Voice Disorders

Question 1

NODULES

Voice Characteristics: ___, ___due to incomplete adduction, ___pitch due to added mass, voice ___, pitch ___, swelling on both VFs initially

Answer 1

NODULES

Voice Characteristics: Hoarse, breathiness due to incomplete adduction, lower pitch due to added mass, voice arrest, pitch breaks, swelling on both VFs initially

Question 2

NODULES CONT.

Other Characteristics: ___, life of the party, blast ___, ___/___too much, ___children, ___adults, “___in the throat” sensation, shooting pain from ear to ear, neck pain

Answer 2

NODULES CONT.

Other Characteristics: vivacious, life of the party, blast laugh, sing/talk too much, male children, female adults, “lump in the throat” sensation, shooting pain from ear to ear, neck pain

Question 3

NODULES CONT.

___ ___ to ___ of vocal fold, often ___

Answer 3

NODULES CONT.

Anterior 1/3 to 1/2 of vocal fold, often bilateral

Question 4

NODULES CONT.

Treatment: Have to fix the ___or they will just return, ___vocally ___behaviors, train good ___ ___, vocal ___(___/___intake, time spent ___, ___, ___, ___and ___clearing, etc.), train ___ ___, ___ ___ ___, maintain a ___ ___ between the vocal folds and the arytenoids until patient has healed growths, ___exercises: ___ ___/___ ___, use ___ for biodfeedback, ___is key, no ___, “___voice”, coup de glotte eliminated, direct voice treatment to alter pitch, loudness, or breath support for good voicing, ___ ___ techniques and ___ exercises

Answer 4

NODULES CONT.

Treatment: Have to fix the behaviors or they will just return, reduce vocally abusive behaviors, train good vocal hygiene, vocal diary (water/caffeine intake, time spent talking, medications, exercise, coughing and throat clearing, etc.), train easy onset, continual airflow phonation, maintain a small space between the vocal folds and the arytenoids until patient has healed growths, breathing exercises: easy onset/continual airflow, use SLM for biodfeedback, smoothness is key, no singing, “resonant voice”, coup de glotte eliminated, direct voice treatment to alter pitch, loudness, or breath support for good voicing, stress reduction techniques and relaxation exercises

Question 5

CONTACT ULCERS OR GRANULOMA

Voice Characteristics: ___ (the dysphonic voice can be hoarse or excessively breathy, harsh, or rough, but some kind of phonation is still possible (contrasted with the more severe aphonia where phonation is impossible), ___ pitch, ___ (not ___ because the vocal folds due adduct unlike nodules), ___ speech, ___ ___ ___ (shock of the glottis, vocal attack), restricted ___ range, excessively high subglottal pressure, complaints: ___ , ___ , ___ in throat, excessive ___ clearing, ___ throat

Answer 5

CONTACT ULCERS OR GRANULOMA

Voice Characteristics: Dysphonia (he dysphonic voice can be hoarse or excessively breathy, harsh, or rough, but some kind of phonation is still possible (contrasted with the more severe aphonia where phonation is impossible), low pitch, grading (not breathy because the vocal folds due adduct unlike nodules), explosive speech, coup de glotte (shock of the glottis, vocal attack), restricted pitch range, excessively high subglottal pressure, complaints: tickle, pain, lump in throat, excessive throat clearing, dry throat

Question 6

CONTACT ULCERS OR GRANULOMA CONT.

Other Characteristics: Typically ___ in their ___ ’s, habitually ___ than optimal ___ (need to sound ___ ), ___ and ___ contribute, tense, Type ___ personality, ___ , ___ , ___ , ___ , ___ , may also occur in patients damaged from ___

Answer 6

CONTACT ULCERS OR GRANULOMA CONT.

Other Characteristics: Typically males in their 40’s, habitually lower than optimal pitch (need to sound authoritative), smoking and alcohol contribute, tense, Type A personality, lawyer, teacher, minister, salesman, coach, may also occur in patients damaged from intubation

Question 7

CONTACT ULCERS OR GRANULOMA CONT.

