Voice disorders Flashcards
What is a neurogenic voice disorder?
when there is some problem with the innervation of the vocal folds
What is an organic voice disorder?
a disease process acting on the vocal folds or a structural problem
What are functional voice disorders?
when the way we use our voice causes the disorder
What is hyperfunction of the voice?
over use, tension, strain
What is a psychogenic voice disorder?
some psychological reason that is causing you to use your vocal folds differently
-nothing physically wrong; sometimes attention perpetuates the problem
What do SLPs diagnose when there is a voice disorder?
dysphonia or aphonia
Define dysphonia
disordered voice
Define aphonia
no voice
What do we often hear with dysphonia?
abnormal pitch, loudness, quality, resonance
When you think of voice quality, what should you consider?
hoarseness, breathiness, harshness, etc
What are the primary treatments for voice disorders?
medical/surgical intervention
-SLPs help develop the best possible voice after medical treatment
What causes a benign cyst on the vocal cords?
blockage in the ducts of the glands within the vocal folds
What do cysts tend to look like?
soft and flexible
When looking at an endoscopy, what can an SLP comment on?
color, margins of the folds, excess whiteness, etc
What should we listen for when analyzing roughness of the voice?
- pitch breaks
- variability in loudness
- glottal fry
- diplophonia
Where does a contact ulcer occur at?
the vocal process of the arytenoids
What is a contact ulcer similar to?
a kanker sore
Is a contact ulcer usually bilateral or unilateral?
can be both
What is the bodies natural tendency when it has a contact ulcer?
the rebuild the tissue that has broken down
-this creates a granuloma
What causes the “cup and saucer” appearance?
the granulation tissue wearing away the tissue on the other vocal fold
What are the acoustic symptoms of a contact ulcer/granuloma?
jitter, spectral noise
What is jitter?
cycle to cycle variation in frequency
What is spectral noise?
lines on a spectogram will be be unevenly spaced and disorganized looking
What (besides a contact ulcer) causes a granuloma?
intubation gastrorefluxesophageal disorder (GERD) coughing throat clearing exhibiting a hard attack
Can contact ulcers and granulomas resolve spontaneously?
yes
Are men or women more prone to granulomas?
women
Why are women more prone to granulomas?
- smaller structures: can cause more irritation to folds during intubation
- woman have thinner mucosa
What are perceptual signs of granulomas and contact ulcers?
breathiness hoarseness throat clearing fatigue voice deterioration pain
what are acoustic signs of contact ulcers and granulomas?
jitter
shimmer
spectral noise
What is shimmer?
cycle to cycle variation in intensity
What is spectral noise?
lines on a spectogram that are uniform and unevenly spaced
What are physiological signs?
things you would see on a straboscopy
What are physiological signs of a granuloma?
- irregular shaped mass on the vocal process
- vocal folds may look like they are vibrating correctly depending on how far back the granuloma is
Can granulomas/contact ulcers be caused by poor vocal behavior?
yes
What is a teflon granuloma?
when someone has a paralyzed vocal fold, they use teflon to bulk up the impaired vocal folds so the unimpaired one can meet it
-these granulomas typically occur years after the injection
Explain a hemorrhage to the vocal folds?
- usually occurs the full length of the vocal fold or just in portions
- very red or lots of swelling
What can cause a hemorrhage to the vocal folds?
- a single episode of traumatic voice use
- laryngeal trauma
- aspirin or steroid use
Are hemorrhages more frequent in males or females?
females
What are perceptual signs of vocal cord hemorrhage?
- pain just prior to the hemorrhage
- vocal fatigue
- loss of future pitches
- hoarseness
- intermittent aphonia
What are acoustic signs of vocal fold hemorrhage?
- increased jitter and shimmer
- reduced frequency or intensity ranges
What are physiological signs of vocal fold hemorrhages?
- redness and swollen
- effect fold appears stiff
- may see vasculature
- reduced amplitude of the wave
- vf margin is usually okay
- likely see asymmetry between the folds
What is sulcus vocalis?
a groove or indentation of the fold
is sulcus vocalis usually unilateral or bilateral?
bilateral
Where does the sulcus vocalis usually run?
into Reinke’s space (can possibly run deeper)
What are perceptual signs of sulcus vocalis?
