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voice disorders Flashcards

1
Q

what are the extrinsic laryngeal muscles of larynx

A
  1. supra hyoid
  2. infahyoid
    (pg. 344)
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2
Q

what are the supra hyoid muscles

A
  1. mylohyoid
  2. geniohyoid
  3. anterior belly of the digastric
  4. hyoglossus
  5. styloglossus
    (pg. 344)
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3
Q

what are the infra hyoid muscles?

A
  1. thyrohyoid
  2. sternohyoid
  3. sternoghyroid
  4. omohyoid
  5. inferior constrictor
    (pg. 344)
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4
Q

what are the abductor muscle(s) of the larynx

A
  • posterior cricoarytenoid

pg. 344

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5
Q

what are the adductor muscles of the larynx

A
  1. lateral cricoarytenoids
  2. interarytenoids (oblique and transverse)
    (pg. 344)
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6
Q

what are the tensor muscles of the larynx

A
  1. cricoarytenoids (pars recta and pars oblique)
  2. thyroarytenoids
    • medial/internal (thyrovocalis)
    • lateral/external (thyromuscularis)
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7
Q

what are the layers of the vocal folds?

A
  1. cover (squamous epithelium, superficial or lamina propria)
  2. transition (form the vocal ligament)
  3. body ( thyroarytenoid muscle)
    (pg. 344)
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8
Q

what are the 3 branches of the vagus (X) nerve?

A
  1. pharyngeal
  2. superior laryngeal
  3. recurrent laryngeal nerve
    (pg. 344)
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9
Q

a. pharyngeal nerve
b. superior laryngeal nerve
c. recurrent laryngeal nerve

-innervates soft palate via pharyngal plexus

A

a. pharyngeal nerve (pg.345)

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10
Q

a. pharyngeal nerve
b. superior laryngeal nerve
c. recurrent laryngeal nerve

  • interanal branch: sensory to glottal area and above
  • external branch: motor to cricothyroid muscle
A

b. superior laryngeal nerve (pg.345)

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11
Q

a. pharyngeal nerve
b. superior laryngeal nerve
c. recurrent laryngeal nerve

  • sensory to glottal area and infra glottal area
  • motor to all intrinsic laryngeal muscles except cricothyroid
  • right and left branches differ in length
  • left branch is longer because it wraps around the aorta before coursing upward
  • right branch wraps around subclavian artery before entering larynx
  • enters larynx though the thyroid gland
A

c. recurrent laryngeal nerve (pg.345)

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12
Q

a. inhalation
b. exhalation
c. vital capacity
d. relaxation pressure
e. checking action

-an active process resulting primarily from acton of diaphragm and external intercostal muscles

A

a. inhalation (pg.345)

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13
Q

a. inhalation
b. exhalation
c. vital capacity
d. relaxation pressure
e. checking action

  • passive during quiet breathing
  • is active during breathing for speech
A

b. exhalation (pg.345)

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14
Q

a. inhalation
b. exhalation
c. vital capacity
d. relaxation pressure
e. checking action

-amount of air available for use when lungs are inflated maximally

A

c. vital capacity (pg.345)

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15
Q

a. inhalation
b. exhalation
c. vital capacity
d. relaxation pressure
e. resting expiratory level
f. checking action

  • pressure generated entirely by passive forces, pulling towards equliibrium
  • equals zero at resting expiratory level; increases when lung volume is above or below REL
  • expiratory pressure is positive
  • inspiratory pressure is negative
A

d. relaxation pressure (pg.345)

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16
Q

a. inhalation
b. exhalation
c. vital capacity
d. relaxation pressure
e. resting expiratory level
f. checking action

  • the volume level in lungs at the end of exhalation in tidal breathing, when no respiratory muscles are active
  • volume level where the forces of contraction of the lungs are balanced by the forces of expansion of the chest wall
A

e. resting expiratory level (pg.345)

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17
Q

a. inhalation
b. exhalation
c. vital capacity
d. relaxation pressure
e. resting expiratory level
f. checking action

  • activity of inhalators muscles to control passive forces of exhalation in order to maintain steady subglottic pressure and airflow needed for speech production
  • these inhalatory muscles, primarily the external intercostals, stay activated until relaxation pressure equals subglottic pressure
A

f. checking action (pg.345 )

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18
Q

the average subglottic pressure during speech is ______ in conversational voice

A
  • 4-6 cm H20 (pg.345)
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19
Q

relaxation pressure and subglottic pressure are equal at about ____% vital capacity

A

55 (pg.345)

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20
Q

true/false: vocal folds open for inhalation and to produce voiceless sounds due to action of the PCAs

A

true (pg.345 )

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21
Q

true/false: during voicing/vibration, vocal folds open due to the buildup of air below the vocal folds sufficient to overcome the resistance of the folds and push the tissue upward and apart

A

true (pg.345)

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22
Q

vocal folds adduct due to the action of the ___ and ____

A

lateral cricoarytneoids and the interarytenoids (pg.346)

