Fall 2026, Advanced Voice & Upper Airway Disorders EXAM 2

What should be avoided during functional voice use?

Excessive respiratory muscle effort.

Where is the infant larynx located?

Approximately C3.

Where does the larynx descend to around age 2?

Approximately C5.

How does the newborn vocal fold cover compare with that of an adult?

It is thicker.

How are collagen fibers organized in the infant larynx?

They are more compact.

When does the three-layer differentiation of the lamina propria occur?

It begins around puberty and continues to approximately age 16.

Which muscle fiber type is more common in young children?

Type II fibers.

What happens to intrinsic laryngeal muscle nerve fibers after puberty?

They continue developing in size and shift toward Type I fibers.

What is the approximate vocal fold length at birth?

3 mm.

What is the approximate vocal fold length around age 10?

10-13 mm.

What is the approximate adult female vocal fold length?

20 mm.

What is the approximate adult male vocal fold length?

30 mm.

What is the approximate fundamental frequency of an infant's cry?

500 Hz.

What is the approximate fundamental frequency at ages 5-8?

200 Hz.

What is the typical adult female fundamental frequency (F0) range?

170-220 Hz.

What feeding-related difficulties may accompany severe laryngomalacia?

Feeding and swallowing difficulties.

What intervention may be needed if severe laryngomalacia obstructs the airway?

Tracheostomy.

What type of stridor does the lecture associate with laryngomalacia?

inspiratory stridor

What is a supraglottic web?

A web of tissue in the supraglottic region that may interfere with airflow.

When might a supraglottic web become symptomatic?

During loud crying or exertion, depending on its size.

What procedure is mentioned for treating a supraglottic web?

Laser treatment.

What is subglottic stenosis?

Narrowing of the airway immediately below the vocal folds.

What can cause acquired subglottic stenosis in children?

Injury from an intubation tube that does not heal properly.

Why is subglottic stenosis concerning?

It narrows the airway and requires prompt medical assessment.

How is subglottic stenosis managed according to notes?

Surgically, although management can be difficult.

Why can rehabilitation after congenital laryngeal web surgery be challenging?

The child may have no prior perception or experience of a clear voice.

What is the primary voice-related concern in presbyphonia?

Vocal fold bowing, producing a breathy, leaky, quieter voice.

What can contribute to phonotraumatic laryngeal pathology?

Genetic predisposition, occupational voice demands, health conditions, acute illness, and vocal misuse.

What health conditions may contribute to phonotrauma?

Chronic reflux, asthma, allergies, and medications used to treat them.

What are examples of acute contributors to voice problems?

Colds, influenza, viral infections, and bacterial infections.

What are examples of vocal misuse?

Yelling at games and producing excessive play sounds, such as animal noises.

Why is the term voice abuse discouraged?

It implies intentional harm and can shame or blame the patient.

What voice characteristics may suggest phonotraumatic behavior?

Hoarseness, raspiness, vocal cracks, strained or strangled voice, hard glottal attacks, and vocal fatigue.

What is puberphonia?

Persistence of a higher-pitched, prepubertal voice after puberty.

Is puberphonia necessarily associated with structural laryngeal abnormalities?

No.

Is surgery generally warranted for puberphonia?

No.

What is a therapy strategy for puberphonia?

Determine whether the patient can access a lower voice (e.g., counting to five in a deeper voice).

What is ventricular phonation?

Using the false vocal folds rather than the true vocal folds to produce voice.

What is another medical term for ventricular phonation?

Plica ventricularis.

What are the two types of ventricular phonation?

Compensatory and maladaptive.

What is an example of compensatory ventricular phonation?

False vocal fold phonation secondary to bilateral vocal fold paralysis.

What is an example of maladaptive ventricular phonation?

Continued false vocal fold phonation after temporary laryngitis.

When should psychogenic aphonia be considered?

When structural and functional causes have been ruled out.

How common is psychogenic aphonia?

It is rare.

What is muscle tension dysphonia (MTD)?

Persistent excessive tension during voice production.

Is muscle tension dysphonia (MTD) patterned and predictable?

Yes, MTD is typically patterned and predictable.

How does MTD respond to behavioral voice therapy?

It generally responds well to behavioral voice therapy.

How is vocal dystonia characterized?

Unpredictable, non-patterned disruptions of voice.

Is vocal dystonia a behavioral or neurological condition?

Neurological.

Can vocal dystonia be resolved through behavioral therapy alone?

No, it cannot be resolved through behavioral therapy alone.

What temporary strategy may improve vocal dystonia symptoms?

Speaking with a different or foreign accent.

