VD Test One Organic Voice Disorder Flashcards
List 4 organic conditions affecting voice.
- acid reflux disease
- contact ulcer & granuloma
- cyst
- laryngitis
Name 2 common etiologies of acid reflux disease for a high percentage of patients.
- GERD gastroesophageal reflux disease
2. LPRD laryngopharyngeal reflux disease
What is GERD?
- the passage of gastric juices from the stomach into the esophagus
What is LPRD?
- if passage of gastric juices move superiorly and through the upper esophageal sphincter, the disorder is identified as LPRD, as the contents spill into the pharynx.
What is the diagnosis of reflux disease often based on?
the patient’s history, the symptoms and the laryngeal signs found at laryngostroboscopy
What increases likelihood of an LPRD diagnosis?
the more symptoms and signs a patient has in the absence of other potential causes
What may be indicated in more severe cases of LPRD in which patient does not respond to anti-reflux medications?
24 hour dual probe pH monitoring may be indicated
List 8 symptoms of LPRD.
- hoarseness
- chronic cough
- throat clearing
- globus sensation
- postnasal drip
- sore throat
- laryngospasm
- dysphagia
What are the laryngeal signs of acid reflux disease (4)?
- posterior glottal redness
- contact ulcers
- pharyngeal irritation
- arytenoid hyperlasia (hypertrophy) and possible granuloma
Name 2 acid reflux medications.
- H2 blockers
2. PPI
How do H2 blockers work?
They work by blocking signals generated by histamine receptors on cells that are responsible for acid secretion.
What do H2 blockers include?
zantac
pepcid
tagamet
axid
How do PPIs work?
They work by shutting down (inhibiting) the cell pumps that maintain the acidic environment in the stomach.
What do PPIs include?
prilosec nexium aciphex prevacid protonix
What medication instructions are more effective than other regimes and combining PPIs with H2 blockers?
A high dose of PPI twice daily for at least 4 months
When should high doses of PPIs be taken?
MUST be taken 30 - 60 minutes BEFORE meals.
List 5 ways one can change his or her lifestyle/diet to help reduce symptoms of acid reflux disease.
- weight reduction
- cessation of smoking
- reduction of alcohol intake
- sleep on side, with head elevated a bit
- don’t eat within 3 hours of bedtime
List 5 ways one can change his or her lifestyle/diet to help reduce symptoms of acid reflux disease.
- reduce intake of carbonated beverages
- reduce intake of citrus based beverages
- reduce intake of fatty foods
- reduce intake of chocolate
- reduce intake of mint (especially peppermint)
What is the role of the SLP with acid reflux management?
The SLP works with the ENT physician and patient to plan a successful reflux management regimen and a voice therapy program that can produce optimal vocal function.
What was the major finding of the Park et. al 2012 research study?
Significantly more patients in the medication plus voice therapy group showed a clinically significant change in RSI, VHI, and perceptual scores at all follow up evaluations.
What did the major finding of the Park et. al 2012 research study suggest.
The study suggested that voice therapy may help to restore reversible mucosal change secondary to acidic reflux, including rapid resolution of symptoms and shortening of the treatment period.
What are contact ulcers?
Contact ulcers are small ulcerations that develop on the medial aspect of the vocal processes of they arytenoid cartilages due to irritation
When are contact ulcers called contact ulcer granulomas?
When granulated tissue forms over these ulcers as a protective mechanism.
Contact ulcers/granulomas seem to result from one of three causes. Name them.
- hard glottal attack along with throat clearing and coughing
- LPRD
- endotracheal intubation
What are the symptoms of ulcers/granulomas?
- deterioration of voice after prolonged vocalization (vocal fatigue)
- laryngeal pain
- chronic throat clearing
- pain that lateralizes/refers to one ear
What are the signs of ulcers/granulomas?
- laryngeal edema and erythema
- bilateral ulcerations with heavy build up of tissue along approximating margins of the posterior glottis
- LPRD
- referred ear pain is common
What is the focus of voice therapy for patients with contact ulcers or granulomas?
To take the effort out of phonation.
Behavioral therapy helps patients with uclers learn to use his or her voice to speak in what way?
Patients must learn to use a voice that can be produced with relatively little strain, to speak with greater mouth and jaw relaxation, to speak at lower levels of volume, and to eliminate all traces of excessively hard glottal attack.
What is a cyst?
- a closed sac filled with fluid or semisolid substance.
In what two ways can cysts be show up?
Congenitally or acquired.
What does a laryngeal cyst appear to look like? What kind of problem is this in contrast to?
Laryngeal cyst = soft and pliable
Vocal nodule = hard, fibrotic structure
Where do cysts usually occur?
usually unilateral, occurring on the vocal folds (inner margin, superior or inferior surface)
What are cysts often caused by even thought there are other causes besides this?
an abnormal blockage of laryngeal mucous glands
How are cysts medically managed?
removed surgically using a small superficial incision along the superior edge of the vocal fold, without disrupting the glottal margin
What is behavioral management confined to post surgically?
helping the patient eliminate any voice compensations (such as increased glottal attack) that may have been used to minimize the negative voice consequences of the cyst
What is laryngitis?
an umbrella term covering any inflammation of the larynx
What are the 3 possible stages of laryngitis?
acute, subacute, chronic
What is acute?
lasting for days, most common in children
What is subacute?
persisting for up to 3 weeks
What is chronic?
persisting longer than 3 weeks, more common in adults
What are 6 multifactorial causes for laryngitis?
- infections
- phonotrauma
- smoking
- LPRD
- autoimmune problems
- radiation therapy
In what kind of laryngitis are antibiotics not prescribed?
acute
What are the behavior interventions for laryngitis?
- breathing in humidified air
- avoiding speaking as much as possible
- using a confidential voice when necessary
- avoiding antihistamines and corticosteroids
- using mucolytics to thin secretions
What is focused on to manage chronic laryngitis?
identifying and eliminating the laryngeal irritants
Behavioral interventions for laryngitis include?
vocal hygiene and education
minimizing vocal hyperfunction
