Presbyphonia and Pediatrics Flashcards
What is presbyphonia?
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
What are laryngeal signs of presbyphonia?
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.
What are the auditory-perceptual findings of presbyphonia?
slower speaking rate; decreasd loudness; change in habitual pitch (sex-dependent); tremor; voice breaks; hoarseness; breathiness
What are the acoustic features of presbyphonia?
decreased fundamental frequency in females; increased fundamental frequency in males; decreased noise to harmonics ratio; decreased SPL; inconclusive findings on jitter and shimmer
What are the primary treatment features of presbyphonia?
voice therapy; laryngoplasty; thryoplasty
What are voice therapy approaches for presbyphonia?
visual feedback; counseling; auditory feedback; relaxation; open-mouth; focus; eliminate vocal abuses
What are possible etiologies for pediatric voice disorders?
hyperfunction and laryngopharyngeal reflux disease
What are the educational risks associated with pediatric voice disorders?
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
When does the larynx begin to develop?
At Day 32
When can you see the larynx?
at day 41
Regarding the position of the larynx, how does it develop?
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.
Regarding the size of the larynx, how does it develop in pediatrics?
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.
What is a pediatric larynx shaped like?
A funnel, with its widest portion at the top and the bottom portion narrow at the level of the cricoid cartilage
What is the consistency of the VFs in a pediatric larynx?
a single layer for the lamina propria; VF mucosa is thin; immature VF ligaments between 1- 4 years old
What are barriers to children receiving tx for voice disorders?
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.
What are the service delivery options?
Classroom-based services; pull-out; small group sessions; individual sessions; collaborative; consultative
What are IEP goals for voice disorders?
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
What should you consider when managing voice disorders?
Consider involvement of parent, teacher, and child; consider lifestyle factors as well
When talking to children about voice, consider the following:
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
What should you do with a child in the first session?
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
What should you do with a child beyond the first session?
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.
Regarding vocal hygiene for children, an SLP can suggest
designated quiet times; drink lots of water; other methods for communication
What are the specific areas that may adversely affect quality of life in the elderly population?
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.
