Voice Conditions Flashcards
What are the three abnormal voice qualities?
Breathy, rough, strained
Breathy - incomplete glottal closure → turbulent airflow
Rough - aperiodic vocal fold vibration → irregular mucosal wave
Strained - considerable medical compression of true vocal folds
What does breathy vocal quality imply?
Incomplete glottal closure → turbulent airflow
What does rough vocal quality imply?
Aperiodic vocal folds vibration (hindi sabay vibration ng vocal folds)→ irregular mucosal wave (garalgal)
What does strained vocal quality mean?
Considerable medial compression of true vocal folds (ipit)
What does harsh vocal quality mean?
Strained + rough
What does hoarse vocal quality mean?
Strained + rough + breathy
What are organic voice disorders?
Organic voice disorders are related to structural deviations of the vocal tracts (lungs, muscles of respiration, larynx, pharynx, and oral cavity) or to diseases of specific structures of the vocal tract.
- Structural deviations
- Additive growth
- Loss of structure
What are the congenital organic voice disorders?
Laryngomalacia
Subglottic stenosis
Esophageal atresia and tracheoesophageal fistula
This is the inward collapse of the supraglottic structures of the larynx during inspiration” (Holinger, 1997). This accounts for 75% of all congenital anomalies of the larynx and is the most prevalent cause of stridor in the neonate (Elluru, 2006). In most children with the condition, symptoms are evident at birth or within the first few hours or days of life (Andrews and Summers, 2002). Severe ______________ is associated with the primary symptoms of inspiratory stridor, suprasternal retraction, substernal retraction, feeding difficulty, choking, post feeding vomit, failure to thrive, and cyanosis (Lee and colleagues, 2007) → shorter utterances.
Laryngomalacia
This is the narrowing of the space below the glottis and above the first tracheal ring. Although rare, it is one of the most common causes of chronic upper airway obstruction in infants and children. It can be congenital or acquired. The congenital __________ is the second most common cause of stridor in neonates, infants, and children. Acquired ___________ is the most common acquired anomaly of the larynx in the pediatric age group, and is the most common abnormality necessitating tracheotomy in children below one year of age
Subglottic stenosis
This represents a failure of the esophagus to develop as a continuous passage. Instead, it ends as a blind pouch.
Congenital esophageal atresia
This represents an abnormal opening between the trachea and esophagus.
Tracheoesophageal fistula
The standard intervention is surgery. However, surgery is not without risks, such as severe respiratory distress, recurrent aspiration pneumonia, failure to thrive, and dysphagia. Any attempt at feeding could cause aspiration pneumonia because the milk or other liquid collects in the blind pouch and overflows into the trachea and lungs. While a fistula between the lower esophagus and trachea may allow stomach acid to flow into the lungs and cause damage. Because of these dangers, patients should be treated as soon as possible after birth.
Esophageal atresia and tracheoesophageal fistula
Treatment by the SLP focuses primarily on feeding (Khan and colleagues, 2009), and secondarily on voice (Oestreicher‐Kedem and colleagues, 2008). The clinician may suspect dysphagia and dysphonia because unilateral vocal fold paralysis has been associated in a small percentage of patients treated surgically for these conditions. Decrease of loudness and shorter utterances due to lack of air support.
