CSD 538 FINAL REVIEW

Newborn VF length

typically ranging from 2.5 to 3.0 mm.

Opera singer on tour has VF hemorrhage- what is the best treatment option?

Treatment options for a patient with vocal fold hemorrhage- includes vocal rest and adopting healthy vocal habits such as drinking more water and avoiding caffeine, alcohol, and tobacco.

Impact of cleft palate on speech, resonance, and feeding

artic- nasal emissions, nasal grimace, articulators are unable to meet in the right positions

voice disturbance- dysphonia, vocal cord nodules, and short utterances

feeding- babies are unable to such on nipple during feeding and nasal regurgitation can occur

resonance- unable to create proper airflow which results in too little or too excessive nasality

Hypernasality

Excessive nasal resonance during speech, resulting from improper airflow through the nose, leading to a nasal tone in the voice.

Hyponasality

Loss of typical nasal resonance during speech, caused by inadequate airflow through the nose when producing sounds that require nasal resonance.

Velopharyngeal insufficiency (VPI)

The insufficient closure of the velopharyngeal port during speaking is a defining feature of velopharyngeal insufficiency (VPI).

• The velopharyngeal port is the orofacial-nasal opening, and normal speech resonance depends on its proper closure.

Unilateral vocal fold paralysis

When one of the larynx's vocal folds is paralyzed, it is known as unilateral vocal fold paralysis. Damage or malfunction of the nerves that regulate the movement of the vocal folds is usually the cause of UVFP. 

• Can occur during: surgery (thyroid/cardiac), neurological conditions (stroke,tumor), viral infections, neck trauma, can also be idiopathic.

• Damage to Recurrent Laryngeal Nerve (RLN), either from viral onset, idiopathic, tumor compressing a nerve, or nerve injury.

Bilateral vocal fold paralysis

A patient with bilateral VF paralysis in abduction would struggle to create voiced sounds and increase their volume. They would have a breathy and weak vocal quality because their VFs are open and would have swallow issues because the glottis is open. 

• Alternatively, bilateral VF paralysis in the adducted position would create difficulty breathing since their VFs are closed. They would have a strained, rough, vocal quality since air is not coming through the VFs.

Adductor Spasmodic Dysphonia (ADSD)

The most common type of spasmodic dysphonia- characterized by involuntary contractions/spasms of the muscles that results in a strained voice because the VF’s are closed when they should be open

• botox is commonly injected into the thyroarytenoid muscle

Abductor Spasmodic Dysphonia (ABSD)

Less common than ADSD, characterized by weak and breathy voice quality due to the vocal folds opening when they should be closed.

• botox is commonly injected into the posterior cricoarytenoid (PCA)

Botox

Temporarily interrupts nerve-muscle communication by inhibiting acetylcholine release, inducing temporary muscle paralysis.

Laryngomalacia

A congenital condition affecting the larynx, characterized by floppy soft tissues that partially collapse the airway during breathing, leading to symptoms such as noisy breathing, feeding difficulties, reflux, and cyanosis.

Polypoid degeneration

Severe form of vocal fold degeneration, characterized by the permeation of the membranous portion with fluid, often caused by long-standing trauma or chronic exposure to irritants such as cigarette smoke or laryngopharyngeal reflux.

Vocal nodules

The most common benign pathology of the vocal folds, characterized by inflammatory degeneration of the superficial layer of the lamina propria, typically forming bilaterally due to high impact stress during phonation or phonotraumatic behaviors.

• firm and callous-like

Vocal fold polyps

fluid filled lesion that develops in the superficial layer of the lamina propria. Has its own blood supply. Typically forms unilaterally and caused by acute vocal trauma or from phonotraumatic behaviors

• sessile pedunculated in appearance

options for speech post-laryngectomy

esophageal speech

tracheoesophageal prosthesis

electrolarynx

Esophageal speech

A method of speech post-laryngectomy that utilizes burping to produce sound by expelling air from the esophagus.

Tracheoesophageal prosthesis

A method of speech post-laryngectomy that involves the insertion of a prosthesis to create a connection between the trachea and esophagus, allowing for speech production.

which speech option post-laryngectomy sounds the most natural?

tracheoesophageal prosthesis

Leukoplakia

White plaque-like formation occurring on the vocal fold surface, considered a precancerous state. Primarily caused by factors such as chronic irritation (cigarette smoking, alcohol use, and environmental exposure to irritants).

what is the risk associated with leukoplakia?

could be cancer

Laryngeal cancer

Cancer affecting the larynx, characterized by symptoms such as hoarseness, change in pitch, vocal strain, sore throat, persistent cough, and stridor, with primary contributing factors including smoking, alcohol use, reflux, and HPV.

