Voice disorders Flashcards

Question

What causes vocal nodules?

Answer 1

* 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

Answer 2

* 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

Answer 3

* 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.***

Answer 4

- 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***

Answer 5

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

Answer 6

Depends on individual case - can be gradual or sudden

Answer 7

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

Answer 8

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

Answer 9

* Education * Vocal Hygiene * Pre and Post surgery care

Answer 10

**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)

Answer 11

* The focal folds can't move/close eith partially (paresis) or not all (paralysis) * Usually gets better over time

Answer 12

* 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

Answer 13

* 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 *

Answer 14

* Education * Environmental changes * Vocal hygiene

Answer 15

* 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

Answer 16

* 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

Answer 17

Can be gradual or accelerated by a decrease in vocal load

Answer 18

* 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.

Answer 19

* 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

Answer 20

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

Answer 21

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

Answer 22

* 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

Answer 23

* 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?

Answer 24

Dysphonia in adolescent or mature males with normal hormonal development

Answer 25

***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***

Answer 26

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

Answer 27

* Education * Counselling

Answer 28

* 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

Answer 29

* 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

Answer 30

* 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

Answer 31

***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***

Answer 32

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

Answer 33

***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.

Answer 34

* 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.

Answer 35

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

Answer 36

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

Answer 37

* 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’)

Answer 38

* 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

Answer 39

* A therapy aimed at using lower resonance (chest resonant) * Cough into words

Answer 40

* Motivation * Focussed attention * High number of trials * Distributed practise * Varied practise targets * Hi frequency feedback on correct attempts

Answer 41

High intesity vocal exercises that increase vocal endurance.