Final Flashcards
Edema
Swelling/fluid accumulation occurs in the vocal folds as a protection mechanism which causes an increase of mass. A person may report sore throat/feeling of something in their throat (extra weight due to swelling/edema)
Chronic Laryngitis
Etiology: Caused by phonotraumatic behaviors (coughing, yelling, excessive talking, etc.)
Distinguishing feature: Longstanding inflammation of the laryngeal mucosa
Treatment: Responds to speech therapy
Acute Laryngitis
Etiology: Caused by bacteria/virus
Distinguishing Feature: Yellow septum observed
Treatment: Does NOT respond to speech therapy
Vocal Nodules
Distinguishing Feature: Localized, benign growths on the vocal folds typically typically bilateral and symmetrical occurring at their midpoint
-most common benign lesions of the vocal folds
Treatment: voice therapy
Nodule Life Cycle
-start as soft, pliable, easily compressible lesions
-overtime, go through hyalinization, the nodules become fibrotic and mature
Reinke’s Edema
Distinguishing characteristics: diffuse polypoid swelling
-Reinke’s space includes epithelium and superficial layer of the lamina propria
-hoarseness severe and persistent, low pitch
Etiology: caused by alcohol and smoking
Treatment: not necessary unless wanted
Pedunculated polyps
Distinguishing Characteristics: benign growth on the vocal cords that has a distinct stalk or “stem” attaching it to the vocal cord, dangling polyp that can flap with airflow, often causing hoarseness or voice quality changes
Treatment: Almost always involves surgical intervention or steroids, therapy will not help at all.
Etiology: caused by vocal abuse or overuse
Sessile polyps
Distinguishing characteristics: broad based polyps that closely adhere to the vocal fold mucosa
Etiology: caused by vocal abuse or overuse
Treatment: surgery to remove them and then therapy
Contact ulcers
Distinguishing characteristics: Benign lesions/ulcerations in the posterior glottis in the area of the arytenoids
-Develops in the posterior aspect of the vocal folds because they drive the posterior vfs together (point of maximum contact)
-One of the first signs is a distinct burning pain
Etiology: phonotrauma
Treatment: Voice therapy/remove misuse behaviors, vocal rest is not recommended
6 Steps of a Vocal Misuse/Abuse reduction program
- identify the patterns/behaviors demonstrated by the patient related to vocal misuse/abuse
- a baseline of occurrence should be identified by either direct observation of the client or having them track and monitor outside of the clinic environment
- make the patient aware of the impact these abuses have on their voice and how they might contribute to an additive lesion
- discuss the identified abuses with the patient, emphasizing the need to reduce their daily frequency. Have them count daily abuses/misuses and tally them
- plot the daily occurence of vocal abuse/misuse on a graph. The graph serves to make the patient aware of what they have been doing and allows them to track progress.
- have the patient bring these graphs to therapy and discuss, really reinforce when you see the occurrences decreasing. Graph should show a gradual decline over time of the abusive behavior
Reasons why voice therapy might be preferable to surgery in instances of phonotrauma
-less time off work
-non-traumatic
-therapy can be more cost effective, especially if insurance covers it
-therapy permanently eliminates the hyperfunctional behavior
Ventricular Dysphonia
-occurs when false vocal folds approach midline and vibrate
-considered atypical
-caused by a lot of muscle tension
5 Indirect therapy approaches
- Consultation Model- providing the patient with information and allowing them to work on their own for the treatment of their voice disorder
- Clinical Surrogates- providing information and activity sheets to someone other than the patient who is willing and able to implement them (teacher, parents)
- Inservice Programs- dissemination of information concerning the prevention of voice disorders to interested groups (teachers, etc.) in a brief manner
- Group Workshops and mini seminars for specialized groups who are at risk or suffer from voice disorders- these are typically provided the university and hospital community and are similar to in-services but only longer and more involved
- Demonstration lessons in school classrooms and lectures in university courses by voice clinicians
Completed vs. modified vocal rest programs
complete: elimination of all activities that either adduct the vocal folds or cause the vocal folds to vibrate and produce sound
modified: the use of the voice is significantly reduced but not completely eliminated
Boone 4 primary responsibilities for SLP when counseling
- receiving information- SLP should actively and nonjudgmentally listen for the real meaning of the patient’s message, without planning what to say next, and then restate in their own words what the patient has said
- giving information- this is the easiest of the counselor functions and involves sharing information with the patient regarding their diagnosis
- clarifying- assist the patient in perceiving more clearly and dealing more constructively with the issues impacting their voice problem
- helping to change the behavior- to do this you must exercise all of the above, with the first step being to clearly explain the target behavior and its potential benefit, and incorporating discussion, practice, observation, and roleplaying
Vocal fatigue
as they use their voice it becomes more effortful to talk, as the effort to talk increases, their vocal quality becomes worse
6 parameters you should have the client address when you ask them to describe their voice disorder
- patient’s description of the voice disorder
- other people’s reactions to the voice disorder
- patient’s rating of severity of the voice disorder
- patient’s description of the effects of the voice disorder
- patient description of what caused the voice disorder
- patient’s description of the onset of the voice disorder
5 Forms of direct voice therapy
- symptomatic voice therapy- involves the direct modification of overt behavioral characteristics of the voice disorder
- lifestyle and environmental modification- analysis of precipitating and perpetuating factors associated with the person’s lifestyle/environment, working with them and their family to make necessary modifications, implementing these modifications, and monitoring their progress
- physiologic voice therapy- the utilization of objective data regarding the patient’s laryngeal function to modify function of the laryngeal musculature and the respiratory support of voice production
- psychodynamic voice therapy- psychosocial goals and the use of emotional or cognitive retraining as a way of changing voice use
- holistic voice therapy- draws on all the approaches mentioned above implementing them sequentially or concurrently based on the patient’s most compelling needs to set the order or priority
Client and clinician related factors which might influence selection of a voice therapy program
Client related:
-age
-type
-severity of disorder
-personality
- their understanding of the program
-contributing factors
-commitment to change
Clinician related
-training
-previous experiences
-interest in voice disorders
-confidence level
-personality
Diplophonia
audible production of 2 different pitches because one vocal fold has more mass than the other vocal fold, so one will vibrate at a reduced rate. They vibrate asynchronously, so they stop vibrating and cancel out. Another reason could be that a lesion may flutter and cause another pitch
The 3 most important determinations to be made from a voice evaluation
- A detailed description of the patient’s voice characteristics and how it varies over time
- how severe the patient’s voice disorder is
- whether the patient would benefit from a voice therapy program
Advantages and disadvantages of vocal rest programs
advantages:
1. Usually see rapid reduction in the size and severity of the lesion
2. allows individuals the opportunity to identify situations that promote misuse
3. allows the therapist to determine the individual’s commitment to the process
disadvantages:
1. may be financially impossible for those who use their voice professionally
2. difficult task for average person to adhere to and is more difficult for those who misuse their voice
3. some patients become depressed with continued vocal rest
Phontrauma
any vocal behavior that cana have a traumatic effect on the vocal folds. We used to say disorders of vocal abuse/misuse, but this is blaming language, so we do not use.
3 Prognostic considerations which might assist in determining whether a voice therapy program will be successful
- patient must recognize there is a problem
- patient must be willing to follow a treatment plan
- patient must be able to give up abusive habits
