Care of Professional Voice-Test 2 Flashcards by britt w

Pt hx: Hoarseness

Laryngitis

Mass lesions

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Pt hx: Breathiness

Improper technique, Prevent full approximation
VF paralysis, Arthritis
Arytenoid dislocation, Unilateral scarring
Senile VC atrophy–singer getting older; aging & overworked VFs, never singing at right register, etc.

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Aging Voice Characteristics

Breathiness and decreased range

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What happens with aging voice?

Muscular tone decreases; Lungs lose capacity; Thorax loses dispensability; Mucosa of vocal tract atrophies; Mucosal secretions change
Nerve endings reduced in #; Laryngeal cartilages ossify; Joints may be arthritic & stiff

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Myasthenia Gravis:

neuro problem; can fatigue anytime during day; short-period of time—immediate time; rest & it gets better; by end of day-thinking nodules

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Fatigue Characteristics

Hoarse; Breaking into different registers; Losing range; Changing timbre

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Possible Cause of Hoarseness related to Fatigue

Misuse of abdom.

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Possible Cause of Breaking into Different Registers related to Fatigue

Singing too long (MG) & neck musculature

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Possible Cause of Losing Range related to Fatigue

Over singing

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Possible Cause of Changing Timbre related to Fatigue

Singing to loudly

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Pt Hx: Volume Disturbance:

Hormonal changes, aging, neurological disease, SLN paralysis (monotone & minor swallowing problems), herpes infection, reflux (increased warmup time), voice limitations, technical errors

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Pt Hx: Pain

Posterior (Intubation granulomas, contact ulcers, etc)
VC Lesions
Laryngeal Joint Arthritis
Infection
Gastric Irritation of Arytenoids
*Excessive Neck Muscular Activity

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Pt Hx: Behavioral

Date of next important performance (can they do major performance, etc.)
Professional singing status & goals
Amount & nature of vocal training
Type of singing & environment
Rehearsal
Warm up/cool down

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Pt Hx: Psychological

Pre-performance anxiety
Stage fright
Insecurity
Depression
Emotional disturbances
Dry mouth, cold clammy skin, thick secretions

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Instead of throat lozenges:

Lozenges add to thickness of secretions

Cut up a lemon into small pieces & let it dry out; put in medicine bottle & suck on those

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Pt General Health Problems

Overall physical condition
URI, post-nasal drip, coughing
Allergies
Infectious sinusitis (diffuse mucosal inflammation)
TMJ dysfunction: decreased range, vocal fatigue, change in quality, change in placement, posterior tongue placement, laryngeal hyperfunction

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Pt Surgery

VF lesions
Tonsillectomy
Anesthesia (intubation)
Thyroidectomy (SLN & RLN)
Thoracic & abdominal surgery (Breathing)

Reflux Laryngitis

Arytenoid Irritant
Eating after a late performance
Bitter taste & halitosis upon awakening
Dry/coated mouth
Scratchy sore throat
Lump in throat
Prolonged warm up time

Foods irritating reflux

Affect amount & viscosity of mucosal secretions, irritating if aspirated:
Milk, nuts, ice cream, chocolate, highly spiced foods, coffee (caffeine)

Exposure to Irritants

Allergies to dust & mold in concert env’t
Drying effect of cold air & dry heat (decreased lubrication): scratchy voice, tickling cough
Smoke-filled rooms
Smoking tobacco/marijuana
Alcohol abuse: muscular incoordination

Vocal Abuse in Speaking (some populations)

Cheerleading in teens
Conducting choirs
Teaching singing

Vocal Abuse in Singing/Common Technical Errors:

Excessive muscle tension in tongue, neck, larynx
Inadequate abdominal support
Excessive volume (singing through hoarseness)
Inadequate preparation, rehearsal, training
Improper range

When evaluating singers….

Have them bring guitar if they use it, stand if that’s how they sing, etc.
Speaking voice & singing voice should match

When working with excessive volume in tx:

Make them do it softly in therapy (harder to sing softly than loudly)-soft is retraining neuromuscular coordination

Age vs. Training

Near puberty female After puberty male Children: mainly vocalize without strain Avoid vocal abuse

Drugs Leading to Dryness, Possible Tremor, Coughing, Clearing

Vitamin C (5-6 g/day), antihypertensives, bronchodilators, antiviral agents, hormones (birth control), antihistamines, diuretics, anticoagulants, antitussives, antacids, antidiarrheal agents, beta blockers, aspirin, tranquilizers

Physical Exam of Professional Voice

``` Nasal cavity status Bruxism, TMJ dysfunction Neck scars/trauma Laryngeal vertical mobility Gag reflex Palatal deviation Tongue, hand, or motor tremor Post-viral infection neuropathy: decreased SLN fx (can also affect RLN)--paresis/paralysis of nerve ```

Evaluation of Singer's Voice Measures of Phonatory Ability

``` MPT, Frequency Range of Phonation (vocal fry to falsetto) Musical frequency range of phonation (lowest to highest acceptable notes) Vocal register (fry, modal, falsetto) Speaking fundamental frequency Intensity range of phonation ```

Eval of Singing Voice

Posture Sing a 5 note scale on /a/ Sing entire range Compare singing vs. speaking voice

Sign that there might be a Vocal Cord Mass:

Pitch break at a certain frequency Voice will sound good except at certain pitches were the voice breaks In some tx: Relax and work into mid- and high-ranges; more flexibility; reduce hard contact

Eval of Singer's Voice: Observations

``` Contraction of neck muscles; jaw jutting Retraction of upper lip; retraction of lower lip Retraction of tongue Position of larynx w/ pitch changes Facial grimacing/forehead tension ```

Other Assessments: Eval of Singing Voice

``` Pulmonary Fx studies Laryngeal airflow measures Visi-pitch analyzer Sona-graph EMG ```

Antibiotics for Vocal Dysfunction

High doses for 7-10 days course Erythromycin/tetracycline Amoxicillin before a performance w/ intramuscular injection

Antihistamines for Vocal Dysfunction

Causes dryness, thick mucous, dry cough x before a performance Rec: corticosteroids Seldane between performances

Mucolytic Agents for Vocal Dysfunction

Helps liquefy viscous mucous, decrease throat clearing, reduce post nasal drip Organidin, Extex, Humibid

Corticosteroids for Vocal Dysfunction

Anti-inflammatory for acute laryngitis Do not recommend overuse Recorded high dosage for short period of time 3-6 days of decadron or Medrol Dosepak one intra-muscular injection if acute

Diuretics for Vocal Dysfunction

Premenstrual period bound fluid retention in Reinke's space | Do not mobilize bound fluids; they cause dehydration & thicken secretions

Analgesics for Vocal Dysfunction

Aspirin predisposes to VC hemorrhage Acetaminophen is best substitute Ibuprofen may interfere with clotting

Dehydration

Dry lining of VC's and larynx Dried mucus Mucosal wave nearly absent

Sprays, Mists, Inhalants

Contain analgesia's; Propellant inhaler may be damaging Prolonged steroid use in asthmatics causes muscle atrophy Afrin, Propylene glycol, water or saline via a vaporizer

Singer's First Aid Kit

Tylenol for headache Prylosec or Gaviscon for reflux Ampicillin, erythromycin, tetracycline for URI Afrin for nasal congestion Sudafed for mild allergy Entex, Organidin, Robitussin, Humibid for post-nasal drip Steroids prescribed in limited dosage by physician