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Voice disorders Flashcards

0
Q

What is a neurogenic voice disorder?

A

when there is some problem with the innervation of the vocal folds

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1
Q

What is an organic voice disorder?

A

a disease process acting on the vocal folds or a structural problem

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2
Q

What are functional voice disorders?

A

when the way we use our voice causes the disorder

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3
Q

What is hyperfunction of the voice?

A

over use, tension, strain

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4
Q

What is a psychogenic voice disorder?

A

some psychological reason that is causing you to use your vocal folds differently
-nothing physically wrong; sometimes attention perpetuates the problem

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5
Q

What do SLPs diagnose when there is a voice disorder?

A

dysphonia or aphonia

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6
Q

Define dysphonia

A

disordered voice

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7
Q

Define aphonia

A

no voice

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8
Q

What do we often hear with dysphonia?

A

abnormal pitch, loudness, quality, resonance

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9
Q

When you think of voice quality, what should you consider?

A

hoarseness, breathiness, harshness, etc

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10
Q

What are the primary treatments for voice disorders?

A

medical/surgical intervention

-SLPs help develop the best possible voice after medical treatment

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11
Q

What causes a benign cyst on the vocal cords?

A

blockage in the ducts of the glands within the vocal folds

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12
Q

What do cysts tend to look like?

A

soft and flexible

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13
Q

When looking at an endoscopy, what can an SLP comment on?

A

color, margins of the folds, excess whiteness, etc

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14
Q

What should we listen for when analyzing roughness of the voice?

A
  • pitch breaks
  • variability in loudness
  • glottal fry
  • diplophonia
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15
Q

Where does a contact ulcer occur at?

A

the vocal process of the arytenoids

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16
Q

What is a contact ulcer similar to?

A

a kanker sore

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17
Q

Is a contact ulcer usually bilateral or unilateral?

A

can be both

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18
Q

What is the bodies natural tendency when it has a contact ulcer?

A

the rebuild the tissue that has broken down

-this creates a granuloma

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19
Q

What causes the “cup and saucer” appearance?

A

the granulation tissue wearing away the tissue on the other vocal fold

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20
Q

What are the acoustic symptoms of a contact ulcer/granuloma?

A

jitter, spectral noise

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21
Q

What is jitter?

A

cycle to cycle variation in frequency

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22
Q

What is spectral noise?

A

lines on a spectogram will be be unevenly spaced and disorganized looking

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23
Q

What (besides a contact ulcer) causes a granuloma?

A 
intubation
gastrorefluxesophageal disorder (GERD)
coughing
throat clearing
exhibiting a hard attack
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24
Q

Can contact ulcers and granulomas resolve spontaneously?

A

yes

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25
Q

Are men or women more prone to granulomas?

A

women

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26
Q

Why are women more prone to granulomas?

A
  • smaller structures: can cause more irritation to folds during intubation
  • woman have thinner mucosa
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27
Q

What are perceptual signs of granulomas and contact ulcers?

A 
breathiness
hoarseness
throat clearing
fatigue voice deterioration
pain
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28
Q

what are acoustic signs of contact ulcers and granulomas?

A

jitter
shimmer
spectral noise

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29
Q

What is shimmer?

A

cycle to cycle variation in intensity

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30
Q

What is spectral noise?

A

lines on a spectogram that are uniform and unevenly spaced

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31
Q

What are physiological signs?

A

things you would see on a straboscopy

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32
Q

What are physiological signs of a granuloma?

A
  • irregular shaped mass on the vocal process

- vocal folds may look like they are vibrating correctly depending on how far back the granuloma is

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33
Q

Can granulomas/contact ulcers be caused by poor vocal behavior?

A

yes

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34
Q

What is a teflon granuloma?

A

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

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35
Q

Explain a hemorrhage to the vocal folds?

A
  • usually occurs the full length of the vocal fold or just in portions
  • very red or lots of swelling
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36
Q

What can cause a hemorrhage to the vocal folds?

A
  • a single episode of traumatic voice use
  • laryngeal trauma
  • aspirin or steroid use
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37
Q

Are hemorrhages more frequent in males or females?

A

females

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38
Q

What are perceptual signs of vocal cord hemorrhage?

A
  • pain just prior to the hemorrhage
  • vocal fatigue
  • loss of future pitches
  • hoarseness
  • intermittent aphonia
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39
Q

What are acoustic signs of vocal fold hemorrhage?

