Voice Exam 2

example of phonotraumatic behavior considered under "vocal abuse"

frequent yelling, prolonged whispering, frequent coughing and throat clearing

Two examples of phonotraumatic behaviors considered under "vocal misuse".

• singing beyond vocal flexibility (eg: a baritone trying to sing like a soprano for prolonged period of time)

• teaching beyond vocal sustainability (eg: an instructor teaching continuous classes for 6 hours without vocal breaks and hydration)

examples of an inappropriate vocal component

consistent clavicular breathing, prolonged used of glottal fry or falsetto, frequent onset and phonation using either hypo or hyper-adduction

falsetto or loft register

seen when CT muscle is at high contraction

true

T/F: Pharyngeal cul-de-sac resonance is also called hot potato voice or "potato in the mouth" speech. The voice quality is perceived as muffled or trapped due to obstruction in vocal tract secondary to swollen throat or changes in resonators (eg: palatal tonsillitis).

false

T/F: speaking in fast rate should NOT impact the breath support and laryngeal tension

medical related etiology of voice disorder

• Direct surgery such as laryngectomy

• Indirect surgery such as thyroidectomy or cardiovascular surgery

• Intubation/extubation or COVID-19

pierre robin syndrome

example of primary etiology of a voice disorder

muscle tension dysphonia

_________________ is the umbrella term for medically unexplainable voice disorder.

true

T/F: Limbic system is activated secondary to fear or anxiety and sends excessive motor impulses to the laryngeal muscles. This may lead to laryngeal function dysregulation or inhibition of phonation.

functional dysphonia

change or loss of voice after a prolonged stress or sudden shock or resistance to puberty

healthy true color of vocal folds

moist and pearly white

impacts prevalence of voice disorders in the US

age, gender, occupation

MTD

most common laryngeal pathology seen in young adults

laryngeal cancer

most common laryngeal pathology seen in middle-aged adults

vocal fold paralysis

most common laryngeal pathology seen in older adults

VF nodules

most common laryngeal pathology seen in children

Reported voice problem

17.9 million adults

seeked professional help for voice problem

10%

reported presence of GERD

8%

risk of voice problem in someone with psychological distress

two-fold

african-american

Which of the ethnic groups is less likely to report a voice problem secondary to disparities related to social determinants of health?

what happens to vocal fold tissue secondary to a structural pathology

• mass of the tissue increases

• tension in the vibrating tissue increases

• flexibility of the vocal fold tissue decreases

• typically pitch increases due to excess muscle tension

vocal tract training

An example of "productive" compensatory adjustment is:

constant increase in vocal effort or muscle tension

An example of "maladaptive" compensatory adjustment is

malignant tumor

This lesion can metastasize into a different location from the primary site through blood stream or lymphatic system

risk factors of laryngeal carcinoma

• excessive alcohol consumption

• chronic smoking

• untreated chronic acid reflux (GERD or LPR)

biopsy

_______________ is the confirmatory test of malignant tumor

how to report vocal fold nodules

Bilateral fibrous/gelatinous masses in between anterior 1/3rds and posterior 2/3rds of vocal folds

vocal fold lesions that only invade epithelium and superficial layer of lamina propria

• VF nodules

• VF polyps

acute vocal fold nodules

the first line of treatment is voice therapy in the following vocal fold lesion

hour-glass pattern

the glottic configuration in VF nodules

true

T/F: A structural lesion or functional etiology causes incomplete glottic closure which leads to excessive loss of glottal airflow. This is non-productive as the glottal air leaking through the anterior or posterior glottal gap canNOT be used for phonatory purposes. Therefore it leads to breathiness or hoarseness in vocal quality.

vocal polyps

presence of hemerrhagic blood vessel feeding the lesion is seen in:

VF granulomas

vocal fold lesion that is so invasive that it may extend upto deep layer of lamina propria and significantly disrupts the viscoelastic properties of vocal fold tissue.

Reinke’s edema

This is a vocal fold lesion which may cause severe fluid retention and inflammation in the space between epithelium and superficial layer of lamina propria.

Sulcus Vocalis

The following vocal lesion might occur secondary to rupture of vocal cysts or presylaryngeus.

voice therapy

appropriate treatment for acute vocal fold nodules

surgical excision

appropriate treatment for vocal cysts

smoking cessation program

appropriate treatment for reinke’s edema

vocal fold augmentation

appropriate treatment for sulcus vocalis

Vocal fold granuloma

a contact ulcer is commonly seen opposite to this vocal lesion

Vocal fold granuloma

the most common vocal lesion secondary to prolonged intubation or extubation

treatment option for recurrent respiratory papillomatis

• antiviral medication such as interferon

• angiogenesis inhibitor such as Avastin

• surgical excursion

laryngomalacia

Stridence during breathing, wheezing, and feeding problems are commonly seen in:

Vocal hemarrhage

first step of treatment is voice rest in:

tylenol (acetominophen)

best medicine to take for pain for a singer or vocal performer

true

T/F: Excessive vocal demands or inappropriate vocal behaviors increase the laryngeal tension which further causes structural changes in vocal fold mucosa.

Spindle-shaped glottis

The following glottic configuration is seen during phonation in a person with presbylarynx or bilateral sulcus vocalis.