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23
Q

true/false: vocal fold vibration occurs when the vocal folds are positioned in the adducted position and airflow from the lungs causes repeated opening and closing

A

true (pg.346)

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24
Q

a. normal voice
b. breathy voice
c. whisper

  • regular bursts of air through the glottal opening
  • full opening and closing of vocal folds with vibration
A

a. normal voice (pg.346)

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25
Q

a. normal voice
b. breathy voice
c. whisper

  • noise puls air burst
  • vocal folds partly open and partly closed; closed portion vibrates
A

b. breathy voice (pg. 346)

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26
Q

a. normal voice
b. breathy voice
c. whisper

  • noisy frication airflow
  • narrow vocal fold opening, no vibration
A

c. whisper (pg.346)

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27
Q

a. voiceless
b. strained (creaky)
c. glottal fry
d. glottal stop

  • noiseless airflow
  • vocal folds open, no vibration
A

a. voiceless (pg. 346)

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28
Q

a. voiceless
b. strained (creaky)
c. glottal fry
d. glottal stop

  • irregular bursts of air through vibrating vocal folds
  • full vocal folds opening and closing with increased medial compression
A

b. strained (creaky) (pg. 346)

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29
Q

a. voiceless
b. strained (creaky)
c. glottal fry
d. glottal stop

  • low frequency irregular air bursts
  • only a small portion of vocal fold margin opens and closes
A

c. glottal fry (pg.346)

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30
Q

a. voiceless
b. strained (creaky)
c. glottal fry
d. glottal stop

  • no vibration at all; stoppage of airflow
  • folds fully shut with no vibration
A

d. glottal stop (pg.346)

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31
Q

____ is a series of ranges of consecutively phonated frequencies that can be produced with nearly identical voice quality and that ordinary do not overlap

A

register (pg.346)

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32
Q

a. pulse register
b. modal register
c. loft register

  • lowest portion of one’s phonation range
  • vocal folds are relaxed and vibrate with minimal subglottic pressure
  • frequency range is about 30-80Hz
  • closed phase is greatest protion of the glottal cycle
  • sometimes heard as glottal fry
A

a. pulse register (pg.346)

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33
Q

a. pulse register
b. modal register
c. loft register

  • the largest portion of one’s frequency range, comprise about 1.5 octave
  • voice quality has the greatest timber and flexibility
A

b. modal register (pg.346)

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34
Q

a. pulse register
b. modal register
c. loft register

  • also known as falsetto, the highest portion of one’s range
  • vocalfolds are stretched and tense, vibrating at their medial edges
  • airflow rate is increased
A

c. loft (pg. 346)

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35
Q

a. jitter
b. shimmer

  • the average cycle-to-cycle change in frequency from one cycle to the next
  • also known as pitch perturbation
A

a. jitter (pg.347)

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36
Q

a. jitter
b. shimmer

-average cycle-to-cycle change in amplitude from one cycle to the next

A

b. shimmer (pg.347)

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37
Q

a. harmonics-to-noise ratio
b. long-term average spectrum
c. soft phonation index
d. voice turbulence index

-quantifies the amount of additive noise in the voice signal

A

a. harmonics-to-noise ratio (pg.347)

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38
Q

a. harmonics-to-noise ratio
b. long-term average spectrum
c. soft phonation index
d. voice turbulence index

-describes the spectral characteristics of speech by averaging the contribution of individual speech sounds

A

b. long-term average spectrum (pg.347)

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39
Q

a. harmonics-to-noise ratio
b. long-term average spectrum
c. soft phonation index
d. voice turbulence index

-acoustic analysis parameter that provides indication of vocal fold adduction and glottal closure during phonation

A

c. soft phonation index (pg.347)

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40
Q

a. harmonics-to-noise ratio
b. long-term average spectrum
c. soft phonation index
d. voice turbulence index

-provides a quantitative index of breathiness

A

d. voice turbulence index (pg.347)

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41
Q

a. airflow rate
b. subglottic pressure
c. glottal resistance
d. maximum phonation time

  • the average rate of airflow through the vocal tract during phonation
  • associated with the efficiency of phonation
A

a. airflow rate (pg.347)

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42
Q

a. airflow rate
b. subglottic pressure
c. glottal resistance
d. maximum phonation time

  • pressure measured below the vocal folds usually during vibration
  • related to degree of medial compression of the closed vocal folds
  • associated with the intensity of voice produced
A

b. subglottic pressure (pg.347)

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43
Q

a. airflow rate
b. subglottic pressure
c. glottal resistance
d. maximum phonation time

  • the ratio of subglottal pressure to airflow rate
  • measured in cm H20/LPS
  • associated with intensity at low and middle frequencies
A

c. glottal resistance (pg.347)

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44
Q

a. airflow rate
b. subglottic pressure
c. glottal resistance
d. maximum phonation time

