Voice Disorders Flashcards
1
Q
classifications of voice disorders (5)
A
phonotrauma; organic; functional; psychogenic; neurological
2
Q
which classification of voice disorders contain the following: VF nodules, VF polyps, reinke’s edema, traumatic laryngitis, VF hemorrhage, VF cyst
A
phonotrauma disorders
3
Q
simply describe phono trauma voice disorders
A
resulting from misuse or abuse of the vocal mechanism
4
Q
simply describe organic voice disorders
A
resulting from a disease process or may be congenital; ex: cancer, acid reflux, laryngeal web, etc.
5
Q
simply describe functional voice disorders
A
includes muscle tension dysphonias
6
Q
simply describe psychogenic voice disorders
A
resulting from an underlying psychological issue and presents no identifiable vocal pathology
7
Q
simply describe neurogenic voice disorders
A
resulting from damage to the RLYN or SLN, disease processes that affect these nerves, or brain injuries or lesions
8
Q
VF nodules is caused by ___
A
chronic / continuous misuse or abuse, sometimes resulting in increased medial compression and impact force during VF vibration
9
Q
VF nodules occur in the ___
A
superficial lamina propria (SLP) and bilaterally
10
Q
VF nodules are soft and gelatinous at first, then become ___ over time; its glottal closure is ___ shaped
A
hard and fibrous; hourglass
11
Q
VF nodules add ___ and ___ to the vocal fold, interfering with the mucosal wave
A
mass and stiffness
*its VF vibration is APERIODIC
12
Q
VF nodules : more common in women than men :: VF nodules : more common in ___ than ___
A
young boys; young girls
13
Q
VF nodules: perceptual, acoustic, aerodynamic characteristics
A
perceptual : rough, breathy, decreased loudness, strained, effortful :: acoustic : decreased pitch range, decreased loudness range :: aerodynamic : increased airflow rates, increased Ps
14
Q
VF nodules patient complaints (4)
A
fatigue, stuck in throat sensation, effort-strain, pain with muscle tension
15
Q
VF nodules: stroboscopic characteristics (4)
A
hourglass; bilateral lesions; decreased / absent mucosal wave where the nodules are; decreased amplitude of vibration
16
Q
VF polyps are caused by ___
A
an isolated acute episode of vocal abuse OR a period of vocal abuse (such as screaming, yelling - possibility increases is VFs are already irritated)
17
Q
VF polyps are a soft, fluid-filled outgrowth of ___
A
tissue in the superior lamina propria
*usually unilateral and can be sessile : broad based :: : pedunculated : narrow stem or stalk
18
Q
true or false: VF polyps can occur anywhere along the membranous VF
A
true, but typically occur in the same regions as VF nodules; can be glottic, supraglottic, or subglottic
19
Q
true or false: VF polyps can be fluid, hemorrhagic, or fibrous
A
true
20
Q
glottic closure of VF polyps is either ___ or ___
A
hourglass or irregular
21
Q
fluid filled VF polyp : decreases stiffness :: ___ VF polyp : increased stiffness
A
hemorrhagic
22
Q
VF polyps: perceptual, acoustic, aerodynamic characteristics
A
perceptual : rough, breathy, sometimes diplophonic, strained :: acoustic : decreased pitch-loudness, increased frequency-intensity perturbations :: aerodynamic : increased airflow, increased Ps
23
Q
true or false: patient complaints for VF polyps is the same or similar as patient complaints for VF nodules
A
true
24
Q
VF polyps: stroboscopic characteristics (6)
A
increased mass and unilateral; usually incomplete closure; affected side vibrates at a lower frequency; aperiodic-hoarse; mucosal wave is increased or decreased; amplitude of vibration increased or decreased
25
(causes of ) VF edema : ___ :: reinke's edema : ___
due to laryngeal tissue trauma or abuse; almost always related to smoking (and more common in women)
26
simple definition of edema
a build up of fluid in the superficial lamina propria layer (reinke's space) of the VFs, increasing the mass of the VFs
*can be bilateral or unilateral
27
___ kind of looks like VF curtains
reinke's edema
28
reinke's edema: perceptual, acoustic, aerodynamic characteristics
perceptual : low F(0), roughness, vocal effort :: acoustic : loss of high pitches, decreased pitch range :: aerodynamic : increased airflow, normal Ps
29
reinke's edema patient complaints (4)
