Disorders Flashcards
What would objective measures would you find with nodules
Increased NHR, VTI, jitter and shimmer
Decreased fundamental frequency due to mass
Decreased intensity from less subglottal pressure
Increased MAR from loss of air in phonation
Lower VSPL and VE
How would you differentiate nodules from polyps
Nodules are bilateral, on anterior 2/3, posterior 1/3 of folds
Arise over time
Polyps are mostly unilateral and have a blood supply
Can form with one incidence of phonotrauma
What are the 2 types of nodules
Acute which are gelatinous in appearance. From hyperfunctional voice use
Chronic which are more fibrous and arise over time with repeated phonotrauma
How do you treat nodules
Voice rest and good vocal hygiene
How do you treat polyps
Surgery
What are the two types of polyps
Sessile which are on the fold
Pedunculated that hang from a stem
What is laryngitis
Inflammation of larynx
How do you treat laryngitis
Good vocal hygiene
Usually heals itself within a week
Medical treatment if an infection is present
What are the symptoms of laryngitis
Hoarseness
Fever
Cough
Lower pitch from edema
What is Reinke’s edema
Edema that forms in the superficial lamina propria
Associated with smoking
What objective measures would you expect to see in Reinkes edema
Increased NHR Increased jitter and shimmer Reduced frequency Reduced intensity, VSPL and VE Increased MAR
What is a laryngeal cyst
Mucous mass found underneath mucosa in superficial lamina propria
Usually in transition area or vocal ligament
Can be anywhere
Need to make a differential diagnosis with contact ulcers
Describe intubation granuloma
Mass arising from arytenoid cartilage due to trauma from intubation
Iatrogenic
What causes contact ulcers
LPR
Laryngeal-pharyngeal reflux
What symptoms would you see with a contact ulcer
Hoarseness
Breathiness
Reduced pitch
Reduced loudness
What causes candida
Antibiotics
Illness
Chemotherapy
How would you identify candida
White spots on mucosa
Stiff irregular folds
Abnormal redness
What changes would you see in the voice with candids
Minimal to moderate changes due to swelling
Pressed, hoarse, or breathy
What is the viral infection that causes a mass in the supraglottal, glottal, or subglottal regions
Human papilloma virus 6 and 11
What is a papilloma
Mass due to HPV in the supraglottal, glottal, or subglottal regions
What objective measures would you find with a papilloma
Increased NHR
Reduced frequency
Reduced vital capacity
What is the primary symptom of a glottal web
Respiratory difficulties
Shortness of breath
Harsh and high pitched voice
Can be anterior or posterior
What causes a glottal web
75%congenital due to folds not separating during embryonic development in the 4th to 10th week
Acquired due to trauma usually iatrogenic
What is a laryngocele
Air filled dilation in ventricles
Congenital
What causes subglottal stenosis
Congenital: malformed cricoid cartilage formed in utero.
3rd most common congenital
Acquired: iatrogenic
Idiopathic. More common middle aged women
What symptoms would you see in subglottal stenosis
Stridor
Dyspnea, cough, significant chest wall movement
What are the symptoms of presbylarynges
Sarcopenia:thinning of muscles Superficial layer of cord thins Collagen in cord becomes more dense Mucosal wave abnormalities Possible bowing of folds
What is sarcopenia
Thinning of muscles
What is sulcus vocalis
Groove in fold
Bilateral and symmetrical
May protrude into vocal ligament
What is varix
Enlarged and dilated vein in folds
What is ecstasia
Fused lesioning of blood vessels in folds
On superficial lamina oropria
What causes muscle tension dysphonia
Phonotrauma
What contributes to poorvocal health
Smoking Marijuana Alcohol Caffeine Sleep deprivation Vocal fatigue Inappropriate vocal use Obesity Allergies
What does improper voice use result in
Increased tension
Inappropriate pitch
Ventricular phonation
Later-medial and posterior-anterior compression
What is the difference between primary and secondary dysphonia
Primary is direct result of disorder
Secondary is from compensation
What causes phonotrauma
Excessive loud talking
Straining during laryngeal inflammation
Coughing or throat clearing
Sports cheering
What are symptoms of phonotrauma
Hosrseness Fatigue Strain Pain Loss of voice Poor projection Loss of pitch/ loudness range
What are good differential diagnoses between muscle tension and neurologic disorders
Usually worse at the end of the day
Varies throughout day
What does a larynoscopy reveal in strain
Compression (lateral medial or anterior posterior)
Supraglottal strain
Hyper adduction
Elevated laryngeal position
What is a hard glottal attack
Rapid adduction of folds before a vowel
