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Voice Disorders > Exam #2 > Flashcards

Exam #2 Flashcards

1
Q

List the types of resonance disorders

A

Hypernasality
Hyponasality
Mixed nasality
Assimilative nasality

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2
Q
  • Discuss the psychosocial impact of a resonance disorder.
A

Viewed more negatively than dysphonic speakers (by listeners) (Lallh & Rochet, 2000)
Considered them less pleasant/reliable/kind/more cruel
Less likely to want to talk to hypernasal speakers
Preferring more social distance

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3
Q
  • List the primary etiologies of resonance disorders.
A

Structural:
orofacial clefts, cervical anomalies, wide nasopharynx, gross tissue deficiencies
Mechanical interference:
tonsils, adenoids, faucial pillars, maxillary advancement dentition related issues
Neurogenic:
stroke or T B I (dysarthria or apraxia of speech, stroke), tumors
Hearing loss or deafness mislearning of timing
Stress (e.g., wind instrument players) fatigue effect
Mislearning:
phoneme-specific nasal air emission

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4
Q
  • Describe the embryological development of the anatomical structures
    relevant for resonance.
A

6-7- primary palate
· Secondary palate: beings 8-9 weeks gestation
· Prior to palate forming, tongue is high and in area of nasal cavity
Frontonasal prominence moves downward
Lateral palatine processes come to midline to fuse
Tongue starts to descend around 8 weeks
Fusion starts of lateral palatine process starts in center and moves anteriorly
Velum & SP are completed by about 12 weeks

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5
Q
  • List the types of clefts.
A

Complete/incomplete
unilateral/bilateral

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6
Q
  • List the different types of “VPI”.
A

Velopharyngeal “Inadequacy”
Velopharyngeal “Insufficiency”
Velopharyngeal “Incompetence”
Velopharyngeal “Mislearning”

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7
Q
  • List the primary assessment components for resonance disorders.
A
  1. Visual examination of oral structures- testing palate and tongue
  2. Auditory-perceptual judgment of resonance- acoustic measires, visipitch (helps determine nasal emissions/different types of resonance)
  3. Articulation testing
  4. Radiological assessment of head & neck- other team members may handle this but can refer out for imaging to check for structural basis
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8
Q
  • Describe the key treatment approaches for resonance disorders.
A

Surgical
Prosthodontic
Exercise
Behavioral
Combination of any of the above
Counseling/support groups for
parents or patients

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9
Q
  • Describe the purpose of a voice assessment.
A

Identify and describe:
* underlying strength and deficits
* effects of the voice disorder on the individual’s activities and participation
* contextual factors- communication barriers/facilitators

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10
Q
  • Describe the reasons why a voice-screening tool is recommended.
A

Screening in children is especially important
Inaccurate judgements (teachers, family members, physician)
Impact on educational and psychosocial development

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11
Q

Describe the ASHA preferred practice patterns related to physician examination of voice clients.

A

All patients/clients with voice disorders must be examined by a physician, preferably in a discipline appropriate to the presenting complaint. The physician’s examination may occur before or after the voice evaluation by the clinician

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12
Q
  • Discuss the potential barriers to examination by an ENT.
A

The voice assessment by the speech-language pathologist may begin prior to a medical examination

But - The clinician should wait to make treatment recommendations until the medical information is obtained

BUT - What if the client cannot visit a specialist?
Sociocultural considerations- may not be a priority
Many people work through voice issues

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13
Q
  • List the primary components of the voice assessment.
A

Background and history
Patient interview
Non-instrumental assessment
Instrumental assessment

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14
Q
  • List at least 4 specific components of the background and history portion
    of a voice assessment.
A
  1. Establish reason(s) for referral
  2. Establish rapport

Areas to focus on:
1. Medical status
2. Auditory and visual status
3. Cognitive and emotional status
4. Education
5. Occupation and vocations
6. Cultural and linguistic background

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15
Q
  • List at least 4 specific components of the interview portion of a voice
    assessment.
A
  1. Description of the problem and cause
  2. Reality distance
  3. Onset and duration of the problem
  4. Variability and consistency of the problem throughout day
  5. Various contexts
  6. Description of voice usage
  7. Abuse/misuse
  8. Psychological screening
  9. Signs of stress/anxiety
  10. Coping and social network
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16
Q
  • Name the primary components of the non-instrumental assessment.
A

