Voice Disorders Exam 1

Front 1

What is the function of the recurrent laryngeal nerve (RLN)? and what does it innervate?

Back 1

1. Branch of the vagus nerve that supplies motor function and sensation to larynx.
2. RLN Innervates: All intrinsic laryngeal muscles, except cricothyroid muscle. Regulates VF movement.

Front 2

List the four types of vocal fold paralysis and give a definition of 2.

Back 2

1. Bilateral abductor paralysis: Unable to abduct.
2. Bilateral adductor paralysis: Unable to adduct.
3. Unilateral abductor paralysis: 1 fold paralyzed near midline, other fold functions normally.
4. Unilateral adductor paralysis: (Most Common): 1 VF paralyzed and rests in adductor position

Front 3

List three causes/etiology of recurrent laryngeal nerve paralysis

Back 3

1. Diseases: brain/skull tumors, thyroid cancer, esophageal cancer, lung/heart disease.
2. Lesions: vagus nerve, skull lesions, cancer, trauma, upper respiratory infections.

Front 4

What are three vocal issues that can result when a person has RLN paralysis?

Back 4

1. Hoarseness
2. Breathy vocal quality
3. Dysphonia (lack of power/quality)
4. Loss of vocal power/quality
5. Loss of VF body/tonicity

Front 5

What are treatment options for RLN paralysis?

Back 5

1. Injection Teflon paste/Bio implants/ Surgery (Thyroplasy)/ Muscle-Nerve Innvervation/Voice Therapy

Front 6

What is one assessment tool utilized to evaluate recurrent laryngeal nerve paralysis?

Back 6

Stroboscopy

Front 7

What are the 5 most common etiologies of SLN damage?

Back 7

1. Malignancies
2. Iatrongenic surgical trauma
3. Non-surgical trauma
4. Neurovascular diseases
5. Neurological diseases

Front 8

In terms of assessment during superior laryngeal nerve paralysis, when would a laryngeal electromyography be performed and what does the procedure entail?

Back 8

1. Allows for differential diagnosis of larynx muscles
2. Procedure: Insert electrodes in larynx & assess function of cricothyroid, thyroarytenoid, posterior cricoarytenoid muscles. Pt asked to inhale/exhale/swallow to evaluate contraction of muscles

Front 9

List three behavioral approaches you could use therapy with an individual who has SLN damage?

Back 9

1. Hard glottal attacks & pushing
2. Half-swallow boom
3. Abdominal breathing
4. Lip/Tongue trill
5. Accent method/appropriate tone focus

Front 10

Why should voice therapy begin as early as possible?

Back 10

1. Eliminate compensatory muscle tension dysphonia (MTD)
2. Allow patients to maximize phonatory ability

Front 11

Why would surgical treatment of superior laryngeal nerve paralysis be performed?

Back 11

After voice therapy fails to improve vocal function

Front 12

What is a medicalization thyroplasty and what does it entail?

Back 12

Surgical implant to maneuver paralyzed VF to appropriate position for glottal closure, thus voicing

Front 13

What is the most common etiology of Arytenoid Dislocation?

Back 13

Tracheal Intubation

Front 14

b. Arytenoid Dislocation is commonly misdiagnosed as ____________.

Back 14

Vocal fold paralysis/paresis

Front 15

What types of assessments are commonly used to diagnose Arytenoid Dislocation?

Back 15

1. Laryngoscopy
2. CT scan of larynx
3. Laryngeal Electromyography (LEMG)
4. Videostroboscopy

Front 16

As a speech pathologist, what voice therapy techniques could be useful for an individual with Arytenoid Dislocation?

Back 16

Simple vocal exercises, laryngeal relaxation techniques, compensatory strategies

Front 17

Which surgical procedure is most commonly used for Arytenoid Dislocation?

