Exam 1 Flashcards
What are functional voice disorders characterized by?
by tension, hyperfunction, larynx “riding high”, anxiety
How many cases of functional voice disorders are dysphonia cases?
10%
T or F: Most functional voice disorders are predominantly men.
False
What does URI stand for?
Upper Respiratory Infection
What are functional voice disorders caused by?
URI, stressful/traumatic event, psychosocial (mood, anxiety, adjustment), organic, idiopathic
T or F: No structural pathology is present unless an organic disorder develops
True (with the exception of organic causes
What are some examples of functional voice disorders?
Puberphonia/Falsetto/Mutational falsetto
Functional aphonia
Functional dysphonia
Paradoxical VF Movement (PVFM)/ PVCD/VCD
What is puberphonia?
“mutational falsetto”
Pitch control disorder (pitch too high, pitch breaks)
T or F: Puberphonia is due to anatomic immaturity of larynx.
False
What does the larynx do in puberphonia?
Larynx “rides high”
What causes puberphonia?
Emotional stress
What does functional aphonia sound like?
Whisper or shrill-sounding voice
What did functional aphonia used to be called?
“hysterical” syndrome and “conversion” symptom or “conversion hysteria”
How long does functional aphonia last?
May be temporary or intermittent
What do 80% of purberphonia cases coexist with?
Psychiatric disorders
What is functional dysphonia also called?
MTD Muscle Tension Dysphonia
What can you see/feel in functional dysphonia client?
Excessive tension of laryngeal/ extralaryngeal muscles (neck, shoulder)
“Clavicular breathing”/“Chest breathing”
What symptoms may clients have with functional dysphonia?
↑ vocal effort
Vocal fatigue
What is ↑ vocal effort & vocal fatigue due to in functional dysphonia?
Hyperfunction
Ventricular compression
Ventricular phonation
A-P press
What does PVFM stand for?
Paradoxical Vocal Fold Movement
What are the etiologies for PVFM?
Psychogenic, LPR, neurological
What does LPR stand for?
Laryngopharyngeal Reflux
What symptoms do you see with PVFM?
Dyspnea Inspiratory stridor (vf’s adduct on inspiration) May be exercise-induced May or may not have dysphonia May have chronic cough
What is PVFM frequently misdiagnosed with?
Asthma
What are organic disorders typically due to?
Abnormal anatomy, tissue changes
purely organic
T or F: Functional disorders can have organic factors OR be wholly functional.
True
T or F: Functional disorders have abnormal anatomy.
False-typically normal anatomy unless functional misuse leads to organic changes.
Give some examples of functional misuse.
Inadequate breath support, hard glottal attack, supraglottal squeeze
What are the classifications of organic disorders?
Congenital
Misuse/Abuse
Disease
Trauma
What is an organic disorder with the classification of congenital-web?
Laryngomalacia
What is an example of an organic disorder with the classification of Misuse/Abuse due to lifestyle diet?
Reflux
What is an example of an organic disorder with the classification of Misuse/Abuse due to lifestyle of smoking?
Reinke’s edema
What is an example of an organic disorder with the classification of Misuse/Abuse due to lifestyle personality?
Nodules
What is an example of an organic disorder with the classification of Disease?
Cancer
What is an example of an organic disorder with the classification of Trauma
Cartilage Dislocation
List types of organic disorders.
Nodules Polyps Cysts Papilloma Granuloma Contact ulcer Sulcus vocalis Congenital Web Hemmorhage Laryngitis Reinke’s edema Leukoplakia Cancer
What are vocal fold nodule(s)?
Benign mass(es) on medial vf surface(s)
What is the etiology of vocal fold nodule(s)?
Misuse/abuse
What are signs/symptoms of vocal fold nodule(s)?
hoarseness, rough voice, ↑ vocal effort, vocal fatigue/strain, loss of upper range, voice variability, vf edema, hourglass closure, ↓ vf vibration, “strong” personality, hearing loss
What are VF polyps?
Generally soft mass
T or F: VF Polyps are usually unilateral
True
What is the etiology of VF polyps?
Misuse/abuse
What are the different types of VF polyps?
fibrous, hemmorhagic, pedunculated
What are signs/symptoms of VF polyps?
hoarseness, rough voice, ↑ vocal effort, vocal fatigue/strain, breathing problems (depending on size), voice variability (especially if pedunculated), vf edema (reactive swelling), throat clearing
What is a VF cyst and where is it located?
Benign opaque mass originating below vf surface
What is the etiology of a VF cyst?
entrapment of vf lining (under the lining) or plugged mucous-secreting gland, vocal misuse/abuse
What are signs/symptoms of VF cysts?
hoarseness, rough voice, ↑ vocal effort, vocal fatigue/strain, vocal fold edema, throat clearing
What is edema?
reactive swelling
What is a laryngocelle?
cyst in laryngeal cavity
What does HPV stand for and what is it?