Behavioural observation
Oral-peripheral mechanism exam
Auditory-perceptual judgments
Voice-related quality of life

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17
Q
  • List the primary options for an instrumental assessment.
A

Laryngoscopy
Acoustic analysis
Aerodynamic analysis

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18
Q
  • Discuss the advantages/disadvantages of instrumental vs. non-
    instrumental assessments.
A

Instrumental
* Advantages:
* Provide objective data
* Standardization
* Visualization of VFIs, analysis of voice, and analysis of lung cancer
* Disadvantages
* Reliance on equipment which may be expensive and unavailable
* Invasive

Non-instrumental
Advantages:
Lower cost
Quick and easy to administer
Can capture the impact on the patient
Non-invasive

Disadvantages:
* Subjectivity
* Lack objectivity
* Cannot directly assess structural/physiological issues
* Do not rly on instrumentation due to lack of confidence with non-instrumental

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19
Q

Discuss the possible causes and factors that impact absenteeism.

A

Causes:
* Lack of insurance
* Accectpance of the voice disorder: reality distance
* Bring awareness to them to gain acceptance-provide education/counseling, show them results
* Distance to the clinic
Factors:
* Perception of disease severity
* Family support and cultural norms
* Patient-clinician rapport and how the clinician responds to poor attendance
* How engaged the clinician is at first meeting
* Self-efficacy

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20
Q
  • Discuss ways to prevent absenteeism.
A

Schedule patient for evaluation at earliest date possible
Use ‘empowering’ and non-judgmental language when speaking with patient
Educate the patient on the necessity of the voice therapy

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21
Q

Compare/contrast direct and indirect treatment approaches.

A

Direct Approaches: modify vocal behaviours and establish healthy voice production.
manipulation of:
* phonation
* respiration
* musculoskeletal function
* Normally a combination
* some clinicians use holistic approach to balance the physiological subsystems.
Indirect Approaches:
* Modification of cognitive, behavioural, psychological, physical environments.
* Typically includes: patient education and counseling to discuss the impact of vocal misuse, appropriate strategies such as ways to maintain vocal health and stress management.

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22
Q
  • Describe the goal of physiologic voice therapy.
A

Restore balance of the three subsystems of voice production:
1. respiration/respiratory support
2. phonation/laryngeal muscle strength, control, stamina
3. resonance/supraglottic modification of the laryngeal tone
(Direct therapy type)

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23
Q

List the physiologic voice therapy approaches.

A
  1. Resonant Voice Therapy
  2. Semi-occluded straw phonation
  3. Vocal Function Exercises along with RVT
  4. Manual Circumlaryngeal Techniques:
  5. Accent Method
  6. Conversation Training Therapy
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24
Q
  • Describe the goal of symptomatic voice therapy.
A

modification of specific vocal symptoms (e.g. pitch, loudness, breathiness, or hard glottal attacks)
direct or indirect approaches

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25
Q

Describe at least two specific symptomatic voice therapy approaches

A
  1. Amplification:
    Supportive tool/instrument, sorta augmentative communication
    Help to prevent vocal hyperfunction
    Amplifies the voice so that they don’t have to produce louder voicing
    e.g., microphone, speaker, FM system
  2. Biofeedback (pitch, quality, loudness, effort) building awareness.
  3. Relaxation- reducing effortful phonation (progressive muscular relaxation, visualization, deep breathing)
  4. Chant-Talk- recitation of syllables using one continuous tone
    Focus on phonation
  5. Yawn-sigh- lowers laryngeal position to widen the supraglottic space
    -produce relaxed voice and encourage natural pitch
26
Q
  • Discuss the specific areas that may adversely affect quality of life in the
    aging population.
A
  1. Voice-related effort and discomfort, increased anxiety and frustration, and the need to repeat oneself
  2. Having a voice disorder is more likely to lead to depression.
27
Q

Define presbyphonia and patient complaints.