Back 17

Closed Reduction Procedure

Front 18

Researchers believe sulcus vocalis is caused by:

Back 18

A. Genetic factors
B. Behavioral components
C. Both A and B (although no consensus exists)

Answer: C

Front 19

Patients with sulcus vocalis may present with:

Back 19

A. vocal fold paralysis
B. harsh or hoarse vocal quality
C. low fundamental frequency

Answer: B

Front 20

In order to obtain a reliable and clear examination of an individual’s larynx, the following is typically performed to identify sulcus vocalis:

Back 20

A. Angioplasty
B. Augmentagram
C. Videostroboscopy

Answer: C

Front 21

d. The preferred treatment for addressing sulcus vocalis is ______, followed by ________.

Back 21

The preferred treatment for addressing sulcus vocalis is surgery followed by voice therapy.

Front 22

One treatment technique involves injecting material deep into the vocal folds to close an insufficient _________.

Back 22

Glottic gap.

Front 23

A vocal fold injection procedure may need to be repeated, as the body may _________ much of the injected material within a year after undergoing the procedure

Back 23

A vocal fold injection procedure may need to be repeated, as the body may absorb much of the injected material within a year after undergoing the procedure

Front 24

What is one method of treatment to address sulcus vocalis?

Back 24

1. Surgery: medialization laryngoplasy/thyroplasty, injection into sulcus
2. Voice Therapy: adjust balance between proper glottal closure/pitch/loudness, produce pitch shifts/loudness changes/experiment with glottal closure, auditory feedback.

Front 25

List what a videostroboscopy allows professionals to observe and assess.

Back 25

1. Allows for visualization or diminished amplitude of mucosal wave
2. Assess appearance/movement/vibratory pattern/tension/vocal quality

Front 26

How would you decide what treatment to use with a patient with Recurrent Laryngeal Nerve Paralysis?

Back 26

Begin with behavioral treatment such as voice therapy and progress to injection/innervation/surgery depending on severity.

Front 27

What are the assessments of Superior Laryngeal Nerve Paralysis (SLN)?

Back 27

1. Strobovideolaryngoscopy
2. Electromyography (EMG)

Front 28

What are treatment of Superior Laryngeal Nerve Paralysis (SLN)?

Back 28

1. Voice Therapy treatment
2. Surgical treatment (Injection of fat collagen, Arytenoid adduction, Thyroplasty)

Front 29

What are treatment of Arytenoid Dislocation?

Back 29

1. Surgical reduction procedures (Closed Reduction Procedures, Open Reduction, Thyroplasty, Botox, etc.)
2. Voice therapy

Front 30

Etiology of Sulcus Vocalis?

Back 30

-Lack of consensus
-Genetic factors/congenital disorder
-from long term VF hemorrhage/cyst

Front 31

What are assessment options for Sulcus Vocalis?

Back 31

Videostroboscopy

Front 32

What are treatment options of Sulcus Vocalis?

Back 32

1. Surgery (Thyroplasty/Injection into sulcus)
2. Voice Therapy

Front 33

What happens when there is damage to Recurrent Laryngeal Nerve?

Back 33

Vocal cord injury -----> Paralysis

Front 34

Vocal Nodules are a result of what?

Back 34

vocal abuse or hyperfunction

Front 35

Describe vocal quality characteristics that may be a result of vocal nodules (5)

Back 35

hoarseness, decreased upper pitch range, vocal fatigue, glottal fry, breathiness.

Front 36

What are the three domains of treatment used to manage vocal nodules?

Back 36

1) Surgical: remove nodule 2) Medical: treat other factors that impact nodules: GERD, allergies, smoking. 3) Behavioral: Behavioral intervention commonly teaches vocal hygiene, reducing vocally abusive behaviors and direct voice treatment for breath support, stress reduction, and alterations in pitch and loudness.

Front 37

Name three factors that help to determine appropriateness of surgical intervention for vocal nodules

Back 37

Surgery is only indicated when other approaches fail to produce desired effects. 1) large size and long age. 2) congenital in nature. 3) pain and negative feelings by patient

Front 38

What role does an SLP play in assessment of vocal nodules?