A
  • increased jitter and shimmer

- reduced frequency or intensity ranges

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40
Q

What are physiological signs of vocal fold hemorrhages?

A
  • 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
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41
Q

What is sulcus vocalis?

A

a groove or indentation of the fold

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42
Q

is sulcus vocalis usually unilateral or bilateral?

A

bilateral

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43
Q

Where does the sulcus vocalis usually run?

A

into Reinke’s space (can possibly run deeper)

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44
Q

What are perceptual signs of sulcus vocalis?

A
  • strained vocal quality
  • reduced pitch ranges
  • reduced loudness
  • fatigue
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45
Q

What are physiological signs of sulcus vocalis?

A
  • 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
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46
Q

What are treatments for sulcus vocalis?

A
  • surgery followed by voice therapy

- voice therapy to reduce bad vocal habits or hyperfunction that has developed

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47
Q

What are other names of geriatric voice?

A
  • senescent voice
  • preplyaryngeis
  • prebyphonia
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48
Q

What might you see with geriatric voice?

A

bowing of the vocal cords

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49
Q

What kind of closure could you see with geriatric voice?

A

gap closure-closure in the back but not along the folds very well

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50
Q

Where do you see most of the changes in geriatric voice?

A

laminae propria

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51
Q

What tends to atrophy in geriatric voice?

A

glands and the muscles

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52
Q

What can possibly ossify in geriatric voice?

A

the thyroid

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53
Q

What are some perceptual signs of geriatric voice?

A
  • a lot of hoarseness
  • women tend to develop a lower pitch
  • breathiness
  • longer pauses (may be from neural processing)
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54
Q

What are some acoustic signs of geriatric voice?

A
  • fundamental frequency increases in males and decreases in females
  • increased jitter
  • increased shimmer
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55
Q

What are physiological signs of geriatric voice?

A
  • 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
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56
Q

What is webbing of the vocal folds?

A

a web that grows across the glottis

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57
Q

What does the webbing of vocal folds cause

A
  • the prevention of normal vibration

- may effect the airway

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58
Q

Is webbing acquired or congenital?

A

can be both

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59
Q

When webbing is acquired, what causes it?

A

trauma or irritation to the anterior commissure

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60
Q

What are perceptual signs of webbing?

A
  • the voice often sounds rough
  • stridor (darth vador)
  • shortness of breath
  • increased pitch (because the parts of the vocal folds that vibrate are shortened)
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61
Q

What are treatments for webbing?

A
  • surgery to remove the web

- voice therapy to restore the voice

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62
Q

What is a papilloma?

A

a benign tumor caused by the human papilloma virus

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63
Q

Where does a papilloma grow?

A

in the epithelium (the most external layer)

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64
Q

Are papillomas subglottic, glottic, or supraglottic?

A

can be all

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65
Q

what happens because papillomas are viral in nature?

A

they come back

-require multiple surgeries to remove them

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66
Q

What are perceptual signs of papillomas?

A
  • hoarseness
  • shortness of breath
  • decrease in pitch
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67
Q

What are physiological signs of papillomas?

A
  • poor glottal closure
  • stiffness around the lesion
  • reduced mucosal wave
  • decrease in elasticity if there have been multiple surgeries
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68
Q

What percentage of papillomas become malignant?

A

2%

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69
Q

What are two conditions that can become malignant?

A

hyperkeratosis and leukoplakia

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70
Q

What color is hyerkeratosis?

A

pinkish

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71
Q

What color is leukoplakia?

A

whitish-almost looks like the plaque on your teeth

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72
Q

What is a more generic term for abnormal tissue growth on the folds such as hyperkeratosis and leukoplakia?

A

excrescence

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73
Q

Can we diagnose/use excrescence?

A

yes because it’s very generic

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74
Q

Where does excrescence usually occur?

A

the epithelium or Reinke’s space

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75
Q

What is something that is really common in smokers?

A

excrescence (hyperkeratosis and leukoplakia)

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76
Q

What else causes excrescence?

A

pollution

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77
Q

Is excrescence more common in males or females?

A

males

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78
Q

Is excrescence bilateral or unilateral?

A

can be both

  • usually asymmetrical
  • rough looking folds
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79
Q

What are perceptual signs of excrescence (hyperkeratosis and leukoplakia)?