vocal fatigue, low pitch, dry throat, vocal effort
30
reinke's edema: stroboscopic characteristics
bilateral / unilateral swelling across entire VF membrane; complete glottal closure; mucosal wave depends on degree of stiffness
if unilateral: affected VF may interfere with vibration; phase asymmetry more likely with unilateral
31
traumatic laryngitis is caused by ___
trauma to VF tissue, usually via excessive yelling, screaming, or loud talking
32
characteristics of traumatic laryngitis (4)
VFs are erythematous-red and swollen; voice is hoarse, low-pitched and breathy; resolves in days up to 2 weeks; may be accompanied by VF hemorrhage
33
if vocal abuse continues, traumatic laryngitis may manifest into ___, particularly if the patient is using more effort or strain to speak (what we call ___)
chronic laryngitis; negative compensatory strategies
34
VF hemorrhage is ___
a ruptured blood vessel in the submucosal layer
35
VF hemorrhage is caused by ___
damage to the small, delicate blood vessels of th VF layers' also, cause is usually phono trauma or trauma to VFs during surgery or medical procedure
*use of anticoagulant medications (aspirin, ibuprofen) increases the risk
36
true or false: VF hemorrhages result in increased VF stiffness and increased VF mass
true
37
VF hemorrhage: perceptual and acoustic characteristics
perceptual : dysphonia to aphonia, hoarseness :: acoustic : decreased pitch / loudness ranges, increased pitch and intensity perturbations
38
VF hemorrhage stroboscopic characteristics (4)
patchy red area on VF; decreased mucosal wave; decreased amplitude of vibration; non vibratory portion where hemorrhage is
39
VF varices and ecstacia are ___ lesions
vascular lesions
40
varices : ___ :: ecstacia : ___
superficial, enlarged and dilated veins; lesioned blood vessel, coalescent hemangiomatmous appearance
41
VF varices and ecstatia (5)
originate in superficial lamina propria (at mid membranous portion); directly related to phono trauma; more prevalent in women; decreased mucosal wave due to increased stiffness; may cause incased pitch range and hoarseness
42
VF cysts are caused by ___
blockage of mucosal glandular duct with subsequent retention of mucus; may occur after vocal abuse or can be congenital
*usually unilateral and more common in women
43
VF cysts are sacks of tissue containing either ___ or ___
liquid (mucus) or a semisolid substance (epithelial cells)
44
VF cysts: perceptual, acoustic, aerodynamic characteristics
perceptual : rough, breathy, may be low-pitched, decreased loudness :: acoustic : decreased pitch range, aperiodicity, increased noise levels :: aerodynamic : increased air flow
45
VF cyst patient complaints (3)
hoarseness; vocal effort / strain ; vocal fatigue
46
VF cyst stroboscopic characteristics (4)
absent / decreased mucosal wave; decreased amplitude of vibration; increased VF cover mass / stiffness; irregular or hourglass glottic closure
47
pseudo cysts
localized collections of serous fluid without a true cyst lining or capsule
*histopathology is poorly understood; appears to be a localized area of reinke's edema
48
muscle tension dysphonia is caused by ___ (2)
excessive extrinsic laryngeal muscle tension (supra / infra hyoid muscles and neck muscles); excessive internal / supraglottic laryngeal muscle tension
49
true or false: muscle tension dysphonia can occur by itself (primary) or secondary to a primary vocal pathology as a result of negative compensatory strategies
true
50
clinical signs of extrinsic laryngeal muscle tension dysophonia (3)
elevated larynx; inability to rock larynx left to right; tension areas: thyrohyoid (and TH space), suprahyoid, floor of mouth, base of tongue
51
muscle tension dysphonia (supraglottic and intrinsic muscle tention) stroboscopic characteristics (5)
anterior-posterior compression; mediolateral compression; VF hyperadduction; supraglottic squeezing; incomplete glottic closure (anterior gap or bowing)
52
muscle tension dysphonia perceptual characteristics; patient complaints
harsh, rough, breathy, tension, effortful, normal / elevated pitch, whisper, aphonia; vocal fatigue, tension, laryngeal pain / discomfort
53
ventricular phonation (2)
