Voice and Resonance Disorders: Practice Quiz 6

Resonance Disorders

The velopharyngeal port is open for

• nasals

• vowels

• vowels and liquids

• liquids and glides

nasals

A client presenting with resonance disturbance secondary to a spastic dysarthria would present with a velopharyngeal

• incompetence

• insufficiency

• dysfunction

• incompetence and dysfunction

• all of the above

incompetence and dysfunction

The word “man” produced by a child with hyponasality might sound more like

• nam

• pam

• bad

• tap

bad

Hypernasality would most easily be detected using

• the motion rate task of puh-puh-puh

• a sustained /s/

• the phrase “the berry is over there”

• the motion rate task of kuh-kuh-kuh

the phrase “the berry is over there”

If a “snap” is heard at the releasing of the nares during production of a sustained /s/,

• the VP port is closed and the problem is probably hyponasality

• the VP port is open

• the tongue is positioned too far back

• this snap suggests a normal VP mechanism

the VP port is open

Many younger children with VP problems exhibit sound

• substitutions

• omissions

• compensatory errors

• all the above

all the above

Nasoendoscopy

• is an instrumental assessment of the velopharyngeal mechanism

• must be performed using topical anesthetic

• is able to capture the production of vowels and semivowels, but not high pressure phonemes

• is not appropriate for children

is an instrumental assessment of the velopharyngeal mechanism

The classic signs of a submucous cleft are

• bifid uvula

• palpable notch in the hard palate

• bluish line down center of soft palate

• all the above

all the above

These provide the source of vibration that gives rise to complex sound waves

• supraglottic structures

• vocal folds

• pharynges

• nasal turbinates

vocal folds

Listening carefully to an individual’s voice during conversation

• will allow the clinician to provide a diagnosis

• can provide a gross indication of what the prominent symptoms are

• will allow any clinician to easily distinguish between hyponasality and hypernasality

• is not part of the evaluation process

can provide a gross indication of what the prominent symptoms are

Individuals with hypernasality

• substitute /m/ for /b/

• often have associated nasopharyngeal reflux

• are at increased risk for hoarseness associated with vocal hyperfunction

• are unable to produce nasal glides

are at increased risk for hoarseness associated with vocal hyperfunction

The clinician can make a gross observation of the relationship of the velum to the pharynx

• through direct visualization of laryngeal structures

• through direct visualization of esophageal structures

• through direct visualization of nasal structures

• through direct visualization of oral structures

through direct visualization of oral structures

A noninvasive computer system that measures the relative amount of oral-to-nasal acoustic energy in an individual’s speech

• SeeScape

• Nasometer

• Oral-to-Nasal Listener

• Praat

Nasometer

Nasoendoscopy involves

• indirect visualization of the velopharynx by endoscope

• indirect visualization of the larynx by endoscope

• direct visualization of the velopharynx by endoscope

• direct visualization of the larynx by endoscope

• A & B

• C & D

C & D

Cleft lip/palate is most likely to occur embryonically during the last trimester of pregnancy.

• True

• False

False

Nasal air emission and hypernasality produce identical effects on speech sound production.

• True

• False

False

Velopharyngeal insufficiency results from inappropriate articulation patterns.

• True

• False

False

Hyponasality refers to too much airflow through the nasal cavity when speaking.

• True

• False

False

25% of children with a repaired cleft palate will have residual velopharyngeal insufficiency.

• True

• False

True

Impaired motion of the VP mechanism due to tissue deficiency is referred to as which of the following?

• VP deficiency

• VP incompetence

• VP inadequacy

• VP insufficiency

VP insufficiency

Which of the following sentences would be most helpful in making a judgment of hyponasality?

• Susie went to the store.

• Give Susie a cookie.

• Mary made lemon jam.

• Pet the puppy.

Mary made lemon jam.

Which of the following best represents a low-tech way for detecting nasal air emission?

