Fripty Study Bundle SLP Set 13 - Student Developed - Fripty Approved

What is a granuloma? Discuss

localized, inflammatory vascular lesion composed of granular tissue. Usually form on vocal process. Caused by vocal abuse, intubation, injury to the larynx, GER. Associated with contact ulcers.

How do individuals with granulomas sound?

Breathy and hoarse. They feel the need to clear their throat.

How do you treat granulomas?

surgery or voice therapy

What is a hemangioma?

Similar to granulomas but soft, pliable and filled with blood. Caused by intubation or hyperacidity

What is leukoplakia?

benign growth, white patches on surface membrane of mucosa. caused by tissue irritation, like with smoking, alcohol or vocal abuse. considered precancerous and must be monitored

How do patients with leukoplakia sound?

hoarse, low pitched breathy and soft. diplophonia

What is hyperkeratosis?

rough, pinkish lesion that appears in oral cavity, larynx or pharynx. caused by tissue irritation, like smoking, GER and vocal abuse.

What is laryngomalacia?

Soft, floppy laryngeal cartilage. The epiglottis is affected. When the child breathes, the epiglottis resists the airstream which causes stridor

What is subglottal stenosis?

narrowing of the subglottic space. can be acquired or congenital. congenital caused by interrupted development. less than 4.0 mm in diameter. acquired caused by prolonged intubation. it can be severe and let no air in, which requires tracheostomy

What is a papilloma?

Tend to occur primarily in childhood. wart like growths caused by HPV. pink or white and can be found anywhere in the airway. They may have airway obstruction.

How does an individual with papillomas sound?

Hoarse, breathy, low pitch. if you have repeated surgeries to remove, mucosa is removed and scar tissue develops, which affects vocal quality. after surgery they still may be hoarse and low pitched, but that's better than not breathing so they do it anyways

How do you treat papillomas?

surgeries. They use cup forceps surgery, interferon medication and CO2 laser surgery (widely used)

What are some types of laryngeal trauma?

burns, MVA, sports related accidents, strangulations, gunshots, swallowing sharp objects

What are laryngeal webs?

A membrane that grows across the anterior portion of the glottis. congenital is present at birth and acquired develops due to trauma to the inner edges of the vocal folds, such as prolonged intubation, surgery or severe laryngeal infection.

How do you treat laryngeal webs?

Immediate surgery followed by tracheostomy. (infants)

Immediate surgery followed by a laryngeal keel which is placed between vocal folds to prevent them from growing (adult)

What is paradoxical vocal fold motion disorder?

aka laryngeal dyskinesia, there is inappropriate closure of the true vocal folds during inhalation. these patients appear asthmatic

What causes PVFM?

Both psychological and physiological causes.

What is GERD?

Gastric content empty into the esophagus. patients may experience sore throat, hoarseness and contact ulcers.

What is vocal fold paralysis?

Can be caused by accidental injury to recurrent laryngeal nerve during surgical procedure, neurological diseases such as ALS, malignant disease such as tumors, intubation trauma, laryngeal trauma, stroke, vagus nerve deficits.

How do patients with ankylosis/paralysis sound?

Breathiness, reduced pitch and volume. Can't cough well, may experience dysphagia

How does unilateral paralysis look? bilateral? ankylosis?

Unilateral paralysis can appear normal. If the paralyzed fold is so far from the midline, it may be difficult to achieve closure, which causes aphonia.

Bilateral paralysis leads to a wide open glottis which causes aphonia.

Ankylosis causes restricted movement of the arytenoids. (because of something like arthritis).

How do you treat VF paralysis?

For unilateral, doctor creates a bulge (teflon, collagen, autologous fat) in the paralyzed fold sot he healthy fold can meet it.

They also do thyroplastly type 1 which is where they go through the thyroid cartilage and medialize the fold and place a small silastic implant in to keep it medialized.

They also do nerve-muscle pedicle reinnervation which is where the surgeon takes a pedicle of a neck muscle with innervation and structures it into the adductors.

What are some treatment techniques that can help VF paralysis patients achieve closure?

elevation in pitch

increased loudness

increased breath support

pushing approach

hard glottal attacks

head turning

What is spasmodic dysphonia?

A focal laryngeal dystonia (involuntary spasms/movements of the laryngeal muscles). Most believe it has neurogenic causes with emotional side effects.

What are two types of spasmodic dysphonia?