2 treatments for functional cause of puberphonia

• laryngeal repositioning and circumlaryngeal massage

• negative practice

inflammatory condition of voice disorder

• rheumatoid arthritis

• LPR

• irritable larynx or allergies

2 hormones significantly impact the voice parameters

• growth hormone

• sex hormone

right external branch of superior laryngeal nerve

right epiglottic petiole deviation is seen in patients with:

superior laryngeal nerve paralysis

Epiglottic Petiole Deviation on the side of paresis/paralysis

Bilateral Adductor VF Paralysis

Inability to close the glottis

Bilateral Abductor VF Paralysis

Inability to open the glottis

Spasmodic Dysphonia

Vocal dystonia / spasms in laryngeal muscles

cadaveric

Least improvement with voice therapy in unilateral VF paralysis when paralyzed VF is at _____________ position.

VF repostioning

Best treatment when paralyzed VF is at cadaveric or partially abducted position

abductor spasmodic dysphonia

Spasms in laryngeal muscles that keep the vocal folds open is seen in ______________ and therefore voiceless to voiced transition is challenging

adductor spasmodic dysphonia

Spasms in laryngeal muscles that keep the vocal folds closed is seen in ______________ . Therefore voiced sounds are challenging and voiceless has no effort/disruption.

paradoxical vocal fold motion

Vocal folds close instead of opening during inhalation. This may lead to inspiratory stridor and a feeling of shortness of breath in _______.

paradoxical vocal fold motion

reduced flow-volume loop

ventricular phonation

false vocal folds vibrate during phonation

rheumatoid arthritis

fixation of cricoarytenoid joint

Abductor Spasmodic Dysphonia

Involuntary breathy bursts / spasms

6 steps of diagnostic voice evaluation

1. Medical examination - head and neck region; oral/nasal spaces; ears; palpation

2. The patient interview - case history, medical conditions, environment conditions, etc

3. The patient-self evaluation - uses their voice to let us know how it is affecting their quality of life

4. The perceptual evaluations of voice - GRBAS and CAPE-V

5. instrumental evaluation of voice - acoustic analysis

6. the functional evaluation of vocal fold movement - visual imaging

pack

Smoking history is well-reported by calculating __________-year(s).

maximum phonation time and s:z ratio

______________________ and _________________________ are two measures to evaluate laryngeal performance and respiratory efficiency, but only requires a stop watch

excessive or dysregulated

Tension in paralaryngeal region indicate ______________ activity of intrinsic and extrinsic laryngeal muscles

normal breathing patterns while speaking

• abdominal/diaphragmatic

• thoracic

stimulability

_______________________ is a very important step that probes for the best voice possible and understands the performance gap between what the patient habitually does and what they potentially can do.

transduction

the process of conversion of one form of energy into a different form.

amplification

NOT a form of signal detection

pitch

the perceptual correlate of fundamental frequency

fundamental frequency

the acoustic correlate of pitch

required for acoustic analysis

• signal detection

• signal manipulation

• signal reconversion

true

T/F: PRAAT identifies the peaks in acoustic signals to determine the time period (T) and then inverses the time period to obtain fundamental frequency (fo).

[fo = 1/T]

loudness

the perceptual correlate of intensity

intensity

the acoustic correlate of loudness

fundamental frequency depends on:

vocal fold tissue properties such as mass, length, and tension

intensity depends on

subglottal pressure

spectrums

voice range profiles or phonetograms are: _____

jitter and shimmer

time-based perturbation measures. They depend on time period. Therefore, are unreliable for type-II and III voices

jitter

measures cycle to cycle variability in fundamental frequency

shimmer

measures cycle to cycle variability in intensity/amplitude

type II and III voices

• they have a high aperiodic or noise energy

• moderate to severe dysphonic voices increases the noise energy and therefore makes the waveform aperiodic. 

• Softwares like PRAAT cannot determine the time period and fundamental frequency of aperiodic signals. Therefore, the acoustic measures (especially time-based) are unreliable.

high SNR value

normal and healthy voices as their harmonic energy (periodic) is higher than noise energy (aperiodic)

cepstrum

a reliable measure that can be used for all three types of voices

phonation threshold pressure

___________________ is the minimum subglottal pressure needed to initiate vocal fold vibration.

pressure gradence

airflow x laryngeal resistence

hypofunctional voice disorders (breathy voice)

mean airflow rates are greatest in these types of voice disorders

bilabial plosives

these are used to measure lung pressure because The oral closure of voiceless plosives would generate intraoral pressures which is equivalent to lung pressures.

greater laryngeal resistance

• laryngeal valve is too tight

• less glottal area

• high glottal resistance

rigid

We pass the scope through oral cavity using ___________ endoscopy.

flexible

We pass the scope through the nasal cavity using ___________ endoscopy.

true about rigid endoscopy

• excellent resolution/magnification and better lighting

• patient can only produce vowel /i/

true about flexible endoscopy

• less resolution and darker image

• patient can produce connected speech and singing tasks

• slightly invasive and therefore may need a medical professional in the province

• used a visual biofeedback tool for therapy

true

T/F: Stroboscopy is a technique which helps to see the vocal fold motion. It depends on a stable fundamental frequency to flash the strobing light in such a way that a traveling wave is created from different points of different cycles. Therefore, this technique does not fit for patients with moderate to severe form of dysphonia due to high aperiodicity.

traveling wave

strobe flashing at different points in the vibratory cycles produce