• Spirometer

• See-Scape

• Nasometer

• Sentence repetition

See-Scape

For individuals with VPD, nasal emission of air is a common articulation error on which of the following types of phonemes?

• Plosives

• Affricates

• Fricatives

• All of the above

All of the above

Therapy aimed at correct place of articulation is usually inappropriate for children with cleft palate because nasal emission and compensatory errors often resolve following successful surgical intervention.

• True

• False

False

The Nasometer collects oral and nasal sound intensity simultaneously using a single microphone located near the upper lip.

• True

• False

False

Radiation is still a concern that must be considered when employing videofluoroscopy to look at the movement of the VP mechanism.

• True

• False

True

If you suspect velopharyngeal insufficiency upon examination, what action should you take?

• Refer to a specialist who can conduct imaging and provide physical/surgical management if needed

• Try behavioral therapy and refer if child does not make progress

• Build a treatment plan around the structure in question.

• None of the above

Refer to a specialist who can conduct imaging and provide physical/surgical management if needed

A dysarthric client with an immobile velum may benefit from a palatal lift.

• True

• False

True

Clients with nasal voices who produce high nasal airflow rates are perceived as having a cold or stuffed-up nose.

• True

• False

False

A pharyngeal flap is constructed from the pharyngeal mucosal tissue and attached to the tissue of the soft palate, such that a 'bridge' of tissue spans the excessive VP opening.

• True

• False

True

During resting breathing, the velum is

• raised

• near or touching the posterior pharyngeal wall

• lowered

• near or touching the base of the tongue

• A&B

• C&D

C&D

The velum is elevated and touching the lateral and posterior pharyngeal walls during

• oral phonemes

• vowels

• voiceless pressure consonants

• all of the above

• none of the above

all of the above

Match the cause of velopharyngeal dysfunction to the best description. (velopharyngeal insufficiency, velopharyngeal mislearning, velopharyngeal incompetence)

• submucous cleft palate

• deafness/hearing impairment

• cerebral palsy

• TBI

• deep nasopharynx

• persisting post-operative nasal emission (with adequate VP ability)

submucous cleft palate —> velopharyngeal insufficiency

deafness/hearing impairment —> velopharyngeal mislearning

cerebral palsy —> velopharyngeal incompetence

TBI —> velopharyngeal incompetence

deep nasopharynx —> velopharyngeal insufficiency

persisting post-operative nasal emission (with adequate VP ability) —> velopharyngeal mislearning

Hypernasality is most apparent on

• nasals

• vowels

• high-pressure consonants

• all of the above

vowels

Hypernasality and nasal air emission mean the same thing.

• True

• False

False

If you pinch your nostrils and make an /m/ sound, it will be exactly like you would produce /b/.

• True

• False

False

A muffled quality resulting from blockage anterior to the VP mechanism is called

• hypernasal resonance

• hyponasal resonance

• cul-de-sac resonance

• mixed resonance

cul-de-sac resonance

Match the oral and nasal resonance disorders. (oral resonance disorder or nasal resonance disorder)

thin voice

laryngeal focus voice

denasality

hypernasality

vocal tract focus that doesn't match gender expression

cul-de-sac resonance

thin voice —> oral resonance disorder

laryngeal focus voice —> oral resonance disorder

denasality —> nasal resonance disorder

hypernasality —> nasal resonance disorder

vocal tract focus that doesn't match gender expression —> oral resonance disorder

cul-de-sac resonance —> nasal resonance disorder

Which of the following is not a category of causes of resonance disorders?

• anatomy

• traumatic

• neurologic

• surgical

• airway compromise

• other

airway compromise

Woodwind players can injure their VP muscles from high intensity performance with high intra-oral pressure. This is called

• musician VPD

• intra-oral VPD

• muscular VPD

• stress VPD

stress VPD

Match the lip anatomy to the description (vertical grooves on either side of the philtrum, thin band of tissue connecting the upper lip to the gum, vertical groove below the nose)

• Frenulum

• Columella

• Philtrum

Frenulum —> thin band of tissue connecting the upper lip to the gum

Columella —> vertical grooves on either side of the philtrum

Philtrum —> vertical groove below the nose

Which of these terms are synonyms?

