quiz 4 Flashcards
1
Q
CAPE-V
A
- Consensus Auditory-Perceptual Evaluation of Voice
- uses visual analog scaling to rate vocal attribute - rater places tick mark along each line - measured and written in column
- speech tasks - vowel /a/, vowel /i/, 6 sentences, 20-30 secs of spontaneous speech
- rate vocal attributes as consistent or intermittent
- vocal attributes: overall severity, roughness, breathiness, strain, pitch, loudness
2
Q
3 vocal registers
A
- glottal fry
- modal/chest register
- falsetto
3
Q
glottal fry
A
- lowest fundamental frequency
- limited range, limited intensity/amplitude
- VF edges are loose and relaxed
- requires minimal subglottal pressure
- common at end of sentences
- not unhealthy bc periodic and low effort
- can lead to being unhealthy when trying to be louder in glottal fry
4
Q
modal/chest register
A
- richest and heaviest timbre of registers
- most common register for conversational speech
5
Q
head voice/falsetto
A
- highest fundamental frequency range of registers except whistle
- lightest timbre of registers
- very little vibration - only outer cover of VF
6
Q
VHI & score interpretation
A
- Voice Handicap Index
- used to assess patient’s judgement about relative impact of voice disorder upon daily activities
- validated, 30 questions asking questions that are functional, physical, and emotional
- rated 0-4, 0 is never, 4 is always
- 0-30 = mild/minimal handicap
- 31-60 = moderate handicap
- 60-120 = severe handicap
- if total score changes 18 pts = real change
- if total score changes 8 points = critical difference
7
Q
VHI 10
A
- derived from original VHI
- 10 critical question from 3 domains
- total of 40
- greater than 11 = abnormal
- 6 points is minimal impact difference
8
Q
mean speaking fundamental frequency
A
- elicit with conversational speech or asking patient to read rainbow passage
- males 100-120
- females 200-220
9
Q
maximum phonation time
A
- tell client to take a deep breath, say /a/ at comfortable pitch and loudness and hold it for as long as they can
- do 3 trials, take best of 3
- normative data says 15-25 seconds
10
Q
primary muscle tension dysphonia
A
- vocal hyperfunction in absence of organic pathology without obvious psychogenic/neurologic etiology
- behaviorally modifiable, unexplained dysphonia
11
Q
secondary muscle tension dysphonia
A
- dysphonia occurring as compensatory technique with an organic, psychogenic, or neurologic etiology
12
Q
puberphonia
A
- failure of voice to reflect development of secondary sex characteristics in puberty
- usually seen in immediate post-pubescent period
- elevated speaking pitch, pitch breaks, strained quality
- patient can produce a normal pitch but doesn’t like it
13
Q
alternative phrasing to “misuse” or “abuse”
A
- can be rude, as patients are using their voice in a functional way
- places blame on patient which is not appropriate
- “caused by high demand for voice”
- “phonotraumatic behaviors”
- “irritation from high collision forces of the vocal folds”
14
Q
theoretical framework for vocal hyperfunction
A
- just because someone uses their voice excessively doesn’t mean it WILL lead to phonotraumatic behavior
- nonphonotraumatic hyperfunction would be primary muscle tension
- vocal hyperfunction + precipitating factors = phonotraumatic hyperfunction
- cycle of developing phonotraumatic lesions, needing more hyperfunction to compensate
- break cycle with voice therapy, surgical removal, return to normal voice function
15
Q
vocal fold nodules
A
- most common benign lesions of VF
- result from continuous voice use
- generally bilateral, whitish perturbances on striking zone of VF
- acute nodules are soft and pliable, reddish, mostly vascular, edematous
- treatment: voice therapy will make person more aware of habits leading to problem
- medical: surgery may be considered if improvement is not achieved with therapy
16
Q
vocal fold polyps
A
- benign, phonotraumatic growth that is a fluid-filled sac on VF, usually unilateral