A
  • hoarseness
  • roughness
  • low pitch
  • diplophonia
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80
Q

What are acoustic signs of excrescence?

A
  • jitter
  • shimmer
  • spectral noise
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81
Q

What are physiological signs of excrescence?

A
  • asymmetric airflow through the wave
  • high airflow through the folds
  • limited mucosal wave (not as limited as if it were malignant)
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82
Q

What is the treatment for excrescence?

A
  • 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
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83
Q

What is an example of a malignant voice disorder?

A

carcinoma

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84
Q

What is the biggest complaint of someone with carinoma?

A

chronic hoarseness

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85
Q

What should you do if someone complains of chronic hoarseness?

A

send them to an ENT immediately

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86
Q

What are risk factors of carcinoma?

A
  • smoking
  • drinking
  • exposed to environmental irritants (pollution, paint fumes)
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87
Q

What is a red flag for carcinoma?

A

someone who has a mouth sore that won’t heal

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88
Q

What percentages of carcinomas are in the larynx?

A

2-5%

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89
Q

Do carcinomas effect more men or women?

A

men

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90
Q

What is the rating scale for carcinoma?

A

TNM system

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91
Q

What is the TNM system?

A

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

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92
Q

What are treatments for carcinoma?

A
  • radiation therapy
  • chemotherapy
  • surgery
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93
Q

What is the surgery for carcinoma called?

A

laryngectomy

-removal of the larynx (you can also do partial removal of the larynx)

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94
Q

What are perceptual signs of carcinoma?

A
  • HOARSENESS
  • feel a lump or tenderness in the neck
  • common complaint is pain with swallowing
  • dsypnea
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95
Q

What is odynophagia?

A

pain with swallowing

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96
Q

What is dsypnea?

A

difficulty breathing

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97
Q

What are acoustic signs of carcinoma?

A

jitter and shimmer

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98
Q

What are the physiological signs of carcinoma?

A
  • excrescence that tends to rise from the epithelium

- causes a lot of stiffness

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99
Q

What can thermal trauma cause?

A

severe edema to the folds and structure from the larynx reflexively closing to protect the airway
-stridor

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100
Q

What is laryngomalacia?

A

when the cartilages are overly flexible

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101
Q

What has happened when a child is born with laryngomalacia?

A

the cartilages haven’t become firm

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102
Q

What is compromised with laryngomalacia?

A

the airway

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103
Q

What will you hear with laryngomalacia?

A

stridor

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104
Q

At what age will most children outgrow laryngomalacia?

A

18 months

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105
Q

What is subglottic stenosis?

A

narrowing below the glottis

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106
Q

What is compromised because of subglottic stenosis?

A

the airway

-child may need a trach

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107
Q

What are some endocrine changes that can effect the voice?

A
  • hypofunction of the pituitary gland
  • hypofunction of the adrenal gland
  • hypothyroidism
  • premenstrual voice
  • menopause
  • puberty
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108
Q

What happens to the voice during hypofunction of the pituitary gland?

A
  • slow growth of the larynx

- presents with a high pitch

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109
Q

what happens to the voice with hypofunction of the adrenal gland?

A

reduced adrenaline causes reduced pitch

-hyperfunction of the adrenal gland causes increased pitch

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110
Q

What does hypthyroidism do to the voice?

A

leads to increased mass of the vocal folds, which deepens pitch

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111
Q

What happens with premenstrual voice?

A

experience a lot of vocal fatigue, reduced pitch range, reduced loudness

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112
Q

What happens during menopausal voice?

A

decreased in pitch

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113
Q

What is puberphonia?

A

voice disorder if puberty

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114
Q

What happens to men during puberphonia?

A

they have a lot of fatigue

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115
Q

What causes neurogenic voice disorders?

A

problems with the innervation of the vocal folds

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116
Q

What places in the brain handle the act of voicing?

A

the pre-central gyrus and the motor strip

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117
Q

What helps with the coordination of voicing?

A

the cerebellum

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118
Q

What helps with refining motor movements

A

basal ganglia

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119
Q

What do cranial nerves do?

A

send the message

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120
Q

Explain a pyramidal system?

A

a very direct path from the motor to the brain stem

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121
Q

What is the pyramidal system involved with?