• tongue base and pharynx

• maxilla and mandible

• velum and uvula

• soft palate and velum

• none of these are synonyms

soft palate and velum

Ankyloglossia signs and symptoms may include [mark all that apply]

• Difficulty lifting the tongue to the upper teeth

• Trouble sticking out the tongue past the lower front teeth

• Difficulty moving the tongue from side to side

• A tongue that appears notched when stuck out

• A tongue that appears heart shaped when stuck out

All of the above, Ankyloglossia signs and symptoms include:

• Difficulty lifting the tongue to the upper teeth

• Trouble sticking out the tongue past the lower front teeth

• Difficulty moving the tongue from side to side

• A tongue that appears notched when stuck out

• A tongue that appears heart shaped when stuck out

The Eustachian tube connects the nasopharynx to the

• pinna

• middle ear

• inner ear

• cochlea

middle ear

The primary muscle in the velum (40% of mass and main elevating muscle) is the

• Levator Veli Palatini

• Tensor Veli Palatini

• Superior Pharyngeal Constrictor

• Palatopharyngeus

• Musculus Uvula

Levator Veli Palatini

Adenoidectomy and tonsillectomy have been implicated in VPI. Match the statement about adenoids and tonsils that best represents their potential for causing VPI. (adenoids or tonsils)

• aid in velopharyngeal closure in children and removal may cause VPI

• are in oral cavity and do not contribute to VP closure

pharyngeal closure in children and removal may cause VPI —> adenoids

are in oral cavity and do not contribute to VP closure —> tonsils

Match the following surgical procedures for VPI to their description. (Pharyngeal flap, Furlow Z plasty, Pharyngeal augmentation)

• Inject substance into posterior pharyngeal wall

• Lengthen velum

• Suture flap from posterior pharyngeal wall to velum

Inject substance into posterior pharyngeal wall —> Pharyngeal augmentation

Lengthen velum —> Furlow Z plasty

Suture flap from posterior pharyngeal wall to velum —> Pharyngeal flap

Identify the categories of treatment of velopharyngeal dysfunction. (Dental and orthodontic treatment, Surgical treatment, Prosthetic treatment)

• Palatal lift, palatal obturation, speech bulb obturator

• Pharyngeal augmentation, Furlow Z-plasty, pharyngeal flap

• Maxillary expansion treatment, bone graft

Palatal lift, palatal obturation, speech bulb obturator —> Prosthetic treatment

Pharyngeal augmentation, Furlow Z-plasty, pharyngeal flap —> Surgical treatment

Maxillary expansion treatment, bone graft —> Dental and orthodontic treatment

A 5-year-old boy enters school and is flagged at his first speech-language screening with the following notes: some articulation errors and hypernasal speech. Parents report that he does have a history of middle ear issues. Your oral mechanism evaluation reveals a dark area on the soft palate and a very small uvula. You refer to the ENT/cleft team in your area with a note.

• Evaluate for nasal obstruction

• Evaluate for submucous cleft

• Evaluate for adenoidal involution

• Evaluate for oronasal fistula

Evaluate for submucous cleft

Match the common sound errors associated with VPD with their descriptions.