- strained vocal quality
- reduced pitch ranges
- reduced loudness
- fatigue
What are physiological signs of sulcus vocalis?
- stiff laminae propria (can cause compromised mucosal wave)
- when the folds are adducted, you should see a groove along the edge
- often there will be air leakage along the folds
What are treatments for sulcus vocalis?
- surgery followed by voice therapy
- voice therapy to reduce bad vocal habits or hyperfunction that has developed
What are other names of geriatric voice?
- senescent voice
- preplyaryngeis
- prebyphonia
What might you see with geriatric voice?
bowing of the vocal cords
What kind of closure could you see with geriatric voice?
gap closure-closure in the back but not along the folds very well
Where do you see most of the changes in geriatric voice?
laminae propria
What tends to atrophy in geriatric voice?
glands and the muscles
What can possibly ossify in geriatric voice?
the thyroid
What are some perceptual signs of geriatric voice?
- a lot of hoarseness
- women tend to develop a lower pitch
- breathiness
- longer pauses (may be from neural processing)
What are some acoustic signs of geriatric voice?
- fundamental frequency increases in males and decreases in females
- increased jitter
- increased shimmer
What are physiological signs of geriatric voice?
- bowing of the vocal folds
- thinning of the vocal folds
- edema/swelling
- in males, posterior chink
- in females, posterior and anterior chinks can happen
- yellowish color to the folds
- atrophy of the vocal folds
What is webbing of the vocal folds?
a web that grows across the glottis
What does the webbing of vocal folds cause
- the prevention of normal vibration
- may effect the airway
Is webbing acquired or congenital?
can be both
When webbing is acquired, what causes it?
trauma or irritation to the anterior commissure
What are perceptual signs of webbing?
- the voice often sounds rough
- stridor (darth vador)
- shortness of breath
- increased pitch (because the parts of the vocal folds that vibrate are shortened)
What are treatments for webbing?
- surgery to remove the web
- voice therapy to restore the voice
What is a papilloma?
a benign tumor caused by the human papilloma virus
Where does a papilloma grow?
in the epithelium (the most external layer)
Are papillomas subglottic, glottic, or supraglottic?
can be all
what happens because papillomas are viral in nature?
they come back
-require multiple surgeries to remove them
What are perceptual signs of papillomas?
- hoarseness
- shortness of breath
- decrease in pitch
What are physiological signs of papillomas?
- poor glottal closure
- stiffness around the lesion
- reduced mucosal wave
- decrease in elasticity if there have been multiple surgeries
What percentage of papillomas become malignant?
2%
What are two conditions that can become malignant?
hyperkeratosis and leukoplakia
What color is hyerkeratosis?
pinkish
What color is leukoplakia?
whitish-almost looks like the plaque on your teeth
What is a more generic term for abnormal tissue growth on the folds such as hyperkeratosis and leukoplakia?
excrescence
Can we diagnose/use excrescence?
yes because it’s very generic
Where does excrescence usually occur?
the epithelium or Reinke’s space
What is something that is really common in smokers?
excrescence (hyperkeratosis and leukoplakia)
What else causes excrescence?
pollution
Is excrescence more common in males or females?
males
Is excrescence bilateral or unilateral?
can be both
- usually asymmetrical
- rough looking folds
What are perceptual signs of excrescence (hyperkeratosis and leukoplakia)?
- hoarseness
- roughness
- low pitch
- diplophonia
What are acoustic signs of excrescence?
- jitter
- shimmer
- spectral noise
What are physiological signs of excrescence?
- asymmetric airflow through the wave
- high airflow through the folds
- limited mucosal wave (not as limited as if it were malignant)
What is the treatment for excrescence?
- counsel the effects of smoking
- reflux can play a part in excrescence
- help them relieve the source of irritation
- after counseling, treatment is medical/surgical
- voice therapy to restore the best voice
What is an example of a malignant voice disorder?
carcinoma
What is the biggest complaint of someone with carinoma?
chronic hoarseness
What should you do if someone complains of chronic hoarseness?
send them to an ENT immediately
What are risk factors of carcinoma?
- smoking
- drinking
- exposed to environmental irritants (pollution, paint fumes)
What is a red flag for carcinoma?
someone who has a mouth sore that won’t heal
What percentages of carcinomas are in the larynx?
