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voice disorders Flashcards

1
Q

What is a Hyperfunctional client?

A

muscle tension dysphonia, pressed voice, lesion

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2
Q

What is a hypofunctional client?

A

bretahy

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3
Q

Classifications of Voice Disorders

A
  • Phonotrauma
  • Organic
  • Functional
  • Psychogenic
  • Neurological
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4
Q

Phonotrauma definition

A

results from misuse or abuse of the vocal mechanism

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5
Q

Organic definition

A

results from a disease process or may be congenital, i.e., cancer, acid reflux, laryngeal web etc.

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6
Q

Functional definition

A

Muscle tensions dysphonias

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7
Q

Psychogenic definition

A

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

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8
Q

Neurological definition

A

results from damage to the RLN or SLN, disease processes that affect these nerves, or brain injuries or lesions

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9
Q

Leukoplakia and Hyperkeratosis

Pre-cancerous lesions

A
  • range from flat plaque-like whitish patches (leukoplakia) to warty lesions (keratosis).
  • Increases VF mass and stiffness, decreases mucosal wave and amplitude, irregular glottic closure, aperiodicity ,
  • VFs are asymmetric
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10
Q

Sulcus vocalis

A
  • A longitudinal groove or indentation in the upper edge of the VFs that parallels the free margins
  • may be caused by phootrauma, smoking, congenital
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11
Q

Laryngeal Cancer

A
  • Globus sensation – ‘full feeling’ in throat
  • May observe inhalatory stridor
  • Throat pain, painful swallowing, problems swallowing, shortness of breath, halitosis
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12
Q

Three categories of phonatory dysfunction:

A

Adduction / Abduction problems

Stability problems

Coordination problems

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13
Q

Stability phonatory dysfunction

A

Parkinson’s, ALS

Essential Tremor

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14
Q

Coordination phonatory dysfunctio

A

Abductor Spasmodic Dysphonia

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15
Q

Adduction / Abduction problems

A 
Vocal Fold Paralysis
Vocal Fold Paresis
SLN Paralysis
Pseudobulbarpalsy
Adductor Spasmodic Dysphonia
Huntington’s Chorea
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16
Q

Paralysis in the adducted position causes

A
  • Strained/strangled, monotone, low pitched, low volume voice w/ possible hypernasality
  • Respiratory compromise due to decreased airway and stridor may be heard
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17
Q

Paralysis in the abducted position causes

A
  • Aphonia.

* Lack of airway protection for swallowing

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18
Q

Management of Bilateral VF Paralysis

Abductor paralysis

A
  1. If airway is acceptable, wait and see if nerves spontaneously recover
  2. Cordectomy, Arytenoidectomy or VF lateralization
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19
Q

Causes of Bilateral VF Paralysis

Abductor paralysis

A

PCA is paralyzed

VFs in medial or paramedian position

20
Q

Causes of bilateral Adductor paralysis

A

TA, LCA & IA are paralyzed

-VFs in abducted position

21
Q

Management of Bilateral VF Paralysis

A
  1. Tracheostomy for safe swallow

2. AC medial rotation

22
Q

Unilateral VF Paralysis Causes:

A
  • Unilateral RLN injury
  • idiopathic
  • tumor, trauma, etc
23
Q

SLN paralysis:

Effect on phonation:

A

inability to raise pitch
decreased pitch range
decreased VF closure

24
Q

SLN Perceptuall charactersitics

A

decreased habitual pitch
breathiness
decreased pitch and intensity ranges

25
Q

Vocal Fold Paresis causes….

A

inadequate VF closure

26
Q

Signs of Presbyphonia or Presbylaryngis

A
  • decreased innervation
  • muscle atrophy = hypotonicity
  • stiffer, thinner mucosa in males
  • thicker, edematous mucosa in females
  • ossification of cartilages
  • loss of collagen & elastin fibers
  • submucus glands atrophy
27
Q

Cause of Presbyphonia or Presbylaryngis

A

aging

28
Q

Spasmodic Dysphonia:

causes

A

CNS lesion – possibly basal ganglia and supplementary motor areas

29
Q

Spasmodic Dysphonia

Effects on phonation

A

Irregular, uncontrollable muscle movements disrupt VF vibration

30
Q

Spasmodic Dysphonia Types

A

Adductor
Abductor
Mixed

31
Q

In adductor SD, what happens?

A
  • VF adductors spasm periodically causing undesired hyperadduction.
  • Result is harsh, strained, strangled sound with obvious effort.
  • Most common.
32
Q

In abductor SD, what happens?

A

VF abductor spasms and abduct causing a breathy, hoarse, weak voice, decreased loudness is a problem

33
Q

Treatment of SD

A

Botox

34
Q

Essential Tremor causes

A

CNS lesion, likely extrapyramidal system

35
Q

Essential tremor is __________ in sustained phonation but___________ in speech

A

always present

can also be present

36
Q

Perceptual characteristics of Essential tremor

A

Tremor, frequency & intensity modulations
Voice stoppages
Strain – struggle
Harshness, monopitch

37
Q

Treatment of essential tremor

A
  • Voice therapy – Barkmeier-Kramer approach
  • Remediate muscle tension if present
  • Breath support
  • Pharmacological
38
Q

Differential Diagnosis of DS and vocal temror and MTD.

A
  1. Laryngeal palpation
  2. Laryngeal massage and teach supraglottic relaxation exs.
    - –If MTD, voice will improve significantly
    - –If tremor, tension / strain-strangle quality will decrease and only tremor will be present
    - —If SD, very little change will be observed.
39
Q

In differentiating between MTD and SD, MD is __________, SD is ______.

A

consistent

not.

40
Q

Cause of Pseudobulbar Palsy

A

Bilateral lesions in corticobulbar tract at level of internal capsule, midbrain or pons.

41
Q

Effects of Pseudobulbar Palsy on phonation

A
  • Laryngeal muscle weakness causing incomplete VF closure

- Laryngeal hyperactivity causing hyperadduction

42
Q

Treatment for Psedubulbar Palsy

A
  • easy onset phonation

- flow phonation, aspirated onsets, frontal tone focus, -adequate breath support.

43
Q

Perceptual Characteristics of Pseudobulbar Palsy

A
  • Breathiness
  • Strain / struggle
  • Harshness
  • Monopitch
  • Monoloudness
44
Q

Amyotrophic Lateral Sclerosis – ALS voice problems

A

hoarseness, harshness, strain/struggle, hypernasal, breathy

45
Q

Lesions to Basal Ganglia or other parts of extrapyramidal system:

A

Hyperkinesias

Hypokinesia

Comps (15 decks)

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