Human Papilloma Virus
Wart-like benign growths of the larynx
What is papillomatosis?
Papilloma in the larynx
What are the etiologies of Papilloma?
acquired at birth, oral sex, unknown
What are the signs and symptoms of papilloma?
hoarseness, rough/scratchy voice, cough/throat clear, globus sensation, breathing problems, ↓ vf vibration, scarring (recurrent)
How many strains of HPV causes laryngeal papillomatosis?
60 Strains
What is a granuloma?
Benign polyp on vocal process
What is the difference between a granuloma and a polyp?
Location-granuloma is located on the vocal process of the arytenoids.
What is the etiology of granulomas?
LPR and Intubation
What are signs and symptoms of granulomas?
globus sensation, heartburn/indigestion (reflux-type), excessive throat clearing, dry cough, post-nasal drip, breathing problems (size-dependent), may be pedunculated
What are contact ulcers?
Raw sores on mucous membrane overlying vocal process of arytenoid
What are the etiologies of contact ulcers?
Misuse/abuse, LPR, smoking, intubation
What are signs and symptoms of contact ulcers?
hoarseness, globus sensation, mild pain when voicing or swallowing, throat clearing, erythema
What is sulcus vocalis?
Thinning or absence of superficial lamina propria
> “ditch”
What does “sulcus” mean in Latin?
cleft, furrow
What are the etiologies of sulcus vocalis?
unknown – developmental? genetic? post hemmorhage/cyst?
What are signs and symptoms of sulcus vocalis?
may not have voice probs, harsh voice, hoarseness, higher pitch, abnormal vf vibration
T or F: Sulcus vocalis is seen in children.
False-never seen in children
What is Laryngomalacia?
When the cartilage fails to stiffen.
What are signs and symptoms of laryngomalacia?
Epiglottis collapses into the airway,
Stridor
What is subglottal stenosis?
Narrow subglottal space
What causes subglottal stenosis?
Arrested deviation of cricoid cartilage (usually doesn’t form);
Intubation trauma
What is esophageal atresia?
occlusion of the esophagus
When does esophageal atresia occur?
When the esophagus hasn’t formed all the way or if something is occluding it.
What is a tracheoesophageal fistula?
Openings between the trachea and esophagus
What may a tracheoesophageal fistula occur with?
Esophageal pouch
What does a web look like and where is it located?
Tissue across larynx, usually anterior
What is the etiology of a web in the larynx
Congenital, post-surgical
What are signs and symptoms of a web?
May not have voice problems; usually no problems breathing
What is a deterrent for webs?
Mitomycin C
What is a hemmorhage of the vocal folds?
Bleeding into superficial lamina propria
What are the etiologies of a hemmorhage of the vocal folds?
misuse/abuse, medications (Coumadin, aspirin: blood thinners)
What are the signs and symptoms of a hemmorhage of the vocal folds?
hoarseness, vf erythema, vf edema, ↓ vf vibration, loss of pitch range, varix (varices)
What does erythema mean?
Redness
What does varix (varices) mean?
Blood spot/blood vessel on vf
What is the #1 cause of vf hemmorhage?
VF edema due to stiffening up from fluid causing hoarseness
What does a hemmorhage also look like on other places of the body?
A bruise: starts off bright red, pale red, then plaquey yellow
What is laryngitis?
Inflammation of the vocal folds
What are the etiologies of laryngitis?
Infection, LPR, allergies
What are signs/symptoms of laryngitis?
hoarseness, sore throat, cough, fever, vf edema, erythema
What is Reinke’s Edema?
Swelling of he entire superficial lamina propria (Reinke’s layer)
What is another name for Reinke’s Edema?
polypoid corditis
What is the etiology for Reinke’s Edema?
Smoking
What are signs and symptoms of Reinke’s Edema?
gravelly voice, low pitch, vf edema, impaired breathing
What is leukoplakia?
White patches/growths on epithelium
What is leukoplakia a precursor for?
Pre-cancerous
What are the etiologies of leukoplakia?
smoking, chemical exposure
What are signs and symptoms of leukoplakia?
hoarseness, ↓ vf vibration, vf edema
What is the #1 sign/symptom of Reinke’s Edema?
VF Edema (swelling) due to taking on a lot of fluid due to the carcinogens going through the system causing the larynx to swell
Why do those with Reinke’s Edema have a lower pitch?
Due to increased fluid production creating greater mass for vf’s.
What does COPD stand for?
Chronic Obstructive Pulmonary Disease
What is the next step from Reinke’s Edema?