adduction and use of the false or ventricular VFs for phonation; patient increases laryngeal muscle tension to compensate for air wastage, inability to build Ps, and decreased loudness
54
secondary ventricular phonation results in ___
decreased glottic closure and increased airflow
55
ventricular phonation perceptual characteristics; patient complaints
diplophonia, rough, harsh, low-pitched, breathy, monotone, decreased pitch range; vocal effort / strain, pain / discomfort
56
the two types of psychogenic dysphonias include ___ (2)
puberphonia (mutational falsetto), conversion dysphonia / aphonia
*there is no underlying organic or physical cause aka no pathology
57
simple definition of puberphonia (mutational falsetto)
persistence of a child-like voice quality after puberty (is learned or psychogenic in nature)
58
puberphonia characteristics
high pitch, hoarse, breathy, decreased loudness; incomplete glottic closure, stiff VFs, decreased amplitude
59
simple definition of conversion aphonia
complete loss of voice (aphonia) with no underlying physical cause
60
conversion aphonia characteristics
on phonation: irregular VF movement, inadequate adduction required to produce vibration; onset due to fear, stress, or traumatic event; non speech / vegetative functions (throat clearing, coughing, laughing, etc.) show normal VF movement and vibration
61
name an idiopathic voice disorder
paradoxical vocal cord movement (PVCM)
62
paradoxical vocal cord movement (PVCM) (3)
characterized by adduction of VFs during quiet breathing; causes stridor, shortness of breath; no known cause (may be learned, psychological, neurological); primary concern is ability to breathe (concerns are nonvocal)
63
paradoxical vocal cord movement (PVCM) is also known as ___
episodic paroxysmal laryngospasm
64
paradoxical vocal cord movement (PVCM) is commonly seen in ___
adolescent athletes; also in women ages 20 - 40
65
paradoxical vocal cord movement (PVCM) characteristics
area tightness, chronic cough, shortness of breath; stridor, wheezing, irregular breath pattern; hoarse, weak, breathy, strained voice; larynx and VF function are normal, but during an episode, inspiratory adduction if observed
66
organic voice disorders that are through disease (8)
ulcers and granulomas; infectious laryngitis; gastroesophageal reflux and laryngeal pharyngeal reflux; VF papiloma; candida; leukoplakia and hyperkeratosis; sulcus vocalis; laryngeal cancer
67
organic voice disorders that are congenital or through trauma (4)
laryngeal web; laryngeal cleft; subglottic stenosis; laryngomalcia
68
contact ulcers and granulomas are typically caused by ___ (3)
GERD or LPR, phonotrauma, and / or intubation trauma
69
contact ulcers and granulomas (5)
form on cartilaginous portion of VF; granulomas are comprised of lymphocytes and fibrotic connective tissue; usually unilateral but can be bilateral; glottic closure is variable (complete or incomplete); decreased mucosal wave
70
contact ulcers and granulomas: perceptual, acoustic characteristics
perceptual : low pitch, vocal fry, hoarse, breathy :: acoustic : low habitual pitch, increased frequency and intensity perturbations (if granuloma is large and if reflux is present)
71
contact ulcers and granulomas patient complaints (4)
vocal fatigue; throat sensation; pain on phonation; voice worsening with prolonged use
72
reflux laryngitis includes ___ and ___
gastroesophageal reflux (GERD) and laryngealpharyngeal reflux (LPR)
73
in reflux laryngitis, regurgitation of ___ and ___ are irritants to the VFs
acid and stomach enzymes
74
reflux laryngitis may cause ___ (4)
VF edema, erythema, arytenoid and posterior commisure hypertrophy, pachydermia (thickening of tissue between arytenoids)
75
symptoms of GERD and LPR (reflux laryngitis) include ___
heartburn, rapid vocal fatigue, sore and burny throat, globus sensation in throat, excessive throat mucus, increased throat clearing, chronic and dry cough or tickle, waking up choking or coughing, acid taste in mouth, regurgitation
76
reflux laryngitis perceptual, acoustic signs
perceptual : hoarse, breathy, decreased F(0) :: acoustic : increased noise, increased frequency, increased intensity perturbations
77
simple definition of infectious laryngitis
inflammatory response of the larynx due to a viral or bacterial infection (VFs and laryngeal inlet appear red and swollen)
