Week Eight

Question 1

What is culture?

Answer 1

A set of customs, beliefs or practises of a group

Question 2

What is identity?

Answer 2

A set of physical, psychological, and interpersonal characteristics that is not wholly shared by another person

Question 3

What is intersectionality?

Answer 3

A framework for understanding how a number of identity markers can interact and compound as multiple forms of oppression in people, groups, or social problems

Identify markers:
- Race
- Class
- Gender
- Ethnicity
- Sexuality
- Religion
- Disability

People can have multiple identity markers that can effect inequities; for example, Māori with disabilities had poorer health outcomes than Māori without disabilities

Question 4

What are three main pathways of health inequities?

Answer 4

1. Differential access to the determinants of health
   - education
   - employment
   - housing
   - income
2. Differential access to healthcare
   - cost
   - geographical
3. Differences in quality of healthcare recieved

Question 5

What is implicit bias?

Answer 5

A form of bias that occurs automatically and unintentionally that affects judgments, decisions, and behaviours

Question 6

How can you retrain implicit bias?

Answer 6

• Individuate: see people as individuals rather than stereotypical members of their ethnic or social groups
• Try to see things from the perspective of the person who is being stereotyped
• Mix with members of other groups
• Expose yourself to media that aims to breakdown prejudices and discrimination
• Treat people as individuals but also as part of the whānau

Question 7

What is phonotrauma?

Answer 7

• Behaviours thought to contribute or cause voice problems

-Behaviours that impair the phonatory mechanism’s capacity to work effectively and efficiently

• More intense = more likely to cause issues

Question 8

What are some characteristics of vocal behaviours categorized as misuse?

Answer 8

1. Increased tension or strain
   - Hard glottal attack
   - High laryngeal position
   - Anteriorposterior laryngeal squeezing
2. Inappropriate pitch level
   - Puberphonia
   - Persistant glottal fry
   - Lack of pitch variability
3. Excessive talking
4. Ventricular phonation
5. Aphonia and dysphonia of psychological origin

Question 9

What is a glottal attack?

Answer 9

Rapid and complete adduction of VFs before initiation of phonation

Question 10

What is the effect of laryngeal height?

Answer 10

Higher laryngeal position can happen in conjunction with raising pitch
- Shortening of vocal tract
- Tensing of VFs
- Tight adduction

Consistently high or low position suggests excessive energy to maintain that position

Question 11

Anterior posterior laryngeal squeezing effects

Answer 11

Squeezing of the larynx
- Arytenoid to epiglottis

Elevating pitch and high front vowels typically separate these laryngeal structures
- tight laryngeal posture with anteroposterior shortening maintain this position during these activities
- May exhibit reduced phonational range/inability to raise pitch

Question 12

What is puberphonia?

Answer 12

High pitched voice beyond age of expected change

Predominantly a problem for males

Must first rule out presence of endochrinological factors
-Pituitary gland or adrenal gland hypofunction
- Sex hormomes

Question 13

What is vocal fry?

Answer 13

• Using lowest vocal register (20-70Hz)
• Tightly adducted vocal folds with increased thyroarytenoid tension
• Short, thick vocal folds
• Reduced rate of airflow and subglottic air pressure
• Multiple openings of the vocal folds, followed by a lengthened closed phase

Question 14

What is lack of pitch variability?

Answer 14

percieved as lacking energy or interest

Question 15

What is ventricular phonation?

Answer 15

• Excessive movement of the false Vfs towards midline during phonation
• Low in pitch, hoarse, diplophonic, rattly, reduced intensity

Can occur to:
- psychogenic dysphonia
- Compensation for poor VF closure
- Component of hyperfunctio
- Unexplained phenomenon

Question 16

What are adaptive dysphonias?

Answer 16

• Vocal behaviours that reflect a patient’s attempt to deal with provocation or stressors (psychological or physiological)

Question 17

What are some vocally traumatic behaviours?

Answer 17

• Excessive prolonged loudness
• Strained excessive use during period of swelling, inflammation, or other tissue changes
• Excessive coughing or throat clearing
• The screamer or noise maker
• Sports and exercise enthusiast

Question 18

What are nodules?

Answer 18

• A reaction of VF tissure to stress induced by frequent hard oppositional movement of the VFs
• Starts as localised VF edema, the soft, red, pliable small nodules. Older nodules are typically white, hard, thick and fibrosed.
• Usually bilateral
• Often mistaken for polyps and vice versa (polyps often bigger and more red)
• Signs/symptoms: sensation of something to clear in throat, hoarseness, reduced phonational and dynamic range. Increased s/z ratio
• Physiologic signs: absence of muscosal wave at nodule site; hourglass closure
• Pathophysiology: affects mass and possibly stiffness of VFs. Glottal closure may result in air escape/breathiness

Question 19

What is a polyps?

Answer 19

• Inflammatory benign tumour in Reinke’s space
• Usually unilateral
• Pedunculated vs sessile
• Do not respond to therapy - require surgery
• Signs/symptoms: sensation of something to clear in throat, hoarseness. Greater severity of dysphonia than nodules
• Physiologic: absence of muscosal wave at site; irregular closure pattern; movement of poly[
• Pathophysiology: affects mass and likely decreases stiffness due to soft and pilable broad area. Glottal closure may result in air escape/breathiness

Question 20

What is a intracordal cyst?

Answer 20

• Blockage of glandular duct and retention of mucous
• Often unilateral

Different types:
- retention
- epidermal
- pseudocysts

• Symptoms
• lowered pitch, hoarseness, decreased phonational range

Question 21

What is edema?

Answer 21

-Build up of fluid: occurs primarily in the superficial layer of the VFs

• When it occurs in the first layer of the lamina propria, it’s called Reinke’s edema
• Reinke’s edema associated with smoking

Signs:
- lowered pitch, hoarseness, sometimes shortness of breath

Question 22

What is laryngitis?

Answer 22

• Inflammation of larynx and vocal folds
• Inflammatory conditions referred to laryngitis:
• Reflux laryngitis
• Acute laryngitis
• Non-infectious laryngitis
• Chronic abuse —> chronic laryngitis —> persistent inflammation and drying and thickening of VFs
• Can lead to tissue damage such as nodule/polyps

-Signs:
- hoarseness and dryness, difficulty achieving a loud voice, increased jitter and shimmer, reduced phonational range

• Physiologic: redness, inflamed folds in acute laryngitis, thick and dry epithelium
• Pathophysiology: increased stiffness but no chnages in mass of folds

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Question 23

What is sulcus vocalis?

Answer 23

• Furrow along upper medial edge of VFs
• Uncertain cause (congenital, developmental, traumatic)
• Signs: hoarseness, breathiness, reduced phonational range

-Physiological: depression or line on upper edge of the fold, unilateral or bilateral. Reduced mucosal wave

Pathophysiology: decreases mass and increases stiffness