2-5%
Do carcinomas effect more men or women?
men
What is the rating scale for carcinoma?
TNM system
What is the TNM system?
0-4 scale
T: size or location of the tumor
N: nodes or involvement of the lymph nodes
M: metastases-if the cancer is spreading
What are treatments for carcinoma?
- radiation therapy
- chemotherapy
- surgery
What is the surgery for carcinoma called?
laryngectomy
-removal of the larynx (you can also do partial removal of the larynx)
What are perceptual signs of carcinoma?
- HOARSENESS
- feel a lump or tenderness in the neck
- common complaint is pain with swallowing
- dsypnea
What is odynophagia?
pain with swallowing
What is dsypnea?
difficulty breathing
What are acoustic signs of carcinoma?
jitter and shimmer
What are the physiological signs of carcinoma?
- excrescence that tends to rise from the epithelium
- causes a lot of stiffness
What can thermal trauma cause?
severe edema to the folds and structure from the larynx reflexively closing to protect the airway
-stridor
What is laryngomalacia?
when the cartilages are overly flexible
What has happened when a child is born with laryngomalacia?
the cartilages haven’t become firm
What is compromised with laryngomalacia?
the airway
What will you hear with laryngomalacia?
stridor
At what age will most children outgrow laryngomalacia?
18 months
What is subglottic stenosis?
narrowing below the glottis
What is compromised because of subglottic stenosis?
the airway
-child may need a trach
What are some endocrine changes that can effect the voice?
- hypofunction of the pituitary gland
- hypofunction of the adrenal gland
- hypothyroidism
- premenstrual voice
- menopause
- puberty
What happens to the voice during hypofunction of the pituitary gland?
- slow growth of the larynx
- presents with a high pitch
what happens to the voice with hypofunction of the adrenal gland?
reduced adrenaline causes reduced pitch
-hyperfunction of the adrenal gland causes increased pitch
What does hypthyroidism do to the voice?
leads to increased mass of the vocal folds, which deepens pitch
What happens with premenstrual voice?
experience a lot of vocal fatigue, reduced pitch range, reduced loudness
What happens during menopausal voice?
decreased in pitch
What is puberphonia?
voice disorder if puberty
What happens to men during puberphonia?
they have a lot of fatigue
What causes neurogenic voice disorders?
problems with the innervation of the vocal folds
What places in the brain handle the act of voicing?
the pre-central gyrus and the motor strip
What helps with the coordination of voicing?
the cerebellum
What helps with refining motor movements
basal ganglia
What do cranial nerves do?
send the message
Explain a pyramidal system?
a very direct path from the motor to the brain stem
What is the pyramidal system involved with?
skilled movement
What would a lesion to the pyramidal system result in?
weakeness
What is the extrapyramidal system?
a very indirect pathway that makes stops and gathers information from other places before it ends
What is the extrapyramidal system for?
posture and tone of muscles
What happens if there is a lesion to the the extrapyramidal system?
it leads to improper tone
-usually causes spasticity
The extrapyramidal system and pyramidal systems often follow each other… which mean what?
if there is a lesion to one, there is often a lesion to the other
How many branches of the vagus nerve are there?
three
What are the names of the three branches of the vagus nerve?
pharyngeal
superior laryngeal
recurrent laryngeal
What does the pharyngeal branch of the vagus nerve do?
controls VP closure (problem with this branch can result in nasality)
What does the superior laryngeal branch of the vagus nerve do?
controls the cricothyroid
lesion to this branch could cause a person to be monotone
What does the recurrent laryngeal branch of the vagus nerve do?
-all other intrinsic muscles of the larynx
-adducts, abducts, tenses and relaxes
-
What would happen if you had a lesion to the recurrent laryngeal branch of the vagus nerve?
paralysis of the folds
What side of the recurrent laryngeal branch of the vagus nerve do you see more paralysis with?
left because it goes around the heart
Do cranial nerve innervate things ipsilaterally or contralaterally?
ipsilaterally (same side)
What happens if there is a lesion close to the brainstem before the branches of the vagus nerve have separated?
all branches can be affected
rare to have bilateral paralysis
What is the most common cause of VF paralysis?
damage to the vagus nerve
-which is a lower motor neuron problem)
What branch of the vagus nerve do viruses tend to pick on?
the superior laryngeal branch (usually a temporary problem)
What is the most common type of paralysis if the recurrent laryngeal branch is affected?
adductor paralysis
What do you sound like when you have adductor paralysis?
breathy
if a fold is experiencing adductor paralysis, where is it often stuck?
the paramedian position
What are some concerns for adductor bilateral vf paralysis?
