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Voice disorders Flashcards

1
Q

What are the different kinds of voice disorders?

A
  • Muscle Tension Voice Disorders (MTVD)
  • Functional Voice Disorders
  • Organic Voice Disorders
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2
Q

What is Muscle Tension Voice Disorder?

A
  • Muscle tension in the larynx caused by inefficient vocal use
  • Common in high voice users/people with high stress.
  • can be compensatory / secondary to an organic / neurological voice disorder.
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3
Q

What is a functional Voice Disorder?

A
  • Loss of voluntary motor control for voice production
  • symptoms cannot be explained by neurological/structural diagnosis
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4
Q

What is an organic voice disorder?

A

Aphonia or dysphonia that occurs as a result of organic changes to the larynx
→ usually diagnosed by ENTs
→ SPs role is secondary to ENT/laryngologist

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5
Q

What causes MTVD?

A

Inefficient use of vocal system

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6
Q

What causes FVD?

A

Psychogenic. Eg Puberphonia
OR
Neurologic

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7
Q

What causes an organic VD?

A

Organic change to laryngeal structures - observable O/E
- Cysts
- Haemorrhage
- Polyps
- Granuloma
- Sulcus
- Congenital laryngeal web
- Reinke’s Oedema
- Cancer
- Progressive neurological disorders e.g. MS, MSG, MND, PD
- Trauma

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8
Q

What is the onset of MDVT?

A

Gradual

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9
Q

What is the onset of FVD?

A

Rapid

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10
Q

What is the onset of an organic VD?

A

Depends on individual situation. Can be gradual or sudden

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11
Q

How do you treat voice disorders?

A

With direct and/or indirect therapy

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12
Q

What is indirect therapy?

A
  • Education
  • Vocal hygiene
  • Counselling
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13
Q

What is vocal hygiene?

A

vocal hygiene suggestions:
* stay hydrated (water)
* stop/reduce alcohol and caffeine intake
* reduce/stop smoking
* reduce/stop coughing/throat clearing
* Reduce stress
* Get enough rest
* Avoid shouting/yelling/whispering
* Don’t strain voice
* manage reflux (GP)
* manage sinus issues/allergies (ENT/Allergist)
* modify medications where appropriate (GP)
* spacer for inhaler,
* nasal sprays/rinses,

Environmental modifications:
* Reduce being in noisy environments
* modify work hours
* consider amplification and non-verbal communication
* reduce exposure to pollutants/smoky environments

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14
Q

What is Psychogenic Voice Therapy?

A
  • Counselling - Focus is on the emotional and psychosocial status of the patient that led to and maintained the voice disorder.
  • Promote overall health and wellbeing since it can impact voice, e.g., what activities bring happiness to the client?
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15
Q

What counselling skills and strategies might be needed? (8 points)

A
  • Acknowledgement of what the client is saying
  • Reflecting back content
  • Reflecting back feelings
  • Paraphrasing
  • Reframing
  • Summarising
  • Mindfulness
  • Cognitive behaviour therapy.
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16
Q

What referrals to other health professionals might be required?

A
  • ENT
  • Psychologist
  • GP for: management of medication, referral, time off work etc
  • Physio for management of headaches, neck and throat pain etc…
  • Dietitian: for diet management
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17
Q

What is the difference between adult and paediatric assessment and treatment of VDs?

A

Nothing - just might need to be creative to make it more engaging for children. Eg fun resources, play, games

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18
Q

How many sessions can you expect it to take to see improvement?

A

3 - 5 sessions

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19
Q

Outcome measures for direct therapy?

A
  • Perceptual measures
  • Acoustic measures
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20
Q

What should you do if therapy technique is not working?

A

Consider:
- Is the client motivated?
- Is my therapy technique good?
- Do they have sufficient awareness?
- Try a different therapy
- Ask supervisor for support
- Is a referral needed? (eg ENT)

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21
Q

What are the signs, symptoms and clinical observations of MTVD?