A
  1. Age-related vocal changes.
  2. Condition related to elderly patients presenting to the otolaryngologist (E N T) with gradual weakening of the voice.
  3. Patients complain of an inability to project their voice over background noise and of a hoarse voice quality that deteriorates throughout the day.
28
Q

Describe features of presbyphonia (laryngeal, auditory-perceptual, acoustic).

A

Laryngeal: Mild bowing of the vocal fold margins appear adducted in the medial position
Anteriorly placed glottal gaps
Prominent arytenoid cartilage vocal processes more visually perceivable compared to normal
Vocal fold edema
Asymmetry of vocal fold vibration

Auditory-Perceptual Features: Tremor- lower frequency
Hoarseness
Breathiness- may be result of bowing
Voice breaks
Decreased loudness
Slower speaking rate
Change in habitual pitch (sex-dependent)- fundamental frequency
-For men, lowers during puberty and then rises again when aging
-Females remain pretty constant, may drop and plateau in older age

Acoustic: May include:
Increased Fo in males
Decreased Fo in females
Decreased S P L
Increased Noise-to-Harmonics Ratio
Inconclusive findings on changes in jitter and shimmer

29
Q

List the primary treatment approaches for presbyphonia.

A

Laryngoplasty
Thyroplasty
Voice therapy- 1st approach

30
Q
  • Describe at least two specific voice therapy approaches for
    presbyphonia.
A
  1. Auditory Feedback- biofeedback, visual display, focused attention on voice when speaking
  2. Counseling
  3. Elimination of Abuses- vocal hygiene focus
  4. Open-Mouth- projecting the voice
  5. Relaxation- especially if they are hyperadducting/experiencing muscle tension
  6. Visual Feedback
31
Q
  • Describe possible etiology associated with pediatric voice disorders.
A

Hyperfunction- puts kids at higher risk of voice disorders due to shouting, etc.
Can see cysts/nodules developed
larygopharyngeal reflux disease

32
Q
  • Discuss at least 5 educational risks of pediatric voice disorders.
A

Difficulty being heard or communicating in educational environments inside or outside of the classroom setting
Limited participation in public speaking activities
Fear of participating in oral reading activities
Limited participation in classroom discussions with peer groups
Fear of conversing in interpersonal interactions
Limited participation in regular physical education routines
Reluctance to participate in activities such as school plays, cheerleading, and debate
Limited participation in music education
Reluctance to participate in interview activities, thereby limiting access to employment and certain educational opportunities
Hindrance of academic goals of other classroom students (i.e., voice quality may be distracting)

33
Q
  • List the 4 terms used to describe the major laryngeal changes that occur in
    development.
A
  1. Position: The infant larynx is positioned high in the neck, between the level of C1 and C3
    Posterior to the mandible
    Mandible provides protection against traumatic injury
    The tip of the epiglottis may touch the velum protects from aspiration during feeding
    Starts to descend (in the neck)
    at around 2 years of age
  2. Size: Smaller than the adult larynx
    Thyrohyoid membrane is much shorter smaller dist. Btw hyoid and thyroid
    Thyroid notch is posterior to the hyoid
    Length of the vocal folds is 2.5 to 3.0 millimeter
    Arytenoids comprise more than 50% of the glottis until 3 years of age
    Prior to puberty, the length and width of the vocal folds do not vary much between boys and girls
    After puberty, the average increase in overall length for:
    females= 4.2 millimeter
    males= 10.9 millimeter
  3. Shape: Shaped like a funnel, widest superiorly and narrowing inferiorly
    Narrowest point is at the level of the cricoid cartilage
    Thyroid prominence (Adam’s Apple) appears at puberty
    Becomes more cylindrical with age
  4. Consistency- VFs (layers) Vocal Fold
    Immature vocal ligament develops between 1 and 4 years of age medial layer within the muscle
    Vocal fold mucosa is thinner in newborns and young children
    Lamina propria is a single layer
34
Q

Describe the service delivery options for pediatric voice therapy.

