Chapter 3 pt. 1: Functional Voice Disorders

What type of voice disorder is Muscle tension dysphonia

functional voice disorder

what disorder is one of the most common functional voice disorders

Muscle tention dysphonia

What is dysphonia

an alteration in normal voice quality

Define muscle tension dysphonia

the occurrence of vocal dysfunction in the absence of laryngeal structural abnormalities

what happens to the larynx in many cases of MTD

the larynx is elevated high in the neck

Why is the larynx elevated in MTD

extrinsic laryngeal muscle tension

where is pain commonly reported in MTD?

neck, jaw, and shoulders

what causes the persistent dysphonia seen in MTD

excessive laryngeal and related musculoskeletal tension

what abnormal vibratory patterns may be associated with MTD

hyper functional true/false vocal fold vibratory patterns

Define primary MTD

dysphonia occurring without the presence of organic pathology or psychogenic/neurologic etiology

which type of MTD represents a persistant, unexplained dysphonia that is Behaviorally modifiable

Primary

what type of MTD makes up 40% of dysphonia cases

primary

Define secondary MTD

dysphonia in the presence of current organic pathology, or psychogenic/neurologic etiology

which type of MTD origniate as a compensatory response to the primary etiology

secondary

when viewing the larynx through a laryngoscopy procedure what are some signs of MTD (8)

-supraglottic and/or glottic tension: excessive tension in supraglottic area

-hyperadduction of the VF: over approximate or squeeze together during phonation

-anterior-posterior compression: notable squeezing of VF from front-to-back

-normal VF structure: no abnormalities such as lesions or mass

-reduced amplitude of vibration: amplitude reduced due to increased tension

-ventricular compression: false VF drawn toward midline, compress over true VF, do not vibrate

-arytenoid cartilage hyperfunction: show signs of excessive muscular activity

-effortful closure patterns: VF closure is strained or effortful

Auditory features of MTD (6)

-strained or effortful voice quality: sounds light, tight, or squeezed

-Phonation breaks: sudden interruptions during speech due to irregular/incomplete VF closure

Abnormal habitual pitch: can be either higher or lower than their normal ptich

-Diplophonia: perception of two distinct pitches caused by the uneven tension of VF, resulting in vibration causing two frequencies

-Breathiness: VF may not close all the way during phonation

-vocal fatigue: strain and overuse cause rapid tiring of voice

how to differentiate MTD for add SD or essential voice tremor

Patients with MTD will be consistent within and across the following tasks:

-quiet breathing

-counting from 1 to 10 in usual voice (not falsetto or whisper)

-all voiced utterances

-variation of pitch and loudness during sustained phonation

Treatment for MTD

focuses on relaxing the head and neck muscles

what are some techniques use in therapy for treatment of MTD

-chant talk

-chewing

-digital manipulation

-focus

-laryngeal massage

-relaxation

-yawn-sigh

define ventricular dysphonia

phonation using false VF vibration rather than true VF vibration

what are the two types of ventricular dysphonia

-compensatory

-non-compensatory

Which type of ventricular dysphonia is described by a reaction to true vocal fold disease

-compensatory

-VF diseases include paralysis, true vocal fold surgery, etc)

Which type of ventricular dysphonia is described by the statement that the VFs are still capable of vibrating

non compensatory

what are the three etiologies of non compensatory ventricular dysphonia

-habitual: caused by excessive voice use

-physo-emotional: physical or physogenic tension and distress

-idiopathic: no known origin

diagnosis of ventricular dysphonia

-is often heard when the true vocal folds vibrate in an abnormal fashion due to false folds riding or loading them

**it is impossible to diagnosis on sound alone

Auditory feature of ventricular dysphonia (impossible to diagnosis on sound alone) (7)

-low pitch: VF are larger

-Monotone

-strained quality

-hoarse

-breathy: incomplete closure

-reduced loudness

-diplophonia: both true and false VF vibrating because they are sitting atop one another

Ventricular dysphonia laryngoscopic findings (6)