A
  • Palpable tension - can feel the tension
  • Worsens with use
  • Improves with rest
  • strain
  • roughness
  • possibly breathiness
  • Improvement in vocal quality observable with therapy trials
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22
Q

Indirect therapy for MTVD?

A
  • Education
  • Vocal hygiene including: reflux, allergies, asthma, drug/alcohol use, sleep, diet, stress,
  • Counselling - stress/anxiety management
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23
Q

Direct therapy for MTVD?

A
  • Resonant Voice Therapy
  • FVE (Stemples)
  • SOVT - straw phonation, laxvox, trills
  • Yawn sigh (for lowering larynx)
  • Giggle release (release constriction)
  • Negative/Contrastive practise
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24
Q

What are vocal nodules?

A

Benign bumps on the vocal folds usually related to voice overuse. They are bilateral.

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25
Q

What causes vocal nodules?

A
  • vocal folds hitting too hard together, causing calluses
    Common in → children, professional voice users (teachers, singers, SPs etc)
  • Shouting
  • Loud talking (often over background noise)
  • Screaming
  • Vocal noises
  • Coughing
  • Throat clearing
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26
Q

What are the signs, symptoms and clinical observations of vocal nodules?

A
  • breathy
  • and easily fatigued voice
  • reduced pitch range
  • less ability to change pitch
  • hoarseness or roughness
  • voice and body tiredness
  • Hard glottal onsets
  • bilateral growths on the vocal folds
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27
Q

What indirect therapy is used for vocal nodules? (3 points)

What about surgery?

A
  • Education
  • Vocal Hygiene
  • Counselling
    No point in surgery to remove nodules if vocal habits don’t change as they will most likely just come back.
28
Q

What direct therapy is used for vocal nodules? (4 therapies)

What is the purpose of therapy?

A
  • Laryngeal manipulation / massage
  • Yell Well/Twang (for teachers and children)
  • Resonant Voice Therapy
  • Negative/Contrastive practise

Purpose is to decrease pressure on the vocal folds

29
Q

What are polyps/cysts?

A

An organic voice disorder
- Polyp - small, swollen, blister-like growth on one or both vocal folds
- Cyst - a small, sac-like structure filled with fluid or semi-solid material that forms within the layers of the vocal fold

30
Q

What is the onset of polyps/cysts?

A

Depends on individual case - can be gradual or sudden

31
Q

What causes polyps/cysts?

A

Polyps and cysts on the vocal folds often result from vocal strain, injury, or chronic irritation.

32
Q

What are the signs, symptoms and clinical observations of polyps/cysts?

A

Can lead to detrimental compensatory techniques that cause a disorder such as MTVD
* Palpable tension - can feel the tension
* Worsens with use
* Improves with rest
* Would expect to hear strain and roughness, possibly breathiness
* Vocal folds appear squashed, muscle tension, constriction, minimal flexibility.
* Improvement in vocal quality observable with therapy trials

33
Q

What indirect therapy is used for polyps/cysts?

A
  • Education
  • Vocal Hygiene
  • Pre and Post surgery care
34
Q

What direct therapy is used for polyps/cysts?

A

Same treatment as for MTD if they have MTD
- Stemples
- resonant voice
- Lip trills with sirening
- stemples
BUT! Generally most polyps and cysts require surgery
- Pre and post surgery care/vocal exercises (as for MTD)
- Alternative communication options (ie AAC)
- Guidelines for returning to voice use (gradual process)

35
Q

What is vocal fold paresis / paralysis?

Does it get better?

A
  • The focal folds can’t move/close eith partially (paresis) or not all (paralysis)
  • Usually gets better over time
36
Q

What causes vocal fold paresis / paralysis? (4 points)

A
  • A viral infection
  • A result of surgery (e.g. thyroidectomy)
  • Injury to the supplying nerves
  • Paralysis/paresis of cricothyroid muscle
  • Not generally caused by tumours pressing on the nerve
37
Q

What are the signs, symptoms and clinical observations of vocal fold paresis / paralysis?

