SHS 719 Exam 2 Dr. Mathews

What is the difference between aphonia and dysphonia?

aphonia- the absence of phonation (no audible speech)

dysphonia- phonation characterized byabnormal voice quality, pitch,loudness, resonance, or durationrelative to a person's age, gender,gender identity, culturalbackground, orgeographic location.

When is a voice disorder functional?

when the vocal mechanism is normal and the cases are behavioral (e.g. vocal abuse)

When is a voice disorder organic?

when there are laryngeal structural changes or neurological problems that may impair voice production.

What are the different types of dysphonia?

disorders of pitch (frequency), disorders of loudness (intensity), disorders of quality, and disorders of resonance

______________ is the average frequency of vocal fold vibrations in an individual.

fundamental frequency

Vocal pitch is generally assessed in these terms:

______________ of a speaker is the average pitch heard in a sample of continuous speech. _____________ is the lowest possible pitch (basal) and highest possible pitch(ceiling) and the variations in between.

habitual pitch

pitch range

Disorders of __________ arise due to inappropriate frequency with which the vocal folds vibrate, breaks in the cycles of vocal fold vibrations, lack of normal variations in the frequency of vibrations and asynchronous vibrations of the two folds. These can have both functional and organic causes

pitch

What are the 4 disorders of pitch?

inappropriate pitch

pitch breaks

monopitch

diplophonia

Which disorder of pitch refers to notes that the vocal pitch is inconsistent with the child's age, size, and gender?

inappropriate pitch

Which disorder of pitch is when the vocal pitch breaks unexpectedly? They are a deviation in the smooth rates which with the vocal folds normally vibrate.

pitch breaks (voice crack)

Which disorder of pitch is the absence of normal pitch variations which maybe due to a neurological disorder?

monopitch

Which disorder of pitch refers to the simultaneous production of two distinct frequencies which occurs when two vocal folds vibrate at different rates because of a lesion, swelling, scarring, or vocal fold paralysis, or when another vibrating source is present in addition to the vocal folds (e.g. the ventricular folds, aryepiglottic folds, or a laryngeal web)?

diplophonia

What are the disorders of loudness?

excessively loud voice and excessively soft voice

What are the characteristics of an excessively loud voice disorder?

voice that is too loud in most every day speaking situations is socially inappropriate and calls attention to itself.

maybe associated with hearing loss, but is usually a functional disorder of voice.

excessive loudness can lead to more serious problems, including the developmentof nodules, polyps or laryngeal hyper function

What are the characteristics of an excessively soft voice disorder?

voice that is too soft interferes with communication and fails to meet the demands of social interaction.

neurological damage or laryngeal pathologies may cause this, but in children, itis frequently a functional disorder possibly due to faulty learning

What are the voice disorders of quality?

breathiness, harshness, hoarseness, and a tense voice

Which disorder of quality involves phonation with excessive and audible air leakage due to inadequate approximation of the vocal folds (increased glottal opening)?(In children, this is usually the result of vocal fold edema, nodules, or polyps)

breathiness

Which disorder of quality is causes by aperiodicity of vocal fold vibrations that results in an unpleasant, strident, or rough voice? (May be associated with excessive vocal effort, hard glottal attacks, abrupt initiation of voice, and constriction of the vocal tract. Possible etiological factors include neurological disorders, laryngeal structural disorders vocal abuse or faulty learning)

harshness

Which disorder of quality is a combination of harshness and breathiness?(a grating or husky voice that includes phonation breaks, diplophonia, and low pitch also characterize it. This may sound dry or wet. A wet voice is generally caused by excessive mucus in the larynx. Etiology can be functional or organic such as edema, nodules, polyps, cysts, papilloma, reflux, laryngitis, allergies, asthma or vocal abuse/misuse)

hoarseness

Which disorder of quality involves phonation produced with excessive adduction and medial compression of the folds? (Voice sounds tight, strained, and effortful. Often a result of organic conditions that promote compensation resulting in hyperadduction of the folds which may exacerbate the organic condition or escalate larygneal hyper function)

tense voice

What are the disorders of resonance?