Leukoplakia
What is an occupation that is at risk for leukoplakia?
Janitor due to mixing cleaning supplies.
What is the next step after leukoplakia?
Cancer
Where is cancer typically located in the larynx?
Glottic (larynx-vocal folds) & supraglottic-(above VF’s in the false VF’s, epiglottis, and tongue base)
Where is cancer rarely located in the larynx?
subglottic in proximal trachea
What are the etiologies of cancer?
smoking, heavy alcohol consumption, asbestos or chemical exposure
What are signs and symptoms of cancer?
hoarseness, rough voice, pain, strain, difficulty/pain swallowing
What is the main sign/symptom of cancer?
Pain
What are the etiologies of laryngeal trauma?
Hit in the neck, weight lifting, foreign bodies
What does paradoxical mean?
The reverse of how it should work.
What is different in the breath patterning of a client of PVFM?
Breath patterning opposite of what should be. They’re adducting on inspiration instead of abducting.
What does aphonia mean?
No voice
T or F: a full whisper uses less muscles than a regular voice.
False-uses more muscles
T or F: a client with PVFM may not have voice issues when speaking.
True
Which one sounds more stressed? A client with funtional dysphonia (MTD) or aphonia?
Functional Dysphonia (MTD)
What is a globus senstation?
The feeling like something is there
What is dyspnea?
Trouble breathing
What things affect good vocal hygiene?
- 64 oz. water/day
- caffeine (is a diuretic) for every 8oz, need 6 oz water
- alcohol
- Reflux
- Cigarettes
- Enough sleep/rest
- Misusing voice
What does diuretic mean/do?
Causing increased passing of urine from where it takes water from cells and voids it out.
What causes heartburn & reflux?
spicy/acidic foods, caffeine, obesity, eating too close to sleeping, exercising too soon after eating, eating meals 3-4 hours before lying down, smoking, elevate had of bed-LPR
Who is laryngomalacia typically associated with?
Children
What are children typically dx with?
VF nodules or laryngomalacia
What is the most prevelant voice disorder?
Vocal Fold Nodule(s)
T or F: It’s rare to see polyps grow bilaterally
True (they do not cause another to form like nodules)
What makes up the CNS?
Motor cortex, primary motor strip, midbrain, brainstem – motor control of larynx
What does Broca’s Area do?
Voice response (preplanning)
What does the insula do?
Motor planning for voice
What does the precentral gyrus do?
Voice production
What does the basal ganglia/thalamus do?
Sensory info for vocalizing (motor)
What do the temporal lobes do (Heschyl’s gyrus)
Audition
What makes up the PNS?
Cranial and spinal nerves
What are the cranial nerves of phonation/voice?
IX, X, XI, XII
What does the Glossopharyneal (IX) nerve do?
Motor to stylopharyngeus muscle
Function: elevates larynx
What does the Vagus (X) nerve do?
Superior Laryngeal Nerve (SLN), Recurrent Laryngeal Nerve (RLN): sensory & motor to larynx, motor to thorax
What does the Spinal Accessory (XI) nerve do?
Neck accessory muscles (Sternocleidomastoid/SCM & trap), levator veli palatini & uvula
What does the Hypoglossal (XII) nerve do
Depression/elevation of larynx (via tongue muscles), neck strap muscles
What does the SLN branch of the Vagus do?
Sensory: (internal branch) mucous membrane supraglottal larynx
Motor: (external branch) cricothyroid muscle
Where does the RLN branch of the Vagus run?
Right: Loops behind R carotid and R subclavian
Left: Loops around aortic arch (male)
What does the RLN branch of the Vagus do?
Motor: TA of VF, PCA (abductor), LCA (adductor), transverse arytenoids (adduction), oblique arytenoids (adduction), and all other laryngeal muscles
If there is Left VF paralysis, where is the lesion?
Immediately think Left RLN (LMN) ipsilateral damage
What are etiologies of neurogenic voice disorders?
Congenital (Huntington’s)
Lesion/tumor/disease (dysarthrias, stroke, cancer)
Trauma (TBI, n. trauma)
What is the sensory function of the Superior Laryngeal Nerve (SLN) of the Vagus?
(internal branch) mucous membrane supraglottal larynx
What is the motor function of the Superior Laryngeal Nerve (SLN) of the Vagus?
(external branch) cricothyroid (CT) m.
Where does the LEFT Recurrent Laryngeal Nerve (RLN) of the Vagus travel to?
loops around aortic arch
Where does the RIGHT Recurrent Laryngeal Nerve (RLN) of the Vagus travel to?
loops behind Right carotid & Right subclavian
What is the motor function of Recurrent Laryngeal Nerve (RLN)?