Increased subglottal pressure to overcome adductive forces which produces sudden explosive sounds
What happens when there is elevated laryngeal positions
Pitch increases
Perceive strain, hoarseness, and increased pitch
What are the symptoms of puberphonia
Hoarseness, breathiness
Pitch breaks, inadequate resonance
Shallow breathing, muscle tension
Lack of variability
What is ventricular dysphonia
Vibration of false folds
Secondary to vocal fold disorder
Gives rise to diplophonia
What are the characteristics of ventricular dysphonia
Low pitch because of added mass
Hoarseness
Reduced intensity due to poor pressure below folds
What causes psychogenic dysphonia
Emotional trauma, stress or attention seeking
How can you tell if someone is faking
They can laugh, whisper
What are the types of assessment
Laryngoscope Perceptual Acoustic Aerodynamic Quality of life EMG
What are the 5 subsystems of motor speech disorders or dysarthria
Respiration Phonation Resonance Articulation Prosody
What do you call a lesion on a muscle
Myopathy
What do you call a lesion on a nerve
Neuropathy
What do you call a lesion at the junction of the nerve and muscle
Myoneural junction disease
What is loss of muscle mass called
Atrophy
What is muscle tension dysphonia
Any inappropriate use of voice
Overuse of laryngeal muscles
What are the two types of muscle tension dysphonia
Primary and secondary
What is the primary concern of muscle tension dysphonia
Airflow especially laryngeal resistance
More resistance = less airflow
What is hyperfunction
Compression of muscles that causes strain
On superior medial, lateral medial, or supraglottic
What assessment do you use for vocal fold paralysis
EMG
What can you expect to see in the assessments of muscle tension dysphonia
Auditory perceptual:strained, raspy
Acoustic: noise etc
Respiration: reduced airflow
Laryngoscopy: lateral medial compression, anterios posterior compression, supraglottal tension, aperiodicity, asymmetry
What are the 3 parts of brain stem
Midbrain
Pons
Medulla
What are the two UMN fibers
Corticospinal
Corticobulbar
Where do the UMN originate
Precentral gyrus
Where do LMN originate
From coricobulbar fibers
What is dysarthria
Any speech disorder caused by neurological impairment
What are the aspects of speech that a motor speech disorder would affect
Respiration Phonation Articulation Resonance Prosody
What do LMN lesions cause
Flaccid dysarthria
What do UMN lesions cause
If bilateral they cause spasticity
If unilateral do not affect voice
What are the 7 types of dysarthrias
Spasticity Flaccidity Unilateral UMN Ataxia Hyperkinesia Hypokinesia Mixed
What is ataxia
Loss of coordination
What causes spasticity
Bilateral UMN
What causes flaccidity
Uni and bilateral LMN
What causes ataxia
Lesion in cerebellum
What is hyperkinesia
Too much movement
What is a classic disease with hypotonia
Parkinson’s
What is a motor neuron disease
Disorder at the junction of LMN and UMN
What is the origin of the LMN
Motor neuron
What are the two braches of the Vegas nerve that innervate the voice production
Superior laryngeal
Recurrent laryngeal
What des the recurrent laryngeal nerve innervate
All intrinsic laryngeal muscles except the cricothyroid
Sensory information below the folds
What are the types of neurogenic voice disorders
Vocal fold paralysis
Spasmodic dysphonia
Organic voice tremor
What muscles are affected by abductor paralysis
Posterior cricoarytenois
What muscles are affected by adductor paralysis
Lateral cricoarytenoid
Interarytenoids
What are the problems associated with adductor paralysis
Phonation
Aspiration
Subglottal pressure
What is the primary concern of bilateral adductor paralysis
Aspiration
What would be the voice quality of someone with bilateral adductor paralysis
Dysphonic with secondary muscle tension
Bresthy
Wesk
What would the voice quality be like with unilateral abduction paralysis
Mildly dysphonic
Possible loudness issues
What is the most common form of vocal fold paralysis
Unilateral adductor paralysis
What type of dysarthria is spasmodic dysphonia
Hyperkinetic
What is the origin of spasmodic dysphonia
Disruption in extrapyramidal fibers in CNS
What are the symptoms of spasmodic dysphonia
Pauses in phonation
Effortful voice production
Strain
Uncontrolled spasms
What voice qualities would you expect in adductor spasmodic dysphonia
Strain
Effortful
Vowels more affected
Intermittent normal phonation
What voice qualities would you expect in abductor spasmodic dysphonia
Intermittent breathiness
Short breaks of aphonia
Intermittent normal phonation
Can affect consonant production
What is essential tremor
CNS disorder
Results in involuntary regular tremors in limbs, head, larynx
