Chapter 7: Voice Management (Psychogenic Voice Therapy)

Question 1

What are voice disorders that can be addressed with psychogenic VT? (5)

Answer 1

1) primary muscle tension dysphonia
2) functional aphonia
3) functional dysphonia
4) functional falsetto
5) paradoxical vocal fold dysfunction (PVFD, aka vocal cord dysfunction (VCD))

Question 2

What are psychogenic voice therapy strategies for functional aphonia and dysphonia? (3)

Answer 2

1) non-speech phonation (cough, throat clear, gargle)
2) falsetto voice technique
3) laryngeal videoendoscopy feedback

Question 3

What are psychogenic voice therapy strategies for functional falsetto? (4)

Answer 3

1) offer reasonable explanation
2) hard glottal attack approach
3) desensitization program
4) VFEs/forward focus

Question 4

What are psychogenic voice therapy strategies for juveniles voice (functional falsetto in females)? (2)

Answer 4

1) may use similar strategies as male falsetto

2) requires engagement of thyroarytenoid muscles, improved breath support, and precise articulation

Question 5

How is PVFD often treated as?

Answer 5

asthma, bc pts experience respiratory distress due to paradoxical approximation of the VFs during respiration

Question 6

What is treatment for PVFD involve? (3)

Answer 6

1) discovery of laryngeal dyskinesia
2) demonstration of the inappropriate VF approximation through videolaryngeaoscopy
3) practice of appropriate respiratory gestures (control of fear and sniff technique)

Question 7

What can PVFD be caused by and what is it a result of?

Answer 7

variety of diseases/disorders

mistimed laryngeal valving disrupting respiration

Question 8

What are 5 possible etiologies of PVFD?

Answer 8

1) laryngospasm
2) attempt to maintain positive thoracic pressure through out the respiratory cycle
3) the adolescent PVFD syndrome
4) conversion reaction to PVFD
5) focal dyskinesia

Question 9

What are the multiple disciplines that can be involved in the treatment of PVFD?

Answer 9

1) family physician
2) pulmonologist
3) speech-language pathologist

Question 10

What are assumptions about PVFD management?

Answer 10

1) underlying etiologies must be addressed
2) individuals are not aware that the larynx is the source of the problem
3) individuals can bring volitional control over the larynx

Question 11

What are 6 signs of LPR?

Answer 11

1) posterior laryngeal cobblestoning
2) posterior laryngeal edema/erythema
3) contact ulcer
4) contact granuloma
5) pharyngeal edema/erythema
6) pyriform sinus edema/erythema

Question 12

What are 14 symptoms of LPR?

Answer 12

1) chronic cough
2) shortness of breath
3) adult onset asthma
4) globus sensation
5) pinpoint pain
6) laryngospasm
7) throat tickle
8) halitosis
9) hoarseness
10) voice fatigue
11) belching
12) chest tightness
13) swallowing difficulty
14) increased drainage

Question 13

What is direct therapy for reflux laryngitis? (5, #3 has 3)

Answer 13

1) pt education about silent reflux
2) vocal hygiene: reduction of phonotraumatic events such as habitual throat clearing/coughing/etc.
3) direct voice re-education
- confidential voice = used for a brief time to decrease acute laryngeal edema and erythema
- restricted voice use = vocal conservation or naps as needed to reduce adductory impact
- use of amplification = when required to compete in significant background noise during early rehab period
4) vocal function exercises
5) resonant voice therapy

Question 14

LPR may be a primary contributing factor to:

And successful LPR treatment often decreases the incidence of it

Answer 14

PVFD

Question 15

What does laryngeal control therapy for PFVD do?

Answer 15

promotes an open laryngeal posture in patients

Question 16

What is laryngeal control therapy for PFVD? (4)

Answer 16

1) quick sniff rescue breath
2) abdominal breathing
3) audible exhalation on /s/
4) breathing retraining in various levels of exertion