Voice 2 Flashcards by Kailyn Coleman

What are the three voice characteristics associated with excessive MTD?

Pitch Break
Phonation Break
Diplophonia

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What is Puberphonia?

failure of the voice to reflect the development of secondary sex characteristics in puberty.

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True or False: Psychogenic Dysphonia is treated with voice therapy.

False! This kind of dysphonia is resistant to therapy

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True or False: It is common for children to outgrow laryngomalacia by 18 to 24 months.

True

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Which congenital anomaly accounts for 75% of all congenital anomalies of the larynx?

Laryngomalacia

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What is the preferred surgical intervention for Laryngomalacia, as compared to tracheostomy procedure? Why is it preferred?

Supraglottoplasty
Why: it eliminates inspiratory obstruction by widening the supraglottis

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True or False: 5% of patients who require surgical intervention for severe laryngomalacia receive it within how many weeks of presentation?

Within 1-2 weeks

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What are the 8 primary symptoms of Severe Laryngomalacia?

Inspiratory stridor
Suprasternal retraction
Substernal retraction
Feeding difficulty
Choking
Post-feeding vomit
Failure to thrive
Cyanosis

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What is Subglottis Stenosis?

The narrowing of the space below the glottis and above the first tracheal ring

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What is one of the most common causes of chronic upper airway obstruction in infants and children?

Subglottic Stenosis

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(Congenital or Acquired) subglottic stenosis is the second most common cause of stridor in neonates, infants, and children.

Congenital

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(Congenital or Acquired) subglottic stenosis is the most common acquired anomaly of the larynx in children, and is the most common abnormality necessitating tracheotomy in children under one.

Acquired

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True or False: The prognosis of acquired subglottic stenosis is significantly poorer than that of the congenital type

True

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True or False: Esophageal Atresia and Tracheoesophageal Fistula cannot co-occur.

False! They can

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What term is a failure of the esophagus to develop as a continuous passage?

Congenital Esophageal Atresia (EA)

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What is an abnormal opening between the trachea and esophagus?

Tracheoesophageal fistula (T E F)

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When and how are Esophageal Atresia and Tracheoesophageal Fistulas diagnosed?

they both are diagnosed in the intensive care unit (I C U) at birth and are treated immediately with surgery

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When assessing a child who has Esophageal Atresia and Tracheoesophageal Fistula, the clinician may suspect dysphagia and dysphonia. Why?

because unilateral vocal fold paralysis has been associated in a small percentage of patients treated surgically for Esophageal Atresia and Tracheoesophageal Fistula.

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True or False: L P R D is synonymous with extraesophageal reflux disease (E E R D), another accepted but older term for reflux upstream from the stomach

True

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What are the 4 key symptoms of LPRD?

Hoarseness*
Chronic cough*
Throat clearing*
Globus sensation*

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What are the 3 key laryngeal signs of LPRD?

-Hypertrophy of the intra-arytenoid or posterior commissure area*
-Erythema and edema of mucosa overlying the arytenoids*
-Erythema and edema of the vocal folds*

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True or False: If the stomach acid passes the LES and remains below the UES, then it is GERD.

True

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If the stomach acid passes the upper esophageal sphincter and has effects on the pharynx and larynx, then it is LPRD.

True

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What are the three things that are needed when making a diagnosis for LPRD?

-patient’s history
-the symptoms
- the laryngeal signs found at laryngostroboscopy

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What are the four tools used to assess reflux severity?

-Reflux Symptom Index (R S I) -Reflux Finding Score (R F S) -Reflex Symptom Score (R S S) -L P R-H R Q O L Scale

What is a Contact Ulcer?

benign ulcerations that develop on the medial aspect of the vocal processes of the arytenoid cartilages due to irritation

When granulated tissue forms over Contact Ulcers as a protective mechanism, they become...