  • is the maximum time a subject can produce a vowel following a deep inhalation
  • may reflect phonation type in addition to characteristics of breath support for speech
  • typically improves with practice and/or training
A

d. maximum phonation time (pg.347)

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45
Q

quality of voice is that perceived by listeners as distinguished from pitch and loudness and sometimes called _______

A

timbre (pg.347)

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46
Q

stroboscopic and related visual measures

a. symmetry
b. amplitude
c. periodicity
d. closed pattern

-refers to whether the left and right vocal folds move symmetrically during vibration

A

a.symmetry (pg.347)

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47
Q

stroboscopic and related visual measures

a. symmetry
b. amplitude
c. periodicity
d. closed pattern

-the extent of horizontal excursion of the vocal folds during vibration

A

b. amplitude (pg.347)

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48
Q

stroboscopic and related visual measures

a. symmetry
b. amplitude
c. periodicity
d. closed pattern

-the regularity of successive cycles of vibration

A

c. peridoicity (pg.347)

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49
Q

stroboscopic and related visual measures

a. symmetry
b. amplitude
c. periodicity
d. closed pattern

-the portion of the vocal folds and any space between them during the most closed phase of vibration

A

d. closed pattern (pg.347)

can be described as complete, incomplete, irregular, hour -glass-shaped, with an anterior to posterior chink

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50
Q

stroboscopic and related visual measures

a. mucosal wave
b. vocal fold edge

  • corresponds to the movement of the superior surface, or cover, of the vocal fold laterally during vibration
  • travels about half the width of the vocal fold at typical pitch and loudness
A

a. mucosal wave (pg.348)

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51
Q

stroboscopic and related visual measures

a. mucosal wave
b. vocal fold edge

-can be described as smooth and even, irregular with an excrescence, etc

A

b. vocal fold edge (pg.348)

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52
Q

larynx forms from branchial arches ____,____, and _____ and all structures are present at ___ months gestation

A

4,5,6 and 3 (pg.348)

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53
Q

the vocal ligament is present by age ____ and develops to about age ____

A

2, 16 (pg.348)

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54
Q

what is ADMET?

A

aerodynamic myoelastic theory of phonation (pg.348)

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55
Q

what are the 5 mechanisms involved in one cycle of glottal vibration that results in vocal fold vibration in ADMET

A
  1. the adductor muscles (LCA and IA) close the vocal folds while the tenors (CT and TA) stiffen the vocal folds to the desired fundamental frequency
  2. as person begins to exhale, sub glottal pressure builds beneath the vocal folds. pressure builds until it is great enough to overcome the resistance of the vocal fold and push the folds open
  3. a glottal pulse is released creating an acoustic shock wave traveling through the vocal folds
  4. once the folds have been blown open forces of the elastic recoil and the bernoulli effect help to bring the folds back to there original position
  5. the opening and closing of the vocal folds during phonation is the result of the aerodynamic and muscular foyers indicated above
    (pg. 348-349)
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56
Q

what does the cover-body theory of vocal fold vibration state?

A
  • the vocal fold cover moves independently of the body
  • the TA muscle (body) participates very little in vibratory movement
  • movement of the vocal ligament falls in between the significant movement of the cover and the minimal movement of the body
  • this theory suggests that anything that interferes with the movement of the cover will affect the resulting voice quality
    (pg. 349)
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57
Q

what are common disorders associated with phono trauma?

A
  1. vocal nodule
  2. polyps
  3. polypoid degeneration (reinke’s edema)
    (pg. 349)
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58
Q

a. vocal nodule
b. polyps
c. polypoid degeneration

  • form from long periods of phonotrauma
  • results in increased intercellular fluid and a buildup
  • abnormal growth form at the junction of the anterior 1/3 posterior 2/3 of the vocal fold (i.e. the middle of the membranous vocal fold)
A

a. vocal nodule (pg.349)

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59
Q

a. vocal nodule
b. polyps
c. polypoid degeneration

  • phonotrauma resulting in hyper functional vocal fold adduction results in would formation arising in the superficial layer of the lamina propria
  • polyps may result from periods of phonotrauma or from a single traumatic accident
A

b. polyps (pg.350)

60
Q

a. vocal nodule
b. polyps
c. polypoid degeneration

  • most often seen in women who are heavy smokers with chronic vocal abuse and perhaps gastroesophageal reflux disease
  • superficial layer of the lamina propria reacts to trauma by increasing fluid in the submucosal lining
A

c. polypoid degeneration (pg.350)

61
Q

diagnostic characteristics

a. vocal nodule
b. polyps
c. polypoid degeneration

  • common in professional voice users, singers, aerobic instruction and the like
  • voice quality ranges from mild to severely impaired and can be described variously as hoarse, breathy, harsh, and/or raspy with phonation breaks and vocal effort
  • quality usually worsens throughout the day
  • jitter and shimmer are often increased
A

a. vocal nodule (pg.349)

