Voice and Resonance Disorders: Practice Quiz 5

Special Populations

Presbyphonia is associated with

• predominance of the closed phase of vibration

• voice that is worse at the beginning of the day

• posterior glottal gaps

• reports of reduced health-related quality of life

reports of reduced health-related quality of life

Match the presbyphonia terms to their definition. (Age-related loss of muscle strength, power, Age-related loss of muscle mass)

• Sarcopenia

• Dynapenia

Sarcopenia —> Age-related loss of muscle mass

Dynapenia —> Age-related loss of muscle strength, power

Presbyphonia includes common auditory-perceptual and laryngeal features. A common glottic configuration for clients with presbyphonia is

• hourglass-shaped

• spindle-shaped

• posterior gap

• anterior gap

• none of the above

spindle-shaped

Some voice changes are considered a normal part of aging.

• True

• False

True

Adults over the age of 70 years are more than twice as likely than those under the age of 70 years to be diagnosed with a voice disorder.

• True

• False

True

Voice therapy should be attempted before laryngoplasty or thyroplasty in the management of presbyphonia.

• True

• False

True

Young adults have a better than chance ability to estimate a speaker’s chronological age within 1 year.

• True

• False

False- But studies indicate that they can estimate age well within 5-10 years.

Hoit and Hixon (1987) found that older people start speaking after taking a ___ breath than younger participants and had ___ syllables in their speech, which supports their report that it takes more energy to speak.

• smaller, fewer

• smaller, more

• larger, fewer

• larger, more

larger, fewer

Match the categories of listener, speaker, and environmental strategies. (Environmental strategy, Listener strategy, Speaker strategy)

• Turn down TV

• Face the speaker and watch their mouth

• Amplification

• Let the speaker know when you don't understand

• Simplify the communication. message

• Repeat or spell the word if the listener doesn't understand

• Revise syntax

• Confirm what you heard by repeating

• Optimize lighting

• Increase acoustics, resonance in communication space

• Ask yes/no question if needed

Turn down TV —> Environmental strategy

Face the speaker and watch their mouth —> Listener strategy

Amplification —> Environmental strategy

Let the speaker know when you don't understand —> Listener strategy

Simplify the communication message —> Speaker strategy

Repeat or spell the word if the listener doesn't understand —> Speaker strategy

Revise syntax —> Speaker strategy

Confirm what you heard by repeating —> Listener strategy

Optimize lighting —> Environmental strategy

Increase acoustics, resonance in communication space —> Environmental strategy

Ask yes/no question if needed —> Listener strategy

Voice therapy programs for older adults include [mark all that apply]

• CTT

• PhoRTE

• RVT

• Universal VFA approaches

• Straw phonation (SOVTE) program

all

Voice therapy programs for older adults include

• CTT

• PhoRTE

• RVT

• Universal VFA approaches

• Straw phonation (SOVTE) program

The majority of adults over age 75 have ___ but not all have ___.

• presbylaryngis, presbyphonia

• presbyphonia, presbylaryngis

presbylaryngis, presbyphonia

Listeners tend to slightly ___ the age of younger speakers and ___ the age of older speakers

• underestimate, overestimate

• overestimate, underestimate

• no trends have been demonstrated in research

overestimate, underestimate

Which of the following is true regarding pediatric voice disorders?

• Are inherited

• Children are at not at risk academically

• Children are at risk socially

• The voice disorder resolves as the child reaches puberty

Children are at risk socially

Barriers to treatment of voice disorders in school settings may include

• Restrictions on how a child qualifies for service

• Difficulty in obtaining laryngoscopic exams

• Lack of parental or physician follow-up

• Lack of education on the part of SLPs, administrators, parents, and medical professionals

• All of the above

All of the above

Children with voice disorders [ mark all that apply]

• Experience few consequences into adulthood

• Represent a large percentage of the speech-language pathologist’s caseload

• Rarely receive therapy

• Have little awareness of voice differences

• Experience few consequences into adulthood

• Rarely receive therapy

Hoarseness is typical in some children so clinicians should wait until puberty to commence therapy if needed.

• True

• False

False

Voice therapy programs for children 4 and older include [mark all that apply]

• CTT

• PhoRTE

• RVT

• Universal VFA Approaches

• SOVTEs

Voice therapy programs for children 4 and older include:

• CTT

• RVT

• Universal VFA Approaches

• SOVTEs

In school-based settings, SLPs can commence treatment with children with voice disorders without imaging.

