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Voice Disorders > Exam 1- Ch. 1-4 > Flashcards

Exam 1- Ch. 1-4 Flashcards

1
Q

What is a Voice Disorder?

A
  • when voice quality, pitch, and loudness differ or are inappropriate for age, gender, cultural background, or geographic location
  • when pt. has concern about having an abnormal voice that does not meet daily needs
  • when either the structure, function, or both of the laryngeal mechanism no longer meet the voicing requirements established by the speaker.
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2
Q

3 subsystems of voice production

A

respiration, phonation, and resonance

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3
Q

What do the 3 subsystems of voice permit?

A

appropriate quality, pitch, and loudness

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4
Q

Muscles of Inspiration

A

Diaphragm
External Intercostals
Sternocleidomastoids
Scalenes
Pectoralis (major and minor)

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5
Q

Muscles of Expiration

A

Internal Intercostals
Rectus & Transverse Abdominis
Internal & External Obliques

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6
Q

During speech, to expiratory muscles assist passive forces to..

A

Compress the abdominal viscera.

Force diaphragm up & depress lower ribs

Decrease thoracic cavity size - sustain pulmonary pressure

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7
Q

Components of the Laryngeal Valve

A

Cartilage, Muscles, Connective Tissues, Mucosa

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8
Q

3 Basic Functions of laryngeal valve

A

Airway Preservation for Ventilation
Airway Protection
Phonation

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9
Q

Three Levels of Folds

A

Aryepiglottic Folds
Ventricular Folds
True Vocal Folds

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10
Q

What are the Laryngeal Cartilages?

A

-Epiglottis
-Thyroid
-Cricoid
-Arytenoids
-Corniculates
-Cuneiforms

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11
Q

Extrinsic Laryngeal Muscles are divided into what two categories?

A

Suprahyoid and Infrahyoid

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12
Q

Name the suprahyoid muscles and their function

A

Raise the larynx

Stylohyoid
Mylohyoid
Digastrics (anterior and posterior bellies)
Geniohyoid

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13
Q

Name the Infrahyoid muscles and their function

A

Lower the hyoid and larynx

Thyrohyoid
Sternothyroid
Sternohyoid
Omohyoid

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14
Q

What are the 5 Intrinsic Laryngeal Muscles?

A
  1. Cricothyroid- Tensor
  2. Thyroarytenoid- Adductor
  3. Lateral Cricoarytenoid- Adductor
  4. Interarytenoid- Adductor
    -Transverse (Horizontal)
    -Oblique (Crossed)
  5. Posterior Cricoarytenoid- Abductor
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15
Q

What do the Intrinsic Laryngeal Muscles do?

A

affect the position, length, and tension of the vocal folds

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16
Q

What are the 5 layers of the vocal folds? (most superficial to most deep)

A

Epithelium
Superficial Lamina Propria (SLLP)
Intermediate Lamina Propria (ILLP)
Deep Lamina Propria (DLLP)
Vocalis Muscle

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17
Q

Does density and stiffness increase from superficial to deep layers of the folds?

Why is stiffness needed?

A

yes

critical for sustained vocal fold oscillation

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18
Q

Epithelium

A

Outermost, mucosal layer of VF, thin pliable capsule
Thin layer of slippery mucous lubrication needed for vocal folds to oscillate best

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19
Q

Superficial layer (SLLP) - a.k.a. “Reinke’s Space”

A

Loose and Flexible
Soft, slippery, gelatin-like substance
Vibrates significantly during phonation

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20
Q

Intermediate layer (ILLP)

A

Mostly elastin fibers
Also vibrates during phonation

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21
Q

Deep layer (DLLP)

A

Mostly collagen fibers- most dense layer of LP
Interspersed with muscle fibers to join LP to underlying vocalis muscle

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22
Q

The combined intermediate and deep layers of the lamina propria is known as..