62
Q

diagnostic characteristics

a. vocal nodule
b. polyps
c. polypoid degeneration

  • lesions may arise anywhere on the vocal fold cover
  • usually unilateral and may be pedunculated
  • voice quality may be minimally impaired or significantly changed
  • pitch is typically lowered
  • jitter and shimmer are elevated
  • may experience the sensation of something catching in the throat with heavy breathing or taking
A

b. polyps (pg.350)

63
Q

diagnostic characteristics

a. vocal nodule
b. polyps
c. polypoid degeneration

  • may be unilateral or bilateral
  • causes loose floppy appearance of the surface of the vocal fold, often pale in color
  • noticeable reduction of fundamental frequency
  • decrease mucosal wave and decreased amplitude of vibration
A

c. polypoid degeneration (pg.350)

64
Q

treatment

a. vocal nodule
b. polyps
c. polypoid degeneration

  • phonotrauma behaviors should be reduced or eliminated to the extent possible
  • sysmptomatic voice treatment has been found effective using approaches such as resonant voice and confidential voice
  • may be surgically removed, although nonsurgical approaches are preferred by many physicians
A

a. vocal nodule (pg.350)

65
Q

treatment

a. vocal nodule
b. polyps
c. polypoid degeneration

  • short-term voice treatment focusing on improved vocal hygiene to reduced phonotrauma
  • many require surgical removal to be eliminated
A

b. polyps (pg.250)

66
Q

treatment

a. vocal nodule
b. polyps
c. polypoid degeneration

  • phonosurgery combined with voice treatment focusing on vocal hygiene is standard
  • the lesion will likely recur if the patient continues to smoke, so smoking cessation is considered key
A

c. polypoid degeneration (reinke’s edema) (pg.350)

67
Q

a. cysts
b. human papilloma virus
c. laryngitis

  • benign collection of material such as fluid, surrounded by a membrane typically arising from the superficial layer of the lamina propria
  • may be congenital or as a result of phono trauma
A

a. cysts (pg.350)

68
Q

a. cysts
b. human papilloma virus
c. laryngitis

  • from type 6 and 11 virus and results in recurrent respiratory papilomatosis
  • may be found anywhere in the respiratory tract (most commonly the vocal folds)
A

b. human papilloma virus (pg.350)

69
Q

a. cysts
b. human papilloma virus
c. laryngitis

  • results in short-term loss of voice and/or impaired voice quality due to a bacterial or viral respiratory infection
  • can result from long-term vocal trauma, GERD, and allergies, among other causes
A

c. laryngitis (pg.351)

70
Q

characteristics

a. cysts
b. human papilloma virus
c. laryngitis

  • may be suspected whenever voice change does not resolve with conservative treatment and an dynamic portion of mucous wave on a vocal fold suggests increased stiffness of that fold
  • voice quality may vary depending on the size and location and whether glottic closure is affected
  • vocal fatigue may be reported along with some lowering of habitual pitch
  • seen to co-occur with other benign tissue changes in the vocal folds
A

a. cysts (pg.350)

71
Q

characteristics

a. cysts
b. human papilloma virus
c. laryngitis

  • appears as masses of nonkeratinized stratified squamous epithelium that typically are white to pink or red in color
  • single or multiple clumps
  • may exhibit a wide variety of changes in voice quality with frequent coughing or throat-clearing and may also experience some restriction in breathing with stridor
A

b. himan papilloma virus (pg.351)

72
Q

characteristics

a. cysts
b. human papilloma virus
c. laryngitis

  • vocie quality is dysphonia and often described as rough with increased spectral noise
  • quality may decrease with increased talking
  • phonational range is reduced; jitter and shimmer are increased
  • may complain of dryness
  • folds are asymmetrically and aperiodically
  • long-standing, negative effects of chronic laryngitis may result in permanent voice changes
A

c. laryngitis (pg.351)

73
Q

treatment

a. cysts
b. human papilloma virus
c. laryngitis

  • voice therapy may help by improving vocal hygiene
  • will only be eliminated with careful surgical removal performed under a microscope
A

a. cysts (pg.350)

74
Q

treatment

a. cysts
b. human papilloma virus
c. laryngitis

  • the standard treatment involves repeated laser removal with close monitoring
  • frequent removal of lesions from the vocal folds often results in the development of scar tissue, with permanent disruption in voice quality as an outcome
  • children must be carefully monitored so that their breathing is not compromised
A

b. human papilloma (pg.351)

75
Q

treatment

a. cysts
b. human papilloma virus
c. laryngitis

-reduce phono trauma; control GERD; maintain adequate hygiene

A

c. laryngitis (pg.351)

76
Q

a. muscle tension dysphonia
b. psychogenic dysphonia
c. puberphonia
d. ventricular phonation

-chronic increased tension of the laryngeal musculature resulting in dysphonia that typically has multifactorial contributing etiologies

A

a. muscle tension dysphonia (pg. 351)

77
Q

a. muscle tension dysphonia
b. psychogenic dysphonia
c. puberphonia
d. ventricular phonation

