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Voice > Phonotrauma > Flashcards

Phonotrauma Flashcards

1
Q

Define phonotrauma

A

Behavior traumatizes or abuses the tissues of the VFs sufficiently to cause a change in the voice

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2
Q

What are 3 types of phonotrauma

A
  1. Misuse
  2. Inappropriate use of voice
  3. Vocal abuse
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3
Q

Define misuse

A

Voice production behaviors that distort the normal characteristics of the phonatory mechanism to produce the best results with minimal effort

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4
Q

6 Characteristics of misuse vocal behaviors

A
  1. Increased strain or tension
  2. Inappropriate pitch level
  3. Excessive talking
  4. Ventricular phonation
  5. Dystonia of psychological origin
  6. Aphonia
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5
Q

Explain increased tension or strain vocal behaviors
3 features of increased tension

A

Either Subjectively (physically observing) or objectively (biofeedback/endoscopy) measuring increased VF tension.
1. Hard glottal attack
2. High laryngeal position
3. Anteroposterior laryngeal squeezing

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6
Q

What is a hard glottal attack

A

-Manner of initiating vowels involving rapid and complete adduction of the VFs prior to initiation of phonation
-sound will be abrupt, explosive, and hard-edge onset of phonation

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7
Q

High laryngeal position results in…

A
  1. Shortening VFs with a subsequent increasing frequencies
  2. Stiffening of VF tissue, altering vibratory pattern & increasing frequency
  3. Increased tendency for tight VF closure
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8
Q

Laryngeal height is primarily controlled by?

A

Extrinsic laryngeal muscles

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9
Q

T/F: Voice disorder is attributed to extrinsic muscles

A

False- not attributed to extrinsic muscles alone, it is a total physiological disturbance

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10
Q

What is antereoposterior laryngeal squeezing

A

The epiglottis and arytenoids approach eachother during phonation, squeezing the larynx

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11
Q

Inappropriate pitch level vocal behavior is associated with what 3 features?

A
  1. Puberphonia (it is a hallmark of puberphonia)
  2. Persistent glottal fry
  3. Lack of pitch variability
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12
Q

What is puberphonia

A

Persistence of a high-pitched voice beyond the age at which voice change is expected to have occurred
-primarily in males (less stigma involved with women having puberphonia)

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13
Q

Voice characteristics of puberphonia

A

-High pitch
-Pitch breaks
-Hoarseness
-Breathiness
-Uncertain/unstable voice

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14
Q

Puberphonia is also called?

A

-Adolescent falsetto
-Pubescent falsetto
-Incomplete mutation
-Mutational falsetto

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15
Q

Persistent glottal fry is refered to as?

A

-Vocal fry
-Pulse register

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16
Q

What is persistent glottal fry?

A

Change in the mechanical mode of vibration and usually and overlap in frequency between adjacent registers

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17
Q

Voice characteristics associated with persistent glottal fry

A

-Popping of corn
-Creaky voice
-imitated sound of a motorboat engine
-vocal fatigue
-slow vibratory pattern
-constant awareness of vibration
-monotonic voice

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18
Q

Describe lack of pitch variability

A

-Monotonic voice (few perceptible variations in fundamental frequency)
-Phonatory mechanism movements rarely vary

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19
Q

Voice characteristics associated with lack of pitch variability

A

-voice lacks energy
Lacking interest
Vocal fatigure
Vocal fry at the end of utterance

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20
Q

How does talking a lot effect vocal behaviors

A

Everyones larynx has a physiological limit dependent on health, restedness, nourishment, emotional stability, medication, exhaustion level, diet, etc.
Excessive talking, exceeding physiological limit is a form of misuse

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21
Q

Voice characteristics associated with excessive talking

A

-Vocal fatigue
-Hoarse
-Weak
-effortful voice
-temporary restoration

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22
Q

What is ventricular phonation

A

False VFs move towards midline, compressive the true VFs
May occue as a compensatory behavior (hyperfunction)

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23
Q

Voice characteristics associated with ventricular phonation

A

There is NO acoustic data to support these perceptual descriptions, but:
-Low pitch
-hoarse
-rattling voice
-rumbling
-cracking
-reduced intensity
-diplophonia

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24
Q

What is an adaptive dysphonia, give an example

A

Psychological origin of voice disorder WITHOUT any actual tissue pathology; often results from patients coping with stress or other physical problem
EX: Muscle tension dysphonia (MTD), functional voice disorders

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25
Q

Describe aphonia

A

-Loss of voice
-Can be partial aphonia (intermittent loss of voice) or total aphonia (complete loss, inaudible and VFs maintained in abducted position)

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26
Q

Define vocal abuse

A

Harsher behaviors (than misuse) with a greater likelihood of causing trauma to the laryngeal mucosa

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27
Q

What abusive behaviors cause vocal abuse?

