Week 9 Flashcards
What can you do without a medical diagnosis from an otolaryngologist?
-Complete a voice eval
You MUST refer pt for a laryngeal exam before starting therapy
Why would a pt come to an SLP first w/o going to an otolaryngologist? How can you help?
Some may be concerned that it is a fatal condition…
Offer to go with them
Etiology of muscle tension dysphonia?
Effortful manner of phonation
Idiopathic
Counterproductive compensation
What are the voice symptoms of muscle tension dysphonia?
Extraneous muscle activity in head, neck, and thorax Excessive or limited breath control Inappropriate loudness Pressed phonation Abrupt initiation of phonation Roughness Breathiness Stridency Intermittent aphonia
What are the anatomic changes of muscle tension dysphonia?
There are none.
What are the anatomic changes of edema?
Swelling and stiffening of medial edge of membranous portion of the vocal folds
Etiology of edema?
Effortful manner of phonation
What are the voice symptoms of edema?
Roughness
Breathiness
Voice and pitch breaks
Reduced pitch and loudness range
What are the anatomic changes of hyperemia/hemorrhage?
Collection of blood under the skin
Stiffness of cover
Etiology of hyperemia?
Effortful manner of phonation
What are the voice symptoms of hyperemia?
Roughness Breathiness Intermittent aphonia Reduced pitch and loudness range Pain
What are the anatomic changes of a vocal fold nodule?
Benign callous-like, fibrous mass
Primary striking zone
Starts off swollen
Etiology of a vocal fold nodule?
Effortful manner of phonation
What are the voice symptoms of a vocal fold nodule?
Roughness Breathiness Stridency Abrupt initiation of phonation Pressed phonation Intermittent aphonia Reduced pitch and loudness rand Deterioration of voice quality with prolonged speaking
What are the anatomic changes of a polyp?
Fluid filled sac on medial egde of the midmembranous portion
Sessile - broad based sac
Pedunculated - a thin stem
Etiology of a polyp?
Effortful manner of phonation
May develop into Reinke’s edema
Could be caused by a virus
What are the voice symptoms of a polyp?
Roughness Breathiness Intermittent aphonia Reduced pitch and loudness range Voice breaks
What are the anatomic changes of a VF cyst?
fluid or semisolid material in a sac
Increase voval fold stiffness
May protrude vocal fold margin
Etiology of cyst?
Effortful manner of phonation
Reflux
Upper respiratory infection
Congenital or acquired
What are the voice symptoms of a cyst?
Roughness Breathiness Vocal fatigue Intermittent aphonia Reduced pitch range
What are the anatomic changes of Reinke’s edema?
Translucent, gelatinous lesion
Length of membranous portion
Etiology of Reinke’s edema?
Effortful manner of phonation
Smoking
Reflux
Hypothyroidism
What are the voice symptoms of Reinke’s edema?
Lowered pitch roughness breathiness stridency Intermittent aphonia Reduced pitch range
What are the anatomic changes of sulcus vocalis?
Unilateral or bilateral furrow
Stiffening
Etiology of sulcus vocalis?
Unclear Congenital Develop with rupture of cyst Follows a hemorrhage Effortful manner of phonation
What are the voice symptoms of sulcus vocalis?
Roughness
breathiness
Intermittent aphonia
Higher than normal pitch
What are the issues associated with changes in the larynx because of neurological disease?
VF bowing
Paresis or paralysis
Spasmodic dysphonia
What are the changes in physiology in VF bowing?
Low tone
Weakness in membranous portion
Muscular atrophy
Etiology of bowing?
Parkinson’s
Aging
Effortful manner of phonation
What are the voice symptoms of bowing?
roughness breathiness stridency intermittent aphonia monopitch/monoloud
What are the changes in physiology in paresis/paralysis?
Reduced adduction and abduction of VFs
VF flaccidity
Etiology of paresis/paralysis?
Damage to recurrent laryngeal nerve
Nerve may regenerate
Viral infection
Stroke
What are the voice symptoms of paresis/paralysis?
Roughness breathiness intermittent aphonia reduced pitch and loudness range shortness of breath weak, ineffective cough difficulty protecting the airway
What are the two types of spasmodic dysphonia (SD)?
Adductor SD
Abductor SD
What are the changes in physiology for SD?
Involuntary adduction or abduction of VF during speech
Etiology of SD?
Idiopathic
Trauma
Genetic
voice symptoms of SD?
Short term variations in severity
Overally severity stabilizes
action induced
Symptoms diminish with sensory tricks
Add
- strain strangled voice
- roughness
- excessive effort
Abd
- Breathy voice breaks
- Intermittent aphonia
- reduced loudness
- Roughness
- Breathiness
Voice symptoms of laryngeal cancer?
Inhalatory/exhalatory stridor Shortness of breth Intermittent aphonia Roughness Breathiness Stridency Reduced vocal pitch and loudness range Dysphagia
What are the anatomic changes of paradoxial VF motion?
Adduction VFs during inhalation
Posterior diamond shaped chunk
Etiology of paradoxical VF motion?
Idiopathic Reflux exercise Irritants Effortul manner of phonation
What is paradoxical VF motion typically misdiagnosed as?
Asthma
Differential diagnosis
- Asthma difficulty expiring air
- PVFM difficulty inspiring
Voice symptoms of PVFM?
Dyspnea- shortness of breath Wheezing on inhalation Tightness in throat Cough Occurs during sport (affects athletes)