  • voice changes occur associated with psychological causes, including anxiety to unconscious emotional distress; may be related to a single incident
  • is more common in women
A

b. psychogenic dsyphonia (pg.351)

78
Q

a. muscle tension dysphonia
b. psychogenic dysphonia
c. puberphonia
d. ventricular phonation

  • not clearly established
  • is considered by most to be a functional voice disorder with possible psychological roots in some causes
  • may be caused by patient attempting to stabilize voicing during puberty when a growth spurt of the speech mechanism results in unstable pitch breaks
A

c. puberphonia (pg.352)

79
Q

a. muscle tension dysphonia
b. psychogenic dysphonia
c. puberphonia
d. ventricular phonation

  • adduction of the false vocal folds due to a psychological problem, a compensatory behavior, a component of a pattern of hyper function or as an unexpected phenomenon
  • in rare cases, the false folds are used as a vibratory source of sound for individuals with nonfunctioning vocal folds
A

d. ventricular phonation (pg.352)

80
Q

characteristics

a. muscle tension dysphonia
b. psychogenic dysphonia
c. puberphonia
d. ventricular phonation

  • vocal fold appearance is essentially normal, although hyper or hypo adduction may be seen
  • larynx may be high in the neck with pain present on palpation
  • dysphonia can range from mild to severely dysphonia, often with a rough, strained quality
  • voice beaks that are very short in duration may be seen using acoustic analysis programs
  • GERD may be a confounding finding
A

a. muscle tension dysphonia (pg.351)

81
Q

characteristics

a. muscle tension dysphonia
b. psychogenic dysphonia
c. puberphonia
d. ventricular phonation

  • vocal fold tissue and movement are determined to be normal; however during speech, the vocal folds are held in a partially abducted position, may be hyper adduct or may appear bowed
  • in some cases, voice may be produced sporadically or intermittently
  • patients may complain of pain on talking
  • onset may occur after an upper respiratory infection
  • a normal cough is typically present
A

b. psychogenic dysphonia (pg.351)

82
Q

characteristics

a. muscle tension dysphonia
b. psychogenic dysphonia
c. puberphonia
d. ventricular phonation

  • occurs more noticeably in male but can be found in females
  • the larynx and other physical changes associated with puberty are normal
  • voice will be high in pitch with the larynx held in an elevated position and neck tension may be evident
  • pitch breaks, phonation breaks, vocal fatigue and breathiness may also be present
  • patient may not be able to shout with this voice
A

c. puberphonia (pg.352)

83
Q

characteristics

a. muscle tension dysphonia
b. psychogenic dysphonia
c. puberphonia
d. ventricular phonation

  • the false vocal folds adduct and obscure the view of the underlying true vocal folds during voicing
  • the true folds may remain in an open position or also close towards midline, the true fold do not appear to vibrate during attempts at phonation in most cases
  • the resulting voice quality is low in pitch and loudness, monotone, rough/harsh, often diplophonic and has a significantly restricted pitch range
A

d. ventricular phonation (pg.352)

84
Q

treatment

a. muscle tension dysphonia
b. psychogenic dysphonia
c. puberphonia
d. ventricular phonation

  • symptomatic voice therapy is the treatment of choice
  • good evidence exists for benefit received from circumlaryngeal massage
  • GERD should be managed and good vocal hygiene behaviors followed
  • in some cases BOTOX injections have been found to successfully break the cycle of chronic, unnecessary, excessive vocal tension
A

a. muscle tension dysphonia (pg.351)

85
Q

treatment

a. muscle tension dysphonia
b. psychogenic dysphonia
c. puberphonia
d. ventricular phonation

  • symptomatic voice treatment focusing on establishing and then extending a vocal tone is the treatment of choice
  • evidence supports the use of circumlaryngeal massage
  • referral to a professional to help the patient understand and deal with underlying psychological issues can be appropriate
  • typically, once voice is reestablished and patients understands that they are in control of their voice, no further loss of voice occurs or it is short lived
A

b. psychogenic dysphonia (pg.352)

86
Q

treatment

a. muscle tension dysphonia
b. psychogenic dysphonia
c. puberphonia
d. ventricular phonation

  • voice therapy focusing on the production and then the establishment of a normal, lower pitch in a hierarchy from a single sound to conversation is the treatment of choice
  • treatment approaches may involve circumlaryngeal massage and/or hard glottal attacks
  • initially, patients may have difficulty using the voice with family and friends and may not identify with the normal, low voice as their own, but with continued use of the normal voice and with support, the transition to habitual use does occur
A

c. puberphonia (pg.352)

87
Q

treatment

a. muscle tension dysphonia
b. psychogenic dysphonia
c. puberphonia
d. ventricular phonation