What is organic voice tremor
Essential tremor limited to larynx
Based on frequency deviations of 4 to 6 hz
What is myasthenia gravis
Neuromuscular disorder Autoimmune Causes weakness and atrophy in muscles Occurs at myoneural junction Disruption of ACH receptors at myoneural junction
How does myasthenia gravis affect voice
Weakness after 5 -6 minutes
Mucosal wave abnormalities
Where are 4 places that you might see a LMN disorder
Motor neuron
Myopathy
Neuropathy
Myoneural junction
What is the function of dopamine
Inhibitory
What type of dysarthria is parkinsons
Hypokinesia
What voice qualities would you expect in parkinsons
Monopitch
Monoloudness
Loudness biggest symptom
Dont have sensory info that they are too soft
What is the voice treatment for parkinsons
Lee Silverman Loud
LSVD
What would happen to reflexes if in the LMN
Reduced
What would happen to reflexes if the lesion is in the UMN
Hyperactive reflex
What are the different types of paralysis
Abductor or adductor
Both unilateral or bilateral
What is a passymuir valve
A valve that redirects air through the folds for speech when there is a stoma
What are possible causes of vocal fold paralysis
Surgery Neurologic disease Head or neck trauma Viral infection Tumor
What are general symptoms of of paralysis
Breathiness
Low intensity
Low pitch
Intermittent diplophonia
What is botox
A toxin that temporarily paralyzes the folds
How can you provide biofeedback for a parkinsons patient
Sound level meter
What are some examples of congenital neuroligic disorders in children
VF paralysis Laryngeal stenosis Laryngomalacia Laryngocele Webbing
What are some prenatal reasons for congenital voice disorders
Maternal substance abuse
Poor embryonic development
What are some perinatal reasons for congenital voicedisorders
Birth trauma
Delayed birth cry
Hypoxia
What is laryngocele
Air filled sac in the vestibule
What are postnatal causes of congenital voice disorder
Neonatal jaundice
Seizures
Encephalitis
What is laryngomalacia
Epiglottis is flaccid and obstructs airway.
Concern is swallowing and aspiration
What are signs of pediatric voice disorder
Dysphonia Intermittent aphonia Voice breaks in singing or speech Excessively loud voice Inability to sustain a note Effortful or strained voice
What is the primary acquired disorder in children
Muscle tension dysphonia
What is the leading cause of acquired voice disorder in children
Phonotrauma
What are actities in kids that may cause vocal nodules
Excessive use Glottal attack Not resting voice when ill Crying, laughing, outbursts Shouting, screaming
What should you consider when working with children
Laryngeal development
Psychological/emotional development
Language speech
General development
What are some anatomical changes in geriatric patients
Atrophy Vocal fold thinning Bowing Discoloration Edema of superficial lamina Ossification Decreased blood supply
What are perceptual voice changes in geriatric patients
Altered pitch Roughness Breathiness Hoarseness Tremor Weakness
Quality. Pitch. Loudness
Why would loudness be affected in geriatric patients
Less air support
Less subglottal pressure
What are the essential elements of a report
Background/case history Laryngoscopy Auditory perceptual analysis Acoustic analysis Aerodynamic analysis Quality of life
Both subjective and objective
What info is in a case history
The problem verbatim Effect of problem on their life Onset and duration Variability or constancy Other symptoms present Medical history/ list of procedures etc Medications Vocal habits Psychological issues
What are components of a subjective aerodynamic assessment
Observe type of breathing
Number of words per breath
S/z ratio
Max phonation duration
What are objective measurements for phonation
Habitual loudness and pitch Loudness variability (contrastive stress) Pitch variability, range Tremor Voice quality with severity
What is LPR
Laryngeal-pharyngeal reflux
What is LSVT
Lee Silverman Voice Treatment
What is MTD
Muscle tension dysphonia
What term is used describe functional disorders
Muscle tension dysphonia
Why is throat clearing destructive
Increased subglottal pressure required to overcome adductive forces to produce a sudden explosive sound
How does unilateral UMN present
Contralateral lower facial weakness
What contributes to PVFM
Reflux Exercise upper airway inflammation Exposure to irritants Environmental allergens Stress Change in temp Vocal maneuvers
How do you diagnose PVFM
Observe neck muscles
Visualization of folds
Symptoms
Thorough history
How do you treat PVFM
Direct: relaxed throat breathing, panting, biofeedback
Indirect: education, relaxation, reassurance, hygiene