78
infectious laryngitis symptoms and treatment
symptoms : total or partial voice loss, hoarse, breathy, low pitch :: treatment : if viral (voice rest, water, antiflammatory medications, non mentholated lozenges), if bacterial (same as viral, but can be treated with antibiotics)
79
laryngeal papilloma is caused by ___
human papilloma virus (HPV)
80
laryngeal papilloma
VF wart-like growths that can also be found in the trachea and / or oropharynx
81
laryngeal papilloma: pathology by age
can have juvenile or adult onset; in children, can be surgically removed but are reoccurring until puberty (resulting in multiple surgeries); 20-40% juvenile cases spontaneously resolve; surgery for adults
82
laryngeal papilloma perceptual, acoustic, aerodynamic characteristics
perceptual : hoarse, breathy, strained :: acoustic : no data :: aerodynamic : no data BUT increased VF stiffness and increased Ps
83
laryngeal papilloma stroboscopic characteristics (3)
incomplete glottic closure, absent mucosal wave, increased VF mass and stiffness
84
laryngeal papilloma re: scars
scarring due to repeated surgeries will further increase stiffness and decrease mucosal wave
85
laryngeal papilloma patient complaints (3)
trouble breathing, decreased pitch and loudness range, vocal effort / strain
86
laryngeal web causes (3)
congenital (75%) or acquired post-surgery or after laryngeal trauma
87
simple definition of laryngeal web
a band of tissue forming on the anterior 1/3 of the glottis
88
laryngeal web characteristics
inhalatory stridor, shortness of breath, high pitched crying (infants); voice is hoarse, high pitched, trouble sustaining phonation
89
laryngomalacia summary (4)
soft laryngeal cartilages that may collapse into airway during inhalation; resolves with maturity; most common cause of infant inspiratory stridor; 10-20% require surgical intervention
90
laryngomalacia stroboscopic characteristics (3)
collapse of laryngeal cartilages in inspiration; enlarged / floppy arytenoid cartilages; excessive AC mucosa
91
laryngeal cleft summary (3)
may be genetic (autosomal dominant); cleft on posterior portion of cricoid cartilage causing narrowed airway; managed surgically
92
laryngeal cleft symptoms / problems (4)
inspiratory and expiratory stridor, dyspnea, aspiration, feeding difficulties
93
subglottic stenosis summary (4)
any narrowing of the tissue below the level of the glottis; can be congenital or acquired (trauma / disease); third most common congenital condition; managed surgically
94
subglottic stenosis symptoms / problems (5)
inspiratory and expiratory stridor; dyspnea; low pitch cough; nostril flaring; excessive chest wall movement
95
simple definition: leukoplakia and hyperkeratosis
precancerous lesions arising from the epithelium; range from plaque-like whitish patches (leukoplakia) to warty lesions (keratosis)
96
leukoplakia and hyperkeratosis are caused by ___ (5)
constant irritation to VFs from smoking, alcohol ingestion, GERD or LPR, environmental pollutants, coughing / throat clearing
97
leukoplakia and hyperkeratosis characteristics (3)
unilateral or bilateral with rough VF edges; increased VF mass and stiffness, decreased mucosal wave and amplitude, irregular glottic closure, aperiodicity, asymmetric VFs; voice is hoarse and rough
98
simple definition of sulcus vocalis (2)
a longitudinal groove or indentation n the upper edge of the VFs that parallels the free margins; in the superficial lamina propria, causes a loss of VF tissue
99
sulcus vocalis etiology (4)
congenital; related to phono trauma; related to smoking; due to a ruptured VF cyst
100
ford sulcus classifications (type I, type 2a, type 2b)
type I : entire VF length into SLP only :: type 2a : entire VF length includes SLP to to the VL causing moderate dysphonia :: type 2b : entire SLP and VL and may involve TA muscle causing severe dysphonia
101
sulcus vocalis (3)
hoarse, breathy, effortful; patient complains of vocal fatigue; unilateral or bilateral
102
sulcus vocalis stroboscopic characteristics (3)
incomplete glottic closure which is sometimes spindle shaped; decreased mucosal wave and amplitude of vibration; increased VF stiffness but decreased mass
103
