Exam #2 Flashcards by Amberly Jones

An example of phonotraumatic behavior considered under “vocal abuse”

frequent yelling, prolonged whispering, frequent coughing and throat clearing

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Two examples of phonotraumatic behavior considered under “vocal misuse”

teaching beyond vocal sustainability (eg: an instructor teaching continuous classes for 6 hours without vocal breaks and hydration)

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what is an inappropriate vocal componenet

consistent clavicular breathing, prolonged use of glottal fry or falsetto
frequent voice onset and phonation using either hyperadduction (pressed voice) or hypoadduction (breathy voice)

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the following is seen when CT muscle is at high contraction

falsetto or loft register

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T or F: pharyngeal cul-de-sac resonance is also called hot potato voice or “potato in the mouth” speech. The voice quality is perceived as muffled or trapped due to obstruction in vocal tract secondary to swollen throat changes in resonators (eg: palatal tonsilitis)

true

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T or F: Speaking in fast rate should NOT impact the breath support and laryngeal tension

false

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an example of medically-related etiology of a voice disorder

direct surgery such as laryngectomy
indirect surgery such as thyroidectomy or cardiovascular surgery
intubation/extubation or COVID-19

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An example of primary disorder etiology of a voice disorder

Pierre Robin Syndrome

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____________________ is the umbrella term for medically unexplainable voice disorder

muscle tension dysphonia

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T or F: Limbic system is activated secondary to fear or anxiety and sends excessive motor impulses to the laryngeal muscles. This may lead to laryngeal function dysregulation or inhibition of phonation

true

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An example of functional dysphonia:

change or loss of voice after a prolonged stress or sudden shock or resistance to puberty

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healthy color of true vocal fold is:

moist and pearly white

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factor(s) that impact the prevalence of voice disorders in USA:

age, gender, occupation

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match the following using the most common laryngeal pathologies seen in children and adults

young adults - vocal nodules
middle-aged adults - laryngeal cancer
older adults - vocal fold paralysis
children - laryngitis

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match the following using the information from 2012 National Health Survey

reported voice problem - 17.9 million adults
seeked professional help for a voice problem - 10%
reported presence of GERD - 8%
risk of voice problem in someone with psychological distress - two-fold

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Which of the ethnic groups is less likely to report a voice problem secondary to disparities related to social determinants of health

african-american

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What happens to vocal fold tissue and voice outcomes secondary to a structural pathology such as vocal fold nodules or polyps?

mass of the tissue increases, tension in the vibrating tissue increases, flexibility of the vocal fold tissue decreases, typically pitch increases due to excess muscle tension

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an example of “productive” compensatory adjustment is:

vocal tract tuning

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An example of “maladaptive” compensatory adjustment is:

constant increase in vocal effort or muscle tension

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the following lesion can metabolize into a different location from the primary site through blood stream or lymphatic system

malignant tumor

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Risk factor(s) of laryngeal carcinoma:

excessive alcohol consumption, chronic smoking, untreated chronic and reflux (GERD or LPR)

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___________________ is the confirmatory test of malignant tumor

biopsy

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According to newer labels, how do you report vocal fold nodules?

bilateral fibrous/gelatinous masses in between anterior 1/3rds and posterior 2/3rds of vocal folds

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two vocal fold lesions which only invade epithelium and superficial layer of lamina propria

vocal fold nodules & vocal fold polyps

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The first line of treatment is voice therapy in the following vocal fold lesion:

acute vocal fold nodules

the glottic configuration in vocal fold nodules

hour-glass pattern

T or F: A structural lesion or functional etiology causes incomplete glottic closure which leads to excessive loss of glottal airflow. This is non-productive as the glottal air leaking through the anterior or posterior glottal gap canNOT be used for phonatory purposes. Therefore it leads to breathiness or hoarseness in vocal quality.

true

presence of hemorrhagic vessel feeding the lesion is seen in:

vocal polyps

The following vocal fold lesion is so invasive that it may extend upto deep layer of lamina propria and significantly disrupts the viscoelastic properties of vocal fold tissue

vocal cysts

this is a vocal fold lesion which may cause severe fluid retention and inflammation in the space between epethelium and superficial layer of lamina propria

reinke's edema

The following vocal lesion might occur secondary card to rupture of vocal cysts or presbylaryngis

sulcus vocalis

Match the following using the appropriate treatment option

acute vocal fold nodules - voice therapy vocal cysts - surgical excision reinke's edema - smoking cessation program sulcus vocalis - vocal fold augmentation

a contact ulcer is commonly seen opposite to which vocal lesion?