  • symptomatic voice therapy is the treatment of choice when normal true vocal fold function is present
  • initial establishment of tone produced by the true folds is key and if so produced, this tone is extended through a hierarchy of lengthening productions
A

d. ventricular phonation

88
Q

a. vocal cord dysfunction
b. inferior (recurrent) laryngeal nerve paralysis
c. superior laryngeal nerve paralysis
d. spasmodic dysphonia

etiology=

  • upper airway sensitivity as physiologic response to an irritant
  • psychogenic as a result of anxiety
  • laryngeal dystonia resulting from a neurological event or process
A

a. vocal cord dysfunction (pg.353 )

89
Q

a. vocal cord dysfunction
b. inferior (recurrent) laryngeal nerve paralysis
c. superior laryngeal nerve paralysis
d. spasmodic dysphonia

  • the vagus nerve or its branches, either superior or inferior, may be damaged leading to paresis or parlays of the muscles of the larynx
  • will affect all of the intrinsic laryngeal muscles except for the cricothryoid muscles
A

b. inferior laryngeal nerve paralysis (pg. 353)

90
Q

a. vocal cord dysfunction
b. inferior (recurrent) laryngeal nerve paralysis
c. superior laryngeal nerve paralysis
d. spasmodic dysphonia

-etiology of this paralysis is unknown, especially since the effects of a unilateral paralysis to only this nerve are quite subtle

A

c. superior laryngeal nerve paralysis (pg.353)

91
Q

a. vocal cord dysfunction
b. inferior (recurrent) laryngeal nerve paralysis
c. superior laryngeal nerve paralysis
d. spasmodic dysphonia

  • a discrete vocal dystonia due to abnormalities in laryngeal motor control arising in the basal ganglia
  • exact etiology remains unknown
A

d. spasmodic dysphonia (pg.353)

92
Q

characteristics

a. vocal cord dysfunction
b. inferior (recurrent) laryngeal nerve paralysis
c. superior laryngeal nerve paralysis
d. spasmodic dysphonia

  • a diamond-shaped posterior glottic chink can be seen endoscopically during inspiration/ expiration
  • feels tightness in the neck and throat and may present with a cough
  • some patients report distinct triggers such as episodes associated with strong odors
  • asthma, allergies and GERD are comorbid factors
A

a. vocal cord dysfunction (pg.352)

93
Q

characteristics

a. vocal cord dysfunction
b. inferior (recurrent) laryngeal nerve paralysis
c. superior laryngeal nerve paralysis
d. spasmodic dysphonia

  • damage to the nerve results in the affected vocal fold typically rising in the paramedian position just lateral to midline
  • the thyroarytenoid muscle fibers atrophy from lack of neruostimulation
  • voice can be breathy and soft and patients typically have a weak cough
  • maximum phonation time is decreased
  • under strobe, the vocal folds will vibrate asymmetrically and aperiodically
A

b. inferior (recurrent) laryngeal nerve paralysis (pg. 353)

94
Q

characteristics

a. vocal cord dysfunction
b. inferior (recurrent) laryngeal nerve paralysis
c. superior laryngeal nerve paralysis
d. spasmodic dysphonia

  • if the internal branch is affected then sensation to the glottal and sub glottal area region is compromised
  • unilateral damage to the external branch affects only the cricothyroid muscle
  • this causes an inability to lengthen the muscle on that side and results in altered pitch control and reduced pitch range
  • may complain of vocal fatigue
A

c. superior laryngeal nerve paralysis (pg.353)

95
Q

what are the 3 types of spasmodic dysphonia?

A
  • adductor SD
  • abductor SD
  • mixed SD
    (pg. 354)
96
Q

a. adductor SD
b. abductor SD
c. mixed SD

  • patients experience irregular, uncontrolled, random closing spasms of the vocal folds during phonation
  • resulting voice is often referred to as strained-strangled
A

a. adductor SD (pg.354)

97
Q

a. adductor SD
b. abductor SD
c. mixed SD

-experiences irregular, random, uncontrolled opening of the vocal folds and the voice is hears as more breathy

A

b. abductor SD (pg.354)

98
Q

true/false: SD may be difficult to differential diagnose from muscle tension dysphonia, or patients may experience muscle tension dysphonia which confound the effect of SD

A

true (pg.354)

99
Q

treatment

a. vocal cord dysfunction
b. inferior (recurrent) laryngeal nerve paralysis
c. superior laryngeal nerve paralysis
d. spasmodic dysphonia

  • medical conditions such as GERD allergies and asthma should be well controlled
  • relaxed, open throat breathing exercises are taught, often within an individually designed patient hierarchy of precipitating events
  • recently, respiratory training exercises using resistance breathing devices have shown promise with this population
A

a. vocal cord dysfunction (pg.353)

100
Q

treatment

a. vocal cord dysfunction
b. inferior (recurrent) laryngeal nerve paralysis
c. superior laryngeal nerve paralysis
d. spasmodic dysphonia

  • many physicians suggest patients wait for 6 months before electing for surgical management
  • arytenoid adduction surgery, reinnervation techniques, use of injectable substances such as teflon, fat or college and vocal fold repositioning known as thryoplasty
  • voice therapy focusing on laryngeal adduction exercises
A

b. inferior laryngeal nerve paralysis (pg.353)