laryngeal cancer statistics (7)
90% are malignant squamous cell carcinomas; typical patient is 60-65 years who is a heavy smoker with moderate alcohol intake; head and neck cancers 2-5%; 1% of all cancer deaths are from laryngeal cancer; 50-70% of all laryngeal cancer deaths are associated with smoking; alcohol and smoking increases risk 22x; male to female ration is 50 to 1 and increasing
104
laryngeal cancer risk factors (5)
smoking, alcohol, environmental irritants, chemicals, asbestos
105
laryngeal cancer characteristics (4)
voice is hoarse, dry, rough, low-pitched, breathy; globes sensation; inhalators stridor; throat pain, painful and problematic swallowing, shortness of breath, halitosis
106
laryngeal cancer perceptual, acoustic, aerodynamic
perceptual : chronic hoarseness, lump in the neck, swallowing problems, neck tenderness, pain during swallowing :: acoustic : depending on severity, increased frequency / intensity perturbations, decreased pitch range, increased f(0), increased noise levels :: aerodynamic : increased airflow rates (little data)
107
name the three categories of phonatory dysfunction
adduction / abduction problems; stability problems; coordination problems
108
list phonatory dysfunction problems for adduction and abduction (6)
VF paralysis, VF paresis, SLN paralysis, pseudobulbar palsy, adductor spasmodic dysphonia, huntington's corea
109
list phonatory dysfunction problems for stability (3)
parkinson's, ALS, essential tremor
110
list phonatory dysfunction problems for coordination (1)
abductor spasmodic dysphonia
111
name the five categories of neurological voice disorders
```
category 1: relatively constant voice disorders
category 2: arrhythmically fluctuating
category 3: rhythmically fluctuating
category 4: paroxysmal
category 5: loss of volitional phonation
```
112
bilateral VF paralysis is caused by ___
latrogenic / surgical trauma (44%), malignancies (17%), intubation (15%), progressive neurological disorders (12%); bilateral cerebral damage, damage to brainstem in area of CN X
*diagnostics through endoscopy
113
bilateral VF paralysis characteristics
paralysis in the adducted position : ___ :: paralysis in the abducted position : ___
strained, low pitch-volume, respiratory compromise; aphonia, lack of airway protection during swallowing
114
bilateral VF abductor paralysis
PCA is paralyzed; VFs in medial or paramedian position; may spontaneously recover; treatments include cordectomy, arytenoidectomy, VF lateralization
115
bilateral VF adductor paralysis
TA, LCA, and IA are paralyzed; VFs in abducted position; treatments include tracheostomy (for safe swallow) and AC medial rotation
116
unilateral VF paralysis is caused by ___
latrogenic / surgical trauma (50%), idiopathic (36%)
*diagnostics through videostroboscopy, nasal scope, laryngeal electromyography, MRI, CN exam (X and XI)
117
true or false: unilateral VF paralysis may recover within 8 to 12 months
true (especially if due to trauma to RLN); if persistent, corrective surgery is considered
118
thematic causes of unilateral VF paralysis (3)
unilateral vagus nerve lesions (90%) causing flaccidity, decreased tone, and dysphagia; common cause if disease-trauma to RLN (injury to left RLN more common than right); other causes including unilateral brainstem strokes, unilateral trauma to RLN, viral infections
119
in unilateral VF paralysis, the affected VF is usually in ___ position
paramedian
120
unilateral VF paralysis vibration (4)
VFs have anterior approximation; healthy VF sometimes crosses midline to aid adduction; airflow sets affected fold into vibration; bernoulli effect aids in VF closure
121
unilateral VF paralysis is treated through ___ and ___
voice therapy (voice is hoarse, breathy, weak, strained) and VF augmentation
122
compensatory muscle tension may occur secondary to paralysis
intrinsic : ___ :: extrinsic : ___
anterior-posterior or medial-lateral compression, supraglottic sphinctering; elevated larynx, neck tension
123
superior laryngeal nerve (SLN) paralysis is caused by ___
latrogenic, viral infections; most common cause is thyroid surgery (unilateral or bilateral) resulting in paralysis of CT muscle
124
superior laryngeal nerve paralysis diagnostics