- aphonic voice
- risk of aspiration is the most concerning
What will people often use to compensate when their VF are paralyzed?
false folds
What will you sound like if you have unilateral abductor VF paralysis?
you should sound normal because one of the folds is at midline, so you are getting complete closure
What happens if you have bilateral abductor VF paralysis?
you can have problems breathing
-you will likely have stridor
What are perceptual signs of adductor paralysis?
- breathiness
- hoarseness
- diplophonia (paralyzed fold often sits higher)
What are acoustic signs of adductor VF paralysis?
- increased jitter and shimmer
- reduced frequency range
- high levels of spectral noise
- reduced intensity ranges
What are physiological signs of adductor VF paralysis?
- high airflow
- at least one relatively immobile fold
- the appearance of one fold being higher than the other
- asymmetry of movement of the folds
- absent mucosal wave
- incomplete closure
What are some voice therapy treatments for VF paralysis?
- may resolve in 9-12 months
- slp help strength the folds
- increase medialization
- do things with head position, physically moving the folds
- suggest amplification
What are surgical/medical treatments for adduct VF paralysis?
surgery to fill affected fold (sometimes use collegian, teflon was used in the past)
What can problems with neuromuscular junction cause?
myasthenia gravis
Is myasthenia gravis an UMN or LMN problem?
LMN
What is the neuromuscular junction?
where the vagus nerve meets the muscle
What happens with myasthenia gravis?
muscle become unreceptive to taking in acetylecholine
What do you tend to see with myasthenia gravis?
at rest the muscles work fine, but with repeated use they will begin to shut out acetylcholine and become fatigued
“fatigue with use, recovery with rest”
What is one of the most common places to see the effects of myasthenia gravis?
the eyelids
What is drooping eyelids called?
ptosis
What is diplopia?
double vision
What do we do during assessment for myasthenia gravis?
stress test
could hear dysphonia, could also cause dysphagia
What are perceptual signs of myasthenia gravis?
- fatigue
- hoarseness
- breathiness
- vocal weakness
What are acoustic signs of myasthenia gravis?
spectral noice
What are physiological symptoms of myasthenia gravis?
- reduced muscle activity with repeated use
- may see sluggish abductor
What are treatments for myasthenia gravis?
-medication called tesilon prescribed by a neurologist
What can an SLP do for someone with myasthenia gravis?
counsel them on
- good vocal behavior
- vocal rest
- amplification
Explain UMN and LMN
UMN: “parent” instructs
LMN: “child” carries out instruction
What does a lesion to an UMN cause?
spasticity
What does a lesion to the LMN cause?
paralysis
What is pseudobulbar palsy/spastic dysarthria?
hypertonicity of the VF
What causes pseudobulbar palsy/spastic dysarthria?
stroke, multiple sclerosis, TBI, or cerebral palsy
What are some comorbidities of spastic dysarthria?
- emotional lability (can’t filter emotions)
- inappropriate or exaggerated reactions
is spastic dysarthria an UMN or LMN lesion?
UMN
What does parkinsonism cause problems with?
substantia nigra
-the substantia nigra is reduced, which also reduced dopamine
What happens when we don’t have enough dopamine?
we have too much acetylcholine which causes hypertonicity and rigidity
What is another name for rigidity?
bradykinesia
What would we expect to see during an oral mech if something has rigidity?
reduced range of motion
What kind of tremor does someone with parkinsonism experience?
a tremor at rest “resting tremor?”
What else does rigidity in parkinsonism cause problem with?
initiating movements
What are the parkinson’s rating scales?
Hoehn and Yahr
-measures what stage they are in
United parkinsons disease rating scale
-measures what stage they are in
What are the perceptual signs of parkinsonism?
- monopitch
- low pitch
- harshness
- breathy and hoarse
- reduced loudness variability
- variable rate of speech
- may hear tremor in the voice
How can all perceptual symptoms be explained with parkinsonism?
by rigidity
What are the acoustic signs of parkinsonism?
