Voice disorders NEW

Question 1

What causes muscle tension dysphonia?

Answer 1

Muscle tension caused by inefficient use of vocal musculature usually in high voice users/people with high stress.
* Causes tension/over activation of adductor (and sometimes abductor) muscles.
* This leads to too much force at onset of voice
* MTD can be compensatory / secondary to an organic / neurological voice disorder.

Question 2

Characteristics of muscle tension dysphonia

Answer 2

● Palpable tension - can feel the tension
● Worsens with use
● Improves with rest
● Would expect to hear strain and roughness, possibly breathiness
● At vocal cord level would see a squash of the vocal folds, muscle tension / constriction, minimal flexibility.
● Improvement in vocal quality observable with therapy trials

Question 3

What is the onset of MTD?

Answer 3

Gradual

Question 4

What causes vocal fold paresis / paralysis?

Answer 4

● A viral infection - often recovers within 6-12 months (usually caused by a viral infection which can take 6-12 months to leave the body)
● A result of surgery (e.g. thyroidectomy)
● Injury to one or both superior laryngeal or recurrent laryngeal branches.
● Paralysis/paresis of cricothyroid muscle
● Not generally caused by tumours pressing on the nerve

Question 5

Characteristics of vocal fold paresis / paralysis

Answer 5

● Aspiration
● Shortness of breath / breathiness
● An unusual amount of effort/exertion
● Strider in voice
● Unable to change pitch
● Symptoms may only occur in some challenging acoustic contexts e.g. when speaking over background noise, when giving a presentation
● May have surrounding muscular pain - compensation to try to bring the vocal folds together
● Observable & often palpable laryngeal tension
● s:z ratio (<1:1.40 i.e. unable to hold the voiced ‘z’ sound indicates a vocal fold pathology/lesion as it requires VF vibration)

Question 6

What is the onset of vocal fold paresis / paralysis?

Answer 6

Sudden

Question 7

What causes presbyphonia?

Answer 7

• Not strictly a VD - part of aging
• Gradual onset but can be accelerated by decrease in vocal load. Eg Due to:
• Retirement
• Loss of a partner resulting in decreased talking at home
• Increased stress e.g. a sick partner
• Injury resulting in hospital stay and decreased participation in usual activities
• Relates to idea of ‘Use it or Lose it!’

Question 8

Characteristics of presbyphonia

Answer 8

• Primary symptom = a change in voice quality. Voice may sound quieter, breathier, hoarse or less clear.
• Can lead to reduced communication, lower QoL and reduced participation in social activities.
• Looser/thinner vocal folds can contribute to a loss of tissue bulk, resulting in the characteristic bowed appearance of glottic closure patterns seen clinically in patients with presbyphonia.
• Consider whether the client has developed secondary MTD in an attempt to adduct atrophied/bowed vocal folds.

Question 9

What is the onset of presbyphonia?

Answer 9

Gradual onset but can be accelerated by decrease in vocal load