L11 Voice Flashcards
dysphonia
abnormal voice quality
aphonia
lack of voice
difference between voice disorder and problem
- Disorder implies that there is some type of mental/physiological impairment
- Problem is more related to when a person’s voice isn’t congruent to how the person wants it to perform - trans/non binary clients
vocal abuse
- outdated term to describe when people engage in voice misuse leading to a voice disorder
- judegemental
- we now use vocal misuse
risk factors for developing a voice problem
- age
- sex
- family
- smoking
- hearing
- occupation
- mental health issues
- locking voice
- acid reflux
- poor posture
- dehydration
voice characteristics
- stamina
- pitch
- loudness
- tremor
- flexibility
- quality
stamina abnormalities
- Run out of breath when I talk
- Phone calls hard
- Group talk hard
- Presentations hard
pitch abnormalities
- Abnormally high/low
- Monopitch
- Pitch breaks
loudness abnormalities
- Abnormally high/low
- Monoloudness
- Excess loudness variation
tremor
Jerky voice quality
flexibility abnormalities
- Lack of dynamic range
- Voice & pitch breaks
- Can’t rapidly access voice
what does VTD stand for
vocal tract discomfort
signs/symptoms of VTD
- Fatigue
- Burning
- Tickling
- Dryness
- Iriritability
- Lump in throat (globus sensation)
- Aching
- Pain
- Mucous
- Difficulty catching breath
- Tightness
- Pushing to get voice out
four classifications of voice problems
- A lesion on the vocal fold membrane
- A neurological voice disorder
- A lack of glottic closure
- Reflux-related
organic voice disorders
aphonia or dysphonia as a result of organic changes to the larynx
characteristics of organic voice disorders
- Mass lesions on the vocal folds
- Tissue changes in the larynx
- Alterations to cartilaginous structures
- Nerve innervation problems
causes of organic voice disorders
- Congenital or acquired
- Infection
- Trauma
- Reflux
- Other irritants
examples of organic voice disorders
- vocal polyps
- vocal cysts
- reike’s oedema
- laryngopharyngeal reflux
- post-nasal drip
- layngeal web
- sulcus vocals
identify the voice disorder
vocal polyps
identify the vocal disorder
vocal cyst
identify the vocal disorder
reike’s oedema
identify the vocal disorder
laryngopharyngeal reflux
identify the vocal disorder
post nasal drip
identify the vocal disorder
laryngeal web
identify vocal disorder
sulcus vocalis
cause of vocal polyps
Trauma or environmental (e.g. irritants)
treatment for vocal polyps
SLT may help, but may not cure. If incurable, then needs surgery to remove
voice in vocal polyps
Rough, probably strained
cause of vocal cysts
May be trauma, or spontaneously develop. Could be a fluid-filled sac or plugged mucous-secreting gland
treatment for vocal cysts
Usually needs surgery and then SLT
voice with a vocal cyst
Rough
cuase of reike’s oedema
smoking
treatment for reike’s oedema
smoking cessation
voice quality with reike’s oedema
Rough, may have stridor
cause of laryngopharyngeal reflux
Dietary – pepsin (enzyme) adheres to larynx, activates in the presence of acid
treatment for laryngopharyngeal reflux
Gaviscon Advance / PPIs BD
voice quality for laryngopharyngeal reflux
cuts in and out, may be rough
cause of post-nasal drip
Nasal irritation. May be environmental (e.g. pollen), idiopathic or secondary to LPR
treatment for post-nasal drip
Sinus rinsing +/- steroidal sprays
voice quality with post-nasal drips
May cut in and out, variable quality. Strained or rough if coughing a lot
cause of laryngeal web
Congenital. Generally only seen in paeds.
