f&vd final

includes all of the lectures that were on quiz 4 and after, and a couple terms from quiz 3. i have a study set for that material too :)

dysphonia

altered quality, pitch, loudness, or increased effort

aphonia

loss of voice

vocal fatigue

client perceives an increase in phonatory effort over time that may be accompanied by decreased phonatory function

globus sensation

feeling like something is in your throat

fixed abduction or adduction

when the vocal cords are stuck and cannot move (abduction = open, adduction = closed)

dyspnea & what are 2 potential/primary causes

feeling out of breath due to interference of airflow due to…

1. vocal pathology

2. uncontrolled adduction or abduction obstructing the airway

odynophagia

pain when swallowing

sharp pain

pain at other times besides odynophagia

vocal fold bowing & two causes

inward curvature of vocal fold due to lost muscle bulk caused by aging or nerve damage

vocal fold paresis

weak vocal fold movement

organic voice disorders

due to detectable physical or biochemical changes within cells, tissues, or organs

lesion

damage or abnormal change in tissue

neoplasm

growth of new tissue, either benign or cancerous

two subtypes of organic voice disorders

structural and neurogenic

organic structural voice disorders

something is physically wrong with the vocal mechanism’s laryngeal or velar structure, due either to lesions in tissue or joint tissue

examples of potential causes of organic structural voice disorders

phonotrauma, medical conditions, birth defects, puberty, smoking

organic neurogenic voice disorders

problems with central or peripheral nervous system innervation due to larynx causing trouble with motor movement and muscle tone

examples of potential causes of organic neurogenic voice disorders

neurological diseases, infectious diseases, growths, tumors

velopharyngeal disfunction

insufficient velopharyngeal closure resulting in a leakage of air to the nasal cavity; causes resonance voice disorders

3 causes of VPD

velum deformed due to congenital disorder, doesn’t close due to neurological disorder, or velum is normal but client is not using habitual sufficient velopharyngeal closure

examples of things that cause medical trauma

surgeries, medical procedures, intubation damage, injury, burn, excessive emotional stress

functional voice disorders

vocal mechanism being used inappropriately even though the physical structure is normal

what do voice alterations due to changes in vocal fold vibration cause

changes in quality and pitch

what do voice alterations due to changes in airflow through vocal cords cause cause

changes in quality and loudness

5 categories of organic disorders

1. growths — neoplasms

2. lesions

3. potential or established disease

4. chronic congenital & acquired

5. related to development/changes across lifespan

3 types of voice issues — growths

1. vocal nodules

2. vocal polyps

3. vocal cysts

4 types of voice issues — lesions

1. laryngeal hemorrhage

2. reinke’s edema

3. contact ulcers

4. sulcus vocalis

2 types of voice issues — potential or established diseases

1. laryngeal leukoplakia

2. laryngeal cancer

two types of chronic congenital and & acquired voice issues

1. laryngeal papilloma

2. laryngeal web

5 types of voice issues related to development/lifespan

1. laryngeal ankylosis

2. presbyphonia

3. puberphonia

4. laryngomalacia

5. VPD

vocal nodules

white soft growth that becomes hard, thick and fibrous like a callous

vocal polyps

blister filled with fluid or blood. can be directly on vocal fold usually at the midpoint (sessile), or attached by a separate piece of tissue (pedunculated)

vocal cysts

blockage in the glandular duct causing retention of mucus or blood

laryngeal hemorrhage

ruptured blood vessels in the submucosal layer of vocal folds (superficial lamina propria). often due to an acute event and increased risk if on blood thinners

reinke’s edema & alternate names for it

aka polypoid corditis, or if extreme called polypoid degeneration; buildup of fluids or polyps in the superficial lamina propria, which causes edema or swelling of the vocal folds

contact ulcers & what’s associated with it

aka laryngogranuloma; an open sore. leaves a bitter taste in mouth and causes odynophagia or sharp pain during coughing or throat clearing

sulcus vocalis

groove in the development or a narrow cut in the vocal fold

laryngeal leukoplakia

white plaque-like lesions and red patches; can be precancerous

laryngeal cancer

aka carcinoma; it can metastasize

laryngeal papilloma & two ways it can be contracted

benign tumor with wart-like bumps. chronic so it can reoccur

HPV 6 and 11 through skin or STD; congenital through mother’s amniotic fluid or infected area that makes contact during the birth process

laryngeal web & symptoms

sheet of tissue over the vocal folds, that can grow back if removed

stridor, shortness of breath, difficulty swallowing, weak cry in infants, higher pitch

laryngeal ankylosis & 2 typical causes

abnormal stiffening and immobility of the cricoarytenoid jount, that can causes fixed addiction, fixed abduction, dyspnea & odynophagia

typically caused by:

1. arthritis/joint disease

2. intubation

presbyphonia

voice issues that occur due to aging changes & anatomical changes. especially loss of muscle mass, muscle strength, and vocal folds becoming thinner, drier and less pliable (vocal atrophy)

puberphonia — organic & causes

remaining prepubescent voice after puberty

congenital laryngeal anomalies, underdevelopment, changes in hormonal development, debilitating disease during puberty

laryngomalacia

malformation of infraglottal tissue, where tissues fall over airway opening, partially blocking it

must resolve without surgery by 18-20 months

three kinds of organic neurogenic disorders, and what can cause them

1. essential tremor — caused by neurological disease or condition

2. spasmodic dysphonia — caused by neurological disease, condition, or acute event

3. unilateral/bilateral vocal fold paresis/paralysis — caused by neurological disease, condition, or acute event

essential tremor & what causes it

shake in the voice. due to involuntary movements of any muscles related to voicing — intrinsic laryngeal, extrinsic laryngeal, pharyngeal, chest wall, abdomen, diaphragm.

disorder is about movement

spasmodic dysphonia & 3 kinds

aka laryngeal dystonia; spasms or jerking movements due to muscle contractions or abnormal fixed postures. may see tremors in other parts of the body as well as in the voice

1. abductor

2. adductor

3. mixed (both)

the disorder is about movement

vocal cord paresis/paralysis & two types for both

weak or lack of movement of the vocal cords

may see vocal fold bowing, and there’s a unilateral type and a bilateral type. unilateral is more common

two kinds of functional use voice disorders

1. inappropriate use

2. psychogenic reasons

two kinds of inappropriate use functional disorders

1. muscle tension dysphonia

2. ventricular phonation

two kinds of psychogenic functional disorders

1. conversion aphonia

2. puberphonia

muscle tension dysphonia

habitual use of excessive muscle tension or constriction; aka functional dysphonia

ventricular phonation

habitual use of the false or ventricular folds during phonation

conversion aphonia

aphonia due to manifestation of stress, depression, or anxiety due to traumatic experience. aka psychogenic aphonia

this is a disorder of movement

puberphonia — functional & 3 possible causes

result of habitual use of a higher pitch or falsetto register. voice sounds the same as the type due to organic reasons

Possible causes:

1. resistance to pubertal changes

2. Difficulty accepting change of voice

3. voice does not match identity

4 specific voice qualities that often face misperception

1. glottal fry

2. upspeak

3. high pitched/nasal voice

4. monotone voice

glottal fry — definition and misperceptions

use of a low, gravely, crackly sounding voice

may be perceived as sexy, edgy or with the time; lazy or immature in the business world/a different generation

upspeak — definition and misperceptions

tendency to raise pitch of voice at the end of a sentence regardless of whether or not it’s a question

may be perceived as contemporary, immature, less confident & less intelligent

high pitched or nasal voice — definition and misperceptions

use of a higher pitch or a denasal/hypernasal voice

may be perceived as immature, less authoritative, less “manly”

monotone voice — definition and misperceptions

use of a vocal tone with no change in pitch or inflection

may be perceived as bored/disconnected, lacking enthusiasm, lacking concern

percentage of people affected by voice disorders and percentage that seek treatment

3-9% of the US population; however, less than 1% seek treatment

Populations that experience higher incidence

1. Female adults

2. Male children

3. Elderly adults

4. Professions who speak for long periods of time

Prevention — what three things to do

1. provide prevention information to individuals and groups; both those who are at a higher risk of them & those who work with those at risk

2. refer clients in need of medical or psychological intervention

3. Remain informed of best practices in vocal health

advocacy — what two things to do

1. support clients with voice disorders or clients who desire voice modification — give them a voice