Esophageal atresia and tracheoesophageal fistula
These are small ulcerations that develop on the medial aspect of the vocal processes of the arytenoid cartilages due to irritation. The typical symptoms are deterioration of voice after prolonged vocalization (vocal fatigue), accompanied by pain in the laryngeal area or sometimes pain that lateralizes out to one ear. Watterson and colleagues (1990) also found hoarseness or roughness reported 75% of the time and throat clearing in 65% of the 57 cases of these conditions. This is the result from one of three causes or a combination of these:
- hard glottal attack along with throat clearing and coughing,
- LPR, and
- endotracheal intubation → roughness and breathiness
Granulomas (contact ulcers)
These are usually unilateral, occurring on the vocal folds (inner margin, superior or inferior surface) or anywhere on the ventricular folds. They are often caused by an abnormal blockage of the ductal system of laryngeal mucous glands (Case, 2002), but there are other causes. This may also be congenital or acquired. This often appears soft and pliable and fluid filled, in contrast to the hard, fibrotic structure of a vocal nodule. Voice therapy postsurgically is usually confined to 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
–symptoms would be roughness and breathiness. + Increased glottal attack
Vocal cysts
Inflammation of the larynx. Often develops in a patient who has had a fever, headache, runny nose (rhinorrhea), sore throat, and coughing. This can also include complaints of odynophagia (sore swallowing), hyperemia (increased blood flow to area), and dysphonia (Dworkin, 2008). Although most problems are viral in origin, the more severe problems (often accompanied by high fever and a very sore throat) may be caused by bacterial infections → strain, roughness. Strome (1982) recommends voice rest, humidification, increased fluid intake (hydration), reduced physical activity, and analgesics. From a voice conservation point of view, absolute voice rest—no attempts at spoken communication, including voice or whisper—should be initiated by the patient with such a laryngeal infection.
Infectious laryngitis
Why is whispering discouraged in cases of infectious laryngitis and other organic changes to the larynx?
Whispering should be discouraged because most people produce a glottal whisper by placing the vocal folds in close approximation to one another, which in effect produces a light voice. The irritated, swollen tissues continue to touch and to vibrate. What infectious laryngitis patients need is total voice rest for a period of two or three days, with the vocal folds in the open, inverted‐V position, and increased fluids (hydration).
These are wart-like growths that are viral in origin, that occur in the ark, moist caverns of the airway, frequently in the larynges of young children. Most common causes of pediatric hoarseness, posts a threat to the airway.
Red flags: shortness of breath and hoarseness. When RRP occurs in the larynx, the additive mass often contributes to dysphonia.
Papilloma
Hindi siya sa middle ng vf nagaappear, mostly sa bandang dulo yung “u” part
A child presents continued hoarseness for more than 10 days, independent of cold or allergy. What should an SLP do?
For this reason, the voice clinician should be particularly alert to any child who demonstrates dysphonia. Any child with continued hoarseness for more than 10 days, independent of a cold or allergy, should have the benefit of a laryngeal examination to identify the cause of the hoarseness.
Passage of gastric juice to the esophagus. It can lead to esophagitis; ulceration; dysphagia; and Barrett’s metaplasia, which is a precancerous condition.
Gastroesophageal reflux (GERD)
Gastric juices move superiorly and through the upper esophageal sphincter, the disorder is identified as _________________, as the contents spill into the pharynx → roughness and breathiness. Other symptoms: morning hoarseness, heartburn, sleeping troubles, sour mouth taste, glottal redness, contact irritation
Laryngopharyngeal reflux (reflux laryngitis)
This may be either congenital or acquired and is of unknown etiology, although vocal abuse and laryngopharyngeal reflux may play a role in the acquired form (Belafsky and colleagues, 2002). In _________, on endoscopy or stroboscopy, we see a furrowed or indentation medial edge of the vocal fold, usually bilaterally symmetrical. The spindle configuration may involve all or any segment of the edge of the fold. The furrow may be confined to the superficial layer of the mucosa or penetrate into the vocal ligament and muscle (Giovanni and colleagues, 2007). The patient presents clinically with some degree of dysphonia, often referred with a confusing array of previous diagnoses such as bowing, presbylaryngis, paralysis, or thyroarytenoid atrophy (Hirano and colleagues, 1990).
What are its symptoms?
Sulcus vocalis
Symptoms: strained, little pitch change, low intensity
This is the age-related atrophy of the vocal folds.
What are its symptoms?
Presbylarynx
Symptoms: weak voice, restricted pitch range, decreased stamina → shorter utterance length