• True

• False

False

Voice disorders do not adversely affect educational performance which limits children's ability to receive services through the Individuals with Disabilities Education Act (IDEA).

• True

• False

False

SOVT exercises are not appropriate for use with pediatric populations.

• True

• False

False

Vocal hygiene programs are typically sufficient in restoring optimal voice in pediatric voice therapy.

• True

• False

False

Match the potential voice differences in individuals with ASD to the most appropriate voice category. (Prosody or Quality)

• Monotone, lack of inflection

• Staccato speech pattern

• Nasal

• Creaky, strained

• Difficulty modulating volume

Monotone, lack of inflection —> Prosody

Staccato speech pattern —> Prosody

Nasal —> Quality

Creaky, strained —> Quality

Difficulty modulating volume —> Prosody

Altering tongue position to a more forward carriage can establish more typical oral resonance in voice for the deaf and hard of hearing child or adult.

• True

• False

True

Individuals who are deaf and hard of hearing with voice changes and/or self-perception of impaired voice demonstrate

• functional voice disorders

• organic voice disorders

• neurogenic voice disorders

• none of the above

functional voice disorders

Cul de sac resonance may be caused by

• phayrngeal obstruction

• large tonsils

• posterior tongue position

• all of the above

all of the above

Individuals who are deaf or hard of hearing have velopharyngeal dysfunction that causes their changes in oral-nasal sound production or resonance.

• True

• False

False

Singing voice is not within the SLP scope of practice regardless of clinician training.

• True

• False

False

Professional voice users, including teachers, singers, actors, and salespeople, make up approximately ___ of the working population in the US.

• 10%

• 25%

• 50%

• 75%

25%

Marking is a vocal technique to preserve the voice that involves

• marking the sheet music for breath groups

• use of negative practice

• singing with reduced volume and intensity

• interjecting SOVTEs into repertoire

singing with reduced volume and intensity

A therapist might work with a professional voice user on

• use of amplification

• use of monitor for external feedback

• singing voice

• speaking voice

• all of the above

all of the above

Voice therapy programs for professional voice users include [mark all that apply]

• CTT

• RVT

• Universal VFA approaches

• Counseling

• Flow phonation

• SOVTEs

(ALL) Voice therapy programs for professional voice users include

• CTT

• RVT

• Universal VFA approaches

• Counseling

• Flow phonation

• SOVTEs

Which of the following represent voice features that may differ between assigned-at-birth males and females?

• Pitch

• Resonance

• Breathy Voice Quality

• All of the above

All of the above

Options for gender-affirming voice care include

• voice therapy

• surgery

• hormone treatment

• all of the above

all of the above

Clinicians should avoid modeling voice features outside of the typical range for the sex assigned at birth.

• True

• False

False

A clinician should avoid working on speech rate with gender-diverse clients since research indicates there are no significant speech rate differences between male and female speech.

• True

• False

False

Across the lifespan, pitch decreases in males and females at puberty, and then ___ in males and ___ in females in geriatric populations.

• increases, increases

• increases, decreases

• decreases, decreases

• decreases, increases

increases, decreases

Testosterone lengthens the vocal tract.

• True

• False

False

Testosterone may aid in pitch change for an adult transgender man who was assigned female at birth.

• True

• False

True

The primary goal of voice feminization training is

• habitual use of an average pitch of 196 Hz or higher

• client satisfaction with their own speech, language, voice

• habitual use of a voice that avoids misgendering by listeners

• use of feminine pitch, resonance, articulation, language and nonverbal communication features as judged by the clinician

client satisfaction with their own speech, language, voice

Self-perception questionnaires used in gender-affirming voice training include

• VHI, GVI, Utah-GPS

• GVI, CAPE-V, Utah-GPS

• TSEQ, GVI, Utah-GPS

• TSEQ, CAPE-V, GRBAS

TSEQ, GVI, Utah-GP

An SLP can diagnose gender dysphoria if a client feels their voice doesn't match their gender identity or expression.

• True

• False

False

Formant frequencies ___ as the length of the vocal tract ___.

• decrease, decreases

• decrease, increases

• increase, increases

• there is no relationship between vocal tract length and formant frequency

decrease, increases

What is a gender neutral pitch range?

• ~150 Hz

• a pitch that could be identified as male or female

• a pitch that is identified by client as gender nonconforming

• all of the above

all of the above

Hormone Replacement Therapy (HRT) may increase pitch for an adult transgender woman who was assigned male at birth.

