Specific Voice Disorders Flashcards
What is a tissue reaction to frictional trauma between the vocal folds?
Vocal nodules
What are the 3 stages of nodule development?
Stage 1, 2, and 3
Also prenodules
Describe Stage 1 of nodule development
Only on the free margin of the VF
Nodules are gelatinous and floppy
Describe Stage 2 of nodule development
Localized swelling or thickening on the edge of the vocal folds
Nodules appear grayish and translucent
Describe Stage 3 of nodule development
Nodules are hard, white, or gray; these nodules are chronic and longstanding.
What are the vocal characteristics associated with vocal nodules?
Harsh quality, breathy voice, limited pitch range, and lower pitch
Where do nodules most commonly occur?
Juncture of the anterior 1/3 and posterior 2/3 of the VF
What is the clinical management for nodules in Stage 1 or 2?
Voice therapy that may include counseling
What is the clinical management for Stage 3 nodules?
Therapy, counseling, may need surgery
With a ______ client, improvement should be noted within 2-3 weeks
Complaint
Where do we want to “place the voice”?
High in the facial mask instead of low in the throat
Placing the voice is trying to change the focus of what?
Resonance
What is the purpose of the yawn sigh?
To facilitate an easy onset
What are the causes of polyps?
URI, contaminants, vocal abuse or a single traumatic event
If polyps are due to vocal abuse, where might they be located?
Junction of the anterior 1/3 and the posterior 2/3 of the VF
What two types of polyps are there?
Pedunculated and sessile
What is the difference between pedunculated and sessile polyps?
Pedunculated are stalk-like and sessile are more broad-based.
Where all could polyps occur?
On the VF, supra- , and sub-glottally
What are the most common voice complaints for polyps?
Hoarseness, frequent throat clearing
What is the management protocol for polyps?
Surgery if they’re large; after surgery you can begin voice therapy
What are contact ulcers?
Benign lesions that develop on the vocal processes of the arytenoid cartilages
What are the most common causes of contact ulcers?
Vocal abuse, GERD, and irritation from intubation during surgery
What are the symptoms of contact ulcers?
**Pain, throat tickle, need to clear throat, aching or dryness in the throat
What are the 3 stages of development of contact ulcers?
1 - vocal fatigue & hoarseness, recovery overnight; redness and swelling between arytenoids
2 - continued hoarseness, fatigue and occasional pain; severe inflammation and early loss of mucosal covering
3 - severe and constant hoarseness, fatigue, and pain; mucosa is completely stripped, starting to see formation of granuloma
What are the vocal characteristics of a contact ulcer?
Low pitch, hoarseness, persistent glottal attacks, and loud voice
Treatment for contact ulcers?
Refer for gastrointestinal eval; vocal rehabilitation
What is a papilloma?
Wart-like growth in the larynx
What is a papilloma caused by?
DNA virus
What is the primary concern of papillomas?
Constriction of the airway because they grow so fast
What population do papillomas typically occur in?
Children; typically do not persist after adolescence
Vocal characteristics of papillomas?
Hoarseness, aphonia, stridor, shortness of breath, and croupy-like cough
What is the primary treatment for papillomas?
Medical - need surgery to preserve the airway
What is a tissue web covering all or part of the glottis?
Laryngeal web
How does a laryngeal web grow?
Anterior to posterior
What might cause a laryngeal web?
It can be congenital or acquired (trauma or infection)
What are the vocal characteristics of laryngeal web?
Higher than normal pitch (b/c of the shortened vibratory surface)
Harsh quality
Shortness of breath
Stridor
What is the treatment for laryngeal web?
Always surgery!
What is vocal fold paralysis?
The inability of one or both VF to move due to a lack of innervation of intrinsic muscles of the larynx
In regards to VF paralysis, what does the label refer to?
It refers to what the affected VF CANNOT do
In unilateral adductor paralysis, what is wrong with the VF?
One VF cannot adduct
What are 90% of VF paralyses due to?
Damage to the vagus nerve or its branches (superior laryngeal or recurrent laryngeal)
What is the difference between the superior laryngeal and recurrent laryngeal?
The muscles innervated - the superior laryngeal innervates the cricothyroid muscles, and the recurrent laryngeal innervates all other intrinsic muscles of the larynx.
What happens to the VF/voice if the cricothryoid muscles are not innervated?
Can’t tense them or make pitch adjustments.
If the recurrent laryngeal nerve is damaged, what difficulty will you have with the VF?
Ability to AD-duct and AB-duct
If an individual has AD-ductor paralysis, what’s wrong the VF?
They can’t close/AD-duct
What is usually the cause of unilateral adductor paralysis?
Trauma to the recurrent laryngeal nerve (surgical injury or trauma)
What are the voice characteristics of unilateral adductor paralysis?
Dysphonic (harsh or hoarse)
Weakness
Breathiness
Loss of fine control for pitch change - may be monotone
How would the voice sound in bilateral AD-ductor paralysis?
Would be completely breathy (because neither VF could AD-duct!) - it’s called paralytic aphonia
What position are the VF in in bilateral AD-ductor paralysis?
Both folds are in the paramedian position and are unable to close
What is the management of vocal fold paralysis?
Surgery, some sort of injection into the VF, a repositioning of the arytenoids, maybe some voice therapy
What are some ways to increase the AD-duction of the VF? (think facilitating techniques)
Pushing technique (not well supported), head positioning, or lateral digital pressure
What is the problem of the VF in AB-ductor paralysis?
The VF are almost primarily AD-ducted/stuck in the midline position; will not AB-duct to a full lateral position for full inspiration
What is the primary problem associated with AB-ductor VF paralysis?
Breathing - the VF won’t open all the way!
What does bilateral AB-ductor paralysis require?
An immediate tracheostomy because the person won’t be able to breathe!