How do symptoms fluctuate in vocal dystonia?

They may improve temporarily for several weeks and then return.

What is the suspected etiology of vocal fold nodules?

Phonotraumatic behavior, potentially combined with genetic predisposition.

Where do vocal fold nodules typically occur?

Middle third of the free membranous vocal fold edge.

What glottal closure pattern is characteristic of nodules?

Hourglass closure.

What is a common voice complaint from patients with nodules?

"My voice wears out."

Why do patients with calloused nodules often use excessive loudness?

They must work harder to initiate vocal fold vibration.

What therapy technique is recommended for vocal fold nodules?

Resonant voice therapy.

Why is resonant voice therapy useful for nodules?

It promotes efficient closure while reducing excessive pressure on lesions.

What do asymmetrical lesions suggest when one nodule is much larger?

Another primary lesion with a reactive contralateral nodule.

What can cause vocal fold polyps?

Excessive coughing or acute/chronic phonotrauma.

How are vocal fold polyps characterized in terms of vascularity?

They may be blood-filled or hemorrhagic.

What is a reactive lesion associated with a polyp?

A contralateral lesion caused by contact with the primary polyp.

What are two possible shapes of a vocal fold polyp?

Focal or broad-based.

What does "pedunculated" mean in relation to a polyp?

Attached by a stalk.

What are common acoustic characteristics of polyps?

Rough voice, stiffness, and potentially elevated pitch.

How do polyps affect laryngeal effort and subglottal pressure?

Patients squeeze vocal folds and require greater subglottal pressure for vibration.

What closure patterns are associated with vocal fold polyps?

Hourglass or variable closure.

What is generally the first treatment approach for polyps?

Behavioral voice therapy, with medical management as needed.

How does inhalation phonation help assess a vocal fold lesion?

Reveals whether the lesion involves only the cover or extends into deeper tissue.

What causes a mucus-retention vocal fold cyst?

Blockage of a glandular duct.

Where do vocal fold cysts arise?

Superficial lamina propria, also called Reinke's space.

Typical glottal closure pattern for vocal fold cysts

Hourglass closure.

Contralateral lesion commonly accompanying a cyst

A reactive nodule.

Can behavioral voice therapy eliminate a cyst?

No.

Primary treatment for a vocal fold cyst

Surgical removal.

Role of voice therapy for vocal fold cysts

Limited preoperative therapy and postoperative therapy.

Potential outcome if a vocal fold cyst breaks apart

It may develop into a sulcus.

Voice qualities associated with vocal fold cysts

Breathy and hoarse voice.

Airflow changes caused by vocal fold cysts

Increased airflow due to incomplete closure.

Effect of cysts on speaking fundamental frequency

May lower frequency through added mass or raise it if stiffness dominates.

Another name for Reinke's edema

Polypoid degeneration.

Cause of increased vocal fold mass in Reinke's edema

Fluid accumulation in the superficial lamina propria.

Mechanical change in Reinke's edema (mass vs. stiffness)

Increased mass (tissue remains soft and pliable).

Effect of Reinke's edema on fundamental frequency (F0)

It lowers F0, producing a deeper voice.

Two major risk factors for Reinke's edema

Long-term smoking and reflux.

Glottal closure pattern noted in Reinke's edema

Complete closure.

Treatment and recurrence profile of Reinke's edema

Surgery can treat it (recurrence is possible); behavioral therapy cannot eliminate it.

Definition of sulcus vocalis

A scar-like furrow or pit along the vocal fold.

Origins of sulcus vocalis

May be congenital or develop after a cyst breaks apart.

Effect of sulcus vocalis on vocal fold pliability

Produces very stiff tissue with reduced edge pliability.

Status of the mucosal wave in sulcus vocalis

It may be absent.

Voice characteristics of sulcus vocalis

Strained, rough, stiff-sounding voice with increased vocal effort.

Primary therapy goal for sulcus vocalis

Reduce vocal effort rather than necessarily improve voice quality.

Definition of vocal fold hemorrhage

Bleeding within the vocal fold following vessel rupture.

Factors increasing vulnerability to vocal fold hemorrhage

Extensive voice use, premenstrual period, and anticoagulant medications like aspirin.

Primary treatment for vocal fold hemorrhage

Complete voice rest (less than two weeks).

Early symptom reported by singers with vocal fold hemorrhage

Difficulty producing a few high notes.

Stroboscopic appearance of vocal fold hemorrhage

A very red or bruised vocal fold.

Effects of vocal fold hemorrhage on stiffness and frequency range

Stiffness increases due to injury and frequency range decreases.