TA of vf, PCA (abductor), LCA (adductor), transverse arytenoids (adduction), oblique arytenoids (adduction) + all other laryngeal m.’s
What are examples of LMN Neurogenic Voice Disorders?
Myesthenia Gravis (MG), Guillaine-Barré, Flaccid dysarthria
What are examples of UMN Neurogenic Voice Disorders
Spastic dysarthria, Hypokinetic dysarthria (PD), Hyperkinetic dysarthria (Spasmodic dysphonia, essential tremor Huntington’s), Ataxic dysarthria
What are examples of Mixed Neurogenic Voice Disorders
ALS, TBI, MS
What are symptoms of LMN Neurogenic Voice Disorders?
Flaccidity: weakness, reduced muscle contraction, reduced ROM
What are symptoms of UMN Neurogenic Voice Disorders in Spastic dysarthria?
Spasticity/hypertonicity, strain/strangle, short phonation time, monopitch
What are symptoms of UMN Neurogenic Voice Disorders in Hypokinetic dysarthria?
Rigidity, bradykinesia, limited ROM, resting tremor
What are symptoms of UMN Neurogenic Voice Disorders in Hyperkinetic dysarthria?
Uncontrolled movements, strain/strangle
What are symptoms of UMN Neurogenic Voice Disorders in Ataxic dysarthria?
Cerebellar lesion, prosodic slowdown, resonance changes, inarticulation, “intoxicated”
What is the most common type of Mixed dysarthria?
Flacid/Spastic
What type of damage is ALS?
UMN & LMN
What type of damage is MS?
myelin sheath degeneration
T or F: TBI is a type of Mixed dysarthria.
True-it can be. Damage is variable
List what we do in a voice evaluation.
Patient history Voice sample –sustained & connected Perceptual analysis (subjective) Acoustic analysis (objective) Stroboscopic assessment Respiratory assessment Resonance/vp assessment Recommendations/POC
What evaluation is objective?
MDVP
What do we use for perceptual analysis?
VHI & CAPE-V
What do we use for acoustic analysis?
MDVP
What do we use for respiratory assessment?
Spirometry, manometry, pneumotachometry
What do we use for resonance/vp assessment?
nasopharyngoscopy, nasometer
What additional assessments may we do in a voice eval?
Oral-facial exam
Hearing assessment
EGG
EMG
What does an EMG stand for and do?
Electromyography
records the electrical activity produced by skeletal muscles (volts)
What does an EGG stand for and do?
Electroglottograph
mean flow rate (MFR) of airflow at glottis
What do we need to ask in patient hx form?
Hx of the problem (Origin, Duration, Severity)
S/S: voice quality, pitch, resonance, loudness, reflux?
throat clear? cough? swallow probs? pain?
Social hx – how do they use their voice?
Related medical hx (surgeries, allergies, URI/resp,
psych/depression, medication list)
Vocal hygiene: caffeine? smoke? hydration?
What are the parameters rated in a videostroboscopic examination?
- Focal Fold Edge
- Glottal Closure
- Phase Closure
- Vertical level of vf approximation
- Amplitude of vibration
- Mucosal Wave
- Vibratory Behavior
- Phase Symmetry
- Periodicity
- Hyperfunction
When do we rate glottal closure? Add or Ab duction?
Adduction
What is phase closure?
The degree to which the vocal folds move together during vocal fold closure during phonation.
What is Vertical level of vf approximation?
The degree to which the vocal folds meet on the same vertical plane during phonation .
What is the assessment of amplitude of vf vibration?
The degree of movement from the medial to the lateral aspects of the vocal fold during phonation.
What is the assessment of mucosal wave?
The assessment of the degree of traveling wave that is present on the superior surface of the vocal fold during phonation.
What is the assessment of vibratory behavior?
The identification of portions of the vocal fold that are non-moving during phonation.
What is the assessment of phase symmetry?
The degree to which the vocal folds move symmetrically during vocal fold closure during phonation.
What is the assessment of periodicity?
The regularity of successive cycles of vibration during phonation.
What is the assessment of hyperfunction?
The extraneous activity in the form of ventricular compression/phonation and/or A-P press.
What does a spirometer measure?
flow, volumes, and lung capacities
What does a manometer measure?
air pressure
Maximum inspiratory pressure (MIP)
Maximum expiratory pressure (MEP)
What does a manometer measure?
cough strength (peak flow), inspiratory muscle phase, laryngeal compression (of vf’s) phase
What does a nasometer measure?
Nasalance
What does nasopharyngoscopy assess?
Assesses vp closure
What Recommendations/Point of Care (POC) do we give?
Patient education Modified voice rest Voice home exercises Reflux management Vocal hygiene Voice therapy and/or re-eval Referral