treatment of laryngeal web
Surgical. Note – causes airway patency issues
cause of sulcus vocalis
Unknown, but possible congenital or through repeated inflammatory processes
treatment of sulcus vocalis
Surgical
voice quality with sulcus vocalis
Breathy and possibly rough with likely higher-than-normal habitual pitch
characteristics of neurogenic voice disorders
- Depends on nerve lesion
- Central lesions tend to involve other symptoms
- Peripheral lesions tend to involve just the voice
causes of neurogenic voice disorders
- Acquired neurological diseases (e.g. MND, IPD, MS)
- Trauma to the head/neck/throat
- Post-infective (usually respiratory tract infection)
- Latrogenic (i.e. caused by the doctor: heart/lung/throat surgery)
examples of neurogenic voice disorders
- dysarthrias
- vocal paresis/paralysis
- presbyphonia
- spasmodic dysphonia
identify the vocal disorder
Vocal Paresis/Paralysis
identify the vocal disorder
Presbyphonia
typical diseases causing flaccid dysarthria
- Myasthenia Gravis
- Motor Neuron Disease/Amyotrophic Lateral Sclerosis
- Guillain-Barré syndrome
voice quality with flaccid dysarthria
- Incomplete glottal closure – sometimes none (aphonic)
- Weak/slowed vocal fold movement
- Monoloudness
typical diseases that cause spastic dysarthria
- Motor Neuron Disease/Amyotrophic Lateral Sclerosis
- Cerebral palsy
- Multiple sclerosis
voice quality with spastic dysarthria
- Monopitch, monoloudness
- Low pitch, pitch breaks
- Harsh vocal quality, breathy voice
typical diseases causing ataxic dysarthria
- Friedrich’s Ataxia
- Multiple Sclerosis
voice quality with ataxic dysarthria
- Harsh vocal quality
- Monopitch, monoloudness
- Excess loudness variation
- Vocal tremor
typical diseases causing hypokinetic dysarthria
- Parkinson’s Disease
- Lewy Body Disease
- Multiple System Atrophy (MSA)
voice quality with hypokinetic dysarthria
- Monopitch, monoloudness
- Breathy voice (vocal bowing)
- Low pitch
typical dieases causing hyperkinetic dysarthria
- Isolated causes
- Essential tremor
voice quality with hyperkinetic dysarthria
- Monopitch, monoloudness
- Strained-strangled voice quality
- Voice breaks
- Transient breathiness
cause of vocal paresis/paralysis
Usually acute nerve injury/severing, but may be stroke-related
treatment for vocal paresis/paralysis
Surgical medialization, voice strengthening
voice quality with vocal paresis/paralysis
Breathy, low volume, reduced pitch range, increased vocal fatigue. Aphonia if bilateral.
cause of presbyphonia
Normal, age-related changes
treatment for presbyphonia
Voice strengthening.
voice quality with presbyphonia
Breathy, low volume, reduced pitch range, increased vocal fatigue.
cause of spasmodic dysphonia
Neurogenic, but may be exacerbated by stress. Vocal folds don’t adduct and abduct smoothly, they jerk randomly together
treatment for spasmic dysphonia
Botox injections. Minimal benefit from SLT.
voice quality with spasmodic dysphonia
Unstable, jerky quality.
- Adductor type – harsh quality (90% of cases)
- Abductor type – breathy, aesthenic
functional voice disorders - muscle tension dysphonia
dysphonia that occurs as a result of disturbed psychological processes that lead to chronic patterns of misuse/dysfunction of the laryngeal musculature
characteristics of functional voice disorders
- Inefficient phonatory pattern
- Habituated voice misuse
- Psycho-social factors
- Tension in intrinsic and extrinsic laryngeal muscles
causes of functional voice disorders
- Upper Respiratory Tract Infection (URTI)
- Associated with organic voice disorder (by compensation)
- Psychosocial stressors
examples of functional voice disorders
- vocal nodules
- muscle tension dysphonia
identify the vocal disorder
vocal nodules
identify the vocal disorder
muscle tension dysphonia
cause of vocal nodules
Usually phonotrauma (i.e. vocal abuse)
treatment for vocal nodules
SLT input usually resolves, but entrenched/fibrotic
nodules may need surgery
voice quality with vocal nodules
Rough, probably strained quality
cause of muscle tension dysphonia
May be triggered by URTI, trauma or stress
treatment for muscle tension dysphonia
SLT. (Almost) no role for ENT
voice quality with muscle tension dysponia
rough, strain
psychogenic disorder
a dysphonia (impaired or disordered voice) or aphonia (absent voice) where the causative or perpetuating factors are largely of psychological or emotional conflict
classification of psychogenic disorders
- classical conversion
- cognitive behavioural conversion
- habituated conversion
classical conversion
psychogenic
Lack of conscious acceptance of psychological problems
cognitive behavioural conversion
psychogenic
Conscious acceptance of issues, but avoidance of same due to desire to avoid conflict (internal or external)
habituated conversion
psychogenic
As with type 2, but the source of anxiety is gone, while the musculoskeletal tension remains
signs of psychogenic voice disorders
- Low mood
- Family/interpersonal difficulties
- Mild-moderate depression
- Difficulty expressing views/emotions
- Stressful life events
- Suppressing anger/frustration
- Anxiety Burden of responsibility
- Common to females
- Over-commitment and helplessness
- Near normal psychological adjustment
Mutational Falsetto/Puberphonia
- Males maintain a high-pitched falsetto voice after puberty
- Often associated with maternal/parental attachment issues
do SLTs diagnose voice problems
nope that’s an ENT job