2. remain informed of research in the area of voice — knowledge is power

4 kinds of assessment types

1. observable and measureable physiological

2. measureable phsyiological

3. auditory

4. self-assessment

flexible endoscope

long tube with camera and light. bendable so it can go in harder to reach areas of the body such as the nose; less steady, so less clear picture. in real time

rigid endoscope

steel metal rod which functions much like a periscope (camera). steady clearer picture. in real time

videostroboscopy

controlled high-speed flashes of light timed to the frequency of the patient’s voice. images acquired during these flashes provide a slow-motion like view of vocal fold vibration during sound productions, which increases ability to see function in movement, but not in real time

three kinds of observable measureable assessments

indirect laryngoscopy, flexible fiberoptic laryngoscopy, videostroboscopy

indirect laryngoscopy — what kind of assessment is it, who can perform it what what does it do

Observable measurable

ENT or SLP with specialized training

can observe only — uses a small long-handled mirror and a light placed on the roof of the mouth

flexible fiberoptic laryngoscopy — what kind of assessment is it, who can perform it what what does it do

Observable measurable

ENT or SLP with highly specialized training

observe and record a video of function; video playback is in real-time, and can produce consonants and vowels since the tube is up the nose

videostroboscopy — what kind of assessment is it, who can perform it what what does it do

observable measurable

ENT or SLP with highly specialized training

observe and record a video of a function, can be with a rigid or flexible tube. goes down the throat; so it’s closer to the VF; video shows a slow-motion movement of the VF, which makes it the best determiner of VF function and movement. can only produce vowels

measurable assessments — four paramaters (ARAM) and what specialist can perform then

1. aerodynamic (respiratory)

2. resonatory

3. acoustic (pitch/intensity)

4. muscular

1-3: ENT or SLP who has the equipment

4: neurologist or MD

measurable aerodynamic — what they measure (4 things) and instruments (3) — VBSA, think s&hs

measures vital capacity, breath support, subglottal air pressure, and airflow;

dry spirometer, pneumotachograph, wet spirometer

measureable resonatory — what is measures and instrument (only 1 for each)

measures nasality through nasometer

measurable acoustic — what it measures (4 things) and instruments (2) — think speech & hearing science stuff

measures fundamental frequency, frequency/pitch instability (jitter), amplitude or intensity instability (shimmer), or percentage of voiced/voiceless

instruments are spectrogram & visipitch

measurable muscular — who can perform it and how is it achieved

neurologist or MD

through a procedure such as an electromyography (EMG) — observes the movements of the laryngeal muscles by recording electrical activity through electrodes on the skin and inserted in the muscle

auditory-perceptual assessment: who performs it, what is its method, and what are its tools

performed by an SLP

method is that SLP listens and makes clinical judgements

tools are checklist-like exams, that organize the information to give normative data, such as the buffalo voice profile III and the consensus auditory perceptual evaluation of voice (CAPE-V)

auditory perceptual assessments: three general parameters

respiration, resonation, and phonation

auditory-perceptual — respiration and resonation — how are they measured?

respiration: observe breath support and endurance during phonation measurements

resonation: read passages with and without nasal sounds; compare them and see if there’s a difference

auditory-perceptual — phonation — how is it measured? (4 ways)

1. maximum phonation time: how long can a vowel be sustained (male 25-35 seconds, females 15-25 seconds)

2. s/z ratio: how long can /s/ and /z/ be sustained; should be a ratio of 1, and greater than 1.4 = reduced function, which means there’s an air leakage

3. dynamic range: gradually count from 1-10 with volume ranging from low to high and high to low

4. singing up and down the scale: determine pitch and pitch range

self assessment — who can perform it, and how

client and SLP

client — fill out answers to questionnaire/survey (e.g. voice handicap index) to determine symptoms, characteristics, habits, and severity of voice issues

SLP — look over the client’s responses and determine the impact their voice is having on their lifed

diagnosis — what can ENT/other professional do vs SLP

ENT: medical diagnosis; specific kind of disorder

SLP: presence of a disorder, and severity of the disorder

prognosis — who can do it and what should be considered for it

any professional; considers components like need for medical intervention, overall health, awareness, willingness to change, family, etc.