A

the “Vocal Ligament”

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23
Q

Vocalis Muscle

A

Forms the “body” of the vocal fold and provides:
Tone, Stability, and Mass
Vocalis still oscillates during vocal fold vibration

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24
Q

Phonation modes (3)

A

Falsetto (loft) - high
Modal (chest) - mid
Glottal fry (pulse) - low

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25
Q

Phonotraumatic etiologies

A

Shouting
Loud talking
Screaming
Vocal noises (child imitating a truck, etc.)
Chronic coughing/throat clearing

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26
Q

Direct surgical trauma etiologies

A

Laryngectomy
Glossectomy
Mandibulectomy
Palatal surgery
Other head and neck combinations

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27
Q

Chronic illnesses/ disorders etiologies

A

“sinus”/Allergies
Respiratory illnesses/Frequent URI
Gastrointestinal disorders
Emotional disorders
Hormonal imbalance
Arthritis
Smoking/Alcohol/drug abuse

28
Q

Primary disorder etiologies

A

Cleft palate
Velopharyngeal insufficiency
Deafness/HOH
Cerebral palsy
Neurologic disorders

29
Q

Personality- Related Etiologies

A

Environmental/life stress
Identity conflict

30
Q

Vocal fold nodules

A

Bilateral, “relatively” symmetrical lesions occurring on the medial edge between ant. 1/3 and posterior 2/3’s of VFs

Causes Mild to Moderate Dysphonia
Roughness, breathiness, increased muscular tension.

Severity depends upon: Size, time since onset, degree of inflammation.

31
Q

Treatment of Vocal fold nodules

A

First line = voice therapy,
Surgical Removal by “skilled” laryngologist second option

32
Q

Vocal fold polyp

A

Fluid-filled, exophytic lesion composed of gelatinous material in SLLP (typically located on middle third of the VF).

Often unilateral but can be bilateral.

Etiology: Phonotrauma

Mild to severe dysphonia depending on: Size, type, and location

33
Q

Treatment of Vocal fold polyps

A

Voice Conservation/Rehab (if small enough)
Phonosurgery (and voice rehab)

34
Q

Vocal fold cysts

A

Fluid-filled, typically unilateral, sessile lesions on medial edge of the VF

Congenital or Acquired
Embedded in SLLP, but often extend into ILLP and DLLP (i.e., the vocal ligament).

No clear etiology, but…
Mucous gland blockage, and/or Phonotrauma.

increase stiffness of VF

35
Q

Treatment of vocal fold cysts

A

Surgical excision/dissection of the cyst off of the vocal ligament

36
Q

Reinke’s Edema

A

SLLP becomes filled with viscous, gelatinous fluid.

Etiologies: Chronic Phonotrauma, Smoking.

Causes increased mass and stiffness.

Signature low pitch and husky hoarse “smoker’s” voice.

37
Q

Treatment of Reinke’s edema

A

Surgery with Pre- and post-operative voice therapy.

38
Q

Vocal fold scarring

A

Increases stiffness of VFs

Reduced oscillation = reduced mucosal wave during VF vibration.

Reduces glottic closure in severe cases

Effects on voice vary depending upon severity, extent, and location of scar.

39
Q

Treatment of vocal fold scarring

A

No accepted/effective behavioral or phonosurgical treatment.

40
Q

Sulcus/sulcus vocalis

A

Special form of scarring that forms a “ridge” along the SLLP that produces bowing

Unilateral or Bilateral

Etiology unknown

41
Q

Granuloma/ Contact ulcers

A

Granulomas- unilateral or bilateral, lesions related to tissue irritation in the posterior larynx typically on medial surface of arytenoid cartilage(s).

Contact ulcer- ulcerated lesion on the same site often on opposite side of granuloma.

S/S: Pain, sore throat, with or w/o voice change

Etiologies: Mechanical (intubation) Chemical (reflux) Persistent Voice Misuse

42
Q

Treatment of Granulomas/ Contact ulcers

A

Medical: Antireflux Regimen, Intracordal Botox injection

Behavioral: Voice Therapy

Surgical (if fail medical and/or behavioral management).

43
Q

Leukoplakia

A

“white plaque”,
Thick substance on superior surface of VFs in diffuse white patches.

44
Q

Hyperkeratosis

A

“excessive keratin”,
Buildup of keratinized tissue, rough, irregular VF margins.

45
Q

Erythroplasia

A

“thickened and red,”
Due to combination of hyperfunctional voice use and chemical irritation especially alcohol and tobacco use.

46
Q

Papilloma

A

Wart-like growths that develop in the epithelium and invade deeper in the LP and vocalis muscle.

Can grow rapidly and in large clusters and compromise the airway.

Etiology: HPV

Lesions can affect cover, transition, and body of the VFs
increase stiffness, compromise vibratory fxn, and cause severe dysphonia.

