Laryngeal relaxation/laryngeal sigh
Resonant voice therapy
Vocal function exercises
SURGICAL REMOVAL- TRY VOICE THERAPY FIRST

Symptoms: increase vocal effort, vocal fatigue, edema.

Question 8

Papilloma/OD

Answer 8

Laser surgery w/Mitomycin C (if at anterior commissure)

symptoms: globus sensation, breathing problems & scarring (recurrent)-caused by HPV.

Question 9

Granuloma/ contact ulcer OD

Answer 9

Benign polyp on vocal process- don’t forget to add vocal process!
symptoms: heartburn/indigestion (reflux type), breathing problems, excessive throat clearing.

Proton pump inhibitor 6+ months
Reflux diet: soda, tomatoes, citrus, spicy food
Hydration
Modified voice rest
Low impact voice

Question 10

Sulcus Vocalis OD

Answer 10

No behavior therapy because not misuse abuse

Higher pitch voice or may have no voice problems

Question 11

Congenital- Surgery

Answer 11

Laryngomalacia- cartilage fails to stiffen
Subglottal stenosis- narrow sub glottal space
Esophageal atresia- occlusion of the esophagus
Tracheoesophageal fistula- openings b/t trachea and esophagus.

Question 12

Web/OD

Answer 12

99% of webs are anterior commissure webs
Surgery w/Mitomycin C

May have no voice or breathing problems

Question 13

Hemorrhage/OD

Answer 13

erythema(VF redness), VF edema & Varix (Varices)

MODIFIED VOICE REST
HYDRATION
Reflux diet- no caffeine, no alcohol or smoking
Steroids

Voice therapy: laryngeal relaxation/ yawn sign & Resonant voice therapy.

Question 14

Laryngitis/OD

Answer 14

Soar throat, cough & fever

MODIFIED VOICE REST- just shut up!
HYDRATION
Medications- Proton pump inhibitor, antibiotics, allergy, steroids.

Question 15

Reinke’s edema/OD

Answer 15

low pitch, vocal fold edema, impaired breathing

Surgery ( if occluding airway)
Smoking cessation
HYDRATION
REFLUX DIET same as hemorrhage 
Proton pump inhibitor

Question 16

Leukoplakia/OD

Answer 16

decreased vocal fold vibration, edema & low pitch

Biopsy
Smoking cessation
HYDRATION
REFLUX DIET

Question 17

Candida/Fungus-OD

Answer 17

Anti-fungal meds & Hydration

Candida might look like leukoplakia if the anti-fungal meds do not work then you need to send the client for a biopsy.

Question 18

Cancer/OD

Answer 18

Pain, strain & difficulty and painful swallowing

Surgery- laser , partial/complete laryngectomy
Voice therapy post laryngectomy: Compensatory for partials/ cordectomy- Alaryngeal voice: electrolarynx, Esophageal Speech, TEP
Smoking cessation
HYDRATION
Radiation/ chemotherapy- radiation is localized and chemotherapy is systemic.

Question 19

Laryngeal trauma

Answer 19

Modified voice rest
HYDRATION
Medications: Steroids or antibiotics

Question 20

LPR/Laryngopharyngeal reflux

Answer 20

Proton pump inhibitor 6+ months
Reflux diet- usually when I see PPI I think of LPR
HYDRATION

Question 21

Neurogenic disorders

Answer 21

LMN: VF paralysis, Myasthenia Gravis, Guillan-Barre, Flaccid dysarthria

UMN: Spastic dysarthria, hypokinetic dysarthria, hyperkinetic dysarthria (SD, essential tremor), Ataxic Dysarthria.

Mixed: ALS, TBI, MS

Question 22

LMN involvement

Answer 22

Paralysis- voice therapy: compensatory techniques (hard glottal attack, isometric push)- Swallowing precautions

Surgery- VF augmentation, VF medialization thyroplasty
Flaccidity- hypernasality- Voice therapy- Compensatory & strengthening techniques, swallowing precautions, palatal lift

Question 23

UMN involvement

Answer 23

Spastic- voice therapy: laryngeal relaxation, neck stretches, resonant voice therapy
Hyperkinetic- botox
Hypokinetic- respiratory training & voice therapy LSVT and vocal function exercises
Ataxic- speech therapy/overarticulation

Question 24

Mixed dysarthria

Answer 24

Mix of dysarthria types ( usually spastic & flaccid)
ALS- no voice exercises
Compensatory, maintain
MS- max out strengthening during remission
TBI- respiratory training

Question 25

Transgender

Answer 25

Surgery
Male to female- thyroid shave
Female to male- vf augmentation

Voice therapy: pitch control- visipitch, vocal function exercises & gestures.