four kinds of nonrehabilitative intervention

1. medical management

2. hormone therapy

3. surgery — only for when issue does not respond to medical management or rehabilitation

4. post-operative care

medical management: definition and when it is used (6 things)

treating the medical condition causing the voice disorder

used for situations such as diseases, infections, reflux, allergies, smoking cessation, neurological conditions

hormone therapy: who receives it

for someone who wants to achieve a more masculine sounding voice. testosterone will cause the larynx to make changes by thickening and lengthening the vocal folds; this cannot be uses for someone who wants to achieve a more feminine voice through estrogen

surgery — removal of lesions — purpose and methods (2)

removal of noncancerous, precancerous, or cancerous lesions

methods:

1. microsurgery, with surgical instruments

2. laser surgery, with lasers

surgery — removal of the larynx — what is it and why

a laryngectomy; removing the larynx when cancer cannot be treated with surgery or radiation

surgery —medialization — purpose (helps 4 things) and methods (3)

purpose: to help close the glottis for…

1. atrophy

2. v.f. bowing

3. scarring

4. neurological disease

methods:

1. arytenoid adduction; rotate cartilage

2. medialization laryngoplasty (thyroplasty; placing an implant between the thyroid cartilage and VF

3. injection laryngoplasty; injecting a gel-like substance into one VF to make it closer to the other VF

surgery — lateralization— purposes (2) and methods (3)

Purposes:

1. to increase lateralization (opening) of the glottis for bilateral vocal fold paralysis and laryngeal ankylosis

2. To decrease abnormal movement/spasms that cause adduction for spasmodic dysphonia

Methods:

1. arytenoidectomy — widens the space

2. vocal fold cordotomy — incision of one or both VF to widen the airway

3. botox injections — to decrease muscle spasms

surgery — nerve reinnervation — purpose and method

to improve adduction or abduction that is affected by paralysis, paresis, or spasm

regenerates the nerves that innervate the laryngeal muscles where a healthy nerve is moved from a different area of the neck to replace the damaged vocal cord. can take as long as 6-9 months to see improvement

surgery — altering tension and length — purposes and methods (3 - 2 increase, 1 decreases)

changing the length, depth, and tension of the VF by elongating or shortening the laryngeal area, which alters the pitch due to an organic issue or someone who wants voice modification

methods for increasing pitch:

1. cricothyroid approximation — sutures cricothyroid in a permanent position of contraction to increase tension

2. anterior glottal web formation — creates a web or scar band at the front of the VF to increase tension

method for decreasing pitch: laryngoplasty; changing shape of thyroid cartilage which decreases tension and stretching of the VF

surgery — reconstruction — purposes (2) and method

Purposes:

1. surgically correcting tissue loss/malformation

2. changing larynx for appearance preference (e.g. tracheal shave)

Method: surgery to change shape or size of larynx

post-operative care, definition and 2 things it may include

protocol that client follows after the surgery

may include:

1. medical regiment

2. vocal rest; which includes not laughing, crying, etc.

3 kinds of rehabilitative intervention

1. indirect therapy: modify cognitive, behavioral, psychological, and physical environments where client uses their voice

2. collaboration: collaborate with relevant professionals

3. direct therapy: focus on manipulation the voice — respiration, phonation, resonation to modify vocal behaviors and establish healthy voice production

indirect therapy: two kinds

1. patient education: discussing things like a&p of the voice, their pathology, vocal hygiene, optimal voice use

2. counseling: addressing things like lifestyle changes, managing best vocal production practices, talking feelings and attitudes, etc.

positive changes that indirect therapy may focus on

preventing phonotrauma/abuse, reducing pathology to promote self-healing, minimizing need for surgery, prevent recurrent pathology

collaboration: who would we collaborate with for…

All

Any organic

Neurogenic

Functional-psychogenic

Trangsgender voice modification

All: ENT
Any organic: pulmonologists, respiratory specialists, endo, genetic counselors, allergists…

Neurogenic: neurologist

Functional-psychogenic: psychologist/psychiatrist/trauma counselor

Trans voice mod: specialty endo, ENT, psychology, surgeon