voice disorders Flashcards
What is a Hyperfunctional client?
muscle tension dysphonia, pressed voice, lesion
What is a hypofunctional client?
bretahy
Classifications of Voice Disorders
- Phonotrauma
- Organic
- Functional
- Psychogenic
- Neurological
Phonotrauma definition
results from misuse or abuse of the vocal mechanism
Organic definition
results from a disease process or may be congenital, i.e., cancer, acid reflux, laryngeal web etc.
Functional definition
Muscle tensions dysphonias
Psychogenic definition
results from an underlying psychological issue and presents no identifiable vocal pathology
Neurological definition
results from damage to the RLN or SLN, disease processes that affect these nerves, or brain injuries or lesions
Leukoplakia and Hyperkeratosis
Pre-cancerous lesions
- 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
Sulcus vocalis
- A longitudinal groove or indentation in the upper edge of the VFs that parallels the free margins
- may be caused by phootrauma, smoking, congenital
Laryngeal Cancer
- Globus sensation – ‘full feeling’ in throat
- May observe inhalatory stridor
- Throat pain, painful swallowing, problems swallowing, shortness of breath, halitosis
Three categories of phonatory dysfunction:
Adduction / Abduction problems
Stability problems
Coordination problems
Stability phonatory dysfunction
Parkinson’s, ALS
Essential Tremor
Coordination phonatory dysfunctio
Abductor Spasmodic Dysphonia
Adduction / Abduction problems
Vocal Fold Paralysis Vocal Fold Paresis SLN Paralysis Pseudobulbarpalsy Adductor Spasmodic Dysphonia Huntington’s Chorea
Paralysis in the adducted position causes
- Strained/strangled, monotone, low pitched, low volume voice w/ possible hypernasality
- Respiratory compromise due to decreased airway and stridor may be heard
Paralysis in the abducted position causes
- Aphonia.
* Lack of airway protection for swallowing
Management of Bilateral VF Paralysis
Abductor paralysis
- If airway is acceptable, wait and see if nerves spontaneously recover
- Cordectomy, Arytenoidectomy or VF lateralization
Causes of Bilateral VF Paralysis
Abductor paralysis
PCA is paralyzed
VFs in medial or paramedian position
Causes of bilateral Adductor paralysis
TA, LCA & IA are paralyzed
-VFs in abducted position
Management of Bilateral VF Paralysis
- Tracheostomy for safe swallow
2. AC medial rotation
Unilateral VF Paralysis Causes:
- Unilateral RLN injury
- idiopathic
- tumor, trauma, etc
SLN paralysis:
Effect on phonation:
inability to raise pitch
decreased pitch range
decreased VF closure
SLN Perceptuall charactersitics
decreased habitual pitch
breathiness
decreased pitch and intensity ranges
Vocal Fold Paresis causes….
inadequate VF closure
Signs of Presbyphonia or Presbylaryngis
- 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
Cause of Presbyphonia or Presbylaryngis
aging
Spasmodic Dysphonia:
causes
CNS lesion – possibly basal ganglia and supplementary motor areas
Spasmodic Dysphonia
Effects on phonation
Irregular, uncontrollable muscle movements disrupt VF vibration
Spasmodic Dysphonia Types
Adductor
Abductor
Mixed
In adductor SD, what happens?
- VF adductors spasm periodically causing undesired hyperadduction.
- Result is harsh, strained, strangled sound with obvious effort.
- Most common.
In abductor SD, what happens?
VF abductor spasms and abduct causing a breathy, hoarse, weak voice, decreased loudness is a problem
Treatment of SD
Botox
Essential Tremor causes
CNS lesion, likely extrapyramidal system
Essential tremor is __________ in sustained phonation but___________ in speech
always present
can also be present
Perceptual characteristics of Essential tremor
Tremor, frequency & intensity modulations
Voice stoppages
Strain – struggle
Harshness, monopitch
Treatment of essential tremor
- Voice therapy – Barkmeier-Kramer approach
- Remediate muscle tension if present
- Breath support
- Pharmacological
Differential Diagnosis of DS and vocal temror and MTD.
- Laryngeal palpation
- 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.
In differentiating between MTD and SD, MD is __________, SD is ______.
consistent
not.
Cause of Pseudobulbar Palsy
Bilateral lesions in corticobulbar tract at level of internal capsule, midbrain or pons.
Effects of Pseudobulbar Palsy on phonation
- Laryngeal muscle weakness causing incomplete VF closure
- Laryngeal hyperactivity causing hyperadduction
Treatment for Psedubulbar Palsy
- easy onset phonation
- flow phonation, aspirated onsets, frontal tone focus, -adequate breath support.
Perceptual Characteristics of Pseudobulbar Palsy
- Breathiness
- Strain / struggle
- Harshness
- Monopitch
- Monoloudness
Amyotrophic Lateral Sclerosis – ALS voice problems
hoarseness, harshness, strain/struggle, hypernasal, breathy
Lesions to Basal Ganglia or other parts of extrapyramidal system:
Hyperkinesias
Hypokinesia
