Psychogenic Voice D/O's & Spasmodic Dysphonia Flashcards

Question

Dystonia

Answer 1

A neurological movement disorder in which the sustained muscle contractions cause twisting & repetitive movements or abnormal postures

Answer 2

No known cause As many as 50% of pts report that their vocal sx's followed a severe upper respiratory infection; frequency of this experience has led some to postulate a viral injury to CNS as cause Other MDs have speculated that head injury may cause it Thought to be an extrapyramidal sign May also be on psychogenic side of it (someone died in front of woman at church)

Answer 3

Permanent neurological condition that causes the voice to become difficult to use & understand b/c of uncontrollable spasms in the VFs People typically experience "choking off" of voice as the VFs squeeze tightly together In a small %age of pts, spasms pull VFs apart & voice "drops out from under" leading to a mixture of vocal sounds & whispers Pts can have both adductor & abductor type One is an adductor type and one is an abductor type (or mixed type)

Answer 4

Pure vocal tremor; essential tremor (have them hold their hands out in front of them b/c you'll see tremor in hands)

Answer 5

Always have them prolong /i/: choking off of voice, strained, strangled

Answer 6

Jerky, strained-strangled, harsh, low-pitch, irregular voice stoppage Sensation of choking, feeling of tightness across neck & chest, straining, & wrenching movements Most common type True VFs (vocalis musculature) are spasmodically tightened (i.e. sudden, intermittent closures of the glottis) during phonation

Answer 7

1. Excessive sphincteric action of the intrinsic laryngeal muscles only 2. Intrinsic & extrinsic muscle movements are excessive & there is medial movement of the ventricular folds 3. Simultaneous contraction of all intrinsic & extrinsic muscles, closure of the ventricular folds & abnormal respiration movements (most severe)

Answer 8

``` Counting from 80-89 (the vowel) "We mow our lawn all year." "We eat eels every day." "A dog dug a new bone." "Where were you one year ago?" "We rode along Rhode Island Avenue." "Eeeee eee eee." Determine SD on vowels--most problems on vowels ```

Answer 9

``` Counting from 60-69 "Peter will keep at the peak." "The puppy bit the tape." "When he comes home, we'll feed him." "Tap the tip of the cap, please." "Keep Tom at the party." "See see see." ```

Answer 10

Less common form of SD resulting in spasmodic separation of VFs (sudden, intermittent glottal opening) during phonation Sudden aphonic episodes in phonation disrupt connected speech by creating problems of voice volume, pitch maintenance, & syllable duration, as well as general speech fatigue due to substantial air wastage Hear voice & then spastic separation of VFs

Answer 11

Speech therapy (not for cure, but to learn to cope w/ problem) Meds (none of which is routinely effective & some of which may have disagreeable side effects) Surgery to paralyze 1 VF in order to weaken or abolish spasms Botulinum toxin injection *People don't seem to progress & get worse

Answer 12

Meds produced by the same bacterium that causes the disease, botulism; bacterium itself is not injected; minuscule amount (1/800th) of the dangerous dose is used Injections results last from 6 wks to 6 months depending on the pt

Answer 13

Disease of involuntary movement 50% of cases inherited & worsen w/ age Causes rhythmic changes in voice Maybe only minor quavering of the voice or severe interruption in continuous voicing It is rhythmical & presents across all voice tasks such as singing & whispering May also have associated shaking of hands or head

Answer 14

AKA paradoxical VF movement disorder Characterized by stridor due to VF adduction during inhalation obstructing airway Normal VF movement during speech, however stridor b/t phrases Obstruction is at VFs not lungs Stridor on inhalation Pts with asthma can get stridor On inhalation, VFs should abduct, but w/ this, VFs slam shut (opposite of what should happen) Going to feel smothered—can’t get air in—no problem with VFs themselves so voice should be normal unless they push voice out & strain a whole lot; Worry about pass out—emergency trach & don’t need it

Answer 15

Teach pt to do diaphragmatic breathing, know this is coming on, exhalation of voice, etc.—use own feedback to help them

Answer 16

1. Idiopathic focal dystonia 2. Associated w/ or masquerading as asthma 3. Exercise induced stridor 4. Psychogenic 5. Associated w/ gastroesophageal reflux

Answer 17

Noisy obstructed breathing, choking episodes, chronic or intermittent hoarseness, difficulty swallowing, a sensation of lump in throat, chronic throat clearing & cough, excessive throat mucous

Answer 18

After a meal After the start of exercise After bending over Awakening the pt from sound sleep

Answer 19

Onset b/t 11-18; females have greater incidence (generally 3:1); high achieving Type A personalities High personal standards &/or social pressures Intolerant to personal failure; competitive, self-demanding, perceives family pressure to achieve high level of success "Choke" under pressure May have recently graduated to higher level of competition w/in their sport

Answer 20

Recalcitrant to asthma medications Individuals w/ "asthma" after L-T steroid use might not truly have asthma, but VCD Individuals w/ significant anxiety

Answer 21

Exercise Induced VCD

Answer 22

Detailed case hx, pulmonary fx tests, lab tests, ENT/pulmonary/allergy evals, flexible laryngoscopy/ videostrob, SLP eval, supplemental PRN: psychological eval

Answer 23

Mass obstruction, bilateral VF paralysis, anaphylactic laryngeal edema, extrinsic airway compression, foreign body aspiration, infectious croup, laryngomalacia, exercise induced asthma/ asthma

Answer 24

Often mistaken for asthma | By exclusion=when pt fails to respond to asthma or allergy meds then VCD is finally considered

Answer 25

Can coexist independently Can also coexist: Pt may experience LPR which causes asthma flare-up & then laryngospasm (VCD) from coughing; may experience chest (asthma) &/or laryngeal (VCD) tightness

Answer 26

Do you have more trouble breathing in than out? Do you experience throat tightness? Do you have a sensation of choking or suffocation? Do you have hoarseness? Do you make a breathing-in noise (stridor) when you're having sx's? How soon after exercise starts do your sx's begin? How quickly do sx's subside? Do sx's recur to same degree when you resume exercise? Do inhaled bronchodilators prevent or abort attacks? Do you experience numbness &/or tingling in your hands/feet or around your mouth w/ attacks? Do sx's ever occur during sleep? Do you routinely experience nasal sx's (postnasal drip, nasal congestion, runny nose, sneezing)? Do you experience reflux sx's?