A

Classroom Pull-out
Classroom-based service delivery
Collaborative method
Consultative method
Individual therapy sessions:
The clinician and child meet one-on-one to establish therapeutic techniques in an intensive manner.
Small-group sessions:
These sessions ideally would be conducted with other children with voice disorders

35
Q
  • List the voice and resonance issues typically observed in individuals who
    are hard of hearing.
A
  1. Deviations in fundamental frequency
  2. Altered formant frequency transitions
  3. Altered phonation range
  4. Variations in vocal intensity
  5. Changes in nasality (cul-de-sac resonance)
36
Q

Describe the factors important for successful voice following a cochlear implant.

A

The changes in voice, depends on:
Pre- versus post-lingual deafness status
Unilateral versus bilateral implantation status
Management (amplification & visual feedback
voice facilitation approaches)

37
Q

List the primary areas of focus during voice therapy for transgender
clients.

A

A. Vocal characteristics
B. Resonance and Articulation
C. Language and Nonverbal Communication
D. Client self-perception and Quality of Life

38
Q
  • List the basic human functions that could be impacted by head and neck cancer.
A

Hoarseness or change in voice
Airway obstruction, difficulty breathing, noisy breathing
Persistent difficulty in swallowing
* Persistent sore throat, or a feeling of something in the throat
* changes in taste
* head and neck mobility limitations
Persistent= greater than 2 weeks
Ear pain
Chronic bad breath
Choking
Unexplained weight loss
Fatigue

39
Q

Define TNM classification of malignant tumors and discuss its importance.

A

-Tumor staging is critical for establishing the disease status and patient prognosis, and for selecting the most effective treatment paradigm
-The presenting stage of the cancer is the most important prognostic indicator for patient survival
-Extent of the spread, size, involvement of lymph nodes, secondary growths
-Imaging helps (CT, MRI)

40
Q
  • List members of the management team for patients with head and neck
    cancer.
A

Slp, radiologist, oncologist, surgeon, anesthesiologist, OT, PT, orthodontist, dentist, plastic surgeon, nurse, respiratory therapist, ENT, social worker, psychologist, financial counseling, prior patient who has undergone a laryngectomy

41
Q
  • List the medical approaches for laryngeal cancer.
A

Radiation Therapy (R T)
Chemotherapy (C T)
Clinical Trials
Surgery

42
Q
  • Describe the surgical options for laryngeal cancer.
A
  1. Total laryngectomy
    May involve the hyoid, may not
  2. Partial laryngectomy (aka conservation surgery):
  3. Cordectomy- removal of VFs
  4. Vertical hemilaryngectomy- half of larynx vertically
  5. Supraglottic laryngectomy- upper portion of larynx removed (above glottis)
  6. Subtotal laryngectomy (aka supracricoid)- same as vertical but also includes upper half of contralateral larynx.
  7. Composite resection- removal of the lining of part of the oral cavity.
43
Q

Describe at least 5 post-treatment complications of laryngeal cancer.

A
  1. Psychosocial trauma from surgery and/or other therapies
  2. Breathing difficulties
  3. Loss of upper body strength
  4. Throat and neck swelling
  5. Limited mobility of the neck and shoulders
  6. Aspiration pneumonia
  7. Increased or decreased mucus production
  8. Stoma stenosis (Body trying to heal the tissue)
  9. Osteoradionecrosis (Bone death as a result of radiation therapy)
  10. Chondroradionecrosis (Cartilage inflammation/death of cells as result of radiation)
  11. Tissue fibrosism (Tissue getting thicker, reduced ROM)
  12. Chronic pain
44
Q
  • Discuss the primary medical outcomes of head and neck cancer.
A
  1. Survival rate (impacted by stage at diagnosis and co-morbidity)
  2. Functional abilities (affected by amount of tumor resected)
  3. Patient’s perception of his or her quality of life
45
Q

Describe the preferred timing of SLP consultation for patients with laryngeal cancer.

A

Both pre and post op is most beneficial
Things might be found once the surgery starts, may change the plans
May also include a swallowing evaluation

46
Q

Compare/contrast the advantages and disadvantages of the different types
of alaryngeal speech modes.

