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661 Midterm 1 > Voice Disorders > Flashcards

Voice Disorders Flashcards

1
Q

classifications of voice disorders (5)

A

phonotrauma; organic; functional; psychogenic; neurological

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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

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3
Q

simply describe phono trauma voice disorders

A

resulting from misuse or abuse of the vocal mechanism

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4
Q

simply describe organic voice disorders

A

resulting from a disease process or may be congenital; ex: cancer, acid reflux, laryngeal web, etc.

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5
Q

simply describe functional voice disorders

A

includes muscle tension dysphonias

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6
Q

simply describe psychogenic voice disorders

A

resulting from an underlying psychological issue and presents no identifiable vocal pathology

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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

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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

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9
Q

VF nodules occur in the ___

A

superficial lamina propria (SLP) and bilaterally

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10
Q

VF nodules are soft and gelatinous at first, then become ___ over time; its glottal closure is ___ shaped

A

hard and fibrous; hourglass

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11
Q

VF nodules add ___ and ___ to the vocal fold, interfering with the mucosal wave

A

mass and stiffness

*its VF vibration is APERIODIC

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12
Q

VF nodules : more common in women than men :: VF nodules : more common in ___ than ___

A

young boys; young girls

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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

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14
Q

VF nodules patient complaints (4)

A

fatigue, stuck in throat sensation, effort-strain, pain with muscle tension

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15
Q

VF nodules: stroboscopic characteristics (4)

A

hourglass; bilateral lesions; decreased / absent mucosal wave where the nodules are; decreased amplitude of vibration

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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)

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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

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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

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19
Q

true or false: VF polyps can be fluid, hemorrhagic, or fibrous

A

true

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20
Q

glottic closure of VF polyps is either ___ or ___

A

hourglass or irregular

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21
Q

fluid filled VF polyp : decreases stiffness :: ___ VF polyp : increased stiffness

A

hemorrhagic

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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

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23
Q

true or false: patient complaints for VF polyps is the same or similar as patient complaints for VF nodules

A

true

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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

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25
Q

(causes of ) VF edema : ___ :: reinke’s edema : ___

A

due to laryngeal tissue trauma or abuse; almost always related to smoking (and more common in women)

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26
Q

simple definition of edema

A

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

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27
Q

___ kind of looks like VF curtains

A

reinke’s edema

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28
Q

reinke’s edema: perceptual, acoustic, aerodynamic characteristics

A

perceptual : low F(0), roughness, vocal effort :: acoustic : loss of high pitches, decreased pitch range :: aerodynamic : increased airflow, normal Ps

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29
Q

reinke’s edema patient complaints (4)

A

vocal fatigue, low pitch, dry throat, vocal effort

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30
Q

reinke’s edema: stroboscopic characteristics

A

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

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31
Q

traumatic laryngitis is caused by ___

A

trauma to VF tissue, usually via excessive yelling, screaming, or loud talking

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32
Q

characteristics of traumatic laryngitis (4)

A

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

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33
Q

if vocal abuse continues, traumatic laryngitis may manifest into ___, particularly if the patient is using more effort or strain to speak (what we call ___)

A

chronic laryngitis; negative compensatory strategies

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34
Q

VF hemorrhage is ___

A

a ruptured blood vessel in the submucosal layer

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35
Q

VF hemorrhage is caused by ___

A

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

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36
Q

true or false: VF hemorrhages result in increased VF stiffness and increased VF mass

A

true

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37
Q

VF hemorrhage: perceptual and acoustic characteristics

A

perceptual : dysphonia to aphonia, hoarseness :: acoustic : decreased pitch / loudness ranges, increased pitch and intensity perturbations

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38
Q

VF hemorrhage stroboscopic characteristics (4)

A

patchy red area on VF; decreased mucosal wave; decreased amplitude of vibration; non vibratory portion where hemorrhage is

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39
Q

VF varices and ecstacia are ___ lesions

A

vascular lesions

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40
Q

varices : ___ :: ecstacia : ___

A

superficial, enlarged and dilated veins; lesioned blood vessel, coalescent hemangiomatmous appearance

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41
Q

VF varices and ecstatia (5)

A

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

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42
Q

VF cysts are caused by ___

A

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

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43
Q

VF cysts are sacks of tissue containing either ___ or ___

A

liquid (mucus) or a semisolid substance (epithelial cells)

