VD Test One Functional Voice Disorder Flashcards
What is a functional voice disorder?
the absence of current organic pathology, without obvious psychogenic or neurologic etiology.
Is muscle tension dysphonia common?
YES
What does persistent MTD result from?
excessive laryngeal and related musculoskeletal tension and associated hyperfunctional true and/or false vocal fold vibratory patterns
How can MTD be categorized?
primary or secondary
Determining whether MTD is primary or secondary what is it based on?
whether organic pathologic conditions contribute to trigger the muscle tension behavior
What is PRIMARY MTD?
- dysphonia in the absence of current organic pathology
- excessive, atypical or abnormal laryngeal muscle movements
What is SECONDARY MTD?
- compensatory response to the primary etiology
- excessive, atypical or abnormal laryngeal muscle movements
Name 5 factors that contribute to MTD?
- deviant body posture and misuse of neck and shoulder muscles
- high stress levels
- excessive voice use
- persistently loud voice use
- laryngopharyngeal reflux disease
List 3 benign laryngeal pathologies resulting from MTD
- vocal fold nodules
- vocal fold polyps
- reinke’s edema
Where do you often find vocal fold nodules?
glottal margin of each fold (anterior middle third junction
What does a vocal fold nodule look like in the early stage?
soft/pliable, reddish
What does an aged/chronic nodule look like?
hard and white
What causes vocal fold nodules?
continuous abuse of the larynx and misuse of the voice
- compensatory muscular tension
- increased laryngeal effort
- excess vocalis tension
- increase pressure to force air through constricted folds
- incoordination of respiration/phonation
- hearing loss
What are some psychological factors that can cause vocal fold nodules?
stress, lifestyle, tension with individuals
What are the voice symptoms of VF nodules?
- VF is stiff and more massive, and vibration is aperiodic; posterior glottal chink may be observed with hourglass closure
- large nodules may cause trouble breathing (dyspnea)
List 6 descriptions for what happens to the acoustics of one’s voice from VF nodules?
- breathiness and air wastage
- hoarse voice quality
- decreased Fo and pitch range
- decreased habitual loudness and dynamic range
- increased perturbation rates, jitter/shimmer
- vocal fatigue, frequent throat clearing
What aerodynamic features occur because of VF nodules?
higher than normal air flows
Ask someone about nodule questions on slide treatment of nodules????
??????
When working with a patient with VF nodules, what behaviors do you address through reduction/elimination?
- smoking
- excess volume
- vocal abuse at public events
- singing style
What should patient increase with VF nodules?
hydration
How long will it take a nodule to go away?
as long as it took to develop
What is a vocal fold polyp?
localized, fluid filled sac on the VF
What is a pedunculated polyp?
attached by slim stalk
What is a sessile polyp?
blister adhere to mucosa
What is a hemorrhagic polyp?
blood filled
Where is a polyp usually located?
- free of margin from TVF
- usually unilateral (90%), can be bilateral
- arise at same location as nodules
Where do polyps usually arise?
on superficial lamina propria, but deeper than nodules
What are nodules typically due to?
vocal abuse
What is a polyp usually due to?
a single event
What can a polyp do spontaneously?
heal
What are 5 things that can happen to one’s voice with polyps?
- similar to those of a nodule
- incomplete VF closure
- decreased phonation time
- decreases pitch
- reduced dynamic range
How can a polyp be treated?
with surgery
Surgery and then voice treatment? OR Voice treatment and then surgery?
Surgery and then voice treatment
What are the 4 steps of micro-flap surgery to remove a polyp?
- small incision
- raise flap
- remove contents via suction
- lay flap down
What is the goal of polyp micro-flap surgery?
- save as much superficial lamina propria as possible
2. disrupt the glottal margin as little as possible
In voice therapy for polyps, what is recommended?
reduce secondary habits such as.... 1. overdriving 2. hard voice onset 3. secondary strain Reduce 1. abusive habits Voice therapy 1. after surgery Keep up good.... 1. vocal hygiene
What does reinke’s edema usually look like?
- usually bilateral and asymmetric
- folds appear fluid filled
- extreme cases confused with polyps
- in stobe, folds appear stiff
What is the cause of Reinke’s edema?
- hyper-function
- smoking
- extreme allergies
What gender is reinke’s edema more common in?
females
What happens to Fo with reinke’s edema?
decreases
What decreases and what extends in patients with RE?
decrease range
extension of low end
What happens to perturbation in patients with RE?
increases
What happens to periodicity of voice in patients with RE?
become aperiodic
What is greater than normal in patients with RE?
greater than normal flow loops
List recommendations of therapy for RE and other related conditions.
- reduce abuse
- decrease intensity
- noise in talking environments
- decrease/stop “throat clearing”
- limited vocal rest, 3 - 4 weeks
- increase hydration
- re-eval in 3 - 4 weeks
What is success of voice therapy for RE highly dependent on?
eliminating the cause of the problem, such as smoking