-Ventricular Band closure: **this is the most distinct finding- FVF are tightly approximated or closed during phonation

-reduced or absent moving of the true vocal folds

-increased activity in the supraglottic region: structures such as aryepiglottic folds and epiglottis

-medial compression: inward squeeze of FVF to midline

-true vocal folds may appear abnormal

-airway protection: during swallowing, FVF should close to protect airway

what are some benign pathologies resulting from excessive muscle tension disorders

-Vocal fold nodules

-vocal fold polyps

-Reinke’s edema

-Laryngitis

what are the most common benign lesions

vocal fold nodules

what is the cause of vocal fold nodules

phonotrauma - continuous abuse of the larynx and muscle of the voice

define vocal fold nodules

-bilateral, whitish protuberances (knots) on the glottal margin of each vocal fold, located at the anterior- middle third junction

nodules range from ___ to ___ in number

1-4

who are at risk of developing voice nodules

professional voice users

Males ages ___ to ___ are the most susceptible to nodules

3 to 10

which populations are more commonly affected

-boys are more commonly affected than girls

-women are more commonly affected than men

Acute or chronic nodules: softer and may appear as swollen spots or blisters on the VF, may be reddish

Acute

Acute or chronic nodules: generally harder and more fibrous, resembling calluses, less likely to resolve spontaneously, and might require more intensive treatment

chronic

Auditory features of nodules (5)

-breathiness

-decreased habitual loudness and dynamic range

-vocal fatigue

-decreased pitch and pitch range

-hoarse voice quality

Treatment for small or recently acquired nodules

can be treated with voice therapy

treatment of larger and more established nodules

-may need surgery

-complete voice rest

-then voice therapy

Define vocal fold polyps

focal abnormality of the superficial lamina propria, usually site where vocal fold nodules occur

are polyps typically bilateral or unilateral

unilateral (90% of the time)

Caused/ contributors of polyps

-precipitated by single event

-contributing factors

—smoking

—inhaled allergens/irritants

—laryngopharyngeal reflux

appearance of polyps

-may be reddish or white

-large or small

-sessile (adhere to mucosal sac) or pedunculate (attached by a slim stalk)

Auditory features

same as nodules

treatment for polys

-surgery: microflap surgery - raises flap of mucosa, remove polyp, then lay flap back down

-voice therapy

—women are more likely to experience resolution of small polyps

—some patients can experience shrinkage

define Reinke’s Edema

-swelling of the superfical lamina propria of the VF

-also known as polypoid degeneration

is Reinke’s edema unilateral or bilateral

bilateral but can be more pronounced on one sidew

what is Reinke’s Edema strongly associated with

smoking

Location impacted by Reinke’s Edema

anterior two-thirds of the glottal margin (part that vibrates)t

treatment options for Reinke’s edema

-first step- eliminating and stoping the cause of the problem

-Voice therapy: behavioral program teaching proper use of voice and reduce phonotraumatic activities

-Phonomicrosurgery: removing excess tissue but still preserving vocal fold function

Define laryngitis

inflammation of the larynx

cause of laryngitis

acute viral infection of the upper respiratory system

chronic laryngitis

-mild: lasting between 3-7 days

-chronic: lasting over 3 weeks

age or gender differences in diagnosis

there are none

what are some comorbid conditions of laryngitis (4)

-upper airway inflammatory conditions such as:

—acute pharyngitis

—acute bronchitis

—pneumonia

—upper respiratory illness

Etiogies of laryngitis

-infectious: viral infection

-non-infectious: phonotrauma, allergy, GERD, asthma, smoking, inhalation, injuries, environmental pollution

signs/symptoms of acute laryngitis

-hoarseness

-early vocal fatigue

-dry cough

-breathing difficulties (rare)

signs/symptoms of chronic layrngitis

-dyspnea (shortness of breath)

-audible stridor

-dysphagia

-drooling

treatment for laryngitis

-eliminate abuse/vocal rest (**ensure client knows not to whisper either)