Back 38

Assessment: Case history, OME, perform videoendoscopy, videostroboscopy, perform perceptual voice eval

Front 39

What role does an SLP play in diagnosis of vocal nodules?

Back 39

Diagnosis: SLP can comment on vocal qualities and function but is not qualified to make diagnosis of vocal nodules without physician.

Front 40

What role does an SLP play in the treatment of vocal nodules?

Back 40

SLPs have been successful in decreasing vocal ratings from mod-severe to mild or WNL with voice therapy. This is the first thing attempted in treatment. There are 5 phases of therapy:
i. Vocal hygiene: (1) client education about how normal voice is produced; (2) identification of voice-use-related (e.g., yelling) and non-voice-use related (e.g., smoky environment) abuses; (3) education about vocal nodules in terms of suspected etiology and effects on voice production; and (4) reduction/elimination of vocal abuse via the “Vocal Abuse Reduction Program
ii. Direct facilitation: Two basic facilitation approaches were used: (1) reduction of loudness, and (2) yawn-sigh exercises
iii. Respiration
iv. Relaxation
v. Carryover: The process started in the therapy room with the client mimicking pertinent speaking situations (e.g., talk- ing on the telephone), continued in next-door local- ities outside the therapy room, and ended in locations outside the clinic (e.g., a restaurant).

Front 41

Describe a vocal fold granuloma and where it typically forms

Back 41

it is inflammatory tissue arising from the connective tissue near the arytenoid cartilages. For a granuloma to form there needs to be a two step process of: 1) mucosal injury 2) subsequent injury of the connective tissues of the arytenoid cartilages

Front 42

Discuss how vocal fold granulomas are assessed and diagnosed

Back 42

Assessed: through clinical history and indirect/flexible pharyngolaryngoscopy and videostroboscopy. Diagnosis: upon appearance and position of lesion. If in doubt: microlaryngoscopy, biopsy, and histopathology.

Front 43

Name at least 2 causes of vocal fold granulomas (7)

Back 43

GERD, vocal misuse/hyperfunction, glottal incompetence with severe hyperfunction, vocal fold atrophy, vocal fold paralysis, vocal fold scar, chronic cough.

Front 44

What are 3 symptoms of vocal fold granulomas?

Back 44

globus sensation, dysphonia, and/or odynophonia

Front 45

Discuss 3 treatment options of vocal fold granulomas

Back 45

. 1) Voice therapy: especially for granulomas originating from vocal abuse. Reduces damaging force/strain patterns on vocal folds. Teaches appropriate breath support to decrease extreme effort.
2) Anti-reflux medication: voice therapy was received in combination with medication.
3) Botox: eliminates friction and contact for VFs allowing for healing. 4) Surgical excision: considered after all other treatment options have been exercised. Most effective: surgical removal with radiation therapy.

Front 46

What are the two types of vocal fold granulations and how are they formed?

Back 46

1) Contact granuloma: Postural stress from forceful adduction and compressional force at the vocal process. It develops from a persistent ulceration that has turned grainy, typically in males, and hydration and soft glottal attack can keep ulceration at bay.
2) Intubation granuloma: intubation tube causes initial injury and persistence of tube causes subsequent injury with higher incidence in women.

Front 47

Compare and contrast mucous-retention cysts and epidermic (squamous-inclusion) cysts (VF cysts)

Back 47

1) epidermic cysts are a result of vocal overuse, pearl-like in appearance, form on the subepithelial layers of VFs, covered by stratified squamous and kerantinized epithelium which makes them resistant to manipulation.
2) Mucous-retention are a result of vocal overuse, laryngitis due to GERD, upper airway infection. Characterized by ciliated cyndrical epithelium covering.

Front 48

What are the three components of a comprehensive assessment of vocal fold cysts?

Back 48

Vocal cysts are diagnosed following a thorough assessment consisting of pertinent medical history, physical examination, and videostroboscopy. Comprehensive assessment provides information regarding the anatomy and vibratory functions of the glottis and phonatory system.

