Quizzes Flashcards
What are the differences between misuse and vocal abuse Phonotrauma?
They do not differ a lot, more of behaviors on a continuum.
-Misuse: voice production behaviors that distort the normal behavior of the phonatory mechanism to work efficiently and effectively. High vocal demands, many people can misuse their voice frequently
-Vocal abuse: behavior that is harsher & that traumatizes the VF tissue sufficiently to cause tissue change
Examples of types of misuse versus vocal abuse
- Misuse: increased tension/strain (hard glottal attack, high laryngeal position, AR laryngeal squeezing), inappropriate pitch level, (puberphonia, persistent glottal fry, lack of pitch variability), excessive talking, ventricular phonation, dysphonia, and aphonia
- Vocal Abuse: excessive/prolonged loudness, excessive use/strain during tissue change (creating further VF damage), excessive coughing, excessive throat clearing, screamer/noise maker, exercise enthusiast
Who is most likely to present with puberphonia? How may this affect them socially with their communication?
Most common: males who went through puberty
It is perceived as unusual or inappropriate for a man to have a high-pitched voice instead of a low-pitch voice. It may make them feel embarrassed
Why do certain children exhibit phonotrauma?
What sort of vocal behaviors lead to this?
Because children are prime exhibitors of excessive talking, screaming, and noise making
These behaviors can cause vocal nodules, which are common in children & are often called ‘screamer’s nodules’ because of this
What are the histological differences between nodules and polyps?
-Polyp: BMZ thinning, decreased fibronectin, and presence of fibrin and iron. Greater central core of fibrous tissue with greater dentify than the LP. It is covered by normal or slightly hyperplastic epithelium
-Nodules: abnormal BMZ with altered anchoring fibers, increased fibronectin, and increased collagen
A person who reports voice changes following attendance at an LSU football game is most likely to be diagnosed with which benign lesion?
Nodules
They will most likely have lost their voice and have irritated VF mucosa (possibly edematous)
What is the difference between an acute and chronic nodule & what is the effect on voice
Acute: soft and pliable appearance. Mostly vascular and localized edema. Usually unilateral
With vocal rest, may get better.
Chronic: hard, fibroused, white, thick. Epithelium may show hypertrophy, rough surfaces. Not always symmetric in size
More stiff and cause more resistance to VF vibration
Usually bilateral
No improvement with vocal rest
How can the size and location of a polyp affect vibration?
If the polyp is bigger, it can interfere with glottal closure and cause breathiness
If found in the subglottis region, rather than the free margin of the VFs, they may cause little alteration to voice quality
If a benign lesion goes away with therapy, we can likely determine it was not what?
A cyst
What are some signs and symptoms of Reinke’s edema?
Symptoms: lower pitch, hoarseness, shortness of breath
Signs: lower findamental frequency, VFs appear fluid-filled, boggy-like structures. Greater excursion of the mucosal wave, incomplete glottal closure
What are the factors that can lead to the development of keratosis?
Smoking
Env pollutants
Why is surgery the primary treatment for Recurrent Respiratory Papiloma instead of voice therapy?
Because they tend to proliferate & can obstruct the airway
How would a laryngeal web affect vocal fold vibration
In a child it may result in stridor
In adults may result in hoarseness and high pitch
3 potential symptoms of inhalation trauma
- Swelling
- Inflammation
- Burns
What does the TNM system refer to
It is a system that evaluates the severity of malignancy: lower numbers indicate lesser involvement & higher numbers indicate severity
T= site of the primary tumor
N= involvement of lymph nodes
M= the spread of the lesion to other body parts (metastasis)
What are the potential treatments for malignant laryngeal tumors
-Surgery
-Radiation therapy
-Chemotherapy
What sort or incident would likely cause a hemorrhage?
-Single episode of traumatic voice use or laryngeal trauma
-Combination of heavy voice use + anticoagulants and salicylates
-Extended use of inhaled steroids
What can cause fixation of the cricoarytenoid joint?
Arthritis, trauma, or joint disease
Do we expect to see tissue changes with mass and stiffness of the VFs with contact granulomas?
There is an irregularity shaped mass of tissue at the vocal process of the arytenoids
What is a common way one can develop a laryngeal granuloma?
Intubation
What are the two types of spasmodic dysphonia?
- Adductor SD
- Abductor
or a mix
What type of adduction do the VFs engage in during Myasthenia gravis?
Hypoadduction
What type of true VF vibratory behavior do you expect to see with myasthenia gravis
Weakness resulting in True VFs not adducting completely
Breathy voice
How is someone’s pitch affected by parkinsons disease
The rigidity and stiffness causes monopitch
What type of adduction do the VFs engage in with Parkinsons Disease
Hypoadduction
Why is the left VF more often involved in cases with unilater VF paralysis compared to the right VF
The left recurrent laryngeal nerve travels further in the body than the right recurrent laryngeal nerve does
As a result the left side has more opportunity for lesions
How do voice symptoms change over the course of the degenerative disease (Amyotrophic Lateral Sclerosis: ALS)?
The early symptoms are hoarseness or harshness with slurred speech
As the disease progresses, all symptoms increase in severity and their debilitating factors
Why is unilateral VF paralysis more common than bilateral VF paralysis
Differing lengths of the RLN on each side
How do the tissue makeup of the VFs differ for a child versus adult?
Infants VF histology is more uniform
Adults are layered and distinct
2 types of congenital anomalies in children
-Laryngomalacia
-Laryngeal paralyese
What is the free radical theory about aging voice
Free radicals are by products from normal cellular metabolism that have one extra electron
Free radicals attack, damaging DNA and protein because the free electron has a strong attraction to be attached to molecules
What changes to the VF tissue structure increases stiffness in the lamina propria
Loss of collagen fibers
Increased fibers
Increased fibronectin
Diminished extracellular spaces
Decreased hyaluronic acid
What muscular changes do we see with VFs due to aging?
The muscles atrophy and get weaker
They stiffen and decrease in surface density
Decreased ratio of satelite cells to myonuclei
What physiologic changes could we expect to see through laryngeal imaging with presbyphonia (aging voice)
Thinning VFs
Edema
Posterior glottal gap
Based on the changes due to presbyphonia, older individuals are most likely to show what auditory-perceptual signs?
-Pitch rises in men and falls in women
-Breathiness
-hoarseness
-Long pauses