A

skilled movement

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122
Q

What would a lesion to the pyramidal system result in?

A

weakeness

123
Q

What is the extrapyramidal system?

A

a very indirect pathway that makes stops and gathers information from other places before it ends

124
Q

What is the extrapyramidal system for?

A

posture and tone of muscles

125
Q

What happens if there is a lesion to the the extrapyramidal system?

A

it leads to improper tone

-usually causes spasticity

126
Q

The extrapyramidal system and pyramidal systems often follow each other… which mean what?

A

if there is a lesion to one, there is often a lesion to the other

127
Q

How many branches of the vagus nerve are there?

A

three

128
Q

What are the names of the three branches of the vagus nerve?

A

pharyngeal
superior laryngeal
recurrent laryngeal

129
Q

What does the pharyngeal branch of the vagus nerve do?

A

controls VP closure (problem with this branch can result in nasality)

130
Q

What does the superior laryngeal branch of the vagus nerve do?

A

controls the cricothyroid

lesion to this branch could cause a person to be monotone

131
Q

What does the recurrent laryngeal branch of the vagus nerve do?

A

-all other intrinsic muscles of the larynx
-adducts, abducts, tenses and relaxes
-

132
Q

What would happen if you had a lesion to the recurrent laryngeal branch of the vagus nerve?

A

paralysis of the folds

133
Q

What side of the recurrent laryngeal branch of the vagus nerve do you see more paralysis with?

A

left because it goes around the heart

134
Q

Do cranial nerve innervate things ipsilaterally or contralaterally?

A

ipsilaterally (same side)

135
Q

What happens if there is a lesion close to the brainstem before the branches of the vagus nerve have separated?

A

all branches can be affected

rare to have bilateral paralysis

136
Q

What is the most common cause of VF paralysis?

A

damage to the vagus nerve

-which is a lower motor neuron problem)

137
Q

What branch of the vagus nerve do viruses tend to pick on?

A

the superior laryngeal branch (usually a temporary problem)

138
Q

What is the most common type of paralysis if the recurrent laryngeal branch is affected?

A

adductor paralysis

139
Q

What do you sound like when you have adductor paralysis?

A

breathy

140
Q

if a fold is experiencing adductor paralysis, where is it often stuck?

A

the paramedian position

141
Q

What are some concerns for adductor bilateral vf paralysis?

A
  • aphonic voice

- risk of aspiration is the most concerning

142
Q

What will people often use to compensate when their VF are paralyzed?

A

false folds

143
Q

What will you sound like if you have unilateral abductor VF paralysis?

A

you should sound normal because one of the folds is at midline, so you are getting complete closure

144
Q

What happens if you have bilateral abductor VF paralysis?

A

you can have problems breathing

-you will likely have stridor

145
Q

What are perceptual signs of adductor paralysis?

A
  • breathiness
  • hoarseness
  • diplophonia (paralyzed fold often sits higher)
146
Q

What are acoustic signs of adductor VF paralysis?

A
  • increased jitter and shimmer
  • reduced frequency range
  • high levels of spectral noise
  • reduced intensity ranges
147
Q

What are physiological signs of adductor VF paralysis?

A
  • 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
148
Q

What are some voice therapy treatments for VF paralysis?

A
  • may resolve in 9-12 months
  • slp help strength the folds
  • increase medialization
  • do things with head position, physically moving the folds
  • suggest amplification
149
Q

What are surgical/medical treatments for adduct VF paralysis?

A

surgery to fill affected fold (sometimes use collegian, teflon was used in the past)

150
Q

What can problems with neuromuscular junction cause?

A

myasthenia gravis

151
Q

Is myasthenia gravis an UMN or LMN problem?

A

LMN

152
Q

What is the neuromuscular junction?

A

where the vagus nerve meets the muscle

153
Q

What happens with myasthenia gravis?

A

muscle become unreceptive to taking in acetylecholine

154
Q

What do you tend to see with myasthenia gravis?

A

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”

155
Q

What is one of the most common places to see the effects of myasthenia gravis?

A

the eyelids

156
Q

What is drooping eyelids called?

A

ptosis

157
Q

What is diplopia?

A

double vision

158
Q

What do we do during assessment for myasthenia gravis?

A

stress test

could hear dysphonia, could also cause dysphagia

159
Q

What are perceptual signs of myasthenia gravis?

