quiz 4

Question 1

CAPE-V

Answer 1

• 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

Question 2

3 vocal registers

Answer 2

• glottal fry
• modal/chest register
• falsetto

Question 3

glottal fry

Answer 3

• 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

Question 4

modal/chest register

Answer 4

• richest and heaviest timbre of registers
• most common register for conversational speech

Question 5

head voice/falsetto

Answer 5

• highest fundamental frequency range of registers except whistle
• lightest timbre of registers
• very little vibration - only outer cover of VF

Question 6

VHI & score interpretation

Answer 6

• 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

Question 7

VHI 10

Answer 7

• derived from original VHI
• 10 critical question from 3 domains
• total of 40
• greater than 11 = abnormal
• 6 points is minimal impact difference

Question 8

mean speaking fundamental frequency

Answer 8

• elicit with conversational speech or asking patient to read rainbow passage
• males 100-120
• females 200-220

Question 9

maximum phonation time

Answer 9

• 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

Question 10

primary muscle tension dysphonia

Answer 10

• vocal hyperfunction in absence of organic pathology without obvious psychogenic/neurologic etiology
• behaviorally modifiable, unexplained dysphonia

Question 11

secondary muscle tension dysphonia

Answer 11

• dysphonia occurring as compensatory technique with an organic, psychogenic, or neurologic etiology

Question 12

puberphonia

Answer 12

• 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

Question 13

alternative phrasing to “misuse” or “abuse”

Answer 13

• 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”

Question 14

theoretical framework for vocal hyperfunction

Answer 14

• 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

Question 15

vocal fold nodules

Answer 15

• 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

Question 16

vocal fold polyps

Answer 16

• 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

Question 17

Reinke’s Edema/Smoker’s Polyps

Answer 17

• 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

Question 18

laryngomalacia

Answer 18

• inward collapse of subglottic structures of larynx during inhalation
• 75% of congenital anomalies of larynx
• most prevalent cause of inspiratory stridor in neonate

Question 19

subglottic stenosis

Answer 19

• 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

Question 20

esophageal atresia

Answer 20

• failure of esophagus to develop as a continuous passage

Question 21

tracheoesophageal fistula (TEF)

Answer 21

• abnormal opening between trachea and esophagus
• can occur with esophageal atresia

Question 22

laryngopharyngeal reflux disease (LPRD)

Answer 22

• 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

Question 23

lifestyle/dietary modifications to manage reflux

Answer 23

• 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

Question 24

reflux medications/alignates

Answer 24

• 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

Question 25

vocal process contact ulcers/granulomas

Answer 25

• 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

Question 26

leukoplakia

Answer 26

• white patch; can be precancerous
• refer out for biopsy, closely monitor

Question 27

erythroplakia

Answer 27

• red patch; can be pre-cancerous
• refer out for biopsy, closely monitor

Question 28

laryngeal cysts

Answer 28

• 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

Question 29

recurrent respiratory papilloma

Answer 29

• 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

Question 30

juvenile onset recurrent respiratory papilloma (JORRP)

Answer 30

• 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

Question 31

sulcus vocalis

Answer 31

• grooved medial edge of VF, usually bilaterally symmetrical
• may in superficial lamina or may tether vocal ligament
• either congenital or acquired

Question 32

laryngeal webbing

Answer 32

• abnormal tissue forms between VF
• can be congenital or acquired
• treatment: if compromising more than 50% of glottis, treatment is required to establish airway