Contact Ulcer Granuloma

What are the 5 associated etiologies with Endocrine Changes

* Hypofunciton of Pituitary Gland Hypothyroidism * Premenstrual voice syndrome * Menopausal voice syndrome * Pregnancy

True or False: Hypothyroidism associated increase in hyaluronic acid tends to lead to retention of fluids (myxedema) in and the THINNING OR THICKENING of the vocal folds.

THICKENING

In Hyperthyroidism, patients often report having a hoarse voice. Whereas in Hypothyroidism, patients often report having a breathy voice.

False! Hypo - hoarse Hyper - breathy

Premenstrual Voice Syndrome (PMVS) often affects how many women? Think fraction form.

May affect around 1/3 of women, especially voice performers

Hypofunctioning of Adrenal Glands is also known as ....

Addison's Disease

Hypo- and Hyper-function of these three systems/structures have direct impacts on voice function

1. Pituitary Gland 2. Adrenal Gland 3. Thyroid Gland

A tumor in the adrenal gland can cause a deepening or heightening of voice?

Deepening

What are the 5 main symptoms of PMVS?

* Vascular changes * Mucosal changes * Muscular changes * Inflammatory changes * Emotional changes

True or False: Women who are on IVF experienced more throat clearing and pregnancy has been associated with vocal changes in response to sex steroid hormones.

True

The three key characteristics of Hemangiomas that are needed to make the diagnosis include...

The sac is soft, pliable, and blood-filled

Infantile hemangiomas are usually found in the ________, while adult hemangiomas occur usually in the __________.

subglottis, supraglottis

True or False: Those with hemangiomas often have vocal hyperfunction, L P R D, or intubation trauma.

True

What is the main course of treatment for Hemangiomas?

Surgical removal As soon as glottal healing permits, a vocal hygiene program and voice therapy should be initiated

What is the umbrella term covering any inflammation of the larynx?

Laryngitis

What are the three stages of Laryngitis?

Acute: Lasting for a few days. Most common in children. Subacute: Persisting for up to three weeks. Chronic: Persisting longer than three weeks. More common in adults.

What are the 6 causes of Laryngitis?

* Infections * Phonotrauma * Smoking * L P R D * Autoimmune problems * Radiation therapy

True or False: In acute laryngitis, antibiotics are usually prescribed

False! In acute laryngitis, antibiotics are usually NOT prescribed

True or False: Thickened patches that are red (keratosis) or white (leukoplakia)

True

What two disorders are most often seen in smokers?

Hyperkeratosis and Leukoplakia

True or False: Voice dysfunction may affect 15-20% of pregnant women, especially during the last five months of pregnancy

True

True or False: Oral contraceptive pills may reduce the irregularity of vocal fold vibration in singers during menstruation

True

True or False: Sulcus vocalis may be either congenital or acquired

True

What are the wartlike growths, viral in origin, that occur in the dark, moist caverns of the airway?

Recurrent Respiratory Papillomatosis (RRP)

What is the most common benign laryngeal neoplasm in children?

Juvenile Onset Recurrent Respiratory Papillomatosis (JORRP)

True or False: 20% of cases of JORRP persist beyond puberty

True

What is a mucosal wave?

Top layer of VF creates a wave (ripple effect) that helps the VF function efficiently. Key player in healthy voice production.

True or False: Treatment of JORRP requires more passive medical/surgical management to assure a safe airway

False! More aggressive

What is Laryngeal Webbing?

Occurs when abnormal tissue forms between the vocal folds

True or False: Laryngeal Webbing is only congenital.

False! Can be congenital or acquired

If muscle tension occurs on the VF, it can alter the mucosal wave which can lead to a voice problem like strain or breathiness.

True

True or False: The Mucosal wave regulates healthy pitch and contributes to a clear strong well controlled voice.

True

If one's mucosal wave is disturbed or absent, there are perceptual characteristics on the voice.

True

True or False: the mucosal wave can be diagnosed through perceptual signs.