Front 49

Name two alternate methods to videostroboscopy for viewing the structure and function of the vocal folds for vocal fold cysts

Back 49

High-speech photography, videokymography, and photoglottography are all alternate methods for evaluating the function and appearance of the vocal folds and for determining the presence of vocal fold cysts

Front 50

Provide two methods in which vocal fold cysts are treated. Provide one pro and one con for each method:

Back 50

No consensus on which patients will respond better to surgery, voice therapy or both. Voice therapy: helped perceptually but did not affect size of cysts. Surgical: necessary when voice therapy alone is unsuccessful, voice therapy is needed afterwards though.

Front 51

What are the two main goals for voice therapy for vocal fold cysts?

Back 51

The most common themes for voice treatment include vocal hygiene, pitch, breath support, and laryngeal tension.

One technique is confidential voice therapy which aims at reducing the force of the vocal folds during phonation. Preventative voice therapy may be useful for populations at high-risk for vocal fold cysts, such as teachers.

Front 52

Why might a voice therapy client with a vocal fold cyst require surgical intervention?

Back 52

Necessary when voice therapy is unsuccessful.

Front 53

Describe three (or more) characteristics of vocal fold polyps

Back 53

Fluid filled mass, unilateral, located on free edge of anterior 3rd portion of VF.

Front 54

What causes vocal fold polyps?

Back 54

Typically they are caused by a single vocal event (yelling, screaming, being at concert, etc) and cause inflammation of the epithelial lining.

Front 55

What does the comprehensive assessment of vocal fold polyps include?

Back 55

medical and voice history, head and neck exam, perceptual assessment of the voice and instrumental assessment, or imaging, of the vocal folds

Front 56

What are 5 signs and symptoms of vocal polyps?

Back 56

effects on the voice: severe dysphonia, hoarseness, breathiness, continuous throat clearing, and lower pitch.

Pts can also present with a “lump in the throat” sensation, voice and body fatigue, neck pain, and shooting pain from ear to ear.

Front 57

Stress reduction techniques and relaxation exercises are used in voice therapy for patients with vocal polyps. T/F

Back 57

True

Front 58

Polyps will not continue to grow with continued vocal misuse/abuse. T/F

Back 58

False

Front 59

What are the two types of VF polyps?

Back 59

Sessile and pedunculated.

The sessile polyp is more broad-based, as the lesion is distributed over the surface of the vocal fold appearing as a fluid filled balloon.

A pedunculated polyp has a narrow base with a large body that can be pushed above or below the surface of the vocal folds, potentially obstructing the glottal area

Front 60

What is Abductor Spasmodic Dysphonia?

Back 60

Prolonged abduction of the vocal folds during voiceless consonants. ABSD is characterized by breathy breaks due to episodic incomplete glottal closure.

Front 61

What is the cause of ABSD?

Back 61

Caused by involuntary spasms in the laryngeal muscles. The cause of the spasms however, are unknown. Research points to the problem’s location at the base of the brain in the basal ganglia, which is responsible for regulating involuntary muscle movement. This regulator can produce incorrect signals when not functioning properly, which in turn may cause the muscles to contract or relax at a greater rate or at an inappropriate time

Front 62

During what activities might ABSD decrease or become absent?

Back 62

Acts of laughing, crying, yelling, throat clearing, coughing, whispering, and humming.

Front 63

What is the general assessment process?

Back 63

Typically treated by an otolaryngologist that specializes in voice disorders. Speech pathologists may be utilized to evaluate and intervene with behavioral approaches to treat the voice disorder. Additionally, a neurologist may evaluate a patient for other forms of dystonia or underlying neurological conditions. The evaluation team will listen to the individual’s speech to locate signs of SD, including voice breaks. The patient is often asked to read and speak specific sentences featuring specific sounds. The larynx will be assessed via endoscopy to rule out a laryngeal component such as vocal nodules or chronic laryngitis that can cause a hoarse voice. Additionally, a laryngeal electro-myography (EMG) test may be ordered to assess the muscles involved.
Typically treated by an otolaryngologist that specializes in voice disorders. Speech pathologists may be utilized to evaluate and intervene with behavioral approaches to treat the voice disorder. Additionally, a neurologist may evaluate a patient for other forms of dystonia or underlying neurological conditions. The evaluation team will listen to the individual’s speech to locate signs of SD, including voice breaks. The patient is often asked to read and speak specific sentences featuring specific sounds. The larynx will be assessed via endoscopy to rule out a laryngeal component such as vocal nodules or chronic laryngitis that can cause a hoarse voice. Additionally, a laryngeal electro-myography (EMG) test may be ordered to assess the muscles involved.

