Voice Disorders

Question 1

During production of /s/ the airflow is modulated. True or false?

Answer 1

False. Airflow is unmodulated during production of /s/.

Question 2

At what age does vocal differentiation begin?

Answer 2

6-12 years

Question 3

At what age does differentiation actually exist?

Answer 3

After 15, (basically after puberty) differentiation exists

Puberty 12-14 females and 13-15 for males

Question 4

How is the larynx of an infant different from the larynx of an adult?

Answer 4

The infantile larynx is softer, more pliable, and proportionally smaller in relation to the size of other structures and lies in a relatively higher position in the neck than its adult counterpart.

Question 5

The airflow duration of /s/ should be longer than the airflow duration of /z/ if the vfs are completely normal and healthy. True or false?

Answer 5

False. Airflow duration should be the same for the production of /s/ and /z/ if the vfs are normal and healthy.

Question 6

What conclusion would you come to if your client scored 1.4 or 1.6 or above on s/z ratio test?

Answer 6

There is likely a vf abnormality.

Question 7

If the /z/ duration is significantly shorter than the /s/ duration then that is indicative of ______.

Answer 7

A glottal pathology growing on your vfs that is keeping you from being able to bring the other fold close to it or keeping you from being able to move it and make some airflow go away.

Question 8

If you notice air escaping or air loss during /z/ production that must mean that the phonatory mechanism is functioning effectively. True or false?

Answer 8

False. If the phonatory mechanism is functioning effectively there should be no air escaping or air loss. All airflow should be enacted in vf vibration.

Question 9

What is the purpose of examination by the ENT?

Answer 9

• Primary identification of laryngeal pathology is the responsibility of ENT
• For ethical and legal protection you should refer all pts to ENT prior to beginning therapy but…..

—Evaluation is not complete until medical Dx from otolaryngologist has been made

—Keep in mind that there are some cases where any delay in medical examination could potentially be life threatening

Question 10

What is Rigid fiberoptic oral endoscopy (RFOE)?

Answer 10

• Performed with a rigid tube inserted into the oral or pharyngeal cavity.
• –has a prism optic system that projects high-intensity light at a predetermined angle illuminating the structures to be observed and recorded.

Question 11

What are the advantages of Rigid fiberoptic oral endoscopy (RFOE)?

Answer 11

high illumination, wide field of view, and excellent image reproduction.

Question 12

What are the disadvantages of Rigid fiberoptic oral endoscopy (RFOE)?

Answer 12

interference with normal speech production and minor patient discomfort.
–More potential for gagging.

Question 13

What is Flexible fiberoptic nasendoscopy (FFN)?

Answer 13

• Performed with a flexible nasendoscope inserted through the nasal passage.
• –High-intensity light, transmitted by a fiberoptic bundle, illuminates structures to be viewed and/or recorded.

Question 14

What are the advantages of the Flexible fiberoptic nasendoscopy (FFN)?

Answer 14

Excellent image of the vocal folds and velopharyngeal structures during voicing, conversation, or singing, and potential for image recording and instant replay.
–Less possibility for gagging.

Question 15

What are the disadvantages of the Flexible fiberoptic nasendoscopy (FFN)?

Answer 15

Equipment expense and possible patient discomfort.

Question 16

What is continuous light method of viewing the vfs? Why might it not be as useful as stroboscopy?

Answer 16

Continuous light: a halogen light is used to illuminate the mechanisms you wish to view. Allows you to just look and see everything. However, the vfs move too quickly for the human eye to actually see the sequence of opening and closing. Therefore, stroboscopy is probably the best way to view the vfs.

Question 17

What is one of the main benefits of viewing the vfs through locked mode stroboscopy?

Answer 17

Locked mode: you are just getting the same picture, same part of cycle over and over again. Therefore, if the vfs are normal then you know to expect to see a periodic, still picture. If you see a highly aperiodic phase then you know that there is probably a glottal pathology.

Question 18

What is the difference between locked mode stroboscopy and walking mode stroboscopy?

Answer 18

Walking mode:
-you are doing an ongoing servoscapy so you see opening and closing and opening and closing

• if you want to see opening and closing of cycle of the person’s cycle use walking mode
• distinct shot of each cycle at a different location of each cycle till the sum of it looks like one opening and closing phase visually

Locked mode:
-you are just getting the same picture, same part of cycle over and over again.

• same piece from each phase so visually you’re just seeing the same picture still picture vs a moving picture
• Should be periodic to certain degree (should look like a still picture)
• allows you to see if phase looks highly aperiodic, thus indicative of glottal pathology

Question 19

According to Talbot’s Law, why does stroboscopy footage look like a continuos movement?