A
  1. Excessive, prolonged loudness
  2. Strain and excessive use during tissue changes
  3. Excessive coughing and throat clearing
  4. Screamer/Noise maker
  5. Sport/exercise enthusiast
28
Q

Excessive prolonged loudness requires what?

A

Increased resistance of the laryngeal valve until an appropriate level of air pressure is produced and released
-VFs must be adducted strongly to create increased medial compression required

29
Q

How are the VFs appearance altered with excessive and prolonged loudness

A

Laryngeal mucosa along the glottal edge will be:
-irritated
-inflamed
-swollen (which can alter VF mass and stiffness)

30
Q

How does excessive and prolonged loudness change voice?

A

-Vibratory behavior is changed
-Breathy voice (due to incomplete closure)
-Faster vibration= elevated pitch

31
Q

Continued vocal abuse should not occur during 3 circumstances:

A
  1. VF edema due to infection, allergic reaction, or noxious environmental agents
  2. Conditions such as chronic sinusitis with purulent drainage and gastric reflux may irritate, swell, and inflame mucosa
  3. Excessive dryness of tissues due to use of certain drugs, extreme dryness of heated buildings, excessive alcohol use, or reduced function of mucus glands
32
Q

Which vocal abuse behavior is a hallmark of habitual cigarette smokers?

A

Excessive coughing and throat clearing

33
Q

Describe effect & etiology of excessive coughing

A

-Evokes a blast of high-pressure air as a mechanism for expelling anything that has attempted to pass through the larynx
-etiology: Reaction to infection or irritation of the mucosa VF edge (allergic reaction can cause irritation/swelling)

34
Q

What causes excessive throat clearing

A
  1. May result from momentary collection of mucus on the VFs that interfere with phonation or allergic reactions of irritants and swelling of VF mucosa
  2. Mucus thickens and becomes tenacious during upper respiratory infections and VF swelling
  3. Certain foods may cause reaction of increased mucus secretions
  4. Inadequate laryngeal lubrication (drug effect, emotional response, excessive smoking, drinking, or poor mucus gland functioning)
35
Q

When is a cough considered chronic?

A

-Dry, unproductive cough persisting 3+ weeks.
-Involves entire larynx & supraglottic structures (wide glottal opening, firm/protracted glottal closure, lung pressure build up, complex expolsive phase

36
Q

What 6 things cause chronic coughing?

A
  1. Mucus irritation (i.e., smoking)
  2. GERD/Reflux
  3. Asthma
  4. Postnasal drip
  5. Chronic bronchitis
  6. Medication
37
Q

Children are prime exhibitors of which vocal abuse behavior?

A

Screamer/Noise Maker- habitually using loud voices in most situations

38
Q

What are vocal nodules often called due to co-occurence?

A

Screamers nodules

39
Q

Child characteristics of screamers nodules?

A

-Boys > Girls
-Produce 3x more vocalization within a 2-hour period
-Higher degree of intra-family conflict associated with hoarse voiced children
-Dysphonic children are behaviorally more active during unstructured class time

40
Q

The abnormal speaking behavior of screamer/ noise maker children is viewed as?

A

Associated with personality or emotional factors

41
Q

Characteristics of the screamer/ nose maker

A

-hoarse
-dysphonia

42
Q

How are sport/exercise enthusiasts demonstrators of vocal abuse?