A
  • fatigue
  • hoarseness
  • breathiness
  • vocal weakness
160
Q

What are acoustic signs of myasthenia gravis?

A

spectral noice

161
Q

What are physiological symptoms of myasthenia gravis?

A
  • reduced muscle activity with repeated use

- may see sluggish abductor

162
Q

What are treatments for myasthenia gravis?

A

-medication called tesilon prescribed by a neurologist

163
Q

What can an SLP do for someone with myasthenia gravis?

A

counsel them on

  • good vocal behavior
  • vocal rest
  • amplification
164
Q

Explain UMN and LMN

A

UMN: “parent” instructs
LMN: “child” carries out instruction

165
Q

What does a lesion to an UMN cause?

A

spasticity

166
Q

What does a lesion to the LMN cause?

A

paralysis

167
Q

What is pseudobulbar palsy/spastic dysarthria?

A

hypertonicity of the VF

168
Q

What causes pseudobulbar palsy/spastic dysarthria?

A

stroke, multiple sclerosis, TBI, or cerebral palsy

169
Q

What are some comorbidities of spastic dysarthria?

A
  • emotional lability (can’t filter emotions)

- inappropriate or exaggerated reactions

170
Q

is spastic dysarthria an UMN or LMN lesion?

A

UMN

171
Q

What does parkinsonism cause problems with?

A

substantia nigra

-the substantia nigra is reduced, which also reduced dopamine

172
Q

What happens when we don’t have enough dopamine?

A

we have too much acetylcholine which causes hypertonicity and rigidity

173
Q

What is another name for rigidity?

A

bradykinesia

174
Q

What would we expect to see during an oral mech if something has rigidity?

A

reduced range of motion

175
Q

What kind of tremor does someone with parkinsonism experience?

A

a tremor at rest “resting tremor?”

176
Q

What else does rigidity in parkinsonism cause problem with?

A

initiating movements

177
Q

What are the parkinson’s rating scales?

A

Hoehn and Yahr
-measures what stage they are in
United parkinsons disease rating scale
-measures what stage they are in

178
Q

What are the perceptual signs of parkinsonism?

A
  • monopitch
  • low pitch
  • harshness
  • breathy and hoarse
  • reduced loudness variability
  • variable rate of speech
  • may hear tremor in the voice
179
Q

How can all perceptual symptoms be explained with parkinsonism?

A

by rigidity

180
Q

What are the acoustic signs of parkinsonism?

A
  • reduced frequency variation
  • short maximum phonation time
  • increased jitter
181
Q

What are some physiological signs of parkinsonism?

A
  • reduced vocal folds movement
  • bowing of the vocal folds
  • increased false fold contraction
  • tremor of the vocal folds
182
Q

What are some voice therapy treatments for parkinsonism?

A
  • exaggeration of one aspect of speech
  • Lee Silverman Voice Treatment LSVT (“think loud”)
  • pitch limiting voice treatment (“think low”
  • delayed auditory feedback
183
Q

What are surgical options for parkinsonism?

A

-deep brain stimulation

184
Q

What is spasmodic dysphonia?

A

a problem with the basal ganglia (it isn’t doing it’s job)

-an unwanted contraction of the vocal folds

185
Q

What is the more common type of dysphonia, adductor ora abductor?

A

adductor

186
Q

What does adductor spasmodic mean?

A

spasming and over adducting

187
Q

What does spasmodic dysphonia sound like?

A

very strained and tight

188
Q

What percentage of spasmodic dysphonia is adductor type?

A

80%

189
Q

What are perceptual signs of adductor spasmodic dysphonia?

A
  • struggle or strain to talk
  • intermittent voice arrests-especially vowel prolongations
  • hoarseness
  • harshness
  • tremor
  • overall sounds chocked off
  • may see visible tension
190
Q

What are acoustic signs of adductor spasmodic dysphonia?

A
  • 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
191
Q

What are some physiological signs of adductor spasmodic dysphonia?

A
  • high airflow
  • hyperadduction
  • may see false folds engage
192
Q

What are the perceptual sign of abductor spasmodic dysphonia?

A
  • intermittent breathy periods during phonation

- pitch drops

193
Q

What are the acoustic signs of abductor spasmodic dysphonia?

A
  • random intensity

- delayed onset voice time

194
Q

What are physiological signs of abductor spasmodic dysphonia?