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44
Q

VF cysts: perceptual, acoustic, aerodynamic characteristics

A

perceptual : rough, breathy, may be low-pitched, decreased loudness :: acoustic : decreased pitch range, aperiodicity, increased noise levels :: aerodynamic : increased air flow

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45
Q

VF cyst patient complaints (3)

A

hoarseness; vocal effort / strain ; vocal fatigue

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46
Q

VF cyst stroboscopic characteristics (4)

A

absent / decreased mucosal wave; decreased amplitude of vibration; increased VF cover mass / stiffness; irregular or hourglass glottic closure

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47
Q

pseudo cysts

A

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

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48
Q

muscle tension dysphonia is caused by ___ (2)

A

excessive extrinsic laryngeal muscle tension (supra / infra hyoid muscles and neck muscles); excessive internal / supraglottic laryngeal muscle tension

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49
Q

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

A

true

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50
Q

clinical signs of extrinsic laryngeal muscle tension dysophonia (3)

A

elevated larynx; inability to rock larynx left to right; tension areas: thyrohyoid (and TH space), suprahyoid, floor of mouth, base of tongue

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51
Q

muscle tension dysphonia (supraglottic and intrinsic muscle tention) stroboscopic characteristics (5)

A

anterior-posterior compression; mediolateral compression; VF hyperadduction; supraglottic squeezing; incomplete glottic closure (anterior gap or bowing)

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52
Q

muscle tension dysphonia perceptual characteristics; patient complaints

A

harsh, rough, breathy, tension, effortful, normal / elevated pitch, whisper, aphonia; vocal fatigue, tension, laryngeal pain / discomfort

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53
Q

ventricular phonation (2)

A

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

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54
Q

secondary ventricular phonation results in ___

A

decreased glottic closure and increased airflow

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55
Q

ventricular phonation perceptual characteristics; patient complaints

A

diplophonia, rough, harsh, low-pitched, breathy, monotone, decreased pitch range; vocal effort / strain, pain / discomfort

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56
Q

the two types of psychogenic dysphonias include ___ (2)

A

puberphonia (mutational falsetto), conversion dysphonia / aphonia

*there is no underlying organic or physical cause aka no pathology

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57
Q

simple definition of puberphonia (mutational falsetto)

A

persistence of a child-like voice quality after puberty (is learned or psychogenic in nature)

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58
Q

puberphonia characteristics

A

high pitch, hoarse, breathy, decreased loudness; incomplete glottic closure, stiff VFs, decreased amplitude

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59
Q

simple definition of conversion aphonia

A

complete loss of voice (aphonia) with no underlying physical cause

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60
Q

conversion aphonia characteristics

A

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

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61
Q

name an idiopathic voice disorder

A

paradoxical vocal cord movement (PVCM)

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62
Q

paradoxical vocal cord movement (PVCM) (3)

A

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)

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63
Q

paradoxical vocal cord movement (PVCM) is also known as ___

A

episodic paroxysmal laryngospasm

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64
Q

paradoxical vocal cord movement (PVCM) is commonly seen in ___

A

adolescent athletes; also in women ages 20 - 40

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65
Q

paradoxical vocal cord movement (PVCM) characteristics

A

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

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66
Q

organic voice disorders that are through disease (8)

A

ulcers and granulomas; infectious laryngitis; gastroesophageal reflux and laryngeal pharyngeal reflux; VF papiloma; candida; leukoplakia and hyperkeratosis; sulcus vocalis; laryngeal cancer

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67
Q

organic voice disorders that are congenital or through trauma (4)

A

laryngeal web; laryngeal cleft; subglottic stenosis; laryngomalcia

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68
Q

contact ulcers and granulomas are typically caused by ___ (3)

A

GERD or LPR, phonotrauma, and / or intubation trauma

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69
Q

contact ulcers and granulomas (5)

A

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
Q

contact ulcers and granulomas: perceptual, acoustic characteristics

A

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
Q

contact ulcers and granulomas patient complaints (4)

A

vocal fatigue; throat sensation; pain on phonation; voice worsening with prolonged use

72
Q

reflux laryngitis includes ___ and ___

A

gastroesophageal reflux (GERD) and laryngealpharyngeal reflux (LPR)