101
Q

treatment

a. vocal cord dysfunction
b. inferior (recurrent) laryngeal nerve paralysis
c. superior laryngeal nerve paralysis
d. spasmodic dysphonia

  • surgical management may be recommended if the damage is bilateral
  • voice therapy is helpful to maximize vocal quality and help minimize vocal fatigue and possible hyper adduction
A

c. superior laryngeal nerve paralysis (pg.353)

102
Q

treatment

a. vocal cord dysfunction
b. inferior (recurrent) laryngeal nerve paralysis
c. superior laryngeal nerve paralysis
d. spasmodic dysphonia

  • no cure exists
  • behavioral treatment approaches used in voice therapy may be helpful but have limited effects
  • standard treatment now involves injection of Botox into one or both vocal folds
A

d. spasmodic dysphonia (pg.354)

103
Q

what is though to result from a lesion in the extrapyramidal system of the central nervous system?

A

essential tremor of the voice (pg. 354)

104
Q

true/false: vocal tremor worsens with fatigue or strong emotion

A

true (pg.354)

105
Q

true/false: there is currently no treatment that has been uniformly efficacious for patients with voice tremor

A

true (pg. 354)

106
Q

_____ injections slightly reduce the frequency and amplitude of the tremor ,but the effect is only temporary for essential tremor of the voice

A

Botox (pg.354)

107
Q

true/false: speech therapy to maximize intelligibility may be helpful for essential tremor

A

true (pg.354)

108
Q

what are some strategies to be addressed during speech therapy for essential tremor?

A
  1. shortening vowel duration
  2. shortening phrases length
  3. elevating pitch
    (pg. 354)
109
Q

a. laryngomalacia
b. subglottic stenosis
c. laryngeal wed

  • most common congenital laryngeal disorder
  • cartilages collapse inward causing stridor and respiratory distress
  • sometimes surgery to protect the airway is performed
A

a. laryngomalacia (pg.354)

110
Q

a. laryngomalacia
b. subglottic stenosis
c. laryngeal wed

  • identified at birth due to respiratory distress
  • thought to be a result of failure in the development of vocal tract tissue
  • reconstruction may be required
  • longterm consequences affecting speech development
A

b. subglottic stenosis (pg.355)

111
Q

a. laryngomalacia
b. subglottic stenosis
c. laryngeal wed

  • mainfests at birth with symptoms of stridor and difficulty breathing
  • common at the anterior commissure
  • thought to result from a disruption in the normal development of the embryo
  • surgical removal is necessary to free the entire length of the vocal folds for vibration
A

c. laryngeal web (pg.355)

112
Q

the most common voice problem in children is ________

A

bilateral vocal nodules (pg.355)

113
Q

true/false: surgery is often recommended in children with bilateral vocal nodules

A

false: surgery is rarely recommended in children, although reflux management may be recommended
(pg. 355)

114
Q

what are the 4 populations who are high risk of voice disorders

A
  1. professional voice users
  2. transgender individuals
  3. persons with velopharyngeal incompetency
  4. persons with hearing loss
    (pg. 355-356)
115
Q

focusing on ____ is the most common, specific feature targeted in therapy, but the overall goal is to modify the overall _____ and _____ projected by the transgender patient

A

fundamental frequency, image and identity (pg. 355)

116
Q

why are people with velopharyngeal incompetency at risk for voice disorders?

A
  • they will attempt to compensate for the poor closure by excessive closing of the laryngeal valve
  • this repeated hyper function may result in formation of traumatic lesions on the vocal folds
    (pg. 355)
117
Q

true/false: the patient should see the speech pathologist before a medical diagnosis

A

false: only after a medical diagnosis (pg.356)

118
Q

the international classification of functioning are categorized into what 3 inter-connected areas?

A
  1. impairments
  2. activity limitations
  3. participation restrictions
    (pg. 356)
119
Q

a. impairment
b. activity limitations
c. participation restrictions

-problems in body function or alteration in body structure

A

a. impairment (pg.356)

120
Q

a. impairment
b. activity limitations
c. participation restrictions

-difficulty in executing activities

A

b. activity limitations (pg.356)

121
Q

a. impairment
b. activity limitations
c. participation restrictions

-problems with involvement in any area of life

A

c. participation restrictions (pg. 356)

122
Q

a. GRBAS
b. CAPE-V

  • grade, rough, breathy, asthenic and strained
  • most common measurement tool used worldwide for estimating voice quality
A

a. GRBAS (pg. 356)

123
Q

a. GRBAS
b. CAPE-V

-clinicians rate voice quality features in 3 contexts (vowels, six specified sentences, conversation) on a 100 mm visual analog scale

A

b. CAPE-V (pg.357)

124
Q

a. modal fundamental frequency
b. phonational range
c. perturbation measures
d. dysphonia severity index
e. multidimensional voice profile

-the average habitual pitch of an individual in conversational speech and other speech tasks