vocal fold granuloma

______________________ is the common vocal lesion secondary to prolonged intubation or extubation

vocal fold granuloma

treatment option for recurrent respiratory papillomatis

antiviral medication such as interferon, angiogenesis inhibitor such as Avistan, surgical escision

stridence during breathing, wheezing, and feeding problems are commonly seen in:

laryngomalacia

first step of treatment is voice rest in

vocal hemorrhage

Best medicine to take for pain for a singer or vocal performer

Tylenol (acetaminophen)

T or F: excessive vocal demands or inappropriate vocal behaviors increase the laryngeal tension which further causes structural changes in vocal fold mucosa

true

the following configuration is seen during phonation in a person with presbylarnx or bilateral sulcus vocalis

spindle-shaped glottis

The following two treatment options work best for functional cause of puberphonia

laryngeal repositioning and circumlaryngeal massage, negative practice

inflammatory condition of voice disorder

rheumatoid arthritis, LPR, irritable larynx or allergies

Two hormones which significantly impact the voice parameters

growth hormonts & sex hormones

a voice disorder can be seen in someone with:

hypo or hyperpituatarism, hypo or hyperthyroidism, premenstural syndrome / menstrual cycles / pregnancy / menopause

Right epiglottic petiole deviation is seen in patients with:

Right external branch of superior laryngeal nerve

match the following term to it's definition

superior laryngeal nerve paralysis - epiglottic petiole deviation on the side of paresis/paralysis bilateral adductor VF paralysis - inability to close the glottis bilateral abductor VF paralysis - inability to open the glottis spasmodic dysphonia - vocal dystonia / spasms in laryngeal muscles

Least improvement with voice therapy in unilateral VF paralysis when paralyzed VF is at ________________ position:

cadaveric

Best treatment when paralyzed VF is a cadaveric or partially abducted position:

VF repositioning

Spasms in laryngeal muscles that keep the vocal folds open is seen in ______________ and therefore voiceless to voiced transition is challenging When the person says "funny", it goes "f....unny" as the spasms keep the vocal folds open for a slightly longer time.

abductor spasmodic dysphonia

Spasms in laryngeal muscles that keep the vocal folds closed is seen in ______________ . Therefore voiced sounds are challenging and voiceless has no effort/disruption. When the person says voiced sentences like "We eat eggs every easter", it sounds effortful and strain-strangled.

adductor spasmodic dysphonia

Vocal folds close instead of opening during inhalation. This may lead to inspiratory stridor and a feeling of shortness of breath in_________________

paradoxical vocal fold motion

match the following term to its defnition

paradoxical vocal fold motion - reduced flow-volume loop ventricular phonation - false vocal folds vibrate during phonation rheumatoid arthritis - fixation of cricoarytenoid joint abductor spasmodic dysphonia - involuntary breathy bursts / spasms

skeletal/striated muscles

attached to bones and responsible for skeletal movements; posture; generation of heat (PNS + CNS)

smooth/non-striated muscles

found in internal organ; control of ANS

cardiac muscle

found in the walls of heart; control of ANS; contraction is involuntary

bioenergetics

production of energy sources required for muscle contraction and relaxation

ATP

- immediate energy system (creatine phosphate or phosphocreatine; aerobic) - glycolysis (anaerobic) - oxidative phosphorylation (aerobic)

type 1

- slow twitch, high fatigue resistance, oxidative, phopshyorylaiton

type 2-a

intermediate, moderate fatigue resistance, IES + glycolysis, (+) oxidative glycotic fibers

type 2-x

fast twitch, quick fatigue, immediate energy system (IES)

which type of muscle type is adaptable with training and can improve their fatigue resistance by increasing their oxidative capacity

type 2-a

True or False: all 3 muscle fiber types adapt to imitate other muscle fibers based on training and load

true

___________________________________brings neuromusculoskeletal adaptations

motor learning/muscle training

laryngeal muscles

TA (tensor), IA (adductor), and LCA (adductor) PCA (abductor) and CT (tensor; respiratory and phonatory function)

TA (tensor), IA (adductor), and LCA (adductor)

- 80% type 2 and type 1 - rapid valving and closure for airway protection; prevent aspiration and phonatory function - IA: quick fatigue

PCA (abductor) and CT (tensor; respiratory and phonatory function)

- about 65% type 1 - PCA: repetitive opening of airways for respiration - no type 2-x fibers

overload

frequency, intensity, duration

example of overload

singing falsetto for 10 minutes vs 30 minutes

target

strength, endurance, longevity, and function

isometric

muscle contraction where length of the muscle does not change (sustained phonation, holding breath)

isotonic

muscle contraction where length of the muscle changes [ascending glide (eccentric) and descending glide (concentric)]