73
Q

in reflux laryngitis, regurgitation of ___ and ___ are irritants to the VFs

A

acid and stomach enzymes

74
Q

reflux laryngitis may cause ___ (4)

A

VF edema, erythema, arytenoid and posterior commisure hypertrophy, pachydermia (thickening of tissue between arytenoids)

75
Q

symptoms of GERD and LPR (reflux laryngitis) include ___

A

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
Q

reflux laryngitis perceptual, acoustic signs

A

perceptual : hoarse, breathy, decreased F(0) :: acoustic : increased noise, increased frequency, increased intensity perturbations

77
Q

simple definition of infectious laryngitis

A

inflammatory response of the larynx due to a viral or bacterial infection (VFs and laryngeal inlet appear red and swollen)

78
Q

infectious laryngitis symptoms and treatment

A

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
Q

laryngeal papilloma is caused by ___

A

human papilloma virus (HPV)

80
Q

laryngeal papilloma

A

VF wart-like growths that can also be found in the trachea and / or oropharynx

81
Q

laryngeal papilloma: pathology by age

A

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
Q

laryngeal papilloma perceptual, acoustic, aerodynamic characteristics

A

perceptual : hoarse, breathy, strained :: acoustic : no data :: aerodynamic : no data BUT increased VF stiffness and increased Ps

83
Q

laryngeal papilloma stroboscopic characteristics (3)

A

incomplete glottic closure, absent mucosal wave, increased VF mass and stiffness

84
Q

laryngeal papilloma re: scars

A

scarring due to repeated surgeries will further increase stiffness and decrease mucosal wave

85
Q

laryngeal papilloma patient complaints (3)

A

trouble breathing, decreased pitch and loudness range, vocal effort / strain

86
Q

laryngeal web causes (3)

A

congenital (75%) or acquired post-surgery or after laryngeal trauma

87
Q

simple definition of laryngeal web

A

a band of tissue forming on the anterior 1/3 of the glottis

88
Q

laryngeal web characteristics

A

inhalatory stridor, shortness of breath, high pitched crying (infants); voice is hoarse, high pitched, trouble sustaining phonation

89
Q

laryngomalacia summary (4)

A

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
Q

laryngomalacia stroboscopic characteristics (3)

A

collapse of laryngeal cartilages in inspiration; enlarged / floppy arytenoid cartilages; excessive AC mucosa

91
Q

laryngeal cleft summary (3)

A

may be genetic (autosomal dominant); cleft on posterior portion of cricoid cartilage causing narrowed airway; managed surgically

92
Q

laryngeal cleft symptoms / problems (4)

A

inspiratory and expiratory stridor, dyspnea, aspiration, feeding difficulties

93
Q

subglottic stenosis summary (4)

A

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
Q

subglottic stenosis symptoms / problems (5)

A

inspiratory and expiratory stridor; dyspnea; low pitch cough; nostril flaring; excessive chest wall movement

95
Q

simple definition: leukoplakia and hyperkeratosis

A

precancerous lesions arising from the epithelium; range from plaque-like whitish patches (leukoplakia) to warty lesions (keratosis)

96
Q

leukoplakia and hyperkeratosis are caused by ___ (5)

A

constant irritation to VFs from smoking, alcohol ingestion, GERD or LPR, environmental pollutants, coughing / throat clearing

97
Q

leukoplakia and hyperkeratosis characteristics (3)

A

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
Q

simple definition of sulcus vocalis (2)

A

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
Q

sulcus vocalis etiology (4)

A

congenital; related to phono trauma; related to smoking; due to a ruptured VF cyst

100
Q

ford sulcus classifications (type I, type 2a, type 2b)

A

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
Q

sulcus vocalis (3)

A

hoarse, breathy, effortful; patient complains of vocal fatigue; unilateral or bilateral

102
Q

sulcus vocalis stroboscopic characteristics (3)

A

incomplete glottic closure which is sometimes spindle shaped; decreased mucosal wave and amplitude of vibration; increased VF stiffness but decreased mass

103
Q

laryngeal cancer statistics (7)

A

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
Q

laryngeal cancer risk factors (5)