Front 64

What is the most popular form of treatment and why?

Back 64

Botox is the primary choice of treatment for both types of SD. This treatment involves injecting Botox into the muscles of the vocal folds, primarily the posterior cricoarytenoid muscles. This form of treatment is temporary, lasting up to 4 months, but is less invasive than surgery. Botox injections become effective within 24-48 hours after the treatment. This treatment is valued due to its flexibility from patient to patient. This option is easily individualized by dosage, time between injections, and muscle or side that is receiving the injection.

Front 65

What is PVFM commonly induced by?

Back 65

Commonly induced by: stress, exercise, gastroesophageal reflux, postnasal drip, respiratory irritants, cold air, panic associated with asthma

Front 66

What happens when a person experiences a PVFM episode?

Back 66

During a PVFM attack, the vocal folds adduct, preventing air to flow efficiently into the thoracic cavity and fill the lungs.

Front 67

Compare and contrast asthma and PVFM.
When symptomatic, a Pulmonary Function (spiromentry):

Back 67

PVCD:
-Forced vital capacity: Normal
-Forced expiratory volume in 1 sec: Normal
-Inspiratory flow: Reduced
-Expiratory flow/inspiratory flow ratio: Elevated
-Bronchodilator treatment: Limited improvement
Asthma:
-Forced vital capacity: Normal
-Forced expiratory volume in 1 sec: Reduced
-Expiratory/Inspiratory flow: Normal or Reduced
-Bronchodilator treatment: Marked improvement

Front 68

Who are the team members involved in assessment/treatment of PVFM?

Back 68

Speech-language pathologist or an otolaryngologist for assessment and treatment is typically completed by an SLP

Front 69

List some ways that PVFM is assessed and what is the gold standard?

Back 69

The gold standard in the field is a laryngoscopic exam. Another effective way to evaluate patients is to conduct a pulmonary function exam to differentiate PVFM from asthma.

Front 70

If a person is symptomatic during assessment, what would a laryngoscopy reveal?

Back 70

If the patient is symptomatic during the exam, the clinician will note adduction of the anterior two-thirds of the vocal folds during inspiration, a small posterior diamond shaped glottic chink, and mediolateral compression of the ventricular folds.

Front 71

Describe the breathing recovery exercise used during a PVFM episode.

Back 71

Deeply sniffing through the nose without raising the shoulders and exhaling through pursed lips.
The deep sniff is a crucial component as this quickly abducts the vocal. The pursed lip technique allows pressure to build behind the lips and through the pharynx, which forces the vocal folds to abduct. However, the client should avoid long inhalations and exhalations as this creates tension. Others research suggests exhaling for eight to ten seconds while making a “s, sh, or f” sound as this forces the vocal folds to abduct during exhalation. If the client is able to identify triggers of an episode, he can use this exercise to prevent his vocal folds from adducting. In order to truly master the deep sniff and exhalation, the client should practice 3 to 5 times per day.

Front 72

Describe treatment activities commonly used with PVFM prior to teaching the breathing recovery exercise.