Site of Lesion: ___ larynx, occur at the back of the vocal folds, at the ___ of the vocal processes of the arytenoids, cartilages strike one another and dig out center, ___ or ___ , opposite ___ digs out a space on the opposing vocal folds

Answer 7

CONTACT ULCERS OR GRANULOMA CONT.

Site of Lesion: Posterior larynx, occur at the back of the vocal folds, at the tips of the vocal processes of the arytenoids, cartilages strike one another and dig out center, unilateral or bilateral, opposite arytenoid digs out a space on the opposing vocal folds

Question 8

CONTACT ULCERS OR GRANULOMA

Treatment: Surgical excision is often necessary, unless reflux has been managed, however, surgical removal of a contact ulcer is often unsuccessful because the granulation recurs, antireflux regimens, vocal reeducation, daily dietary habits and voice use and abuse

Answer 8

CONTACT ULCERS OR GRANULOMA

Treatment: Surgical excision is often necessary, unless reflux has been managed, however, surgical removal of a contact ulcer is often unsuccessful because the granulation recurs, antireflux regimens, vocal reeducation, daily dietary habits and voice use and abuse

Question 9

CONTACT ULCERS OR GRANULOMA CONT.

Site of Lesion: ___ larynx, occur at the back of the vocal folds, at the ___ of the vocal processes of the arytenoids, cartilages strike one another and dig out center, ___ or ___ , opposite ___ digs out a space on the opposing vocal folds

Answer 9

CONTACT ULCERS OR GRANULOMA CONT.

Site of Lesion: Posterior larynx, occur at the back of the vocal folds, at the tips of the vocal processes of the arytenoids, cartilages strike one another and dig out center, unilateral or bilateral, opposite arytenoid digs out a space on the opposing vocal folds

Question 10

CONTACT ULCERS OR GRANULOMA

Treatment: ___ excision is often necessary, unless ___ has been managed, however, surgical removal of a contact ulcer is often unsuccessful because the granulation recurs, antireflux regimens, vocal ___ , daily ___ habits and voice use and abuse

Answer 10

CONTACT ULCERS OR GRANULOMA

Treatment: Surgical excision is often necessary, unless reflux has been managed, however, surgical removal of a contact ulcer is often unsuccessful because the granulation recurs, antireflux regimens, vocal reeducation, daily dietary habits and voice use and abuse

Question 11

GERD

Voice Characteristics: Extremely ___ , worse in the ___ , chronic ___

Answer 11

GERD

Voice Characteristics: Extremely hoarse, worse in the morning, chronic cough

Question 12

GERD CONT.

Other Characteristics: ___ , ___ and ___ , ___ , excess ___ and ___ , excessive ___ -based foods, ___ juices, ___ clothing, late night ___ , ___ , sleep apnea, 7-10% experience daily ___

Answer 12

GERD CONT.

Other Characteristics: Overweight, asthma and allergies, smoking, excess alcohol and caffeine, excessive tomato-based foods, citrus juices, tight clothing, late night eating, peppermint, sleep apnea, 7-10% experience daily heartburn

Question 13

GERD CONT.

Site of Lesion: ___ ___ (hallmark), ___ (redness), ___ (swelling) posterior glottis, ___ ___ (ventricular cords hide true cord during phonation, only in extreme cases), ___ ’s edema can progress to ___ (posterior glottis has been exposed to acid. Tissue elephant skin like)

Answer 13

GERD CONT.

Site of Lesion: POSTERIOR GLOTTIS (hallmark), erythema (redness), edema (swelling) posterior glottis, ventricular obliteration (ventricular cords hide true cord during phonation, only in extreme cases), reinke’s edema can progress to pachydermitits (posterior glottis has been exposed to acid. Tissue elephant skin like)

Question 14

GERD CONT.