Abductor spasmodic dysphonia: involuntary vocal fold abduction when the patient tries to phonate. Loudness is reduced, occasionally aphonic. Breathy/whispered speech.

Adductor spasmodic dysphonia: most common. overpressure due to prolonged over adduction of VF. voice sounds choked/strangled.

How do you treat abductor spasmodic dysphonia?

botox, speech therapy, pharmacological intervetnion

How do you treat adductor spasmodic dysphonia?

CO2 laser surgery: paralyzed fold thinned with CO2 laser beam. widens glottis

Recurrent laryngeal nerve resection: cuts the nerve and reduced hyper adduction

Botox: must be done every 3-6 months

AAC

Voice therapy: inhalation phonation, increased pitch, relaxation, head turning, yawn-sigh approach, soft

What is MS and how does it affect voice?

Progressive demyelination of white matter. Pts may have impaired prosody pitch and loudness. harshness. breathiness. hypernasality. articulation breakdown.

What is myasthenia gravis and how does it affect voice?

It produces fatigue and muscle weakness. Decreased acetylcholine at myoneuronal junction. Patients are hypernasal, breathy, hoarse and soft. There may be dysphagia and distorted articulation. Treated with steroids

What is ALS and how does it affect voice?

Progressive, fatal disease involving degeneration of UMN and LMN. They sound breathy, low pitched and monotonous. Poor respiratory control. Treatment is usually on AAC because it's a progressive disease.

What is Parkinsons disease and how does it affect voice?

Lack of dopamine in the substantia nigra of basal ganglia. Patients sound breathy, low pitched and monotonous.

Treated with L-dopa and LSVT

What are some voice treatment techniques for patients with neurological diseases?

This helps with voice and also dysarthria, since most patients have that as well.

Improve articulation through exaggerating consonants and slowing rate of speech

Improve resonance through increased mouth opening (improving VP closure)

Improve prosody

Improve respiration through relaxation, teaching efficient breathing

Improve vocal fold approximation

Discuss vocal nodules

Nodes that develop on VF. They increase the mass of VF which causes them to vibrate slower, resulting in lower pitch. They also make smooth vocal fold approximation impossible, which causes breathiness and and hoarseness. Treated with voice therapy or surgery. Develop anteriorly

Discuss polyps

Softer than nodules and are filled with fluid or vascular tissue. Polyps are typically unilateral (whereas nodules are bilateral). Sessile polyps have a broad base on the vocal fold whereas pedunculated polyps are attached by a stalk. They sound breathy and hoarse and may have diplophonia (because healthy fold vibrates at a different rate)

What are contact ulcers? Discuss

Sores or ulcerated tissue. Caused by slamming of arynteoid cartilages that occur during low pitch phonation (because ulcers appear along posterior 1/3), or by GERD, where acid irritates the area between the arytenoid cartilages or by intubation.

These patients complain of laryngeal pain and sound hoarse and are constantly clearing their throat.

What are the fundamental steps in voice therapy?

Thoroughly evaluate

MEDICAL EVAL FIRST

Educate patient

Help reduce vocally abusive behavior and facilitate normal voice

Use audio recordings

Use visual feedback

Hydration therapy

What is the open-mouth approach for voice therapy?

speaking with a wider mouth to help improve oral-nasal resonate

What is the chant-talk method for voice therapy?

speaking in a connected manner, soft glottal attack, even stress, prolongation of sounds

How can you use digital manipulation for voice therapy?

Placing thumb and finger on either side of laryngeal cartilage and pushing downward while patient phonates

What is puberphonia?

men speaking in a high voice despite anatomical changes. can be due to psychological factors, endocrine disorders or neurological diseases.

How can you treat puberphonia?

These individuals can benefit from digital manipulation. Also, relaxation, yawn-sigh, open-mouth approach can also help.

What is the lombard effect?

Helps lower pitch. Playing background/masking noise while the client is talking which forces them to increase their loudness which usually lowers the voice.

What is a psychogenic voice disorder?

Voice is abnormal but laryngeal structures are normal. During phonation, VFs may be abducted

What is hysterical or conversion aphonia? how is it treated?

No structural pathology. Aphonia is experienced after an emotional traumatic event.

If there is no structural cause, usually treated with counseling.

We can employ behavior therapy with the lombard effect, relaxation techniques, encouraging coughing, grunting, laughing, prolonging a cough into a vowel, inhalation phonation, yawn-sigh