hyper nasality, hyponasality, cul-de-sac resonance,and assimilation nasality

Which disorder of resonance involves inadequate nasal resonance due to too little nasal resonance? (A child can sound "stuffed up". This could be due to an obstructed nasal passage or nasopharynx, excessive or thick secretions secondary to chronic upper respiratory infections or allergies, structural deviations of the nasal septum or sinus cavities, enlarged adenoids, significant hearing loss, or faulty learning.)

hyponasality

Which disorder of resonance involves excessive nasal resonance on nonnasal speech sounds? (Etiologic factors include: craniofacial anomalies such as short palate or velum, clefts of the hard or soft palate, submucous clefts and velopharyngeal insufficiency (VPI). This can be associated with deafness, faulty learning, and cerebral palsy in some children.)

hyper nasality

Which disorder of resonance involves a tongue posteriorly retracted deep into the oral cavity and hypo pharynx resulting in muffled "bottom of the sac" resonance? (This is generally associated with oral apraxia, cerebral palsy, deafness or faulty learning.)

cul-de-sac resonance

Which disorder of resonance involves when oral sounds that surround nasal sounds become nasalized? (It is a disorder of accurate opening and closing of the velopharyngeal port needed to discriminate oral and nasal sounds.It is often associated with VPI, craniofacial abnormalities, or neurological disorders like cerebral palsy resulting in spastic dysarthria)

assimilation nasality

______________ and ______________ refer to behaviors that are injurious to vocal fold tissue and oftencontribute to a voice disorder.

vocal abuse, phonotrauma

What are examples of vocal abuse?

yelling, screaming, cheering, making noises while playing,grunting, excessive crying, and chronic throat clearing or coughing

_______________ is a set of unhealthy vocal behaviors that include speaking with inappropriate pitch or loudness, poor respiration, poor resonance, excessive rate, or hard gotta attacks.

vocal misuse

_______________ is the viewing of thelarynx and surrounding structuresby using a laryngeal mirror or a rigidor flexible fiberoptic endoscope.

laryngoscopy

A small round mirror mounted at an angle on a long, thin handle is a ___________

laryngeal mirror

A firm tube that is inserted into the oral cavity and oropharynx is a ____________

rigid endoscope

A bendable tube that is inserted into the nasal passage and can be placed above the velum in the nasopharynx to assess VP structure and function is a ____________

flexible endoscope

______________ refers to the use of a strobe light in conjunction with a flexible or rigid scope.

stroboscope

In general, clinicians design specific tasks to help assess what 6 voice characteristics?

Vocally abusive behaviors, breathing and breath support for voice production, pitch, loudness, vocal quality, and laryngeal tension

During a clinical assessment of pitch, what do you measure?

-habitual pitch (sample the child's pitch at several points during one or more of the following clinical tasks: have the child count from 1 to 10, have the child sustain /a/, record a spontaneous speech sample and a reading sample)

-pitch range (measure the highest pitch, the lowest pitch, and the overall pitch range of the child's voice during clinical tasks and listen for any changes in voice quality that occur when pitch changes)

During a clinical assessment of loudness, what do you measure?

-loudness range (have the child count starting at a whisper for the first number and gradually get louder with each number until they get to their loudest)

-average loudness (use an instrument and measure the child's vocal intensity at several points in a speech sample to calculate the average decibel level)

When clinically assessing vocal quality, what methods do you use?

-administer the CAPE-V (Consensus Auditory-Perceptual Evaluation of Voice: measures overall severity, roughness, breathiness, strain, pitch, and loudness)

-assess conversational voice

-measure the s/z ratio

-assess vocal endurance

-assess coughing and throat clearing

-identify hard glottal attacks

When clinically assessing resonance, what methods do you use?

-use the Resonance and Velopharyngeal Function Protocol to clinically asses without instrumentation

(may only need to address this as part of the orofacial examination as resonance does not always accompany other voice disorders)

Given a case with the following characteristics, what would the diagnosis be?

-The assessment documents a voice disorder of pitch, loudness, quality or resonance.

-There is evidence of vocal misuse or phonotraumatic behaviors that are related to the diagnosed voice problem.