Treatment: ___ management, don’t eat before bed, ___ head rest, eating less than 3 to 4 hours at night, avoid ___ based, avoid ___ , avoid ___ , avoid ___ clothing, objective diagnosis: ___ (barium swallow), esophageal endoscopy, ph probe, ___

Answer 14

GERD CONT.

Treatment: Behavioral management, don’t eat before bed, elevate head rest, eating less than 3 to 4 hours at night, avoid tomato based, avoid peppermint, avoid caffeine, avoid tight clothing, objective diagnosis: esophagram (barium swallow), esophageal endoscopy, ph probe, pharmacologic

Question 15

ADDUCTOR SPASMODIC DYSPHONIA

Voice Characteristics: Begin as nonspecific ___ , ___ * (hyperadduction of true and often false vocal folds), ___ , effortful, voice ___ /___ , ___ , ___ , ___ , ___ , ___ , reduced ___ , ___ makes it worse, ___, vowels are initiated with hard glottal attacks

Answer 15

4. ADDUCTOR SPASMODIC DYSPHONIA

Voice Characteristics: Begin as nonspecific hoarseness, strained* (hyperadduction of true and often false vocal folds), groaning, effortful, voice breaks/arrests, choked, jerky, grunting, pinched, monopitched, reduced loudness, stress makes it worse, strangled , vowels are initiated with hard glottal attacks

Question 16

ADDUCTOR SPASMODIC DYSPHONIA CONT.

Other Characteristics: ___ age time of onset (___ ’s-___ ’s), report wide ___ in severity voice is vulnerable to moods of ___ and ___ , ___ labor can cause the voice to ___ , ability to produce ___ voice when ___ or taken off guard, silent ___ movements may occur during ___ ___ , ___ of face, ___ like representations are common

Answer 16

ADDUCTOR SPASMODIC DYSPHONIA CONT.

Other Characteristics: Middle age time of onset (40’s-50’s), report wide fluctuations in severity voice is vulnerable to moods of anxiety and depression, physical labor can cause the voice to worsen, ability to produce normal voice when surprise or taken off guard, silent lip movements may occur during voice arrest, flushing of face, stuttering like representations are common

Question 17

ADDUCTOR SPASMODIC DYSPHONIA CONT.

Site of Lesion: ___

Answer 17

ADDUCTOR SPASMODIC DYSPHONIA CONT.

Site of Lesion: thyroartyenoid??

Question 18

ADDUCTOR SPASMODIC DYSPHONIA CONT.

Treatment: Resistance to therapy, symptomatic voice therapy (first stage), musculoskeletal tension reduction, vocal quality and pitch modification, psychotherapy, recurrent laryngeal nerve resection, Botulinum toxin injection in TA (preferred approach), easy onset, continual airflow

Answer 18

ADDUCTOR SPASMODIC DYSPHONIA CONT.

Treatment: Resistance to therapy, symptomatic voice therapy (first stage), musculoskeletal tension reduction, vocal quality and pitch modification, psychotherapy, recurrent laryngeal nerve resection, Botulinum toxin injection in TA (preferred approach), easy onset, continual airflow

Question 19

ADDUCTOR SPASMODIC DYSPHONIA CONT.

Treatment: ___ to therapy, symptomatic voice therapy (first stage), ___ ___ reduction, vocal quality and pitch modification, ___ , recurrent laryngeal nerve resection, ___ ___ injection in ___ (preferred approach), ___ ___ , ___ ___

Answer 19

ADDUCTOR SPASMODIC DYSPHONIA CONT.