A

Singing loudly
Grunting while playing sport
Grunting while lifting weights
Yelling in sports arena
Concert

43
Q

Typical course of vocal problems seen in sport/exercise enthusiast

A

Return to normal after reduced vocal use and good sleep

44
Q

6 Basic pharmacological principles for Effects of drugs

A
  1. Biological response variability (individuals vary response to drugs based on age, stress, kidney fn, body composition, nutritional status, drug + drug interaction, etc.)
  2. Placebo effect: expectations influence degree and type of effect
  3. Dose-response relationship (intensity of the drugs effect should be proportional to the dose of the drug administered)
  4. Multiple effects of a singular drug (side effects often affect voice production)
  5. Drug efficacy versus drug dosage (we want a reasonable dose to result in adequate therapeutic effects without side effects)
  6. Elderly population may respond differently
45
Q

Why does the elderly population respond different to drugs

A

loss, reduction, or alteration of certain body structures and function related to aging

46
Q

What type of relationship do many drug-responses have?

A

Sigmoid-shaped curve

47
Q

What is a sigmoid-shaped curve

A

Drug intensity gradually increases > Intensity rapidly increases > gradually increases > reaches plateau/ceiling level

48
Q

What happens when you increase a drug after it reaches ceiling?

A

The drug won’t produce any further enhancing effects
It may only produce toxic side effects

49
Q

Drugs can cause negative voice-related effects involving:

A
  1. Coordination and proprioception
  2. Airflow
  3. Fluid balance
  4. Secretions of upper-respiratory tract
  5. Change in VF structure
  6. VF mucosa irritation
  7. Miscellaneous
50
Q

Explain voice-related effects of drugs on coordination and proprioception

A

Any agent stimulating or depressing the CNS can affect coordination (including find motor control of phonatory behavior)

51
Q

CNS stimulant drugs often cause?

A

-Appetite suppression
-Nervousness and tremor

52
Q

CNS depressant drugs often cause?

A

-Sedative effect
-muscle coordination (slurred, slowed speech)

53
Q

CNS anesthetic drugs often cause?

A

Block nerve impulse conduction & reduce pain sensation
(turning off bodies alarm for indicating a problem)

54
Q

Explain voice-related negative effects on airflow

A

Drugs that dilate or constrict the bronchioles affect the movement of pulmonary air through the larynx

55
Q

Bronchodilators VS bronchoconstrictors

A

Bronchoconstrictors cause more severe adverse effects on voice- life threatening effect on respiratory function

Bronchodilators cause nervousness and tremor

56
Q

Explain the voice-related effects on fluid balance from 2 drug types

A

-Diuretics reduce the formation of edema
-Corticosteroids are a drying agent directing affecting protein bound water BUT not a curative effect

57
Q

When treating edema with drugs, what will be more effective?

A

Corticosteroids will be effective in acting as a drying agent
Protein-bound water will not respond to diuretics

58
Q

What negative effects can diuretics cause?

A
  1. Rebound effect- wears off then return of edema at higher degree
  2. Reduction of blood flow to edema
  3. Loss of electrolytes with decrease potassium
  4. Damaged mucous membrane
59
Q

What causes decreased secretions of salivary and mucous glands?

A

Drying agents
Low moisture in air

60
Q

What causes increased secretions of salivary and mucous glands?

A

Wetting agents
BUT efficacy not proven

-Water is most effective
-Ambient humidity
-Expectorants
-Saliva substitutes

61
Q

What types of drugs cause changes to the VF structure?

A
  1. Androgens (causing irreversible voice change)
  2. Synthetic androgens (low percent of voice changes)
62
Q

What internal factor causes VF mucosa irritation

A

GERD/Gastric reflux
Drugs may predispose individuals to GERD

63
Q

5 Additional agents that cause adverse effects on voice production and performance

A
  1. Ototoxic drugs (chemo)
  2. Herbal Tea (NOT FDA regulated)
  3. Aspirin (only if person has bleeding disorder)
  4. Beta-blockers
  5. Tobacco & smoked/inhaled drugs
64
Q

3 main overlapping phases of wound healing

A
  1. Inflammatory response (first 72 hours)
  2. Proliferate phase (begins at 48 to 72 hours)
  3. Maturation/Tissue remodeling- initial re-epithelialization within first 2 weeks
65
Q

What is the timeline of healing?

A

-3 days: transition from inflammatory phase to earliest tissue reformation
-1 week: epitheliamization seen within 5 to 7 days re-establishing barrier
-1 month: tissue structures reform, scar formation begin
-3 to 6 months: chronic healing

Voice (5 decks)

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