(descriptions: Nasal air emission, Glottal stop, Pharyngeal fricative, Posterior nasal fricative, Pharyngeal plosive, Generalized backing)

• Stopped air flow between tongue and posterior pharyngeal wall

• Turbulent air flow between tongue and posterior pharyngeal wall

• Vocal folds adduct and open (like a grunt)

• Turbulent air flow between tongue and velum

• Place of articulation moves posteriorly

• Audible air coming out of nose on voiceless consonants

Stopped air flow between tongue and posterior pharyngeal wall —> Pharyngeal plosive

Turbulent air flow between tongue and posterior pharyngeal wall —> Pharyngeal fricative

Vocal folds adduct and open (like a grunt) —> Glottal stop

Turbulent air flow between tongue and velum —> Posterior nasal fricative

Place of articulation moves posteriorly —> Generalized backing

Audible air coming out of nose on voiceless consonants —> Nasal air emission

Match the surgery to the typical timeline. (Cleft lip surgery or Cleft palate surgery)

• Generally repaired at 3-6 months

• Generally repaired at 9-12 months

Generally repaired at 3-6 months —> Cleft lip surgery

Generally repaired at 9-12 months —> Cleft palate surgery

Indicate whether the velum is open or closed during the following behaviors. (open or closed)

• nasal sound production

• vomiting

• breathing

• gagging

• wind instrument playing

• bearing down

• swallowing

• oral sound production

nasal sound production —> open

vomiting —> closed

breathing —> open

gagging —> closed

wind instrument playing —> closed

bearing down —> closed

swallowing —> closed

oral sound production —> closed

The most common velopharyngeal closure pattern is

• circular

• circular with Passavant’s ridge

• coronal

• sagittal

coronal

The atrophy of adenoids (starting at 5 years old and mostly gone by teens) generally has no negative effect on speech unless children have tenuous VP closure due to submucous cleft or history of CP.

• True

• False

True

Removal of enlarged tonsils

• may cause impaired resonance due to decreased VP closure

• may improve resonance due to removal of resonance blockage

• all of the above

• none of the above

may improve resonance due to removal of resonance blockage

The tonsils can be viewed during the oral mechanism exam.

• True

• False

True

The adenoids can be viewed during the oral mechanism exam.

• True

• False

False

Cleft lips may be [mark all that apply]

• complete

• incomplete

• unilateral

• bilateral

• microform

Answer is all of the above - cleft lips may be

• complete

• incomplete

• unilateral

• bilateral

• microform

Select the structures typically involved in complete and incomplete cleft palate. (soft palate only, hard palate and soft palate)

• Complete cleft palate

• Incomplete cleft palate

Complete cleft palate —> hard palate and soft palate

Incomplete cleft palate —> soft palate only

The free-floating premaxilla is associated with

• complete cleft palate

• unilateral cleft lip and palate

• bilateral cleft lip and palate

• bilateral cleft lip

bilateral cleft lip and palate

Unilateral orofacial clefts are more common on the

• left

• right

• no evidence that either side is more prevalent

left

Cleft lip occurs more often in ___. Cleft palate occurs more often in ___.

• girls, boys

• boys, girls

• No significant differences in these groups

boys, girls

Cleft lip or palate is the most common birth defect in the United States. Clefts happen very early in pregnancy, and is considered a ___ condition, meaning it is caused by a combination of genetic predisposition and environmental factors, rather than a single identifiable cause.

• behavioral

• hereditary

• multifactorial

• embryologic

multifactorial

Cleft lip and cleft palate can be associated with a large number of craniofacial and genetic sequences or syndromes, some of which are rare. Orofacial clefts are associated with

• Velocardiofacial syndrome

• Stickler syndrome

• Pierre Robin sequence

• Treacher-Collins syndrome

• All of the above

All of the above

Speech Disorders in children with orofacial clefts may include [mark all that apply]

• Short upper lip

• Nasal obstruction

• Velopharyngeal Dysfunction

• Dental/Occlusal Abnormalities

• Palatal Fistula

• Hearing Loss

Answer: All of the above, Speech disorders in children with orofacial clefts may include all

• Short upper lip

• Nasal obstruction

• Velopharyngeal Dysfunction

• Dental/Occlusal Abnormalities

• Palatal Fistula

• Hearing Loss

An infant's Eustachian tube is in a more horizontal position than an adult's.