A

Electrolarynx: Advantages: easy to use; small; has loudness and pitch controls; adequate loudness for noisy places; good intelligibility
Disadvantages: electric sound; moderate cost of device; ongoing cost of batteries; difficult to use with scarring and fibrosis; requires good articulatory abilities; requires practice

Esophageal Speech: Advantages: non-electric sound; no dependence on external device
Disadvantages: difficult to learn; not loud enough for noisy places; requires excellent articulatory skills; if gas does not go ‘up and out’ it only has one other direction to go…

Tracheoesophageal Speech: Surgical fistula (TEP – tracheoesophageal puncture) between trachea and esophagus
This allows air from the lungs to be directed into the pharyngoesophageal segment via a shunt
Patient occludes stoma (manually or hands-free device)

47
Q
  • Discuss at least 5 psychosocial considerations related to laryngeal cancer.
A
  • Financial stress
  • Job loss/economic impact
  • Anxiety and fear of recurrence
  • Pain anxiety
  • Substance abuse
  • Acceptability
  • Quality of relationships
  • Social isolation
  • Emotional stress
  • Altered body image
  • Decreased self-esteem
  • Sexuality
  • Depression
  • Fatigue
48
Q

Define Hypernasality

A

Too much nasal resonance on vowels and consonants, i.e., phonemes other than /m, n, n g/

49
Q

Define Hyponasality

A

Not enough nasal resonance on the phonemes /m, n, n g/ - sound like /b, d, g/
Occurs usually due to occlusion of the nasal cavity or blockage of the V P port

50
Q

Define mixed nasality

A

Too much nasal resonance on vowels and vocalic consonants, and not enough nasal resonance on /m, n, n g/
Most commonly seen in apraxia of speech

51
Q

Define assimilative nasality

A

Voiced consonants/vowels are nasal when adjacent to a nasal consonant.
(timing issue)

52
Q

Define cul-de-sac resonance?

A

sound is resonating in a cavity and is trapped their, sounds like muffled speech (enlarged tonsils)

53
Q

Velopharyngeal “Inadequacy”

A

is the more umbrella or general term which describes V P problems regardless of etiology

54
Q

Velopharyngeal “Insufficiency”

A

is a term that implies a structural basis

55
Q

Velopharyngeal “Incompetence”

A

is a term that implies a neurogenic basis
size and shape are fine, but there may be a planning/CN issue

56
Q

Velopharyngeal “Mislearning”

A

implies a learned behavior habituated speech pattern developed, typically due to a lack of auditory feedback

57
Q

Describe Resonant Voice Therapy

A
  1. Pressed voice: Hyperadduction
    rich in harmonic content
    strenuous, excessive mechanical stress on laryngeal tissues, unhealthy
  2. Breathy voice: Hypoadduction
    poor harmonic content
    inefficient
  3. Resonant voice:
    “middle ground” laryngeal adduction
    reinforcement of oscillatory glottal airflow by the vocal tract

-vocal placement exercises
-breathing exercises
-resonant humming

58
Q

Describe Semi-Occluded Straw Phonation:

A

Increase in air pressure above the vocal folds, reducing the impact collision force of the VFs.
e.g. lip trill, straw phonation

59
Q

Describe Vocal Function Exercises (going along with RVT)

A

-systematic voice manipulations
-strengthen and coordinate the laryngeal musculature
-improve efficiency
-Improved VF vibration and airflow

60
Q

Describe Manual Circumlaryngeal Techniques

A

-reduce musculoskeletal tension and hyperfunction
-clinician may get a glimpse of improved voicing
-reinforce with sensory feedback to maintain improved posturing

61
Q

Describe the Accent Method

A

-pulsed abdominal breaths to facilitate glottal closure
-Building a new respiratory and voice pattern
-Takes advantage of the Bernoulli effect
-basic syllables  conversation
Building your way up to conversational level

62
Q

Describe Conversation Training Therapy

A

-clear speech (intelligibility)
-Improved articulation
-auditory and kinesthetic awareness (directed attention)
-Hearing and feeling the changes in voice
negative practice
-Having the client produce breathy/harsh voice to feel the difference
-basic gestures- facilitate conversations without overusing the voice
prosody

Voice Disorders (2 decks)

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