False. This needs to be diagnosed through visual .

How are Recurrent Respiratory Papillomatosis diagnosed?

Through Laryngoscopy

When is the typical onset of RRP in children?

Diagnosed between 2-4 years old

In adult RRP, it occurs in more females than males .

False! More males

True or False: RRP is more aggressive in children.

True! Children need around 20 surgeries for treatment

What is the generic term that means “furrow” or “indentation.”

Sulcus

True or False: In sulcus vocalis, one sees a grooved medial edge of the vocal fold, usually UNILATERAL

False! bilaterally symmetrical

RRP can be recurrent, requiring multiple surgeries to remove after growths

True

If a child is experiencing vocal hoarseness beyond __ days without a cause, you need to refer to ENT and approach treatment carefully.

10 days

What are the three groups of Laryngeal Cancers?

1. Supraglottal, involving structures such as the ventricular and the aryepiglottic folds, the epiglottis, the arytenoid cartilage, and the walls of the hypopharynx 2. Glottal, from the anterior commissure to the vocal process ends of the arytenoids 3. Subglottal, involving the cricoid cartilage and trachea

How are Laryngeal Cancers treated?

Radiation therapy Surgery for minor to moderate lesions. Hemi laryngectomy Supraglottal laryngectomy Total laryngectomy for extensive lesions.

What is the most frequent event producing the postsurgical acquired web?

Laryngeal or tracheal surgery

As an abnormal healing process, both folds grow together anteriorly, forming a glottal web sometimes called a _______.

Synechia

What does "Glottal Incompetence" mean?

VF Abduction and Adduction dysfunction

Many traumatic VF paralyses have spontaneous recovery within the first ___ to ___ months of therapy.

9-12 months

What is the first step in intervention for VF paralysis?

Voice Therapy. If it is ineffective, then surgery will be considered.

What are the 7 key VF paralysis intervention strategies?

1. Half-swallow Boom 2. Head-turn 3. Digital Manipulation 4. Focus 5. Pitch shift/Nasal-glides 6. Tongue protrusion /i/ 7. Inhalation Phonation

What 2 main surgical options are used for UVFP?

1. VF Medicalization including: - Injection laryngoplasty -Thyroplasty (Isshiki Type Arytenoid adduction) 2. Vocal fold re-innervation

Improve voice quality, swallowing, Helpful to VF paralysis, or if there is VF atrophy/issues to its structure, boeing to VF.

Laryngoplasty

Manipulate or add implants to VF. Implants are usually made of synthetic materials

What indicates a need for a laryngoplasty due to glottal incompetence?

1. 2. 3.

Contraindications for Laryngoplasty include...

Absolute 1. Bilateral paralysis 2. CNS lesion resulting in dysarthria 3. For electively lowering pitch 3. To close a posterior glottal gap 5. In the psychologically unstable patient Related 6. Bleeding disorder 7. xxx 8. Anxiety 9. Allergy to implant material

The surgeon uses a free-moving wedge to move VF to midline during which surgical procedure?

Thyroplasty

Laryngoplasty is effective as it improves voice quality and prevents VF atrophy.

False! While laryngoplasty is effective in improving voice quality, it cannot prevent VF atrophy

Medialization laryngeoplasty is often referred to as...

Thyroplasty

Thyroplasty differs from Laryngoplasty because Thyroplasty....

Aims to restore/improve voice quality by adjusting the position of the vocal folds whereas laryngoplasty focuses on repairing/rebuilding the VF

__________ is typically used for unilateral vocal fold paralysis.

Thyroplasty

True or False: UVFP is a common cause of neonatal stridor.

False! BVFP

In BVFP, adductor paralysis the VF remain at midline, causing serious respiratory problems where patients may need a tracheostomy

False! Abductor

In BVFP, adductor paralysis neither VF is capable of moving midline, thus making phonation impossible and placing the individual at risk of __________________.

Aspiration