Functional Voice disorders Flashcards
How are functional voice disorders characterized?
- tension
- hyperfunction
- larynx “riding high”
- anxiety
_______ voice disorders can be controlled, but not _______ voice disorders.
Functional
neurogenic
What percentage of functional voice disorders comprise of dysphonia cases?
10%
Functional voice disorders occurs predominantly in what gender and what type of personality
women
type A
What can cause functional voice disorders
- upper respiratory infection
- stressful/traumatic event
- idiopathic
- organic voice disorder
- neurogenic
- psychosocial (mood, anxiety, adjustment)
What structural pathology is present in functional voice disorders?
There is no structural pathology present in functional voice disorders unless, it is caused by an organic voice disorder.
What are the classification of etiologies for functional voice disorders?
1-Psychogenic: caused by underlying psychological factors
2-Neurogenic: Parkinson’s disease: Basal ganglia not making dopamine; thyroid doesn’t get the dopamine
3-misuse/abuse: caused by hyperfunction
o Excessive throat clearing
o Excessive/inappropriate singing/performing
4-organic: compensatory hyperfunction as a result of organic pathology
o Cancer
o Nodules
5 - Idiopathic
What are the four functional voice disorders?
- Puberphonia/falsetto/mutational falsetto
- Functional aphonia
- Functional dyshonia/muscle tension dysphonia
- Paradoxical VF movement (PVFM)/PVCD/VCD
What is puberphonia?
A pitch control disorder, pitch is either too high or there are breaks in pitch.
_______ lower is normal development.
1 octave
Who is usually diagnosed with puberphonia
Male puberty/post adolescent puberty males
What usually causes puberphonia?
Emotional stress/psychogenic
What happens to the larynx in puberphonia?
- The larynx “rides high” because it was not dropped in puberty
- but there is nothing wrong with the larynx
- Not due to anatomic immaturity of larynx
A 20 year old male will be diagnosed with puberphonia if he has a frequency of _____ instead of ______.
200 Hz
120 Hz
(Remember make sure the larynx has been examined before diagnosing)
What are the larynx features of the visual assessment of puberphonia (laryngeal characteristic of high pitch)?
- incomplete glottal closure
- increased vocal fold stiffness
- decreased vibratory amplitude
What is functional dysphonia also known as?
Muscle tension dysphonia
What is muscle tension dysphonia?
- high muscle tension
- Excessive tension of laryngeal/extralaryngeal muscles
- Pulls muscles from neck and chest to make voice
What kind of breathing occurs with functional dysphonia/muscle tension dysphonia?
chest breathing/clavicular breathing: shallow breathing from excessive use of accessory muscles
What are characteristics of functional dysphonia (muscle tension dysphonia)?
- increased vocal effort
- vocal fatigue
- hyperfunction: Ventricular compression, ventricular phonation, anterior - posterior press
What is found in the patient history of clients with MTD? (Book pg. 170)
- psychogenic factors: stress, anxiety, depression
- high vocal demand
What are the larynx features of the visual assessment of functional dysphonia/muscle tension dysphonia?
- Excessive glottic and supraglottic medial contraction
- anterior posterior contraction of the supraglottal musculature including arytenoids
- Psychogenic bowing of vocal folds
- decreased Vibratory amplitude of vocal folds
what is bowing of vocal folds?
Vocal fold bowing occurs when one or both of the vocal folds become atrophied or weak and a gap forms between the vocal fords, which prevents them from closing completely and vibrating normally
What is paradoxical vocal fold movement?
- Vocal folds are not moving as they should when they are breathing
- Vocal folds adduct when you inhale and abduct when you exhale
- ———–Trying to get air in but VF are coming together causing inspiratory stridor
What happens when somebody has severe Paradoxical vocal fold movement?
Vocal folds completely adduct so client will stop breathing
Paradoxical vocal fold movement (PVFM) is often misdiagnosed as what?
PVFM is often misdiagnosed as asthma because of the wheezing that occurs during inspiration and expiration.
What is a synonymous descriptor for paradoxical vocal fold movement?
episodic paroxysmal laryngospasm
What is episodic paroxysmal laryngospasm? (Dr. C called it laryngospasm)
forceful vocal fold adduction/spasm starts during inspiration and may carry over into the expiratory phase of breathing.
What are the etiologies of paradoxical vocal fold movement?
- psychogenic (often)
- neurogenic (rare)
________ ________ often co-exists with psychogenic instead of directly causing PVFM.
laryngopharyngeal reflux
What is laryngopharyngeal reflux?
Stomach acid reflux shoots up into esophagus and gets to the larynx burning the larynx and vocal folds. (Carmichael notes) (Book text is similar: pg. 146)
When do you see LPR in PVFM?
When you scope the client.
What are the symptoms of PVFM?
- dyspnea: problems with breathing
- inspiratory stridor (VFs adduct on inspiration)
- may be exercise induced
- may or may not have dysphonia
- may have chronic cough
How does an SLP induce PVFM?
By asking the client to exercise
Wheh does PVFM usually occur?
When client is under pressure or stress.
PVFM is usually _______.
intermittent.
Functional dysphonia looks like what neurogenic disorder?
Spasmodic dysphonia
What conditions are associated with muscle tension dysphonia?
-organic disorders: laryngitis nodules polyps -laryngeal pharyngeal reflux (book pg 170)
What is functional aphonia?
Whispering or shrill-sounding voice
What used to be the term for functional aphonia?
hysterical syndrome
conversion symptom
conversion hysteria
How long does functional aphonia usually last?
may be temporary or intermittent
What percentage of functional aphonia cases coexist with psychiatric disorders?
80%
What is the percentage that tend to fake functional aphonia?
20%
How can the clinician find out if the patient is faking functional aphonia?
Look at larynx and ask client to say “eeeee”. Ask client to cough or clear throat; if vocal folds come together, client is faking it.
If vocal folds don’t get together during functional aphonia then they _____ come together when client clears throat or cough.
can’t