Week 9 Flashcards by Lillie Parker

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

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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

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Etiology of muscle tension dysphonia?

Effortful manner of phonation
Idiopathic
Counterproductive compensation

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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

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What are the anatomic changes of muscle tension dysphonia?

There are none.

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What are the anatomic changes of edema?

Swelling and stiffening of medial edge of membranous portion of the vocal folds

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Etiology of edema?

Effortful manner of phonation

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What are the voice symptoms of edema?

Roughness
Breathiness
Voice and pitch breaks
Reduced pitch and loudness range

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What are the anatomic changes of hyperemia/hemorrhage?

Collection of blood under the skin

Stiffness of cover

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Etiology of hyperemia?

Effortful manner of phonation

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What are the voice symptoms of hyperemia?

Roughness
Breathiness
Intermittent aphonia
Reduced pitch and loudness range
Pain

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What are the anatomic changes of a vocal fold nodule?

Benign callous-like, fibrous mass
Primary striking zone
Starts off swollen

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Etiology of a vocal fold nodule?

Effortful manner of phonation

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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

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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

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Etiology of a polyp?

Effortful manner of phonation
May develop into Reinke’s edema
Could be caused by a virus

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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) ```