- anywhere on free edge of VF, usually striking zone
- may be mistaken for acute nodules, cysts, or papilloma
- medical: microlaryngeal surgery
- pre-op counseling/evaluation, post-op rehab
17
Q
Reinke’s Edema/Smoker’s Polyps
A
- chronic, diffuse swelling of superficial lamina propria
- usually bilateral, may be worse on one side
- strongly associated with smoking
- treatment: therapy can optimize vocal function but will not eliminate edema; smoking will prevent lesions from worsening
- medical: can zap them with a laser
18
Q
laryngomalacia
A
- inward collapse of subglottic structures of larynx during inhalation
- 75% of congenital anomalies of larynx
- most prevalent cause of inspiratory stridor in neonate
19
Q
subglottic stenosis
A
- narrowing of space below glottis and above first tracheal ring
- congenital or acquired
- rare, but one of most common cuases of upper airway instruction in pediatrics
20
Q
esophageal atresia
A
- failure of esophagus to develop as a continuous passage
21
Q
tracheoesophageal fistula (TEF)
A
- abnormal opening between trachea and esophagus
- can occur with esophageal atresia
22
Q
laryngopharyngeal reflux disease (LPRD)
A
- gastric juices move through UES and spill into pharynx
- causes hoarseness, cough, throat clearing, globus sensation, sore throat, dysphagia
- laryngeal signs: hypertrophy of interarytenoids, erythema/edema, irritation, ulceration, granulation near vocal process
- treatment: SLP, ENT, patient work to plan successful reflux management and voice therapy program
23
Q
lifestyle/dietary modifications to manage reflux
A
- lose weight
- limit alcohol/caffeine
- limit mint/peppermint
- don’t eat 3hr prior to bedtime
- limit intake of carbonation
- cessation of smoking
- sleep on left side with head elevated
- reduce intake of fatty foods
- reduce intake of chocolate
24
Q
reflux medications/alignates
A
- medications are either H2 blockers or proton pump inhibitors
- alignates: OTC product made from algae; ingest it, turns to gel, floats to top of stomach, acts as raft blocking reflux
25
vocal process contact ulcers/granulomas
- benign ulcerations developing of medial aspect of vocal processes of arytenoid cartilages due to irritation
- granulated tissue forms over ulcers as a protective mechanism, turning into contact ulcer granulomas
- etiologies: hard glottal attacks with throat clearing, LPRD, intubation
- treatment: reflux meds, lifestyle modifications for reflux, behavioral voice therapy, surgery can remove granulation tissue but may return
26
leukoplakia
- white patch; can be precancerous
- refer out for biopsy, closely monitor
27
erythroplakia
- red patch; can be pre-cancerous
- refer out for biopsy, closely monitor
28
laryngeal cysts
- closed sac filled with fluid or semi-solid substance
- often soft and pliable
- usually benign, unilateral, anywhere on VF
- often caused by abnormal blockage of ductal system of mucous glands
- may be phonotraumatic lesion
- treatment: surgical removal with superficial lesion on superior edge of VF
- behavioral voice therapy to optimize healing and help efficient voice production
29
recurrent respiratory papilloma
- wart-like growths, viral in origin, growing in dark, moist caverns in airway
- seen more commonly in children, usually benign
- treatment is aggressive surgical management to assure airway
30
juvenile onset recurrent respiratory papilloma (JORRP)
- wart-like growths, viral in origin, occurring in dark, moist caverns of airway; usually benign
- associated with mothers who have genital HPV
- most common cause of pediatric hoarseness
- treatment is aggressive surgical management
31
sulcus vocalis
- grooved medial edge of VF, usually bilaterally symmetrical
- may in superficial lamina or may tether vocal ligament
- either congenital or acquired
32
laryngeal webbing
- abnormal tissue forms between VF
- can be congenital or acquired
- treatment: if compromising more than 50% of glottis, treatment is required to establish airway