videostroboscopy, including pitch glides, rotation of posterior glottis to affected side, difference in VF vertical levels
125
superior laryngeal nerve paralysis characteristics
decreased habitual pitch, breathiness, decreased pitch and intensity ranges; patient inability to raise pitch, decreased pitch range, decreased VF closure
126
treatment of superior laryngeal nerve
voice therapy, may spontaneously recover
127
VF paresis is caused by ___ (7)
neuropathy, goiter / thyroiditis, idiopathic, viral, trauma, lyme's disease, stroke (bilateral)
128
VF paresis diagnostics
videostroboscopy, tasks include rapid repeat /i/, rapid repeat /i/ /hi/, rapid repeat /p/ /t/ /k/, whistling, observe coal processes for nodules and cysts; electromyography
129
VF paresis characteristics
inadequate VF closure during phonation; perceptually, decreased intensity range and maximum intensity, breathy, hoarse, unstable, inconsistent; muscle tension secondary to paresis; vocal fatigue
130
VF paresis is treated through ___ and ___
voice therapy and VF augmentation
131
presbyphonia-presbylaryngis is caused by ___
AGING; decreased innervation, muscle atrophy = hypotonicity, ossification of cartilages, loss of collagen and elastin fibers, submucus glands atrophy
males : stiffer, thinner mucosa :: females : thicker, edematous mucosa
132
presbyphona stroboscopic characteristics
vocal processes prominence, atrophy and VF thinning, VF bowing, glottic gap, decreased amplitude of vibration, edema, yellowish discoloration
133
presbyphonia effects on phonation
VF bowing, incomplete glottic closure, decreased amplitude, increased aperiodicity
males : F(0) increases :: females : F(0) decreases
134
presbyphonia perceptual characteristics
breathy, hoarse, low pitch, tremor; patient complains of vocal fatigue, throttle being heard, dislikes sound of own voice, strain and effort
*treatment through voice therapy and VF augmentation
135
spasmodic dysphonia (SD) / focal dystonia is caused by ___
CNS lesion, probably basal ganglia and supplementary motor areas
136
spasmodic dysphonia diagnostics
videostroboscopy, acoustic analysis; must differentially diagnose from vocal tremor and MTD
137
name the three types of spasmodic dysphonia
adductor, abductor, mixed
138
spasmodic dysphonia phonation
irregular, uncontrollable muscle movements disrupt VF vibration
139
adductor spasmodic dysphonia
VF adductors (LCA, IA, TA) spasm periodically causing hyperadduction; results in harsh, strained, strangled sound with effort; MOST COMMON
perceptual: strain-struggle, phonation breaks, pitch breaks, hoarse, breathy, harsh, effort
140
abductor spasmodic dysphonia
VF abductor (PCA) spasmsand abduct VF causing breathy, hoarse, weak, decreased loudness
perceptual: breathy, phonation breaks, difficult transitions from voiceless stops to vowels, pitch breaks, prolonged vowels
141
mixed spasmodic dysphonia
mixture of adductor and abductor spasmodic dysphonia
142
spasmodic dysphonia and women
women affected more, age of onset between 30 and 50 years; reported to occur after URI, laryngeal trauma, vocal and emotional stress
143
spasmodic dysphonia treatment
botox, adjunct voice therapy
144
essential tremor is caused by ___
CNS lesion, likely extrapyramidal system
145
essential tremor diagnostics (2)
acoustic analysis, videostroboscopy
146
simple definition of essential tremor
tremors at 3 - 7 Hz frequency characterized by regular steady fluctuations in loudness and pitch
147
essential tremor effects on phonation
phonatory instability and tremor
148
essential tremor of the larynx (5)
aka organic / familial tremor; can be isolated to the voice; always present in sustained phonation; tremor quiet at rest but present during volitional movement; onset is middle to late middle age - more common in WOMEN
149
essential tremor perceptual characteristics (6)
tremor, frequency and intensity modulations, voice stoppages, strain-struggle, harsh, monopitch
150
essential tremor treatments (2)
voice therapy : barkmeier-kramer approach, remediation of muscle tension, breath support :: pharmacological : propranolol, diazepam, primidone, clonazepam
151
differential diagnosis step one
perform laryngeal palpitation; ask: "is this SD or vocal tremor or muscle tension dysphonia?"