A
  • Aspiration
  • Shortness of breath / breathiness
  • Speech effortful
  • May have surrounding muscular pain
  • Symptoms may only occur in some challenging acoustic contexts e.g. when speaking over background noise, when giving a presentation
    *
38
Q

What is indirect treatment for vocal fold paresis / paralysis? (3 points)

A
  • Education
  • Environmental changes
  • Vocal hygiene
39
Q

What is direct treatment for vocal fold paresis / paralysis?

A
  • Stemple’s VFE
  • plosive release
  • Sirens - for stretch
  • Negative/Contrastive practise
    Aim
  • to encourage healing after surgery
  • to provide compensation (e.g. (digital manipulation for paresis)
  • to treat compensatory MTD
  • to improve the voice they have - not aiming for perfection
40
Q

What is presbyphonia?

A
  • AKA the ageing voice.
  • Not a voice disorder, rather the ageing process causes changes to the vocal tract.
  • If the voice changes become severe, then presbyphonia can contribute to reduced QoL
41
Q

What is the onset of presbyphonia?

A

Can be gradual or accelerated by a decrease in vocal load

42
Q

What causes presbyphonia?

A
  • Part of the aging process
  • Can be caused by a decrease in vocal load, such as
  • Retirement
  • Loss of a partner
  • Increased stress e.g. unwell partner
  • Injury resulting in hospital stay and decreased participation in usual activities
  • Use it or lose it theory
  • Consider whether client has developed secondary MTD in an attempt to adduct atrophied/bowed vocal folds.
43
Q

What are the signs, symptoms and clinical observations of presbyphonia?

A
  • A change in voice quality
    Quieter
    Breathier
    Hoarse
    less clear
  • Can lead to reduced communication, lower QoL and reduced participation in social activities.
  • Looser, thinner vocal folds, resulting in characteristic bowed appearance of glottic closure patterns
44
Q

Indirect treatment for presbyphonia?

A
  • Vocal hygiene
  • education
  • Counselling: promote overall health and wellbeing since it can impact voice, e.g., what activities bring happiness to the client?
45
Q

Direct treatment for presbyphonia? (4 points)

A
  • Stemples (VFE)
  • PhoRTE (similar to LSVT and Stemples)
  • Reading out loud, increase talking and singing
  • Negative/Contrastive practise
46
Q

What is puberphonia?

A
  • A functional voice disorder
  • Mutational falsetto
    Pre-adolescent voice in males who have gone through puberty
    “juvenile voice” in females
    Normal physical development and larynx but voice not “allowed” to drop
47
Q

Case history questions specific to puberphonia?

A
  • Have you grown hair under your arms or anywhere else?
  • Have you grown taller or had a growth spurt recently?
  • Have you noticed body odour?
  • To parent: has your child gone through normal puberty development?
48
Q

What is the onset of puberphonia?

A

Dysphonia in adolescent or mature males with normal hormonal development

49
Q

What causes puberphonia? (4 points for males)

What about diagnosis for females?

A

Can be many causes in males:
- An attempt to stabilise pitch changes (especially if early through puberty)
- Perceived benefit from not growing up
- Overidentification/strong relationship with Mo
- Bullying due to low voice

Female version often not often diagnosed unless weak/high pitched voice quality leads to difficulties in work/social consequences

50
Q

Signs, symptoms and clinical observations of puberphonia?

A

Higher than expected pitch
eg
* pre-adolescent voice in male who has gone through puberty
* ‘juvenile’ voice in females

51
Q

Indirect therapy for puberphonia?

A
  • Education
  • Counselling
52
Q

Direct therapy for puberphonia? (7 points)

A
  • Low pitch “BOOM” or cough and count – shape into words/reading/ speech
  • Stemples (VFE)
  • Yawn sigh to lower larynx
  • Laryngeal manipulation
  • Biofeedback – record voice, playback -new voice vs old voice pros and cons
  • Negative/Contrastive practise
  • Hierarchy of contexts for voice use – gradual exposure
53
Q

What is Resonant Voice Therapy? (5 key points)

A
  • Production of voice characterised by oral vibratory sensations (resonance)
  • The client should generally feel a ‘buzz’ or vibration in the front of the mouth
  • Helps to close the vocal folds and reduce tension of the muscles around the larynx
  • Relaxes the vocal folds
  • Aim is for clients to produce their voice with less strain
54
Q

How do you teach resonant voice?