Laryngectomy stoma

is the surgical removal of the larynx, completely and permanently. The remaining trachea is sutured to the anterior neck. There is NO CONNECTION from the nose or mouth to the lungs, so traditional airway manipulation will not work.

• known as Neck Breathers - individuals who breathe through a neck stoma.

Trach tube

is a surgical procedure that creates an opening through the neck into the trachea. There is still a connection from the nose or mouth to the lungs, so traditional airway manipulation will work.

• can be short-term or permanent.

why is it important to know the difference between a laryngectomy and a trach tube?

For a laryngectomy, it is impossible to deliver oxygen to the lungs with nasal cannula, face mask, or bag-mask ventilation. Attempts to intubate the trachea from above the stoma via the oral or nasal route will be unsuccessful.

Medialization thyroplasty

A surgical procedure commonly used to treat unilateral vocal fold paralysis, involving the placement of a mesh device into the paralyzed vocal fold to bring it closer to the working vocal fold.

• can also be used to treat spasmodic dysphonia and help transgender patients achieve the pitch they are wanting.

Goals of voice therapy

To enhance voice quality by optimizing conditions under voice production, with the objective of achieving the best possible voice within a patient's anatomical and physiological capabilities, and restoring a functional voice for employment and general communication purposes.

Hygienic Voice Therapy

Focuses on modifying or eliminating behavioral causes of voice disorders to improve vocal quality.

Symptomatic voice therapy

Modification of deviant vocal symptoms such as breathiness, inappropriate pitch, loudness, hard glottal attacks, etc.

• Focuses on modifying aberrant vocal symptoms observed by the patient or SLP, such as: high pitch, breathy voice, or hard glottal attack 

psychogenic voice therapy

Focus on psychosocial and emotional factors that caused voice disorder. Once that is treated, then the voice will improve

physiological voice therapy

vocal function based on objective voice assessment (laryngeal function study)

Strives to improve the balance among voice respiratory support, laryngeal muscle strength, control and stamina, and supraglottic modification of the laryngeal tone

• Promotes a healthy vocal fold cover

• concentrates on the modification of the underlying physiology of the voice producing mechanisms: respiration, phonation, resonance

• Direct exercises are used to activate the laryngeal muscle and work other subsystems, such as respiratory and supraglottal systems

eclectic voice therapy

Uses a combination of other approaches to provide the most effective therapy

what are the treatment options of voice therapy?

hygienic

symptomatic

psychogenic

physiological

eclectic

what happens to the larynx if infected with human papilloma virus (HPV)?

associated with an increase in cancers located in tonsils and base of tongue

• first reported in 1983

what are some treatments associated with if the larynx is infected with HPV?

Surgery alone

Transoral robotic surgery (TORS)

Full course radiation therapy (XRT)

Combination radiation and surgery

Chemotherapy before or during radiation

psychogenic disorders

unexplained physical symptoms without relevant organic pathology

• 45% of visits to clinics

• psychogenic and neurogenic symptoms can co-occur

• may manifest as speech/voice disorder

  • voice is most common type

• differential diagnosis- the symptoms must fit the “rules” of a motor speech or voice disorder

can psychogenic disorders be treated by SLP’s?

Many of them can be!

• prognosis is typically good

• patient’s belief that the problem is organic must be addressed

appropriate referrals for psychogenic disorders

behavioral therapy

respiratory therapy

considerations for working with singers

Singers may be prone to reflux

Problem may be in the speaking voice

Voice issues may be subtle, not readily visible on strobe exam

While under a scope, have them sing for you and see what you notice

typical complaints of singers

Loss of upper notes

Loss of flexibility

Prolonged warm-up

Difficulty singing loudly or softly

Difficulty with register changes (passagio)

irritable larynx syndrome

1st described in 1999

develops as a reaction to changes in the central nervous system, leaving sensorimotor pathways in hyper-excitable state. Adaptation to chronic noxious stimuli results in an altered response

Intrinsic laryngeal muscles

Responsible for the movements of the laryngeal cartilages and finer control of the laryngeal structures.

• total of 5 (all of which are paired)

• these muscles work together to regulate the tension in the vocal ligament and the size/shape of the glottal space

Vocal fold mobility

The degree of vocal fold movement during phonation.

Stroboscopy

Imaging the larynx using a strobe light, providing great image quality and allowing retrieval of the images for later examination.

True slow motion

Allows viewing of vocal fold movement in slow motion, unlike stroboscopy which only allows frame-by-frame review.

Videostroboscopy

Most commonly used visual imaging for voice disorders, rating parameters such as glottal closure, supraglottic activity, and overall laryngeal function.