Back 72

1. SLPs use visualizations and comparisons to help the client gain awareness and understanding of treatment methods. Many of these clients experience tension in their throat, so it is important that they differentiate a “tight throat” versus a “relaxed throat.” This can be explained by distinguishing the feeling of tension and relaxation in other parts of the body. For example, a client may tighten and relax the muscles of the legs. As clients become aware of the feeling of tension in other parts of the body, they will become aware of tension in the throat, which is typically an indicator of a PVFM attack.
2. learn diaphragmatic breathing while lying down with one hand on the chest and the other hand below the rib cage to feel the movement. The client should practice breathing without moving the shoulders and develop an awareness of this from of breathing. Various speech and nonspeech respiration exercises can be used to further practice relaxed breathing. Nonspeech tasks include panting, blowing, sniffing, and pursing the lips during inhalation. The client may also practice respiration with phonation using lip trills, humming, glides of sibilant fricatives, nasal sound prolongations, and coordinating respiration with speech in conversation. Once the relaxed respiration component is mastered, treatment will focus on the PVFM attack.

Front 73

Is vocal fatigue a voice disorder? Why or not?

Back 73

Vocal fatigue is not considered a voice disorder on its own. It is however, one of the nine major symptoms of a voice disorder.
Vocal Fatigue: One of nine major symptoms of voice disorders.
Can be defined by the following patient syptoms:
-Increased vocal effort/discomfort
-Reduced range of pitch
-Reduced vocal power
-Reduced control of the quality of voice
-Increased symptoms with vocal use
-Reported improvement with rest

Front 74

Research indicates that vocal fatigue can be the consequence of many factors. List some of the possible etiologies.

Back 74

Existing theories:
Symptom of a voice disorder with either functional or organic cause predisposes an individual to laryngeal pathology

Biomechanical factors:
Muscle fatigue, stress fatigue of the vocal fold covering, fluid imbalance, and temperature rise

Other possible causes include:
neurotransmitter depletion, reduced blood circulation, and excessive vibratory exposure to the vocal fold lamina propria resulting from prolonged voice use.

Front 75

What is currently the most accurate technique used to assess vocal fatigue?

Back 75

-Considered a physiological condition (not an acoustic or aerodynamic condition)
-There has been difficulty establishing a consistent acoustic marker for vocal fatigue, as it is difficult to establish what “fatigue” is in a numerical sense.
-Objective measurements: electroglottography, standard acoustic metrics, or pitch and loudness measures (research inconsistent and considered unreliable)
-Subjective measurements: Questionnaires that rely on voice users description of increased vocal effort with continued use and report a decrease in symptoms with vocal rest (currently considered most appropriate).
-Clinician observations and/or patient reports of vocal fatigue may also include frequent lip licking, swallowing, throat clearing, sips of water, attempts to relieve tension of the face, neck, and shoulders through postural readjustments, and frequent breathtaking

Front 76

What is the difference between indirect and direct treatment?

Back 76

-Treatment: Depends on the patient’s concerns/underlying voice problem or disorder
-Indirect treatment
--Education: Providing information re: anatomy and physiology of the vocal folds, benefits of hydration, etc.
--LPR Diet Modification: Food diaries, how LPR affects voice, medication effects on voice, etc.
--Environmental Modifications: Amplification, room organization, etc.
--Stretches & Relaxation: Breathing, posture, alleviating muscle tension, etc.
--Motivational Issues: Empowering the patient
--Psychosocial Counseling: Stress/anxiety effects on voice
--Homework Preparation: Necessity of varied and random practice at home

-Direct treatment
--Resonant Voice: Lessac-Madsen Resonant Voice Therapy (LMRVT), vocal function exercises, etc.
--low Phonation: Confidential voice therapy, stretch and flow phonation, etc.
--Transfer to Speech: Any treatment used to transfer to spontaneous or conversational speech (i.e. speaking above background noise, at a distance, projection, etc.)
--Direct Manipulation: Laryngeal massage

There is no specific treatment approach to target vocal fatigue.
Frequently SLPs combine indirect/direct treatments to cater to the patient and their voice disorder with hopes of improving or eliminating vocal fatigue.

Front 77

Give an example of a direct treatment and an indirect treatment used in vocal fatigue.