• True

• False

True

Match the speech issues to the categories of communication disorders associated with VPD. (Abnormal resonance, Abnormal airflow, Abnormal phonation, Abnormal articulation)

Laryngeal hyperfunction

Nasal grimace

Obligatory distortion

Too much sound in nose during vowel

Laryngeal hyperfunction —> Abnormal phonation

Nasal grimace —> Abnormal airflow

Obligatory distortion —> Abnormal articulation

Too much sound in nose during vowel —> Abnormal resonance

Nasal congestion can mask hypernasality.

• True

• False

True

Speech therapy is considered ineffective and inappropriate as a means to correct VPI when there is inappropriate nasality or nasal emission due to abnormal structure/physiology.

• True

• False

True

Speech therapy for children with VPD is effective and appropriate for [mark all that apply]

• Compensatory articulation problems secondary to VPI that cause nasal emission

• Misarticulations that cause nasal air emission or hypernasality that is phoneme specific

• Hypernasality or variable resonance due to apraxia

• Hypernasality or nasal emission following surgical correction

• Phoneme-specific nasal air emission that is stimulable for change

Answer: all of the above; Speech therapy for children with VPD is effective and appropriate for all:

• Compensatory articulation problems secondary to VPI that cause nasal emission

• Misarticulations that cause nasal air emission or hypernasality that is phoneme specific

• Hypernasality or variable resonance due to apraxia

• Hypernasality or nasal emission following surgical correction

• Phoneme-specific nasal air emission that is stimulable for change

Cleft palate repair timing considers

• Speech development: before the onset of first words because less likely to develop deviant compensatory articulation patterns

• Facial growth: the face has grown enough to allow for better access to the surgical site.

• Surgical complexity

• All of the above

All of the above

Match the descriptions to the speech error. (compensatory errors or obligatory distortions)

• Errors where articulation is changed due to abnormal structure

• Errors where articulation is normal but structures cause error

• Treated with physical management only

• May be addressed with behavioral therapy

Errors where articulation is changed due to abnormal structure —> Compensatory errors

Errors where articulation is normal but structures cause error —> Obligatory distortions

Treated with physical management only —> Obligatory distortions

May be addressed with behavioral therapy —> Compensatory errors

For a child with velopharyngeal insufficiency due to a history of repaired cleft palate, their speech is most likely to demonstrate

• Mixed nasality

• Hypernasality and cul-de-sac resonance, which sound different

• Hypernasality and nasal air emission, which sound similar

• Hypernasality and nasal air emission, which sound different

Hypernasality and nasal air emission, which sound different

In the absence of technology/instrumentation to assess nasal air emission, an SLP could place a mirror or spoon under the client's nose and watch for foggy mirror or a straw in one nostril and listen for nasal airflow and have the client produce sounds, words and sentences balanced for oral and nasal sounds.

• Mirror fog is expected for all sounds.

• Mirror fog is expected for any sounds.

• Mirror fog is only expected during breathing between sounds.

• Mirror fog is expected on nasal sounds and breathing between words.

Mirror fog is expected on nasal sounds and breathing between words.

Which of the following strategies may increase efficiency and effectiveness of feeding with infants with cleft lip and palate? [mark all that apply]

• Use of special nipples

• Squeeze bottles

• Feeding in supine (lying on back) position

• Nipple placement

Strategies to increase efficiency and effectiveness of feeding with infants with cleft lip and palate?

• Use of special nipples

• Squeeze bottles

• Nipple placement

When a normal speaker says the words "beet, bait, bought" with the nares open and then with the nares pinched shut

• the initial plosive sound will be distorted

• all productions will sound the same

• nares shut will sound hyponasal

• nares shut will sound hypernasal

all productions will sound the same

A pharyngeal plosive is a(n)

• obligatory distortion

• compensatory error

• all of the above

compensatory error

Compensatory productions maintain the placement of articulation (alveolar, velar, glottal) but sacrifice the manner of production (plosive, fricative, affricate).

• True

• False

False