A

smoking, alcohol, environmental irritants, chemicals, asbestos

105
Q

laryngeal cancer characteristics (4)

A

voice is hoarse, dry, rough, low-pitched, breathy; globes sensation; inhalators stridor; throat pain, painful and problematic swallowing, shortness of breath, halitosis

106
Q

laryngeal cancer perceptual, acoustic, aerodynamic

A

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
Q

name the three categories of phonatory dysfunction

A

adduction / abduction problems; stability problems; coordination problems

108
Q

list phonatory dysfunction problems for adduction and abduction (6)

A

VF paralysis, VF paresis, SLN paralysis, pseudobulbar palsy, adductor spasmodic dysphonia, huntington’s corea

109
Q

list phonatory dysfunction problems for stability (3)

A

parkinson’s, ALS, essential tremor

110
Q

list phonatory dysfunction problems for coordination (1)

A

abductor spasmodic dysphonia

111
Q

name the five categories of neurological voice disorders

A 
category 1: relatively constant voice disorders
category 2: arrhythmically fluctuating
category 3: rhythmically fluctuating
category 4: paroxysmal
category 5: loss of volitional phonation
112
Q

bilateral VF paralysis is caused by ___

A

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
Q

bilateral VF paralysis characteristics

paralysis in the adducted position : ___ :: paralysis in the abducted position : ___

A

strained, low pitch-volume, respiratory compromise; aphonia, lack of airway protection during swallowing

114
Q

bilateral VF abductor paralysis

A

PCA is paralyzed; VFs in medial or paramedian position; may spontaneously recover; treatments include cordectomy, arytenoidectomy, VF lateralization

115
Q

bilateral VF adductor paralysis

A

TA, LCA, and IA are paralyzed; VFs in abducted position; treatments include tracheostomy (for safe swallow) and AC medial rotation

116
Q

unilateral VF paralysis is caused by ___

A

latrogenic / surgical trauma (50%), idiopathic (36%)

*diagnostics through videostroboscopy, nasal scope, laryngeal electromyography, MRI, CN exam (X and XI)

117
Q

true or false: unilateral VF paralysis may recover within 8 to 12 months

A

true (especially if due to trauma to RLN); if persistent, corrective surgery is considered

118
Q

thematic causes of unilateral VF paralysis (3)

A

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
Q

in unilateral VF paralysis, the affected VF is usually in ___ position

A

paramedian

120
Q

unilateral VF paralysis vibration (4)

A

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
Q

unilateral VF paralysis is treated through ___ and ___

A

voice therapy (voice is hoarse, breathy, weak, strained) and VF augmentation

122
Q

compensatory muscle tension may occur secondary to paralysis

intrinsic : ___ :: extrinsic : ___

A

anterior-posterior or medial-lateral compression, supraglottic sphinctering; elevated larynx, neck tension

123
Q

superior laryngeal nerve (SLN) paralysis is caused by ___

A

latrogenic, viral infections; most common cause is thyroid surgery (unilateral or bilateral) resulting in paralysis of CT muscle

124
Q

superior laryngeal nerve paralysis diagnostics

A

videostroboscopy, including pitch glides, rotation of posterior glottis to affected side, difference in VF vertical levels

125
Q

superior laryngeal nerve paralysis characteristics

A

decreased habitual pitch, breathiness, decreased pitch and intensity ranges; patient inability to raise pitch, decreased pitch range, decreased VF closure

126
Q

treatment of superior laryngeal nerve

A

voice therapy, may spontaneously recover

127
Q

VF paresis is caused by ___ (7)

A

neuropathy, goiter / thyroiditis, idiopathic, viral, trauma, lyme’s disease, stroke (bilateral)

128
Q

VF paresis diagnostics

A

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
Q

VF paresis characteristics

A

inadequate VF closure during phonation; perceptually, decreased intensity range and maximum intensity, breathy, hoarse, unstable, inconsistent; muscle tension secondary to paresis; vocal fatigue

130
Q

VF paresis is treated through ___ and ___

A

voice therapy and VF augmentation

131
Q

presbyphonia-presbylaryngis is caused by ___

A

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
Q

presbyphona stroboscopic characteristics

A

vocal processes prominence, atrophy and VF thinning, VF bowing, glottic gap, decreased amplitude of vibration, edema, yellowish discoloration