• True

• False

False

Gender affirming voice training should wait until clients have transitioned socially to allow opportunities for practice in functional situations.

• True

• False

False

Cisgender SLPs may not actively modify their voice or behaviorally normalize a new vocal presentation but may drive institutions, research, and standards of care. Some strategies to make up for these limitations include [mark all that apply]

• Listen and learn from individuals with lived experience

• Support gender-diverse researchers

• Support gender-diverse clinicians

• Review forms and operations for gender inclusion

All of the above

Clinicians may provide gender-affirming care as long as it is best practice regardless of state laws.

• True

• False

False

Cough that persists despite medical management is labeled as

• Chronic cough

• Specific chronic cough

• Pathologic chronic cough

• Refractory chronic cough

Refractory chronic cough

Behavioral cough suppression therapy is a medical treatment and outside of the SLP scope of practice.

• True

• False

False

Paradoxical Vocal Fold Motion is also known as Vocal Cord Dysfunction, Inducible Laryngeal Obstruction, Exercise induced Laryngeal Obstruction, or Laryngeal Dyspnea

• True

• False

True

PVFM is inappropriate abduction of the vocal folds during inspiration.

• True

• False

False

Some behaviors can help differentially diagnose PVFM and asthma. Match the symptom to the more likely disorder. (asthma or PVFM)

• No response to asthma medication

• Symptoms controlled by anti-asthma meds

• Symptoms develop after 5-10 minutes of intense exercise

• Sudden onset, occurs within a few minutes of increased activity

• Longer recovery period of 15-30 minutes

• Rapid symptom resolution

No response to asthma medication —> PVFM

Symptoms controlled by anti-asthma meds —> Asthma

Symptoms develop after 5-10 minutes of intense exercise —> Asthma

Sudden onset, occurs within a few minutes of increased activity —> PVFM

Longer recovery period of 15-30 minutes —> Asthma

Rapid symptom resolution —> PVFM

Paradoxical vocal fold movement occurs only after puberty

• True

• False

False

Select potential triggers for PVFM [mark all that apply].

• exercise

• cold air

• smells

• coughing

• stress

all

The Relaxed Throat Breathing technique used with PVFM directs the client to [mark all that apply]

• inhale through mouth with jaw dropped

• inhale through nose like smelling flowers

• exhale through loose, pursed lips

• exhale through nose

• inhale through nose like smelling flowers

• exhale through loose, pursed lips

A tracheostomy

• is an external opening superior to the level of the larynx

• fundamentally alters the physiology of voice and swallow

• always accommodates a speaking valve for communication

• is permanent

fundamentally alters the physiology of voice and swallow

A speaking valve (such as the Passy Muir) for clients with tracheostomy [mark all that apply]

• allows air to pass through the tracheostomy on inhalation

• allows air to pass through the tracheostomy on exhalation

• closes on inhalation to push air up via the larynx (voice box) to exit via the nose and mouth

• closes on exhalation to push air up via the larynx (voice box) to exit via the nose and mouth

• allows air to pass through the tracheostomy on inhalation

• closes on exhalation to push air up via the larynx (voice box) to exit via the nose and mouth

Clients with tracheostomy have similar anatomical changes to clients with total laryngectomy.

• True

• False

False

Highly implicated in oral and oral pharyngeal and laryngeal cancers is

• alcohol

• tobacco

• chewing tobacco

• all the above

all the above

Counseling with respect to the breathing and speech changes with total laryngectomy should be

• avoided before surgery due to the patient’s preoccupation with his or her immediate health prognosis

• conducted only by another successful laryngectomee

• conducted presurgically, but only with family members

• offered presurgically, and include written and video illustrations of the changes that occur in the speech mechanism and alaryngeal communication options

offered presurgically, and include written and video illustrations of the changes that occur in the speech mechanism and alaryngeal communication options

The post-laryngectomy communication option that does not require air pressure through the PE segment is

• primary TEP

• esophageal speech

• secondary TEP

• electrolarynx

electrolarynx

The three general communication options for the laryngectomee are mutually exclusive.

• True

• False

False

All three post-laryngectomy speech options require that the client be able to articulate clearly.

• True

• False

True

Clients who experience fibrotic changes secondary to radiation therapy for cancer are at risk for dysphonia but not dysphagia.

• True

• False

False