A
  • poor glottal closure

- sensation that the arytenoids are going to come apart

195
Q

What is the rating scale for spasmodic dysphonia?

A

USDRS: unified spasmodic dysphonia rating scale

-patient rates themselves

196
Q

What are some treatments for spasmodic dysphonia?

A
  • yawn sigh
  • botox injections every 4-6 months
  • cut recurrent laryngeal nerve (very extreme)
197
Q

Does adductor paralysis cause hyperfunction or hypofunction ?

A

hypofunction

198
Q

Does abductor paralysis cause hyperfunction or hypofunction?

A

hyperfunction (can sound normal though)

199
Q

Does adductor spasmodic dysphonia cause hyperfunction or hypofunction?

A

hyperfunction

200
Q

Does abductor spasmodic dysphonia cause hyperfunction or hypofunction?

A

hypofunction

201
Q

What is an esstential tremor?

A

something is wrong with the posture or tone of the vocal folds
-regular and involuntary movements

202
Q

Where do essential tremors occur?

A

they can occur in any part of the body

-usually confined to one body part

203
Q

What are essential tremors also considered?

A

action tremors

204
Q

What is an action tremor?

A

when you are more actively engaged in something it becomes worse

205
Q

What do essential/action tremors have a frequency of?

A

4-7 Hz

206
Q

a regular tremor has a _________ frequency but a ________ amplitude

A

higher frequency but a lower amplitude

207
Q

do essential/action tremors run in the family?

A

yes

208
Q

What age do essential/action tremors happen?

A

age 50

209
Q

What are perceptual signs of an essential tremor?

A
  • regular modulations of pitch or loudness
  • hear a “beating” of the voice
  • could hear harshness
  • strained or struggled sound
  • can be described as tremulous
210
Q

What are acoustic signs of an essential tremor?

A
  • variation in intensity

- average rate is 5.7 Hz

211
Q

What are physiological signs of an essential tremor?

A

rhythmic movement of one or more laryngeal structures

212
Q

How do you assess an essential tremor?

A

best way=vowel prolongation

-you will hear the beating sound in the voice

213
Q

What are some treatment options for an essential tremor?

A

medical=medications

-slps can help by decreasing loudness, raise pitch, shorten vowels, using /h/ sound before vowels

214
Q

Is Huntington’s disease/chorea a pyramidal disease or extrapyramidal?

A

extrapyramidal

215
Q

What does Huntingtons’s chorea look like?

A
  • lots of extra movements
  • dance like movements
  • can be throughout the body, if it’s in the larynx you may hear it
216
Q

What kind of disorder is ataxic dysarthria?

A

a cerebellar disorder

217
Q

What happens with ataxic dysarthria?

A

there is an incoordination of articulators

218
Q

What can voiced sounds sound like with ataxic dysarthria?

A

voiceless

219
Q

What is one of the most typical signs of ataxic dysarthria?

A

scanning speech

  • every syllable gets the same amount of stress
  • sounds like Siri
220
Q

What kind of lesion is amyotrophic lateral sclerosis?

A

a mixed lesion, typically a lesion to the upper and lower motor neuron

221
Q

What will you see with ALS because of the upper and motor neuron lesions?

A

weakness from the LMN lesion

spasticity because of the UMN

222
Q

in ALS, will the vocal folds tend to be more spastic or weak?

A

Spastic

223
Q

What is the life expectancy after someone is diagnosed with ALS?

A

2 years

224
Q

What is a functional voice disorder?

A

a voice disorder that is caused by how someone is using their own voice

225
Q

What are the two main types of functional voice disorders?

A

muscle tension dysphonia and psychogenic

226
Q

What is a muscle tension dysphonia?

A

when someone yells, screams, or engages in a lot of vocally abusive behaviors
-disorders of misuse or abuse

227
Q

What is considered vocal misuse?

A

milder behaviors that only have to do with vocalizing

-i.e. puberty voice, character voices

228
Q

What is considered vocal abuse?

A

can be a vocal behavior or a non vocal behavior that is damaging to the vocal folds

229
Q

What are some examples of vocal abuse?

A
  • throat clearing
  • coughing
  • screaming or yelling
  • harsh whispering
230
Q

What are some examples of non vocal abusive behaviors?