Treatment: Resistance to therapy, symptomatic voice therapy (first stage), musculoskeletal tension reduction, vocal quality and pitch modification, psychotherapy, recurrent laryngeal nerve resection, Botulinum toxin injection in TA (preferred approach), easy onset, continual airflow

Question 20

ABDUCTOR SPASMODIC DYSPHONIA

Voice Characteristics: ___ with ___ (esp at beginning of ___ ), vocal folds ___ ___ , ___ or ___ voice is interrupted by moments of ___ or ___ (unphonated) segments, breathy with aphonia, releasing bursts of ___ air (breathy releases of air owing to sudden hyperabduction or loss of tone of the true vocal folds), spasms, can follow laryngitis, abductor spasms occur more strongly during the production of ___ consonants, to a lesser extent during voiced consonants, and least of all during vowels

Answer 20

ABDUCTOR SPASMODIC DYSPHONIA

Voice Characteristics: breathy with aphonia (esp at beginning of vocalization), vocal folds spasmodically hyperabduct, normal or hoarse voice is interrupted by moments of breathy or whispered (unphonated) segments, breathy with aphonia, releasing bursts of unphonated air (breathy releases of air owing to sudden hyperabduction or loss of tone of the true vocal folds), spasms, can follow laryngitis, abductor spasms occur more strongly during the production of unvoiced consonants, to a lesser extent during voiced consonants, and least of all during vowels

Question 21

ABDUCTOR SPASMODIC DYSPHONIA CONT.

Site of Lesion: Spasm of the ___ ___ , ___ contracts during phonation

Answer 21

ABDUCTOR SPASMODIC DYSPHONIA CONT.

Site of Lesion: Spasm of the posterior cricoarytenoid, PCA contracts during phonation

Question 22

ABDUCTOR SPASMODIC DYSPHONIA CONT.

Treatment: ___ in ___ , ___ ___ (humming), ___ therapy, ___ ___ injections in the ___ and/or ___ ___ arytenoid (___ ), ___ exercises, ___

Answer 22

ABDUCTOR SPASMODIC DYSPHONIA CONT.

Treatment: Botox in PCA, continual phonation (humming), behavioral therapy, botulinum toxin injections in the cricothyroid and/or posterior cricioid arytenoid (PCA), breathing exercises, counseling

Question 23

ACUTE LARYNGITIS (INFLAMMATION)

Voice Characteristics:
• Will not be able to ___
• ___
• Vocal folds do not vibrate well resulting in ___ or ___

Answer 23

ACUTE LARYNGITIS (INFLAMMATION)

Voice Characteristics: • Will not be able to voice
• Hoarseness
• Vocal folds do not vibrate well resulting in aphonia or dysphonia

Question 24

ACUTE LARYNGITIS (INFLAMMATION) CONT.

Other Characteristics:
•	Comes on very quickly
•	\_\_\_ or \_\_\_ gets in the vocal folds – causes extensive \_\_\_ 
•	Chemical irritants
•	Feel \_\_\_ otherwise
•	Thought to be associated with \_\_\_ \_\_\_ 
•	\_\_\_ , \_\_\_ pain, \_\_\_ , \_\_\_ 
•	If there is \_\_\_ , only if they try to \_\_\_ the \_\_\_ 
•	\_\_\_ looks swollen
•	Pharyngeal and laryngeal erythema

Answer 24

ACUTE LARYNGITIS (INFLAMMATION) CONT.

Other Characteristics:
• Comes on very quickly
• Virus or bacteria gets in the vocal folds – causes extensive swelling
• Chemical irritants
• Feel fine otherwise
• Thought to be associated with gastric reflux
• Cough, throat pain, redness, swelling
• If there is pain, only if they try to force the voice
• Glottis looks swollen
• Pharyngeal and laryngeal erythema

Question 25

ACUTE LARYNGITIS (INFLAMMATION) CONT.

Site of Lesion: ___ looks swollen
??

Answer 25

ACUTE LARYNGITIS (INFLAMMATION) CONT.

Site of Lesion: Glottis looks swollen

Question 26

ACUTE LARYNGITIS (INFLAMMATION) CONT.

• Laryngitis lasting longer than ___ to ___ days is not normal and needs ___ attention

Answer 26

ACUTE LARYNGITIS (INFLAMMATION) CONT.