Back 77

direct: direct manipulation, low phonation, transfer to speech, resonant voice
indirect: education, LPR diet modification, environmental modifications, stretches and relaxation, motivational issues, psychosocial counseling, homework/prep

Front 78

What are some of the patient-reported symptoms of vocal fatigue?

Back 78

Increased vocal effort and discomfort, reduced range of pitch, reduced vocal power, reduced control of voice quality, increased symptoms with increased vocal use, and improvement reported with rest.

Front 79

Give a possible situation in which an SLP may combine an indirect treatment with a direct treatment.

Back 79

Literally would combine them in every situation. Educate (on diet, exercises, environmental modifications etc.) and motivate the patient while treating the patient using any of the given direct treatments. Provide a home program targeting the stretches/exercises.

Front 80

What is the etiology of VF leukoplakia?

Back 80

There is no known etiology. It is suspected that VF leukoplakia stems from vocal fold abuse and misuse.

Front 81

How do we assess VF leukoplakia (clinical eval and 2 parts of instrumental assessment)?

Back 81

Assessment involves a clinical evaluation (to address medical history, complaints about voice, vocal hygiene, and voice/speech history) and an instrumental evaluation, which includes videostroboscopy (videoendoscopy & stroboscopy) and vocal fold biopsy (to determine presence and degree of dysplasia).

Front 82

What are the 3 treatments for VF leukoplakia?

Back 82

1. surgical removal
2. in office laser treatments (time and cost efficient, more exact, decreased risk of complication)
3. vocal hygiene counseling (oral antifungal tx, better mouth care, drinking more water, no smoking/alcohol abuse, limited activities that cause reflux)

Front 83

What are 3 risk factors for VF leukoplakia?

Back 83

The most common cases involve patients who had a history of smoking or taking other inhalants, alcohol consumption, laryngopharyngeal reflux, and infections.

Front 84

T/F: Leukoplakia is precancerous and has a high rate of malignancy.

Back 84

T

Front 85

What is the cause/etiology of recurrent respiratory papillomatosis?

Back 85

RRP is a viral induced disease caused by human papillomavirus (HPV) types 6 and 11. Epithelial lesions appear as clusters of many wart like bumps affecting the upper airway, specifically the vocal folds, larynx and trachea (Handa & Shashidhar, 2011; Graupp et al., 2013). Evidence suggests that HPV is sexually contracted through oral genital contact. Juvenile onset of RRP can be transmitted to an infant by an infected mother through contact with cervical warts during birth (Derkay & Darrow, 2006).

Front 86

What are some common symptoms of RRP?

Back 86

Hoarseness
Low in pitch
Strained voice
Weak voice
Breathy voice
Shortness of breath

Front 87

How is RRP assessed?

Back 87

1. Recognition of symptoms
2. Diagnosis by an ENT
laryngoscopy
videostroboscopy
3. Biopsy

Front 88

What are the two main treatment options for RRP?

Back 88

1. Surgery
Cold steel excision
2. Laser
CO2 Laser
Microdebrider
3. Treated with pharmaceuticals as well to delay growth following surgical/laser treatment

Front 89

What is the role of the SLP in assessment and tx of RRP?

Back 89

Assessment: rigid/flexible scope; referral to ENT/physician
Treatment: improve voice quality by working on respiration, loudness, pitch, phonation, resonation

Front 90

What prevention options are there to reduce the risk of RRP?

Back 90

No cure currently exists, therefore, the greatest promise for future management of RRP rests with the development of an all encompassing HPV vaccine.

Front 91

EVT is often misdiagnoised as...?

Back 91

spasmodic dysphonia

Front 92

T/F: A key feature of EVT is variations in loudness and/or pitch caused by tremor (rhythmic and present across all types of vocalizing

Back 92

T

Front 93

What are typical complaints of EVT patients?

Back 93

Shaky/jerky voice that worsens with fatigue/anxiety

Front 94

T/F: A person with essential tremor always has EVT

Back 94

F

Front 95

Who can diagnose EVT?

Back 95

neurologist & otolaryngologist

Front 96

How does one determine if EVT is present?