A
  • consuming alcohol
  • smoking
  • caffeine
  • being around pollutants
231
Q

What is a psychogenic dysphonia?

A

a disorder that often starts as something organic like an upper respiratory infection, then continues when the organic problems have resolved

232
Q

What is a primary MTD?

A

the way you use your voice that causes the disorder

233
Q

what is a secondary MTD?

A

some neurogenic or organic disorder that causes you to use your voice differently
-often strategies used to compensate for the neurogenic/organic disorder

234
Q

What is the most common benign lesion of the vocal folds?

A

vocal nodules

235
Q

What causes vocal nodules?

A

chronic abuse

236
Q

Where do vocal nodules usually occur?

A

about a third of the way back on the vocal folds

237
Q

Are vocal nodules usually unilateral or bilateral?

A

bilateral

238
Q

What do vocal nodules tend to look like?

A
  • whitish in color

- sessile in shape (half moon shape)

239
Q

What part of the vocal fold do nodules occur on

A

Reinke’s space

240
Q

are bilateral nodules usually the same size?

A

they can be but one can be much larger than the other

241
Q

What kind of a closure will a person usually have with nodules?

A

hourglass or incomplete closure

242
Q

Do nodules usually cause the vocal folds to be stiff or flaccid?

A

stiff

243
Q

What happens to the mucosal wave when someone has nodules?

A

it is reduced

244
Q

What are signs of early vocal nodules?

A
  • edema/swelling
  • won’t be white yet
  • more soft/pliable
245
Q

What are signs of longstanding nodules?

A
  • fibrous
  • white
  • very hard looking
246
Q

What population are nodules most common in?

A
  • young school age boys

- woman ages 20-50 (a lot of the time teachers)

247
Q

What are perceptual signs of vocal nodules?

A
  • 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
248
Q

What are some acoustic signs of vocal nodules?

A
  • increased jitter and shimmer
  • fundamental frequency is often in the normal range
  • tend to have noise in the spectrum
249
Q

What is the s/z ratio of someone with vocal nodules?

A

1.65

250
Q

Explain the s/z ratio test?

A
  • 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
251
Q

What are the physiological signs of vocal nodules?

A
  • incomplete closure
  • almost always posterior chink
  • sometimes an hourglass closure
  • absence of mucosal wave
252
Q

What are some treatments of vocal nodules?

A
  • vocal hygiene counseling
  • vocal rest
  • facilitating approaches
253
Q

What are vocal polyps?

A

an growth caused by a one time vocal abusive episode

254
Q

Are polyps usually unilateral or bilateral?

A

unilateral

255
Q

When do polyps tend to be on the vocal folds?

A

a third of the way back

256
Q

Where can polyps attach on the vocal folds?

A

subglottaly or supraglottaly

257
Q

What color are polyps?

A

can be red or white

258
Q

What shape are polyps?

A

sessile or pedunculated (having a stem/stalk)

259
Q

can polyps be hemorrhagic?

A

yes

260
Q

What happens to the unaffected fold when one has a polyp?

A

can be irritated, which can cause a lesion in Reinke’s space

261
Q

smoking is a causitive factor in what percentage of polyps?

A

80%

262
Q

Are polyps more common in males or females?

A

males

263
Q

What will the polyps be like? (stiff or flexible?)

A

can vary, some are stiff and others are very loose and flexible

264
Q

What are perceptual signs of polyps?

A
  • hoarseness
  • breathiness
  • roughness
  • sensation of something inside the throat
265
Q

What are the acoustic signs of polyps?

A

(similar to nodules)

  • increased jitter and shimmer
  • reduced ranges of frequency and intensity
  • increased spectral noise
266
Q

What are the physiological signs of polyps?

A
  • aperiodic VF movement (hula dance)
  • asymmetry of VF movement
  • mucosal wave can be decreased or absent
  • decreased glottal closure
267
Q

How do you treat polyps?

A
  • try voice therapy first
  • often need laser surgery to fix
  • still need voice tx after surgery
268
Q

Do polyps normally resorb with just voice tx?

A

no

269
Q

What is Reinke’s edema?

A

swelling in Reinke’s space (swelling to the superficial layer of the lamina propria)

270
Q

Is Reinke’s edema usually unilateral or bilateral?

A

bilateral, but assymetrical

271
Q

Do you see chinks in the vocal chords with Reinke’s edema?

