Presbyphonia and Pediatrics

Question 1

What is presbyphonia?

Answer 1

Age-related voice changes (not due to dz); pt c/o inability to project voice over background noise as well as a hoarse vocal quality that lessens throughout the day

Question 2

What are laryngeal signs of presbyphonia?

Answer 2

glottal gaps placed anteriorly; swollen vocal folds; vocal folds vibrate asymmetrically; vocal processes of the arytenoid cartialges are prominent; margins of the vocal folds move mildly.

Question 3

What are the auditory-perceptual findings of presbyphonia?

Answer 3

slower speaking rate; decreasd loudness; change in habitual pitch (sex-dependent); tremor; voice breaks; hoarseness; breathiness

Question 4

What are the acoustic features of presbyphonia?

Answer 4

decreased fundamental frequency in females; increased fundamental frequency in males; decreased noise to harmonics ratio; decreased SPL; inconclusive findings on jitter and shimmer

Question 5

What are the primary treatment features of presbyphonia?

Answer 5

voice therapy; laryngoplasty; thryoplasty

Question 6

What are voice therapy approaches for presbyphonia?

Answer 6

visual feedback; counseling; auditory feedback; relaxation; open-mouth; focus; eliminate vocal abuses

Question 7

What are possible etiologies for pediatric voice disorders?

Answer 7

hyperfunction and laryngopharyngeal reflux disease

Question 8

What are the educational risks associated with pediatric voice disorders?

Answer 8

struggle with being heard in educational settings inside and outside of the classroom; may not participate in public speaking activities, oral reading activities, and discussions with peers; may become afraid of speaking publicly and conversing in public interactions

Question 9

When does the larynx begin to develop?

Answer 9

At Day 32

Question 10

When can you see the larynx?

Answer 10

at day 41

Question 11

Regarding the position of the larynx, how does it develop?

Answer 11

Larynx starts high in the neck between C1 and C3 posterior to the mandible, which protects it from traumatic injury. At 2 years old, the larynx drops. The velum and the epiglottis’s tip may be touching each other.

Question 12

Regarding the size of the larynx, how does it develop in pediatrics?

Answer 12

thyroid notch is posterior to the hyoid bone; thyrohyoid membrane is small, size of larynx is smaller than in adults; VF lenght is 2.5 to 3.5 mm, arytenoids make up more than 50% of the glottis.

Question 13

What is a pediatric larynx shaped like?

Answer 13

A funnel, with its widest portion at the top and the bottom portion narrow at the level of the cricoid cartilage

Question 14

What is the consistency of the VFs in a pediatric larynx?

Answer 14

a single layer for the lamina propria; VF mucosa is thin; immature VF ligaments between 1- 4 years old

Question 15

What are barriers to children receiving tx for voice disorders?

Answer 15

lack of resources in rural areas; hard to get laryngoscopic exams; parents and physicians do not follow-up; medical professionals, teachers, and parents do not know the impact, limits on what qualifies as service for the child.

Question 16

What are the service delivery options?

Answer 16

Classroom-based services; pull-out; small group sessions; individual sessions; collaborative; consultative

Question 17

What are IEP goals for voice disorders?

Answer 17

eliminate vocal abuses; breathe properly and use appropriate phrasing patterns; use the following appropriately: oral mechanism, pitch, tone, quality, and resonance; relaxation; be aware of factors that contribute to voice problems and discriminate them; use non-verbal body actions and interpersonal skills during daily conversations

Question 18

What should you consider when managing voice disorders?

Answer 18

Consider involvement of parent, teacher, and child; consider lifestyle factors as well

Question 19

When talking to children about voice, consider the following:

Answer 19

anatomy and physiology; vocal hygiene; qualities of effective listeners and speakers; dynamics of interpersonal interactions and how that impacts voice; key words related to voice production

Question 20

What should you do with a child in the first session?

Answer 20

Do a full voice evaluation (preferably with parents present); have child or parent complete a voice checklist; educate the child and parent about voice production, stressing that it is not effortful; have the child produce a hypofunctional voice; list all vocal misuses and target the easiest one to eliminate; encourage child to record instances of vocal misuse to spur self-awareness and identify previously unknown contexts; reward the child

Question 21

What should you do with a child beyond the first session?

Answer 21

review their diary and reward them; target vocal misuses considered tough; encourage to use a less effortful voice but do not push them too hard.

Question 22

Regarding vocal hygiene for children, an SLP can suggest

Answer 22

designated quiet times; drink lots of water; other methods for communication

Question 23

What are the specific areas that may adversely affect quality of life in the elderly population?

Answer 23

putting much effort into their voice and/or feeling uncomfortable with it; being asked to repeat themselves. These areas frustrate them and worry them, leading them to feel depressed. Individuals with HL and cognitive issues are more likely to be deprssed.