133
Q

presbyphonia effects on phonation

A

VF bowing, incomplete glottic closure, decreased amplitude, increased aperiodicity

males : F(0) increases :: females : F(0) decreases

134
Q

presbyphonia perceptual characteristics

A

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
Q

spasmodic dysphonia (SD) / focal dystonia is caused by ___

A

CNS lesion, probably basal ganglia and supplementary motor areas

136
Q

spasmodic dysphonia diagnostics

A

videostroboscopy, acoustic analysis; must differentially diagnose from vocal tremor and MTD

137
Q

name the three types of spasmodic dysphonia

A

adductor, abductor, mixed

138
Q

spasmodic dysphonia phonation

A

irregular, uncontrollable muscle movements disrupt VF vibration

139
Q

adductor spasmodic dysphonia

A

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
Q

abductor spasmodic dysphonia

A

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
Q

mixed spasmodic dysphonia

A

mixture of adductor and abductor spasmodic dysphonia

142
Q

spasmodic dysphonia and women

A

women affected more, age of onset between 30 and 50 years; reported to occur after URI, laryngeal trauma, vocal and emotional stress

143
Q

spasmodic dysphonia treatment

A

botox, adjunct voice therapy

144
Q

essential tremor is caused by ___

A

CNS lesion, likely extrapyramidal system

145
Q

essential tremor diagnostics (2)

A

acoustic analysis, videostroboscopy

146
Q

simple definition of essential tremor

A

tremors at 3 - 7 Hz frequency characterized by regular steady fluctuations in loudness and pitch

147
Q

essential tremor effects on phonation

A

phonatory instability and tremor

148
Q

essential tremor of the larynx (5)

A

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
Q

essential tremor perceptual characteristics (6)

A

tremor, frequency and intensity modulations, voice stoppages, strain-struggle, harsh, monopitch

150
Q

essential tremor treatments (2)

A

voice therapy : barkmeier-kramer approach, remediation of muscle tension, breath support :: pharmacological : propranolol, diazepam, primidone, clonazepam

151
Q

differential diagnosis step one

A

perform laryngeal palpitation; ask: “is this SD or vocal tremor or muscle tension dysphonia?”

152
Q

differential diagnosis step two

A

perform laryngeal massage and teach supraglottic relaxation exercises; improvement with MTD and tremor; if SD, little improvement is observed

153
Q

MTD is ___, SD is not

A

consistent

154
Q

true or false: vocal tremor with muscle tension can sound like spasmodic dysphonia

A

true

155
Q

true or false: severe muscle tension dysphonia can sound like spasmodic dysphonia

A

true

156
Q

pseudobulbar palsy is caused by ___

A

bilateral lesions in the corticobulbar tract at the level of the internal capsule, midbrain, or pons

157
Q

pseudobulbar palsy diagnostics

A

neurologist

158
Q

pseudobulbar palsy effects on phonation

A

laryngeal muscle weakness and hyperactivity co-exist causing both hyper adduction and incomplete closure

159
Q

pseudobulbar palsy treatment (5)

A

voice therapy: easy onset phonation, flow phonation, aspirated onsets, frontal tone focus, adequate breath support

160
Q

pseudobulbar palsy perceptual characteristics (5)

A

breathy, strain-struggle, harsh, mono pitch, mono loud

161
Q

amyotrophic lateral sclerosis (ALS)

A

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
Q

hyperkinesias (too much movement) are caused by ___

A

basal ganglia lesions or other parts of the extrapyramidal system

163
Q

name and describe three hyperkinesia categories and their effects on voice

A

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
Q

hypokinesias (too little movement) are caused by ___

A

basal ganglia lesions or other parts of the extrapyramidal system

165
Q

parkinson’s disease (4)

A

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
Q

simple definition of multiple sclerosis

A

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
Q

multiple sclerosis perceptual characteristics (2)

A

impaired loudness control, harsh, hypernasal; decreased respiratory control, slow speech rate, impaired articulation

168
Q

simple definition of myasthenia gravis

A

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
Q

myasthenia gravis and gender

A

women : onset in their 30s :: men : onset in their 60s

*occurs twice as often in women

170
Q

myasthenia gravis perceptual characteristics (3)

A

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

661 Midterm 1 (6 decks)

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