Answer 19

Stroboscopy takes a picture of a different portion of each cycle then puts it all together so it looks like one complete cycle,

According to Talbot’s Law, the picture stays a little longer on the retina even after you’ve gone on to next picture so it adds together and looks like a continuous movement because each picture adds to the next one.

Question 20

If the onset of your client’s voice problem was sudden then what are a few things you can assume?

Answer 20

the problem could be something highly remediable or it could be something that is more concerning like cancer.

Question 21

If there is difficulty breaking the pattern of a vocal issue, how long has the patient probably had the issue?

Answer 21

a long time; gradual onset

Question 22

Your client tells you their vocal challenge arrives at the beginning of the day. What is a probable cause of problem?

Answer 22

Reflux is most likely involved.

Question 23

If vocal problem arrives towards the end of the day what is most likely causing the problem?

Answer 23

Vocal abuse (excessive coughing or loudness), misuse (excess tension while talking), or overuse (excessive talking)

Question 24

Normal voice behavior that takes its toll with time (e.g., teacher of 40 years)

Answer 24

Vocal Overuse

Question 25

Abnormal vocal behaviors that cause stress or injury to the vocal folds (e.g., excess tension while speaking)

Answer 25

Vocal Misuse

Question 26

Normal vocal behaviors used in excess, leading to vocal fold injury (e.g., excessive loudness or cough)

Answer 26

Vocal Abuse

Question 27

Laryngitis sicca

Answer 27

Caused by inadequate hydration of the vocal folds.

Thick, sticky mucus prevents the folds from vibrating in a fluid, uniform manner.

Question 28

What are some possible causes of laryngitis sicca?

Answer 28

Dehydration

• Dry atmosphere
  * Mouth breathing
  * Medications with dehydrating side effects

Question 29

How could allergies contribute to vocal problems?

Answer 29

Allergies typically result in hyponasality and increased mucous on vocal folds.
In some cases vocal folds swell and pitch is reduced.
If someone with allergies takes antihistamines or steroids (generally the spray) can lead to fungal infections on the vfs like candidiasis.

Question 30

Difference between Laryngopharyngeal Reflux Disease (LPRD) and Gastroesophageal Reflux Disease (GERD)?

Answer 30

Some people have an abnormal amount of reflux of stomach acid up through the lower sphincters and into the esophagus.
This is referred to as GERD, or Gastroesophageal Reflux Disease.

For others, the reflux makes it all the way up through the upper sphincter and into the back of the throat
This is called LPRD, or Laryngopharyngeal Reflux Disease.

Question 31

Why would someone with LPRD be more at risk for vocal problems then someone with GERD?

Answer 31

The laryngeal area is much more sensitive tostomach acid and digestive enzymes, so smaller amounts of the reflux into this area can result in more damage.

Question 32

What are symptoms of LPRD?

Answer 32

Chronic cough
Adult onset asthma
Globus sensation
Pinpoint pain
Laryngospasm
Throat tickle (Frequent throat clearing)
Halitosis
Bad/bitter taste in mouth (Especially in morning)
Hoarseness
Voice fatigue
Belching
Increased drainage

Question 33

Why are mouth-breathers more at risk for glottal pathology than nasal breathers?

Answer 33

Mouth breathing could dehydrate the vfs and all kinds of allergens and pathogens are being breathed in, whereas nasal breathers have a filter system (nasal hairs).

Question 34

Why might it be helpful to have someone with a glottal pathology maintain a daily chart?

Answer 34

Could reveal lifestyle issues that could exacerbate vocal problem such as:

• eating fatty foods
• eating prior to sleeping (allow 3 to 4 hours)
• smoking
• Sleeping flat on back
• over eating
• wearing tight clothing
• bending over after eating
• overweight

Question 35

True or false: you can tell just by listening to someone’s voice what they have and what is causing their glottal pathology.

Answer 35

False, there could be a multitude of things that cause a glottal pathology but you can’t pinpoint the cause without also looking at the vocal folds.

Question 36

Mutational falsetto (puberphonia) therapy goals

Answer 36

Improve vocal quality
Lower pitch
Reduce excess tension
Educate

Question 37

Mutational falsetto (puberphonia) methodology

Answer 37

Extending the cough or throat clearing
Digital pressure to lower pitch
Yawn sigh
Laryngeal Massage

Question 38

What is mutational falsetto (puberphonia)?

Answer 38

High pitched, breathy voice that isn’t adaptable.

Question 39

Extended cough or throat clearing

Answer 39

Cough is typically representative of fundamental frequency
Explain to client that the vocal folds are able to produce a voice that is representative of their age and that you can help them achieve
Cough and then extend it to phonation
Have pt do it
Proceed through hierarchy