• Laryngitis lasting longer than 10 to 14 days is not normal and needs medical attention

Question 27

CHRONIC LARYNGITIS

Voice Characteristics: 
•	\_\_\_ 
•	\_\_\_ 
•	\_\_\_ \_\_\_ 
•	\_\_\_ 
Urge to \_\_\_ \_\_\_

Answer 27

CHRONIC LARYNGITIS

Voice Characteristics: 
•	Hoarse
•	Dysphonia
•	Vocal fatigue
•	Cough
Urge to clear throat

Question 28

CHRONIC LARYNGITIS CONT.

Vocal folds look good
Glottis looks good
• Gastric reflux associated (thought)
• Non-specific – glottis looks good, vocal folds look good, but hoarseness
• Hypertrophic – arytenoids are swollen, edema and erythema (indicator of GERD), hoarse and chronic cough, excess smoking and alcohol
• May look red and swollen (depends on how much reflux is spilling over at night)
• Chronic cough (some), urge to clear throat
• Contributing factors: smoking, air pollution, alcohol, and vocal abuse

Answer 28

CHRONIC LARYNGITIS CONT.

Vocal folds look good
Glottis looks good
• Gastric reflux associated (thought)
• Non-specific – glottis looks good, vocal folds look good, but hoarseness
• Hypertrophic – arytenoids are swollen, edema and erythema (indicator of GERD), hoarse and chronic cough, excess smoking and alcohol
• May look red and swollen (depends on how much reflux is spilling over at night)
• Chronic cough (some), urge to clear throat
• Contributing factors: smoking, air pollution, alcohol, and vocal abuse

Question 29

CHRONIC LARYNGITIS

Voice Characteristics: 
•	\_\_\_ 
•	\_\_\_ 
•	\_\_\_ \_\_\_ 
•	\_\_\_ 
Urge to \_\_\_ \_\_\_

Answer 29

CHRONIC LARYNGITIS

Voice Characteristics: 
•	Hoarse
•	Dysphonia
•	Vocal fatigue
•	Cough
Urge to clear throat

Question 30

CHRONIC LARYNGITIS CONT.

Other Characteristics:
• ___ ___ associated (thought)
• Non-specific – ___ looks good, ___ ___ look good, but hoarseness
• Hypertrophic – ___ are swollen, ___ and ___ (indicator of GERD), ___ and ___ cough, excess ___ and ___
• May look red and swollen (depends on how much reflux is spilling over at night)
• ___ ___ (some), urge to clear throat
• Contributing factors: ___ , ___ ___ , ___ , and ___ abuse

Answer 30

CHRONIC LARYNGITIS CONT.

Other Characteristics:
Vocal folds look good
Glottis looks good
• Gastric reflux associated (thought)
• Non-specific – glottis looks good, vocal folds look good, but hoarseness
• Hypertrophic – arytenoids are swollen, edema and erythema (indicator of GERD), hoarse and chronic cough, excess smoking and alcohol
• May look red and swollen (depends on how much reflux is spilling over at night)
• Chronic cough (some), urge to clear throat
• Contributing factors: smoking, air pollution, alcohol, and vocal abuse

Question 31

CHRONIC LARYNGITIS CONT.

Site of Lesion:
• Hypertrophic – ___ are swollen, ___ and ___ (indicator of GERD)

Answer 31

CHRONIC LARYNGITIS CONT.

Site of Lesion:
• Hypertrophic – arytenoids are swollen, edema and erythema (indicator of GERD)

Question 32

CHRONIC LARYNGITIS CONT.

Treatment:
___ ___

Answer 32

CHRONIC LARYNGITIS CONT.

Treatment:
Vocal hygiene

Question 33

CHRONIC LARYNGITIS CONT.

Treatment:
___ ___

Answer 33

CHRONIC LARYNGITIS CONT.

Treatment:
Vocal hygiene

Question 34

CONVERSION APHONIA

Voice Characteristics: ___ (involuntary), pure or noiseless, ___ , ___ , ___ , intermittent ___ -___ ___ and ___ , moments of ___ voice, can begin with ___

Answer 34

CONVERSION APHONIA

Voice Characteristics: Whispers (involuntary), pure or noiseless, harsh, sharp, piercing, intermittent high-pitched squeaks and squeals, moments of normal voice, can begin with hoarseness

Question 35

CONVERSION APHONIA CONT.