152
differential diagnosis step two
perform laryngeal massage and teach supraglottic relaxation exercises; improvement with MTD and tremor; if SD, little improvement is observed
153
MTD is ___, SD is not
consistent
154
true or false: vocal tremor with muscle tension can sound like spasmodic dysphonia
true
155
true or false: severe muscle tension dysphonia can sound like spasmodic dysphonia
true
156
pseudobulbar palsy is caused by ___
bilateral lesions in the corticobulbar tract at the level of the internal capsule, midbrain, or pons
157
pseudobulbar palsy diagnostics
neurologist
158
pseudobulbar palsy effects on phonation
laryngeal muscle weakness and hyperactivity co-exist causing both hyper adduction and incomplete closure
159
pseudobulbar palsy treatment (5)
voice therapy: easy onset phonation, flow phonation, aspirated onsets, frontal tone focus, adequate breath support
160
pseudobulbar palsy perceptual characteristics (5)
breathy, strain-struggle, harsh, mono pitch, mono loud
161
amyotrophic lateral sclerosis (ALS)
progressive disease with unknown cause; affects UMNs and LMNs (cortex, brainstem, spinal cord); lack of innervation causing twitches,weakness, spasticity; articulation problems and dysphagia; voice is hoarse, harsh, strain-struggle, hyper nasal, breathy
162
hyperkinesias (too much movement) are caused by ___
basal ganglia lesions or other parts of the extrapyramidal system
163
name and describe three hyperkinesia categories and their effects on voice
choreas with irregular pitch / loudness / respiration; athetosis with variable loudness / pitch / vocal quality; huntington's chorea with strained, strangled, harsh, mono pitch, variable loudness / pitch, jerky loud outburst, sudden forced changes in breath
164
hypokinesias (too little movement) are caused by ___
basal ganglia lesions or other parts of the extrapyramidal system
165
parkinson's disease (4)
lack of dopamine in substantia nigra; slow, rigid movements; voice is breathy, weak, decreased loudness, mono pitch, mono loudness, hoarse / harsh, tremor; VF bowing or incomplete closure with compensatory supraglottic squeezing, anterior-posterior compression, and false VF approximation
166
simple definition of multiple sclerosis
demyelinating progressive disease that attacks the myelin sheath causing breaks in transmitting axons in white matter in the PNS and CNS; dampens or slows neuronal signal
167
multiple sclerosis perceptual characteristics (2)
impaired loudness control, harsh, hypernasal; decreased respiratory control, slow speech rate, impaired articulation
168
simple definition of myasthenia gravis
autoimmune disease that is progressive failure to sustain maintained or repeated contraction of striated muscles; due to blockage of acetylcholine at neuro muscular junction which results in flaccidity
169
myasthenia gravis and gender
women : onset in their 30s :: men : onset in their 60s
*occurs twice as often in women
170
myasthenia gravis perceptual characteristics (3)
breathy, hypernasal, weak, decreased loudness, intermittent aphonia due to rapid fatigue; incomplete adduction / abduction of VFs with movement deteriorating with task repetition; patient fatigues rapidly