- reduced frequency variation
- short maximum phonation time
- increased jitter
What are some physiological signs of parkinsonism?
- reduced vocal folds movement
- bowing of the vocal folds
- increased false fold contraction
- tremor of the vocal folds
What are some voice therapy treatments for parkinsonism?
- exaggeration of one aspect of speech
- Lee Silverman Voice Treatment LSVT (“think loud”)
- pitch limiting voice treatment (“think low”
- delayed auditory feedback
What are surgical options for parkinsonism?
-deep brain stimulation
What is spasmodic dysphonia?
a problem with the basal ganglia (it isn’t doing it’s job)
-an unwanted contraction of the vocal folds
What is the more common type of dysphonia, adductor ora abductor?
adductor
What does adductor spasmodic mean?
spasming and over adducting
What does spasmodic dysphonia sound like?
very strained and tight
What percentage of spasmodic dysphonia is adductor type?
80%
What are perceptual signs of adductor spasmodic dysphonia?
- struggle or strain to talk
- intermittent voice arrests-especially vowel prolongations
- hoarseness
- harshness
- tremor
- overall sounds chocked off
- may see visible tension
What are acoustic signs of adductor spasmodic dysphonia?
- won’t have as much energy at their fundamental frequency
- will have more frequencies present
- spectogram will look very dark (meaning low in pitch)
- irregular vertical striations
What are some physiological signs of adductor spasmodic dysphonia?
- high airflow
- hyperadduction
- may see false folds engage
What are the perceptual sign of abductor spasmodic dysphonia?
- intermittent breathy periods during phonation
- pitch drops
What are the acoustic signs of abductor spasmodic dysphonia?
- random intensity
- delayed onset voice time
What are physiological signs of abductor spasmodic dysphonia?
- poor glottal closure
- sensation that the arytenoids are going to come apart
What is the rating scale for spasmodic dysphonia?
USDRS: unified spasmodic dysphonia rating scale
-patient rates themselves
What are some treatments for spasmodic dysphonia?
- yawn sigh
- botox injections every 4-6 months
- cut recurrent laryngeal nerve (very extreme)
Does adductor paralysis cause hyperfunction or hypofunction ?
hypofunction
Does abductor paralysis cause hyperfunction or hypofunction?
hyperfunction (can sound normal though)
Does adductor spasmodic dysphonia cause hyperfunction or hypofunction?
hyperfunction
Does abductor spasmodic dysphonia cause hyperfunction or hypofunction?
hypofunction
What is an esstential tremor?
something is wrong with the posture or tone of the vocal folds
-regular and involuntary movements
Where do essential tremors occur?
they can occur in any part of the body
-usually confined to one body part
What are essential tremors also considered?
action tremors
What is an action tremor?
when you are more actively engaged in something it becomes worse
What do essential/action tremors have a frequency of?
4-7 Hz
a regular tremor has a _________ frequency but a ________ amplitude
higher frequency but a lower amplitude
do essential/action tremors run in the family?
yes
What age do essential/action tremors happen?
age 50
What are perceptual signs of an essential tremor?
- regular modulations of pitch or loudness
- hear a “beating” of the voice
- could hear harshness
- strained or struggled sound
- can be described as tremulous
What are acoustic signs of an essential tremor?
- variation in intensity
- average rate is 5.7 Hz
What are physiological signs of an essential tremor?
rhythmic movement of one or more laryngeal structures
How do you assess an essential tremor?
best way=vowel prolongation
-you will hear the beating sound in the voice
What are some treatment options for an essential tremor?
medical=medications
-slps can help by decreasing loudness, raise pitch, shorten vowels, using /h/ sound before vowels
Is Huntington’s disease/chorea a pyramidal disease or extrapyramidal?
extrapyramidal
What does Huntingtons’s chorea look like?
