Voice Disorders Ch. 4

Front 1

phonotrauma

Back 1

behaviors that contribute to the cause or development of voice disorders. any traumatic even that happens to the mechanism.

Front 2

misuse

Back 2

a pattern of inefficient vocal production (bad behavior but only sometimes). increased tension or strain, inappropriate pitch level, excessive talking, ventricular phonation, psychological aphonia/dysphonia

Front 3

misuse: tension or strain: hard glottal attack

Back 3

voice sounds strained/tense, increased muscle tension observed. initiating vowels with abrupt, explosive, hard edged phonation. build up of SGP against tightly adducted VF

Front 4

misuse: tension or strain: high laryngeal positions

Back 4

shortens vocal tracts (raising formant frequencies)
stiffens VF (altering vibration)
tightens VF closure.
necks feels sore/pain at end of day. may be normal for professional singers. increased tension in ex/in muscles.

Front 5

misuse: tension or strain: anterior/posterior laryngeal squeezing

Back 5

results in reduced pitch range. epiglottis and arytenoids approximate during phonation. visualization of TVF obscured by tensed muscles. pitch elevation facilitates better view of larynx during scope. diagnosis and treat excess tension and strain.

Front 6

misuse: inappropriate pitch level

Back 6

look for the cause, as this is just the symptom

Front 7

misuse: inappropriate pitch level: puberphonia

Back 7

persistence of a high-pitched voice beyond the age at which voice change is expected to have occurred (mutational or adolescent falsetto). more common in males, less stigma for females. pretty benign.

Front 8

causes of puberphonia

Back 8

inadequate laryngeal growth? endocrinological problem? psychosocial factors? accompanying characteristics: pitch breaks breathiness, hoarseness, pitch jumps

Front 9

misuse: inappropriate pitch level: persistent glottal fry

Back 9

also called pulse register, takes the least amount of energy. very low F0 and least flexible. closed phase is 90% of the cycle (prolonged), see with scope and strobe. tightly approximated VF and flaccid free edges. low airflow in irregular bursts. increased tension with increased loudness (difficult to get loud).

Front 10

causes of glottal fry

Back 10

neurological, psychological, bad habit, fatigue. monotone voice, decreased variation in F0, vocal fatigue when attempting increased loudness.

Front 11

misuse: inappropriate pitch level: lack of pitch variability

Back 11

monotone voice, fatiguing. causes may be neurological (Parkinson's), psychological, or just a bad habit

Front 12

misuse: excessive talking

Back 12

larynx has physical limits that are even lower in an unhealthy person. characteristics: rough, hoarse, weak, effortful, improves with rest.

Front 13

misuse: ventricular phonation

Back 13

greater than expected movement of ventricular folds to midline during phonation. can occlude TVF. characteristics: low pitch, hoarse, rattling, rumbling, crackling, reduced intensity (can't get loud), diplophonia.
may be compensatory. inspiratory speech used as therapy (must use TVF this way).

Front 14

misuse: psychologically based aphonia/dysphonia

Back 14

if physiology is normalized, voice returns to normal. characteristics vary widely. aphonia tx begins with coughing, clearing throat and laughing to hear voice. voice problem reflects coping with stress. could have hoarseness, breathiness, aphonia, dysphonia, tension, etc. treat the maladaptive beh while rooting out etiology.

Front 15

misuse and abuse

Back 15

abuse= prolonged and excessive. fine line between the 2. more of a continuum. cannot predict when misuse will turn into abuse. changes in phonatory beh are difficult for pt to detect.

Front 16

abuse: excessive prolonged loudness

Back 16

have to create greater SGP by increasing tension or approximation (tightly adduct). pathology at vocal edge: irritation, inflamation, swelling--> increased mass, stiff cover, changed vibratory beh-->leads to tissues changes and lesions at points of greatest contact. further damage by trying to overcome disordered voice.

Front 17

excessive prolonged loudness (characteristics and causes)

Back 17

hoarseness after prolonged speaking, breathiness after lesions develop. VF irritated due to infection, allergies, noxious environment, GERD, dryness due to drugs or environment.

Front 18

abuse: excessive throat clearing and coughing

Back 18

blast of air can be damaging if occurs too much. caused by allergies, infections, drug reactions, XRT, emotions, smoking/drinking, pathology of mucous glands. cough for more than 3 weeks (chronic). GERD, smoking, asthma, bronchitis, post-nasal drip.