Back 96

An assessment is performed using a flexible laryngoscope to provide a view of the vocal folds at rest and during phonation. Tremor is indicated when spontaneous rhythmic muscular activity of the pharyngeal, laryngeal, and supraglottic muscles occurs at rest. However, EVT can occur both at rest and during sustained phonation

Front 97

Why is EVT often misdiagnosed as spasmodic dysphonia?

Back 97

The perceptual characteristics are similar. Patient complains include perception of shaky/jerky voice, which is similar to SD.

Front 98

What other parts of the body are often affected in someone with EVT?

Back 98

Bilateral postural/kinetic tremor of the hands when there are no other neurological signs

Front 99

If avoiding psychostimulants does not work to alleviate symptoms of EVT, what is the next step in treatment?

Back 99

Pharmacological treatments

Front 100

Which surgical options are available to those with EVT?

Back 100

1. Deep brain stimulation: chronic stimulation of the thalamus by a physician
2. Thalamotomy: can eliminate/alleviate EVT but causes dysarthria. Places a lesion on the thalamus opposite of the side with more severe tremors.

Front 101

Which surgical option is most often recommended?

Back 101

Deep brain stimulation

Front 102

What are the 3 possible causes/etiology for Reinke's edema in 90% of patients?

Back 102

1. excessive smoking
2. laryngopharyngeal reflux
3. vocal abuse/misuse

Front 103

What are some of the voice characteristics of people with Reinke's edema?

Back 103

hoarse, breathy, tired voice and often complain of a lump in the throat feeling; they have deeper voices and reduced ability to produce high notes

Front 104

What does the GRBAS scale measure?

Back 104

Grade, Roughness, Breathiness, Asthenia, Strain

Front 105

Explain one of the 3 types of surgical procedures for Reinke's edema?

Back 105

Mechanical stripping: removes the enlarged mucosa of the medial edge of the VF

Front 106

What does the voice range profile (VRP) measure?

Back 106

pitch range, max-min intensity range, total VRP area, area in the range of high frequency and fundamental frequency

Front 107

What are the 3 types of Reinke's edema according to Yonekawa's Classification scale?

Back 107

Type 1: Edematous swelling in the upper surface of VF with adequate glottal function
Type 2: Edematous swelling from upper to lower vocal fold surface, beyond boundaries of both VF, with the surface of the VF in partial contact
Type 3: Edematous swelling is advanced so the only opening of the vocal folds that can be seen is at the posterior portion of the glottis

Front 108

Name one subjective and one objective voice assessment for Reinke's edema.

Back 108

Subjective: GRBAS
Objective: VRP

Front 109

According to research for surgical interventions for Reinke's edema, which procedure demonstrated significantly better voice quality and normalization sooner post-surgery?

Back 109

aspiration

Front 110

What is involved in assessment of Reinke's edema?

Back 110

1. Rigid laryngoscopy - detailed view of the voicebox (larynx)
2. Flexible laryngoscopy - provides images and records the voicebox during phonation (e.g., speaking, singing, coughing)
3. Laryngeal stroboscopy -provides specialized slow-motion view of vocal fold vibration during sounds
4. Yonekawa's classification scale- categorized RE into 3 types based on severity & perceptual changes
5. Subjective voice measures: GRBAS, Visual analogue Scale (VAS)
6. Objective: voice range profile (VRP), maximum phonation time (MPT)

Front 111

What treatments are available for Reinke's edema?

Back 111

1. Eliminating the irritant (first step in treatment)
2. Voice therapy (proper hygiene regimens, voice exercises)
3. Phonosurgery if the above are not effective
4. Surgical procedures (mechanical stripping, aspiration, laser surgery)

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Explain the surgical procedures for Reinke's edema.

Back 112

1. Mechanical stripping- enlarged mucosa of the medial edge of VF is removed, the top layers are stripped
2. Aspiration- suctioning (medial edges of VC are preserved, material in Reinke's space is removed by aspiration)
3. Laser surgery- coagulation of the subepithelial layer