- lots of extra movements
- dance like movements
- can be throughout the body, if it’s in the larynx you may hear it
What kind of disorder is ataxic dysarthria?
a cerebellar disorder
What happens with ataxic dysarthria?
there is an incoordination of articulators
What can voiced sounds sound like with ataxic dysarthria?
voiceless
What is one of the most typical signs of ataxic dysarthria?
scanning speech
- every syllable gets the same amount of stress
- sounds like Siri
What kind of lesion is amyotrophic lateral sclerosis?
a mixed lesion, typically a lesion to the upper and lower motor neuron
What will you see with ALS because of the upper and motor neuron lesions?
weakness from the LMN lesion
spasticity because of the UMN
in ALS, will the vocal folds tend to be more spastic or weak?
Spastic
What is the life expectancy after someone is diagnosed with ALS?
2 years
What is a functional voice disorder?
a voice disorder that is caused by how someone is using their own voice
What are the two main types of functional voice disorders?
muscle tension dysphonia and psychogenic
What is a muscle tension dysphonia?
when someone yells, screams, or engages in a lot of vocally abusive behaviors
-disorders of misuse or abuse
What is considered vocal misuse?
milder behaviors that only have to do with vocalizing
-i.e. puberty voice, character voices
What is considered vocal abuse?
can be a vocal behavior or a non vocal behavior that is damaging to the vocal folds
What are some examples of vocal abuse?
- throat clearing
- coughing
- screaming or yelling
- harsh whispering
What are some examples of non vocal abusive behaviors?
- consuming alcohol
- smoking
- caffeine
- being around pollutants
What is a psychogenic dysphonia?
a disorder that often starts as something organic like an upper respiratory infection, then continues when the organic problems have resolved
What is a primary MTD?
the way you use your voice that causes the disorder
what is a secondary MTD?
some neurogenic or organic disorder that causes you to use your voice differently
-often strategies used to compensate for the neurogenic/organic disorder
What is the most common benign lesion of the vocal folds?
vocal nodules
What causes vocal nodules?
chronic abuse
Where do vocal nodules usually occur?
about a third of the way back on the vocal folds
Are vocal nodules usually unilateral or bilateral?
bilateral
What do vocal nodules tend to look like?
- whitish in color
- sessile in shape (half moon shape)
What part of the vocal fold do nodules occur on
Reinke’s space
are bilateral nodules usually the same size?
they can be but one can be much larger than the other
What kind of a closure will a person usually have with nodules?
hourglass or incomplete closure
Do nodules usually cause the vocal folds to be stiff or flaccid?
stiff
What happens to the mucosal wave when someone has nodules?
it is reduced
What are signs of early vocal nodules?
- edema/swelling
- won’t be white yet
- more soft/pliable
What are signs of longstanding nodules?
- fibrous
- white
- very hard looking
What population are nodules most common in?
- young school age boys
- woman ages 20-50 (a lot of the time teachers)
What are perceptual signs of vocal nodules?
- hoarseness
- breathy
- low pitch
- maybe some soreness
- often report that the upper third of their pitch range is hard to reach
- voice will deteriorate with use, often as the day goes on
What are some acoustic signs of vocal nodules?
- increased jitter and shimmer
- fundamental frequency is often in the normal range
- tend to have noise in the spectrum
What is the s/z ratio of someone with vocal nodules?
1.65
Explain the s/z ratio test?
- have a patient sustain /s/ for at least three times
- have a patient sustain /z/ at least three times
- then divide /z/ time by the /s/ time
What are the physiological signs of vocal nodules?
- incomplete closure
- almost always posterior chink
- sometimes an hourglass closure
- absence of mucosal wave
What are some treatments of vocal nodules?
- vocal hygiene counseling
- vocal rest
- facilitating approaches
What are vocal polyps?
an growth caused by a one time vocal abusive episode
Are polyps usually unilateral or bilateral?
unilateral
When do polyps tend to be on the vocal folds?
a third of the way back
Where can polyps attach on the vocal folds?
subglottaly or supraglottaly
What color are polyps?
can be red or white
What shape are polyps?
sessile or pedunculated (having a stem/stalk)
can polyps be hemorrhagic?
yes
What happens to the unaffected fold when one has a polyp?
can be irritated, which can cause a lesion in Reinke’s space
smoking is a causitive factor in what percentage of polyps?
80%
Are polyps more common in males or females?
males
What will the polyps be like? (stiff or flexible?)
can vary, some are stiff and others are very loose and flexible
What are perceptual signs of polyps?
- hoarseness
- breathiness
- roughness
- sensation of something inside the throat
What are the acoustic signs of polyps?