Front 19

abuse: screamer and noise maker

Back 19

aggressive children who yell and scream in play and interactions (sound effects). more common in boys, 65% come from unstable families. hoarseness, breathiness. sports & exercise enthusiast. yelling with high pitch and tensions, grunting. leads to swelling --> build up of intrathoracic pressure against laryngeal valve. improves with rest, abuse if recurring.

Front 20

damaging effects of drugs on the voice

Back 20

litter research has been done on larynx and drugs. biological response variability: everybody is different due to age, body composition, biochemistry, kidney function, genetics, disease, stress levels, nutritional status, drug interaction

Front 21

damaging effects of drugs cont'd

Back 21

placebo effect
dose-response relationship (allergic reactions, drugs work up to a certain dosage, level off, and then neg effects)
multiple effects of single drug (side effects)
drug efficacy vs. drug dosage (the more effective drug may have worse side effects, smaller dose with more side effects may be worse than larger dose of another drug)
geriatric effect (change in body structure, metabolism, and more drugs in system)

Front 22

voice related effects of drugs: coordination and proprioception

Back 22

any drug that works on the CNS may affect fine motor control needed for phonation. stimulants (amphetamine), depressants (alcohol, tranquilizers--worsen spas. dysphonia, not good before larnygeal exam), anesthetics: lack of sensory feedback may change VF function

Front 23

voice related effects of drugs: airflow

Back 23

if the bronchioles are affected, it changes the airflow dynamics. bronchial dialoators used as anti-asthma agents (may make pt tremor/nervous). bronchial constrictors: most common allergic reaction-life threatening. allergens and industrial toxins.

Front 24

voice related effects of drugs: fluid balance

Back 24

drugs to control swelling (diuretics, such as those used for hypertension). decongenstants (cold and allergy remedies), corticosteroids (used for performers, do not cure prob), rebound effects (when decongestants wear off, edema is worse that before, contd usage can damage mucous membranes).

Front 25

special note: effects of inhaled corticocteroids for asthma on the voice

Back 25

some evidence of vf changes (dysphonia, bowing). chronic asthmatics my alter vocal tract function. increased F0 of 20 Hz (voice lower) after one year of use and cumulative effects (builds tissue).

Front 26

voice related effects of drugs: secretions of upper respiratory tract

Back 26

dry air environment causes coughing which further dries mucosal lining of upper airway. drugs further dry it (antihistamines, anti diarrheal, anti tussive, anti psychotics, anti depressants, anti hypertensives). artificial saliva, for ppl with saliva gland path (XRT), but poor pt compliance. mints, tictacs, sipping water and gum chewing.

Front 27

voice related effects of drugs: changes in VF structure

Back 27

andorgens (male hormone) given to postmenopausal women and body builders. virilization=increased mass. low pitch, husky voice. irreversible!

Front 28

voice related effects of drugs: irritation of VF mucosa

Back 28

GERD results from weakening of lower esophageal sphincter (LES). drugs that cause this: dopamine, atropine, smoking, calcium blockers, sedatives/tranquilizers, nitrates, caffeine, fat, alcohol, spicy foods, ototoxic drugs, herbal teas, aspirin, beta blockers, smoked/inhaled drugs

Front 29

miscellaneous drugs: ototoxic drugs

Back 29

some antibiotics, usually IV form (lasix, bumex used for CHF and HTN, chemo drugs). laryngeal physiology may change due to HL and affect laryngeal tissue

Front 30

miscellaneous drugs: herbal supplements

Back 30

42-57% take and dont tell the Dr. Some have serious side effects, no FDA regulations.

Front 31

miscellaneous drugs: aspirin and beta blockers

Back 31

VF hemorrhage if too much blood thinner use.
beta blockers used for stage fright, don't seem harmful though verdict is still out.

Front 32

miscellaneous drugs: smoking and tobacco

Back 32

directly related to laryngeal Ca. 95% of Ca caused by smoking. leukoplakia and hyperkeratosis=preCa. Reinke's edema related to smoking. causes redness and irritation of larynx and upper resp tract. emphysema and COPD decreased respiratory function/vocal function. lung Ca. affects phonation.