Classifications of Voice Disorders Flashcards
PVD [FUNCTIONAL NEUROLOGICAL DISORDER] Type 1 - Aphonia (also conversion reaction):
(Baker, 2007)
Aphonia with normal or tight whisper.
Perceptual: breathy/strained
Glottic Closure: may range from intensive laryngeal valving, glottic chink, bowing, or hypoadduction of true vocal folds.
Marked FVF/AP constrictions probable. May obliterate view of true vocal folds.
Sensation of ‘globus’
PVD [FUNCTIONAL NEUROLOGICAL DISORDER] Type 2 - Dysphonia (also conversion reaction)
(Baker, 2007)
Dysphonia with segments of whispered voice, including females using high-pitched, falsetto phonation with childlike articulation and intonation.
Perceptual: high-pitched, whispery squeaks, breathiness, hoarseness, or low-pitched harshness.
Glottic cosure: intensive valving, bowing, hypoadduction, glottic chink.
Marked FVF/AP constriction likely.
Sensation of ‘globus’
PVD [FUNCTIONAL NEUROLOGICAL DISORDER] Type 4 - Puberphonia / mutational falsetto
(Baker, 2007)
Dysphonia in adolescent/mature males with normal hormonal development
Perceptual: high-pitched, breathy voice, falsetto quality with irregular pitch breaks
Glottic closure incomplete
FVF/AP constriction unlikely
Onset - usually sudden
Course - may be variable with intermittent episodes of normal voice, aphonia, or dysphonia (dependant on circumstances)
Psycho-social factors/trauma (or URTI) linked with onset
Normal phonation can’t be voluntarily produced
Normal phonation in unconscious moments or reflex activities ie laugh or cough
(Baker, 2007)
Psychogenic Voice Disorder [FUNCTIONAL NEUROLOGICAL DISORDER]
- Diagnostic Classification System for Voice Disorders (Baker, 2007)
Onset - usually Gradual
Course - usually consistent, more variability if vocal demands change
Onset may be linked with URTI, post-operation, or in association with pre-existing organic condition but nature and severity of dysphonia is explained as a form of compensation
Stimulable - reflex activities ie yawn, laugh, cough or modifications of vocal technique may improve phonation
Symptoms consistent with hyperfunctional vocal patterns. Palpable tension of extrinsic laryngeal muscles. Patterns of laryngeal tension.
(Banker, 2007)
Muscle Tension Voice Disorders (Diagnostic Classification System for Voice Disorders) (Baker, 2007)
Onset - sudden or gradual, dependant on nature of organic pathology
Not stimulatble - patient effort facilitating techniques don’t significantly improve phonation
Psycho-social factors aren’t causative, but may result from, or aggravate, the disorder
Muscle tension patterns are compensatory, not causative
(Baker, 2007)
Organic Voice Disorders - Diagnostic Classification System for Voice Disorders (Baker, 2007).
MTD Type 1 - No secondary Pathology
Baker, 2007
Dysphonia with palpable tension in extrinsic and intrinsic laryngeal musculature
Perceptual: breathy/strained/rough
Glottic Closure: complete/incomplete with posterior glottic chink most characteristic.
FVF involvement possible.
MTD Type 2a - Secondary Pathology
Baker, 2007
Dysphonia with vocal trauma-induced inflamation, oedema, vocal nodule, contact ulcer, ployp etc
Perceptual: moderate hoarseness
Glottic Closure: incomplete/AP chink, hourglass, posterior glottic chink.
FVF likely.
MTD Type 2b - With Secondary Pathology
Dysphonia with more diffuse erythema, vocal trauma-induced chronic laryngitis.
Perceptual: severe low-pitched, hoarseness/harshness.
Glottic closure: incomplete, AP chink.
FVF probable
MTD Type 2c - With Secondary Pathology
Baker, 2007
Dysphonia with vocal trauma-induced Reinke’s oedema, polypoid degeneration.
Perceptual: severe, low-pitched hoarseness/harshness.
Glottic closure: incomplete/AP chink.
FVF/AP constriction likely.
OVD Type 1 - Mass lesions or tissue changes
Baker, 2007
Aphonia/dysphonia due to tissue/mass changes (infection, LPR, chemical irritants; cysts, sulcis, papilloma, smoking-induced Reinke’s oedema; intubation granuloma/contact ulcer, laryngeal web, aging, endocrine imbalance.
Perceptual: breathy/strained/rough
Glottic closure: AP chink/incomplete/irregular/hourglass/bowing.
Globus (with reflux)
FVF/AP constriction inevitable
OVD Type 2 - Laryngeal trauma
Baker, 2007
Aphonia/dysphonia due to laryngeal trauma, blunt/penetrating injuries, compound fracture to thyroid cartilage, subluxation of arytenoid.
Perceptual: severe hoarseness
Glottic closure: irregular/incomplete, distortion to vertical plane of true vocal folds.
FVF/AP constriction inevitable
OVD Type 3 - Neurological Lower Motor Neurons
Baker, 2007
Aphonia/dysphonia due to VF paresis (damage to RLN/SLN)
Perceptual: Breathiness/hoarseness
Restrictions to pitch range with SLN
Glottic closure: Incomplete/posterior chink
FVF probable
OVD Type 4 - Neurological
Baker, 2007
Adductor/Abductor spasmodic dysphonia
Perceptual: adductor - strained, voice arrests. Abductor - breathy, phonation breaks
Glottic closure:
Adductor - complete, hyperadduction of true vocal folds. Abductor - incomplete and short closed phase.
Marked FVF/AP involvement
OVD Type 5 - Neurological Upper Motor Neuron with dysarhrophonia
(Baker, 2007)
Aphonia/dysphonia with weakness and incoordination of muscles of articulation, respiration, resonance and phonation/may affect swallowing as well.
FVF/AP possible.