Other Characteristics: Associated with ___ , ___ , ___ , and ___ in the ___ and upper and lower ___ and chest regions are common in the conversion group, often triggered by ___ or ___ , 80% ___ , ___

Answer 35

CONVERSION APHONIA CONT.

Other Characteristics: Associated with laryngitis, discomfort, pain, and tightness in the larynx and upper and lower neck and chest regions are common in the conversion group, often triggered by colds or flu, 80% female, whispers

Question 36

CONVERSION APHONIA CONT.

Site of Lesion: Normal ___ , normal or partial adduction of vocal folds on vowel production or coughing, ___ and ___ bone are often ___ , sudden ___ , associated with laryngitis

Answer 36

CONVERSION APHONIA CONT.

Site of Lesion: Normal larynx, normal or partial adduction of vocal folds on vowel production or coughing, larynx and hyoid bone are often elevation, sudden onset, associated with laryngitis

Question 37

CONVERSION APHONIA CONT.

Treatment: Unintentional relief from ___

Answer 37

CONVERSION APHONIA CONT.

Treatment: Unintentional relief from stressors

Question 38

PARADOXICAL VOCAL FOLD DYSFUNCTION (PVFD)

Voice Characteristics: Vocal folds paradoxically ___ when they should be ___

Answer 38

PARADOXICAL VOCAL FOLD DYSFUNCTION (PVFD)

Voice Characteristics: Vocal folds paradoxically close when they should be opening

Question 39

PARADOXICAL VOCAL FOLD DYSFUNCTION (PVFD) CONT.

Other Characteristics: Performance ___ , redundant or ___ laryngeal tissue, ___ ___ mimics ___ (not responsive to ___ medication)

Answer 39

PARADOXICAL VOCAL FOLD DYSFUNCTION (PVFD) CONT.

Other Characteristics: Performance anxiety, redundant or floppy laryngeal tissue, esophageal reflux mimics asthma (not responsive to asthma medication)

Question 40

PARADOXICAL VOCAL FOLD DYSFUNCTION (PVFD) CONT.

Site of Lesion: ??

Answer 40

PARADOXICAL VOCAL FOLD DYSFUNCTION (PVFD) CONT.

Site of Lesion: ??

Question 41

PARADOXICAL VOCAL FOLD DYSFUNCTION (PVFD) CONT.

Treatment: Patients are taught to ___ ___ through their ___ to maximize ___ opening and ___ through a restricted ___ aperture (___ lips or product a soft /___ /), teaching ___ ___ and overall ___ , in cases where PVFD is exercise induced or occurs only during athletic events, treatment includes teaching breathing patterns that complement the sport and help reduce ___ - replicate their ___ areas (___ ___ ___ , etc.), ___ ___ is the cause: ___ expiration of the tissue may be necessary, ___ primary cause: ___ referrals are necessary - ___ massage (if MSTD), may refer to ___ , medialization/laryngoplasty: physician will first inject with fat or collagen to make sure it will be effective, ___ therapy (___ exercises)

Answer 41

PARADOXICAL VOCAL FOLD DYSFUNCTION (PVFD) CONT.

Treatment: Patients are taught to inhale slowly through their nose to maximize glottal opening and exhale through a restricted oral aperture (pursing lips or product a soft /s/), teaching abdominal breathing and overall relaxation, in cases where PVFD is exercise induced or occurs only during athletic events, treatment includes teaching breathing patterns that complement the sport and help reduce anxiety - replicate their struggle areas (run up stairs, etc.), redundant tissue is the cause: surgical expiration of the tissue may be necessary, anxiety primary cause: psychiatric referrals are necessary - laryngeal massage (if MSTD), may refer to counseling, medialization/laryngoplasty: physician will first inject with fat or collagen to make sure it will be effective, behavioral therapy (adduction exercises)