A

not usually

272
Q

Does mass of the vocal folds increase with Reinke’s edema?

A

yes, and pitch decreases

273
Q

What will the vocal folds be like with Reinke’s edema?

A

floppy

274
Q

What is Reinke’s edema strongly associated with?

A

smoking, reflux, and hyperfunction

275
Q

What is the natural reaction of the folds when they are being misused?

A

get swollen

276
Q

Is Reinke’s edema most likely in women or men?

A

women

277
Q

What does someone’s voice sound like if the have Reinke’s edema?

A

husky and low pitched

278
Q

What are perceptual signs of Reinke’s edema?

A
  • low pitch
  • hoarseness
  • shortness of breath possible (because of possibly compromised airway)
  • likely see decreased pitch range
279
Q

What are the acoustic signs of Reinke’s edema?

A
  • low fundamental frequency (a woman will have a fundamental frequency of around 108 Hz)
  • increased jitter and shimmer
  • spectral noise
280
Q

What are physiological signs of Reinke’s edema?

A
  • large fluid filled folds
  • huge excursion of the mucosal wave
  • likely will see complete closure
281
Q

What is laryngitis?

A

inflammation of the larynx including the vocal folds

282
Q

What is the medical term for laryngitis?

A

erythema

283
Q

What is laryngitis caused by?

A
  • exposure to noxious agents (organic)
  • reflux (organic)
  • dust and allergens (organic)
  • vocal abuse (functional)
284
Q

What happens if you continue to use your voice after you have laryngitis?

A

could cause other things like nodules or atrophy to the vocal folds

285
Q

What are perceptual signs of laryngitis?

A
  • roughness
  • hoarseness
  • dryness of the throat
  • sore throat
286
Q

What are acoustic signs of laryngitis?

A
  • increased jitter and shimmer
  • reduced frequency and intensity ranges
  • variable frequency
  • high spectral noise
287
Q

What are some physiological signs of laryngitis?

A
  • red tissue
  • epithelium appears thickened
  • movement of the folds is often asymmetrical or aperiodic
  • reduced mucosal wave
288
Q

What is ventricular dysphonia?

A

when someone is using their false folds to vibrate

289
Q

What is often happening during ventricular dysphonia?

A

the false folds are “loading” on top of the true folds and the sound is a combination of both the folds

290
Q

What does ventricular dysphonia sound like?

A
  • monotone
  • low in pitch
  • diplophonia
  • unpleasent
291
Q

What is a psychogenic voice disorder?

A

when there are underlying psychological factors causing a person to use their voice differently

292
Q

are people who have psychogenic often completely aphonic?

A

yes

293
Q

What are things you can do to try and get people with a psychogenic voice disorder to phonate?

A

ask them to cough, throat clear, hum, laugh, say “mhm”

294
Q

what do people who loose their voice get when people give them a lot of attention for not having a voice?

A

secondary gain

295
Q

Why don’t psychogenic voice patients often not respond well with voice therapy?

A

it isn’t getting to the root of their problem

296
Q

What are the 4 types of psychogenic voice disorders?

A
  • puberphonia
  • functional aphonia
  • functional dysphonia
  • somatization (Briquet’s dysphonia)
297
Q

What are some techniques you can use to get a patient to get to their normal voice when they have puberphonia?

A
  • coughing
  • digital manipulation
  • use masking
  • encourage glottal fry
298
Q

What is functional aphonia?

A

when a person speaks in a whisper

299
Q

What are some voice treatments for functional aphonia?

A

reflexive voicing tasks

300
Q

What is functional dysphonia?

A

when someone has some voice but it’s abnormal

301
Q

What causes functional dysphonia?

A

often an imbalance between respiration, phonation and resonance

302
Q

How can you assess stimulability for functional dysphonia?

A
  • matching pitch
  • matching loudness
  • match other qualities
303
Q

What is somatization/Briquet’s dysphonia?

A

some true psychological trauma has caused a patient to loose their voice

304
Q

What type of psychogenic voice disorders is most resistant to change?

A

somatization/Briquet’s dysphonia

305
Q

What is a conversion disorder?

A

a psychological trauma is converted into a physical symptom

306
Q

Which psychogenic disorder is considered a true conversion disorder?

A

Briquet’s dysphonia

Voice (5 decks)

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