47
Q

Treatment of Papilloma

A

Surgical, but recurrence is common requiring multiple de-bulking surgeries (increased likelihood of VF scarring).
Pharmacotherapy (as a primary or secondary approach)

48
Q

Stenosis

A

fibrous tissue overgrowth that narrows the airway

49
Q

Subglottic stenosis & Glottic stenosis/web

A

acquired scar across medial edges of the VFs beginning in the anterior commissure and extending posteriorly.

Etiology:
Subglottic Stenosis: Congenital, Post-intubation scarring, reflux.

Glottic Stenosis/Web: Congenital or Acquired

Treatment: Surgery

50
Q

Vascular leisons

A

caused by traumatic injury to small blood vessels of the VF; focal or diffuse discoloration of VF.

Etiology: intense screaming, singing, coughing, crying.

Hemorrhage = small capillary on surface of VF ruptures abruptly and bleeds into SLLP.

Hematoma = accumulation of blood that has leaked from the ruptured vessel.

Varix = mass of blood capillaries that appears as small, longstanding blood blister that has hardened over time with an adynamic VF segment.

Ectasia = larger collection of varices.

Vascular injuries have potential to increase stiffness of the cover, with localized scarring in more severe cases.

Voice quality can vary from severe at time of bleed (acutely) to mild later.

Small varices or ectasias may have negligible effects on voice

51
Q

Treatment of Vascular lesions

A

Aggressive Voice Conservation (complete voice rest).
Medical (Steroids).
Laser Cauterization
Surgery: Microexcision of persistent varix.

52
Q

Puberphonia

A

Post-pubescent males who speak in falsetto or near top of their modal frequency range.

Voice weak, often breathy or raspy, unable to increase intensity or shout.

Etiology poorly understood, but…
Resistance to puberty,
Feminine self-identification,
Desire to maintain childhood soprano singing voice,
Embarrassment when voice lowers dramatically

Behavioral voice therapy usually effective

53
Q

Juvenile voice

A

Post-adolescent females with higher-than-normal pitch, breathy voice, child-like speech distortions and prosody

Etiology unknown, but…
Women who resisted transition into adulthood or,
Habituated the altered laryngeal and vocal tract posture.

54
Q

Presbyphonia

A

related to processes of laryngeal aging.

“older” sounding voice…
Thin, muffled voice quality,
Decreased loudness, Increased breathiness, Pitch instability

Lack of vocal endurance and flexibility.

Classic laryngeal appearance is a slightly bowed glottic configuration presumably related to “thinned or atrophic” VFs.

Voice rehabilitative therapy can be effective.

55
Q

What is the bernoulli principle and what does it have to do with phonation?

A

movement of fluid flows from a lower pressure than the flow that surrounds it

tells us that as the breath from the lungs through the trachea and passes through the glottis, the pressure of the glottis becomes lesser than the pressure surrounding it causing the VF to adduct

The makeup and recoil of the tissues than the changes in pressure; the initial pressure subglottally is what initiates oscillation initially

56
Q

Name an example of a structural pathology

A

polyp, nodule, etc.

57
Q

Example of a neurological pathology

A

spasmodic dysphonia, dysarthria

58
Q

Example of a psychological pathology

A

functional dysphonia

59
Q

Who invented the laryngeal mirror (1854)?

A

Manuel Garcia

60
Q

What are the three types of onset?

A

Pressed onset (hard attack)
Breathy onset
Balanced onset

61
Q

what will pressed onset do to the voice over time?

A

will damage voice over time

62
Q

what is breathy onset?

A

air is preceding muscle adduction

63
Q

Does high pitch = high register?

A

No

pitch and register are not directly correlated

64
Q

describe phonation

A

Phonation starts with inhalation, the main inspiratory muscles are the external intercostals and the diaphragm.
the diaphragm contracts downward compressing the abdominal viscera creating a pressure vacuum pulling air into the lungs. Inspiration is complete and expiration will be initiated which is what causes the vocal folds to vibrate.
the main expiratory muscles are the internal intercostals and the diaphragm. at onset of expiration a recoil occurs causing the diaphragm to move back up to resting point and this causes a buildup of positive pressure subglottally. the pressure overcomes the resistance of the vocal folds causing them to abduct and vibrate for vocalization. after expiration the buildup of pressure has subsided causing the folds to adduct completing the cycle of phonation.

65
Q

Myoelastic aerodynamic theory

A

Previously thought that pressure changes subglottally cause the folds to abduct and adduct; but now with the myo theory we understand that the pressure change is not as big of a factor in the adduction of the folds because of elastic recoil forces and that they cause a big part of bringing the folds back to midline

Voice Disorders (1 decks)

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