A

a. modal fundamental frequency (pg.357)

125
Q

a. modal fundamental frequency
b. phonational range
c. perturbation measures
d. dysphonia severity index
e. multidimensional voice profile

-the pitch range the patient can produce from low to high

A

b. phonational range (pg.357)

126
Q

a. modal fundamental frequency
b. phonational range
c. perturbation measures
d. dysphonia severity index
e. multidimensional voice profile

  • instability measures reflecting variability in period and amplitude from cycle to cycle
A

c. perturbation measures (pg.357)

127
Q

a. modal fundamental frequency
b. phonational range
c. perturbation measures
d. dysphonia severity index
e. multidimensional voice profile

-a weighted combination of maximum phonation time, high and low frequency values and percent jitter to select perceived voice quality

A

d. dysphonia severity index (pg.357)

128
Q

a. modal fundamental frequency
b. phonational range
c. perturbation measures
d. dysphonia severity index
e. multidimensional voice profile

-computerized acoustic analysis program that measures up to 19 different acoustic parameters from a segment of prolonged vowels and compares an individuals production to predetermined thresholds and norms

A

e. multidimensional voice profile (pg. 357 )

129
Q

a. maximum phonation time
b. airflow rate
c. estimates of subglottic pressure
d. laryngeal airway resistance

-the max time an individual can prolong a vowel on one breath of air

A

a. max phonation time (pg.357)

130
Q

a. maximum phonation time
b. airflow rate
c. estimates of subglottic pressure
d. laryngeal airway resistance

-estimate of glottal valving efficiency

A

b. airflow rate (pg.357)

131
Q

a. maximum phonation time
b. airflow rate
c. estimates of subglottic pressure
d. laryngeal airway resistance

-estimates are made in reference to oral pressure determined just following release of the bilabial voiceless plosive /p/ using a mask integrated with special sensors

A

c. estimates of sub glottal pressure (pg.357)

132
Q

a. maximum phonation time
b. airflow rate
c. estimates of subglottic pressure
d. laryngeal airway resistance

  • the ratio of air pressure to the flow of air through the glottis
  • measured in H2O per cc per second
A

d. laryngeal airway resistance (pg.357)

133
Q

what features are assessed during laryngolic/ stroboscopic assessment?

A
  1. glottal closure
  2. symmetry of movement
  3. periodicity
  4. amplitude of movement
  5. movement of the mucosal wave
    (pg. 357)
134
Q

what are 4 additional areas that should be assessed during a voice evaluation?

A
  1. resonance
  2. tremor
  3. motor speech production
  4. intelligibility
    (pg. 357)
135
Q

what are 5 guidelines for good vocal health?

A
  1. rare or minimal use of loud, effortful voice
  2. attention to potential larygo-pharyngeal reflux
  3. reducing unnecessary coughing and throat-clearing
  4. adequate hydration
  5. holistic elements: good nutrition, enough rest, regular physical exercise, good mental health
    (pg. 358)
136
Q

a. resonant voice therapy
b. botox
c. vocal function exercise

-focuses on optimizing voice quality through a focus on maximizing oral-pharyngeal resonance and the degree of medial compression between the vocal folds

A

a. resonant voice therapy (pg.358)

137
Q

a. resonant voice therapy
b. botox
c. vocal function exercise

-injection into thyroarytenoid or other intrinsic muscles for treatment of spasmodic dysphonia and sometimes essential tremor of the voice

A

b. botox (pg.358)

138
Q

a. resonant voice therapy
b. botox
c. vocal function exercise

-have been shown to be useful in improving vocal range, stability, flexibility and resonance in a variety of normal and disordered populations

A

c. vocal function exercise (pg.358)

139
Q

what are the effects related to surgery?

A
  1. loss of function related to excised tissues, including effects on speech and swallowing
    (pg. 359)
140
Q

what are the effects related to chemotherapy?

A
  1. fatigue, nausea, loss of appetite, change in case and potentially hair loss
    (pg. 359)
141
Q

what are the effects related to radiation?

A
  1. inflammatory reactions, tissue fibrosis, loss of appetite, fatigue, xerostomia, necrosis, mucositis, pain
    (pg. 359)
142
Q

a. supra-glottic laryngectomy
b. partial laryngectomy
c. semi-laryngectomy

-any surgery that involves removing part of the voice producing mechanism

A

b. partial laryngectomy (pg.360)

143
Q

a. supra-glottic laryngectomy
b. partial laryngectomy
c. semi-laryngectomy

-the structures and tissues above the level of the true vocal folds are surgically removed

A

a. supra-glottic laryngectomy (pg.360)

144
Q

a. supra-glottic laryngectomy
b. partial laryngectomy
c. hemi-laryngectomy

-a vertical portion of laryngeal tissue is resected

A

hemi-laryngectomy (pg.360)

145
Q

true/false: glossectomy refers to the surgical recoil of tongue tissue

A

true (pg.361)

PRAXIS SLP (18 decks)

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