Phonotrauma & Trauma-Related Dysphonias

Question 0

Rough voice

Answer 0

Aperiodic vibration of the vocal folds

Question 1

Breathy voice

Answer 1

Voice produced with incomplete closure of the vocal folds

Question 2

Hoarse voice

Answer 2

Simultaneously rough and breathy

Question 3

Jitter

Answer 3

Cycle to cycle frequency perturbation

Question 4

Shimmer

Answer 4

Cycle to cycle amplitude perturbation

Question 5

Harmonics-to-noise Ratio

Answer 5

Compares loudness of the harmonics of the vocal source vs. extraneous noise

Question 6

Harmonics

Answer 6

Whole number multiple of the fundamental frequency

Question 7

Vocal Parameters

Answer 7

Quality
Pitch
Loudness
Prosody 
Resonance

Question 8

Zemlin’s 6 parameters

Answer 8

Average/habitual pitch
Maximum pitch range
Maximum phonation time
Dynamic range
Harmonics-to-noise ratio
Jitter

Question 9

Laryngitis

Answer 9

Inflammation of the vocal folds and larynx
Etiology: phonotrauma, overexposure to noxious agents, GERD, LPR, environmental agents
May be acute (bacterial/viral infection) or chronic (vocal abuse/misuse)

Question 10

Laryngitis characteristics

Answer 10

Perceptual: hoarseness, potential pitch changes
Acoustic: greater than normal amplitude and frequency perturbation

Question 11

Vocal nodules

Answer 11

Benign growths on the vocal folds, usually in the anterior 1/3
Etiology: usually vocal abuse
Reaction of the tissue to constant stress induced by frequent, hard oppositional movement of the vocal folds

Question 12

Vocal nodules characteristics

Answer 12

Perceptual: hoarseness, breathiness, patient may complain of soreness or pain in the neck, may complain of feeling something in their throat, May throat clear often
Acoustic: dependent on size/severity
Increased frequency and amplitude perturbation
Fundamental frequency within normal range

Question 13

Vocal polyps

Answer 13

Fluid filled area under the mucosal layer believed to be result from period of vocal abuse but may occur from single traumatic incident

Question 14

Pedunculated polyp

Answer 14

Localized and attached to the vocal fold by a slim stalk of tissue

Question 15

Sessile polyp

Answer 15

Closely adhering to the mucosa

Question 16

Hemorrhagic polyp

Answer 16

Appearance of a blood blister

Question 17

Vocal polyps characteristics

Answer 17

Perceptual: hoarseness, roughness, or breathiness
Pt may report sensation of something in the throat
Acoustics: increased jitter and shimmer
Reduced phonation range

Question 18

Reinke’s Edema (polypoid degeneration)

Answer 18

The buildup of fluid that occurs primarily in the superficial layer of the vocal folds
Etiology: trauma and misuse
Secondary to excessive use of the vocal folds or a result of infection and inflammation
Often seen in female smokers

Question 19

Reinke’s Edema characteristics

Answer 19

Perceptual: low pitch, hoarseness, may have decreased pitch range and increased effort to produce voice
Acoustic: low fundamental frequency for sex and age of patient
Gray vocal folds

Question 20

Vocal fold cysts

Answer 20

Small spheres on the margins of the vocal folds or on the superior surface of the fold
Often mistaken for early nodules or polyps
Etiology: May be caused by a blockage of a granular duct, causing a retention of mucosa possibly combined with phonotrauma or may be congenital

Question 21

Vocal fold cysts characteristics

Answer 21

Perceptual: hoarseness, lowered pitch, patient may report a tired voice
Acoustic: reduced phonation range in females
Yellowish vocal folds

Question 22

Contact ulcer

Answer 22

Benign lesion that develops on the vocal process of the arytenoid cartilages
May be unilateral or bilateral
Etiology: vocal abuse (regular hyperadduction of the vocal processes of the arytenoid cartilages), GERD

Question 23

Contact ulcers characteristics

Answer 23

Perceptual: low pitch (May be glottal fry), persistent hard glottal attacks, patient may complain of pain in the larynx, vocal fatigue, or referred pain to neck or ear

Question 24

Keratosis of the larynx

Answer 24

Epithelial lesions in which there is an abnormal tissue growth on the vocal folds
Originates in the epithelium but may extend into lamina propria
Pathological condition comprised of an accumulation of keratin on the epithelial surface
Etiology: smoking, alcohol abuse, environmental pollutants, vocal hyperfunction, prolonged laryngitis

Question 25

Keratosis of the larynx characteristics

Answer 25

Perceptual: hoarseness, rough vocal quality

Question 26

Laryngeal carcinoma

Answer 26

Lesions that invade the tissue and destroy normally behaving cells
Greater stiffness of vocal fold tissue
May restrict or inhibit mucosal wave
Etiology: Smoking, environmental irritants, chemicals, metabolic disturbances, unknown causes

Question 27

Laryngeal carcinoma characteristics

Answer 27

Perceptual: hoarseness, lump in neck, broadening larynx, tenderness in neck, dysphagia
Acoustic: increased frequency and amplitude perturbation
Changes dependent on severity

Question 28

Hemorrhage

Answer 28

A rupture of the blood vessels results in bleeding into the submucosal layer
Reddened, edematous vocal fold appearance, usually unilateral
Etiology: single episode of traumatic voice use, laryngeal trauma, combo of heavy voice use and anticoagulants, extended use of inhaled steroids

Question 29

Hemorrhage characteristics

Answer 29

Perceptual: hoarseness, loss of upper range, vocal fatigue, dryness
Patients may complain about pain at time of injury

Question 30

Laryngeal granuloma

Answer 30

Trauma to the vocal fold or vocal process due to contact with the intubation tube causing granulation tissue to form
Etiology: complication of intubation

Question 31

Granuloma characteristics

Answer 31

Perceptual: breathiness, hoarseness

Some may not affect phonation dependent on location

Question 32

Laryngeal web

Answer 32

Sheet of tissue between the vocal folds usually at the anterior end
Etiology: forceful mechanical trauma or chronic infection when laryngeal tissue forms between vocal folds
May also be congenital

Question 33

Laryngeal web characteristics

Answer 33

Perceptual: hoarseness, high pitch

Question 34

Laryngeal burns and characteristics

Answer 34

Etiology: thermal, chemical
Perceptual: hoarseness, may have pain during phonation