(similar to nodules)
- increased jitter and shimmer
- reduced ranges of frequency and intensity
- increased spectral noise
What are the physiological signs of polyps?
- aperiodic VF movement (hula dance)
- asymmetry of VF movement
- mucosal wave can be decreased or absent
- decreased glottal closure
How do you treat polyps?
- try voice therapy first
- often need laser surgery to fix
- still need voice tx after surgery
Do polyps normally resorb with just voice tx?
no
What is Reinke’s edema?
swelling in Reinke’s space (swelling to the superficial layer of the lamina propria)
Is Reinke’s edema usually unilateral or bilateral?
bilateral, but assymetrical
Do you see chinks in the vocal chords with Reinke’s edema?
not usually
Does mass of the vocal folds increase with Reinke’s edema?
yes, and pitch decreases
What will the vocal folds be like with Reinke’s edema?
floppy
What is Reinke’s edema strongly associated with?
smoking, reflux, and hyperfunction
What is the natural reaction of the folds when they are being misused?
get swollen
Is Reinke’s edema most likely in women or men?
women
What does someone’s voice sound like if the have Reinke’s edema?
husky and low pitched
What are perceptual signs of Reinke’s edema?
- low pitch
- hoarseness
- shortness of breath possible (because of possibly compromised airway)
- likely see decreased pitch range
What are the acoustic signs of Reinke’s edema?
- low fundamental frequency (a woman will have a fundamental frequency of around 108 Hz)
- increased jitter and shimmer
- spectral noise
What are physiological signs of Reinke’s edema?
- large fluid filled folds
- huge excursion of the mucosal wave
- likely will see complete closure
What is laryngitis?
inflammation of the larynx including the vocal folds
What is the medical term for laryngitis?
erythema
What is laryngitis caused by?
- exposure to noxious agents (organic)
- reflux (organic)
- dust and allergens (organic)
- vocal abuse (functional)
What happens if you continue to use your voice after you have laryngitis?
could cause other things like nodules or atrophy to the vocal folds
What are perceptual signs of laryngitis?
- roughness
- hoarseness
- dryness of the throat
- sore throat
What are acoustic signs of laryngitis?
- increased jitter and shimmer
- reduced frequency and intensity ranges
- variable frequency
- high spectral noise
What are some physiological signs of laryngitis?
- red tissue
- epithelium appears thickened
- movement of the folds is often asymmetrical or aperiodic
- reduced mucosal wave
What is ventricular dysphonia?
when someone is using their false folds to vibrate
What is often happening during ventricular dysphonia?
the false folds are “loading” on top of the true folds and the sound is a combination of both the folds
What does ventricular dysphonia sound like?
- monotone
- low in pitch
- diplophonia
- unpleasent
What is a psychogenic voice disorder?
when there are underlying psychological factors causing a person to use their voice differently
are people who have psychogenic often completely aphonic?
yes
What are things you can do to try and get people with a psychogenic voice disorder to phonate?
ask them to cough, throat clear, hum, laugh, say “mhm”
what do people who loose their voice get when people give them a lot of attention for not having a voice?
secondary gain
Why don’t psychogenic voice patients often not respond well with voice therapy?
it isn’t getting to the root of their problem
What are the 4 types of psychogenic voice disorders?
- puberphonia
- functional aphonia
- functional dysphonia
- somatization (Briquet’s dysphonia)
What are some techniques you can use to get a patient to get to their normal voice when they have puberphonia?
- coughing
- digital manipulation
- use masking
- encourage glottal fry
What is functional aphonia?
when a person speaks in a whisper
What are some voice treatments for functional aphonia?
reflexive voicing tasks
What is functional dysphonia?
when someone has some voice but it’s abnormal
What causes functional dysphonia?
often an imbalance between respiration, phonation and resonance
How can you assess stimulability for functional dysphonia?
- matching pitch
- matching loudness
- match other qualities
What is somatization/Briquet’s dysphonia?
some true psychological trauma has caused a patient to loose their voice
What type of psychogenic voice disorders is most resistant to change?
somatization/Briquet’s dysphonia
What is a conversion disorder?
a psychological trauma is converted into a physical symptom
Which psychogenic disorder is considered a true conversion disorder?
Briquet’s dysphonia