-There is a physician's diagnosis of laryngeal pathology associated with vocalmisuse or phonotraumatic behaviors

dysphonia

Given a case with the following characteristics, what would the diagnosis be?-The child demonstrates a complete loss of voice or the inability to produce phonation for speech and a laryngologist has ruled out organic pathology or etiology.

-There is case history evidence of some gain from the problem

-Alternatively, there is evidence of a URI or illness requiring complete vocal rest that proceeded this condition.

-The child produces phonation on such nonspeech acts as coughing, throat clearing ,or laughing

functional aphonia

Given a case with the following characteristics, what would the diagnosis be?

-The assessment supports a voice disorder of pitch, loudness,quality or resonance

-The voice disorder is associated with a medically diagnosed organic or neurological condition

organic or neurological voice disorder

Given a case with the following characteristics, what would the diagnosis be?

-The child demonstrates a voice disorder of pitch, loudness, quality or resonance that is associated with a pervasive pattern of excessive effort and tension that affects the muscles and structures of the larynx.

-An ENTs examination has confirmed the presence of laryngeal hyper function

-Laryngeal hyperfunction is associated with vocal abuse or misuse.

-Laryngeal hyperfunction is associated with an effort to compensate for such structural deviations as congenital malformations, webs, papillomas, paralysis, nodules, polyps, etc.

hyper functional voice disorder

Given a case with the following characteristics, what would the diagnosis be?

-The assessment documents hypernasality or assimilation nasality in the absence of any unrepaired palatal cleft

-A medical examination confirms VPI

velopharyngeal incompetence (VPI)

_____________ is the act of swallowing and is just one process in the broader context of feeding.

deglutition

____________ is a broad term to encompass the process for getting food/liquid into the mouth.

feeding

___________ is a swallowing deficit.

dysphagia

______________ refers to all aspects of sensory and motor functions involving the structures in the oral cavity and pharynx related to swallowing.

oral sensorimotor function

______________ is the process by which all living organisms obtain the food and nourishment necessary to sustain life and support growth.

nutrition

What are the risk factors for feeding and swallowing disorders?

birthweight and gestational age, neurodevelopmental factors, congenital heart disease, structural anomalies, tracheostomy, and in utero constraint

What are the anatomical differences between infants and older children?

-overall the oral cavity is going to be smaller.

-some children depending on age and development may have teeth.

-in infants, you will see fat pads or sucking pads in the cheeks which are very important for sucking and their lack of development or continuation beyond developmentally appropriate age should be considered.

-as growth and development occur, two important changes emerge:

1 the angle of the nasopharynx at the skull base becomes more acute and approaches 90 degrees 2 the pharynx elongates so that an oropharynx is created.

___________________ refers to the cognitive processes for the analysis of information derived from evidence and science rather than assumptions or conjectures. (Clinicians need to judge the type and credibility of sources and recognize the

impact on behaviors.)

critical thinking

__________________ refers to the application of the information to the clinical situation for an individual patient. (Requires integration of the best data and the ability to sort through a cluster of features and accurately diagnose. Elements of this include: knowledge, skill or experience, context)

clinical reasoning

_________________ refers to the decisions based on "knowing the patient.' May include interpretation or conclusion about patient's needs, concerns or health problems as well as decision to take or not to take action.

clinical judgment

What are possible signs and symptoms of swallowing deficits in the oral preparatory or bolus formation stage?

-food falls out of mouth

-pooling in anterior sulci

-lack of tongue action to form bolus

-lack of chewing

What are possible signs and symptoms of swallowing deficits in the oral transit stage?

-pooling in lateral sulci

-food pushed out of mouth

-slow bolus formation

-piecemeal deglutition

-delayed swallow

What are possible signs and symptoms of swallowing deficits in the pharyngeal stage?

-pooling in valleculae and pyriform sinuses

-residue in pharyngeal recesses after swallow

-gurgly voice quality

-aspiration on liquids, safe for thicker textures

-aspiration on paste, safe with liquids

-choking on mixed textures in the same bite

-swallow delayed a few seconds for best texture

-aspiration for all textures (frequent)