A
  • Hum
  • What do you feel? - ‘Not sure’
  • Hum again and think about the front of your face
  • What do you feel at the front of your face? - ‘I can feel it vibrating’
  • Great that vibration is what we are looking for. Let’s pop our fingers on the front of our face like this so you can feel the vibrations
  • Hum with your fingers on your mouth. What can you feel? - ‘vibrations’
  • Great! Now I want you to play with the shape of your mouth and the pitch (demonstrate up and down). I want you to keep doing that until you get to the point where you feel the most buzz (or vibration)
  • Now let’s add to it. Try these - mi mi mi…. my my my… mo mo mo

Next steps
* Words – voiced and voiceless
* Phrases
* Paragraph reading
* Controlled conversation
* Emotional manipulations

55
Q

What are Vocal Function Exercises? (Stemples) (3 points)

Can clients do them independently?

A

VFEs are exercises that:
- strengthen the vocal folds
- impove co-ordination of the muscles used for voice production
- Improve co-ordination with respiration and phonation

Clients can do these independently as long as they have shown they can do them without strain or force

56
Q

What are semi-occluded voice techniques? (Definition plus 4 examples)

A

Exercies that narrow the vocal tract, reducing strain and taking pressure off/relaxing the vocal folds. Eg
- Straw Phonation
- LAX VOX
- Trills
- Humming

57
Q

What is Yell Well?

A

Yell Well is a ‘twang’ therapy for children (and teachers). It is:
* designed specifically to address the need for children to be able to yell without hurting their voice, as a normal part of play and development
* uses principles of body anchoring, twang and giggle release for release of constriction to produce a loud voice safely
* adheres to principles of motor learning to train child’s perceptual awareness
* an alternative approach to the treatment of VF nodules in children.

58
Q

What is giggle release?

A
  • For release of constriction
  • Like a big smile/giggle posture – imagine having a silent laugh about something
  • Afterwards airflow feels bigger? Throat feel more open.
59
Q

What is Yawn Sigh?

A

Uses reflexive effects of a yawn (PROPER YAWN!) to promote open laryngeal posture – lower larynx and retraction of false vocal folds - release of constriction.

60
Q

What is Voicecraft Sob Voice Quality?

A

Fixes “all in one” BUT is DIFFICULT and not great for perfectionists!

61
Q

What are softer or easy onsets?

A
  • Produce less strain on the VFs
  • Soft/Breathy before tone – air escapes prior to vocal folds adducting fully (eg ‘he’)
  • Simultaneous/smooth/easy onset – vocal fold come together gently simultaneously with airflow (eg ‘one’)
    As opposed to:
  • Hard / Glottal – vocal folds adduct/press prior to voice starting (eg ‘egg’ ‘apple’)
62
Q

What is twang?
What are some tips for teaching twang?

A
  • A technique used in speech and voice therapy to improve vocal quality and efficiency.
  • Focuses on creating a bright, focused, and resonant sound which helps project the voice without straining the vocal folds.
  • Beneficial for people who have issues with vocal strain, weak voice, or reduced volume,
  • makes the voice louder and clearer with less effort.
    Tips for producing twang
  • Nasty sound (nyer nyer nyer)
  • Cat sound
  • Zooming car
63
Q

What is boom therapy?

A
  • A therapy aimed at using lower resonance (chest resonant)
  • Cough into words
64
Q

Principles of motor learning relating to voice therapy?

A
  • Motivation
  • Focussed attention
  • High number of trials
  • Distributed practise
  • Varied practise targets
  • Hi frequency feedback on correct attempts
65
Q

What is phorte?

A

High intesity vocal exercises that increase vocal endurance.

1 Voice Disorders (2 decks)

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