Voice Test 2

Front 1

What kind of disorder are contact ulcers?

Back 1

Organic, but there is probably a behavioral component.

Front 2

This category of voice problems can be the most responsive to vocal therapy.

Back 2

Muscular Tension Dysphonia

Front 3

Those who experience life stress and seize up in their VFs.

Back 3

Laryngeoresponders

Front 4

What is primary muscular tension dysphonia?

Back 4

There's no organic pathology (yet!)

Front 5

What is secondary muscular tension dysphonia?

Back 5

Follows organic pathology, perhaps in compensation for voice changes.

Front 6

Laryngoscopy shows us too much tension in the larynx and surrounding structures: evidence of a habit of squeezing hard to produce voice.

Back 6

Vocal Hyperfunction

Front 7

Larynx may ride higher in the neck, squeezed right up to the hyoid bone. Instead of feeling the larynx down at the base of the cervical spine, it may be high. Not much space between superior margin of the thyroid cartilage and the hyoid bone.

Back 7

Vocal Hyperfunction

Front 8

You can see VFs that close together at midline, but also those that squeeze together both anterior and posterior. Structures squeezing in on each other.

Back 8

Vocal Hyperfunction

Front 9

Many English speakers precede vowels with glottal stop.

Back 9

Hard Glottal Attack

Front 10

You'll notice this a lot in people with a lot of angry things to say.

Back 10

Hard Glottal Stops

Front 11

How much abuse can a larynx take?

Back 11

There is variability across individuals and within individuals.

Front 12

How might the tolerance of the larynx change within an individual?

Back 12

As they get older, it might be harder for them to get their voice back after yelling at a concert, for example.

Front 13

What might you find with MTD?

Back 13

1. Significant levels of life stress
2. Possible depression
3. Possible GERD
4. Possible elevation of the larynx, narrowing of the thyrohyoid space
4. Stiffness and pain on palpation
5. Complaints of vocal fatigue
6. Voice changes may include pitch alterations, hoarseness, breathiness, harshness

Front 14

Hoarseness most common symptom. Aperiodicity. Also reports of breathiness, air leakage through the glottis, harsh quality to voice caused by muscular strain.

Back 14

MTD

Front 15

Follows a concert or sporting event; resolves rapidly.

Back 15

Acute Traumatic Laryngitis

Front 16

More vocal effort = more damage

Back 16

Chronic Traumatic Laryngitis

Front 17

Characterized initially by edema and erythema (redness)

Back 17

Traumatic Laryngitis

Front 18

More worrisome and less reversible changes may develop over time. Development of fibrous tissue. Much harder to get rid of.

Back 18

Chronic Laryngitis

Front 19

Most superficial layer of the lamina propria

Back 19

Reinke's Space

Front 20

Chronic swelling of Reinke's space

Back 20

Reinke's Edema

Front 21

Associated with smoking and GERD in addition to vocal abuse.

Back 21

Reinke's Edema

Front 22

Tx for Reinke's Edema

Back 22

1. Smoking cessation
2. GERD management
3. Voice therapy
4. Surgery? (but generally m ore behavior management)

Front 23

Gelatinous material on the VFs. Can’t be coughed up. You see this most commonly in pts who have history of smoking and history of reflux.

Back 23

Reinke's Edema

Front 24

Reinke's Edema is often caused by:

Back 24

Vocal Hyperfunction

Front 25

Most common type of benign laryngeal lesion

Back 25

Vocal Nodules

Front 26

Usually (but not always) bilateral, positioned medially, found at the junction of the anterior 1/3 and posterior 2/3 of the vocal fold

Back 26

Vocal Nodules

Front 27

They start out soft and firm up over time, becoming fibrotic: think of a callus

Back 27

Vocal Nodules

Front 28

In children, these affect more boys than girls.

Back 28

Vocal Nodules

Front 29

In adults, these affect more women than men.

Back 29

Vocal Nodules

Front 30

Most common presentation is bilateral.

Back 30

Vocal Nodules

Front 31

With vocal nodules, this type of treatment should be first:

Back 31

Voice therapy (not surgery)

Front 32

Usually unilateral
May arise from one instance of laryngeal trauma

Back 32

Polyps

Front 33

With polyps, continued phonotrauma=

Back 33

Bigger polyp

Front 34

Affect more men than women, and smokers are more vulnerable.

Back 34

Polyps

Front 35

May be sessile (broad-based) or peduculated (perched on a narrow stem)

Back 35

Polyps

Front 36

. A pedunculated polyp can cause intermittent problems as it:

Back 36

flops down into glottis intermittently.

Front 37

Often treated surgically. But because they likely have hyperfunction, voice therapy is important to limit odds it will come back.

Back 37

Polyps

Front 38

Sometimes called "polypoid degeneration"

Back 38

Reinke's Edema

Front 39

Is surgery more common with polyps or nodules?

Back 39

Polyps

Front 40

The false vocal folds may approximate during phonation, or they may rest on the true folds and compromise normal phonation.

Back 40

Ventricular Dysphonia

Front 41

Chronic irritation and it’s painful maybe so they use the false vfs instead. Or maybe a lesion. False vfs are heavier so it’s lower pitched than you would epxect. False vfs not built to vibrate like true vfs. You get aperiodicity which is perceived as hoarsness. And flat melodic contour.

Back 41

Ventricular Dysphonia

Front 42

Sometimes they flop down and get in the way even though they’re not vibrating. They get in the way of the true vfs and cause them to vibrate more slowly. May get diplophonia.

Back 42

Ventricular Dysphonia

Front 43

Older adults may be vulnerable to MTD and related pathologies due to:

Back 43

Age-related changes in the vocal folds

Front 44

Normal to see bowing, and it’s common for them to push the vfs together creating dysphonia

Pitch ranges tend to get more compressed. A little bit of the drop in the pitch of the voice. There is a tendency to chalk up voice problems in older people as age related changes in the larynx, but you should be aware of what we could do.

Back 44

Effects of aging

Front 45

appears to have a psychogenic component also related to behavioral issues, like after strenuous exercise.

Back 45

PVFM

Front 46

Even though contact ulcers are organic, remember that there is likely:

Back 46

Vocal hyperfunction that needs to be addressed.

Front 47

Sometimes these have their own blood supply.

Back 47

polyps