Voice Flashcards
voice disorder
when quality, pitch, loudness or flexibility differs from the
voice of others of similar age, sex & cultural group
dysphonia
abnormal voice quality
aphonia
lack of voice
professions associated with voice problems
- teachers
- uni students
- student teachers
- call centre operators
- singers
- elderly/nursing home
- drill sergeants
- tour guides
- priests
causes of organic voice disorders
- Congenital or acquired
- Infection
- Trauma
- Reflux
- Other irritant
reinke’s oedema
Cause: Smoking
Feature: abnormal fluid accumulation = swelling and thickening of VCs
Treatment: Smoking cessation
Voice: Rough, may have stridor
vocal cysts
Cause: May be trauma, or spontaneously develop. Could be a fluid-filled sac or
plugged mucous-secreting gland. Note – cysts are submucosal and may only be seen
on stroboscopy.
Treatment: Usually needs surgery and then SLT
Voice: Rough.
vocal polyps
Cause: Trauma or environmental (e.g. irritants)
Features: growths on VCs
Treatment: SLT may help, but may not cure. If incurable, then needs surgery to remove
Voice: Rough, probably strained
how are voice disorders charactericed visually?
endoscopy or videostroboscopy
laryngopharyngeal reflux
- Cause: Dietary – pepsin (enzyme) adheres to larynx, activates in the presence of acid
- Treatment: Gaviscon Advance / PPIs BD
- Voice: Cuts in and out, may be rough
are men or women more likely to have voice disorders?
women
is socio-economic status related to voice disorders?
no
are girls or boys more likely to have voice disorders?
boys
family affect on voice problems in children?
having an older sibling = more likely
how does mental health affect voice?
stressful life events and psychological problems predispose to voice problems
- usually contributory factors to psychogenic voice disorders
characteristics of dysphonia
hoarse, breathy, weak, rough, croaky, high/low, strained
voice characteristics
pitch, loudness, tremor, flexibility, stamina, quality
vocal tract discomfort characteristics
Fatigue Aching
Burning Pain
Tickling Mucous
Dryness Difficulty catching breath
Irritability Tightness
Lump in the throat (globus sensation) Pushing to get voice out
posture is important for…
voice production
post-nasal drip
Cause: Nasal irritation. May be environmental (e.g. pollen), idiopathic or secondary to LPR
Treatment: Sinus rinsing +/- steroidal sprays
Voice: May cut in and out, variable quality. Strained or rough if coughing a lot
laryngeal web
Cause: Congenital. Generally only seen in paeds.
Treatment: Surgical. Note – causes airway patency issues
Voice: May be rough/strained, breathing may be stridorous, resonance may be ‘off’
sulcus vocalis
Cause: Unknown, but possible congenital or through repeated inflammatory processes
Features: groove on vocal fold
Treatment: Surgical
Voice: Breathy and possibly rough with likely higher-than-normal habitual pitch
neurogenic voice disorders characteristics depend on…
location of nerve lesion
Central lesions tend to involve other symptoms
Peripheral lesions tend to involve just the voice
cause of neurogenic voice disorders
Acquired neurological diseases (e.g. MND, IPD, MS)
Trauma to the head/neck/throat
Post-infective (usually respiratory tract infection)
Iatrogenic (i.e. caused by the doctor: heart/lung/throat surgery)
vocal paresis/paralysis
Cause: Usually acute nerve injury/severing, but may be stroke-related
Treatment: Surgical medialization, voice strengthening
Voice: Breathy, low volume, reduced pitch range, increased vocal fatigue. Aphonia if bilateral
presbyphonia
Cause: Normal, age-related changes
Features: muscle atrophy, loss of elasticity, mucosal thinning, changes in hydration
Treatment: Voice strengthening.
Voice: Breathy, low volume, reduced pitch range, increased vocal fatigue.
most common voice disorders
muscle tension voice disorders (MTVD)
causes of MTVD?
- Upper Respiratory Tract Infection (URTI)
- Associated with organic voice disorder (by compensation)
- Psychosocial stressors
vocal nodules
Cause: Usually phonotrauma (i.e. vocal abuse)
Intervention: SLT input usually resolves, but entrenched/fibrotic
nodules may need surgery
Voice: Rough, probably strained quality
muscle tension dysphonia
Cause: May be triggered by URTI, trauma or stress
Treatment: SLT. (Almost) no role for ENT
Voice: Rough, strained
- supraglottic squeeze
- stiff, tense VCs
supraglottic squeeze
squeezing of space above glottis- lateral squeeze and anteroposterior squeeze
can there be physical causes co-occurring with psychogenic voice disorders?
yes
classifying psychogenic disorders
Type 1: classical (hysterical) conversion
Type 2: Cognitive Behavioural Conversion
Type 3: Habituated Conversion
Type 1: Classical (Hysterical) Conversion
5% of patients
Lack of conscious acceptance of psychological problems
La belle indifference
Type 2: Cognitive Behavioural Conversion
95% of patients
Conscious acceptance of issues, but avoidance of same due to desire to avoid conflict (internal or external)
Type 3: Habituated Conversion
As with type 2, but the source of anxiety is gone, while the musculoskeletal tension remains
Common features of PVDs
Low mood
Family/interpersonal difficulties
Mild-moderate depression
Difficulty expressing views/emotions
Stressful life events
Suppressing anger/frustration
Anxiety
Burden of responsibility
Common to females
Over-commitment and helplessness
Near normal psychological adjustment
mutational falsetto/puberphonia
- one of the most common psychogenic voice disorders
- Males maintain a high-pitched falsetto voice after puberty
- Often associated with maternal/parental attachment issues
classification of voice problems
hyperfunctional, functional, organic, MTD, supraglottic squeeze, glottal insufficiency
comprensensatory mechanisms make a person’s voice…
worse over time, not suddenly
distress associated with voice problems
psychological distress, anxiety, depression, stress (can precede voice problems, and make problem worse)
biopsychosocial model
health includes: psychological, sociological, biological
