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26 Cards in this Set

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Key structures and cartilages for voice disorders

1.) Hyoid bone- most extrinsic or laryngeal muscles attach here




2.) Epiglottis- leaf shaped cartilage, protects trachea by closing down inferiorly and posteriorly over laryngeal area




3.) Thyroid Cartilage- sometimes called adam's apple. Shields other laryngeal structures from damage.

Mean fundamental frequency of Men

100-150 HZ




Typical fundamental frequency 125 Hz

Mean fundamental frequency of women

180-250 Hz




Avg fundamental frequency 225 Hz

Pitch

The perceptual correlate of frequency. Pitch is determined by mass, tension, and elasticity of the vocal fold's.




Higher pitch- thinner more tense VF's


Lower pitch- folds are thicker, more relaxed

Jitter

refers to variations in vocal frequency. Can be measured instrumentally as a patient sustains a vowel.




Normal: < 1%

Volume

The perceptual correlate of intensity, volume or loudness. The greater the amplitude the louder the voice

Shimmer

Refers to the cycle-to-cycle variation of vocal intensity.




Normal: < 1%

Quality

The perceptual correlate of complexity. It refers to the physical complexity of the laryngeal tone; which is modified by the resonating cavities.




1. Hoarseness


2. Harshness


3. Strain-Strangle


4. Breathiness


5. Glottal Fry


6. Diplophonia


7. Stridency

Instrumental Evaluation

1.) Indirect Laryngoscopy- specialist uses bright light source and a small round mirror




2.) Direct laryngoscopy- performed by surgeon




3.) Flexible fiber-optic laryngoscopy- uses a thin flexible tube containing a lens and fiber optic light bundles




4.) Endoscopy- flexible and rigit can be used with a flashing light source (stroboscopic)

Acoustic Analysis

Acoustic measurements are useful at evaluating the effectiveness of voice therapy




Sound spectography- graphic representation of sound waves intensity and frequency as a function of time.

Electroglottography (EGG)

non-invasive procedure that yields an indirect measure of vocal fold closure patterns.




surface electrodes are placed on both sides of the thyroid cartilage.

Electromyography (EMG)

invasive procedure that directly measures laryngeal function to study the pattern of electrical activity of the vocal folds and to view muscle activity patterns.




useful when attempting to determine vocal fold pathology especially that's caused by neurological and neuromuscular diseases.

Aerodynamic measurements

refer to the airflows, air volumes, and average air pressures produced as part of the peripheral mechanics of the respiratory, laryngeal, and supralaryngeal areas.

Respiration Assessment

1.) Clavicular Breathing


2.) Diaphragmatic-abdominal breathing


3.) Thoracic breathing

Phonation Assessment

1.) maximum phonation time- a measurement of the patient's ability to sustain phonation during one exhalation.




2.) S/Z ratio- pt produces two long /s/ phonemes; then two long /z/ phonemes. The clinician divides the longest /s/ by the longest /s/. A s/z ratio of more that 1.4 is indicative of possible laryngeal pathology.

Resonance Disorders

1.) Hypernasality- sounds like pt is speaking through nose. * cleft palate, VPI




2.) Hyponasality- lack of nasal resonance on nasal sounds. "baby" instead of "maybe" * enlargement of tonsils and adenoids




3.) Assimilative nasality- occurs when the sound from a nasal consonant carries over to adjacent vowels.




4.) Cul-de-sac- produced by backward retraction tongue. Sounds muffled or hollow

Treatment of hypernasality

* Use nasometer


* use a piece of paper and mirror to put under pt's nose so they can see airflow


* increase pt's mouth opening so oral resonance is enhanced


* increase pt's loudness


* increase pt's pitch

Treatment of hyponasality

Focusing on directing the tone into the facial mask. Have pt say words with nasal sounds (moon, me)




Nasal- glide stimulation- selects words with many glides and nasals( lawn mower, many, manners, lemon)




Visual aids- piece of tissue or mirror to put under pt's nose.

Functional Voice Disorders

mechanisms of respirations, phonation, and resonance: structurally normal




1. Ventricular dysphonia- associated with severe muscle tenson




2. Vocal Fold Nodules- most common benign vocal fold pathologies, continuous abuse of larynx and misuse of voice/phonotraumatic behaviors.




3. Vocal Fold Polyps- focal abnormality in superficial layer of lamina propria. Usually unilateral sessile or pdunculated.




4. Vocal Fold Cyst- chronic stress, benign, mucous filled lesion




5. Reinke's edema- chronic, bilateral/unilateral associated with smoking and LPR




6. Laryngitis: Voice changes secondary to inflammation of VF mucosa, reaction to viral/bacterial infections

Psychogenic Voice Disorders

voice affected by emotion and psychological state, resistant to change with voice therapy approaches, psychological support/counseling referral.






1.) Puberphonia- inappropriate use of the high-pitched voice, beyond pubertal age in males.




2.) Functional aphonia- whispers with prosody and rhythm of normal speech, no voicing, loss of voice, secondary to laryngeal pathology





Organic Voice Disorders

structural pathology of VFs




1. Laryngomalacia-inward collapse of supraglottic structures of larynx during inspiration.




2. subglottic stenosis- narrowing of space below glottis




3. Espohageal atresia- from birth, failure of esophagus to develop as a continuous passage




4. Acid Reflux disease


5. Contact Ulcers (granulomas)


6. Hyperkeratosis- pinkish, rough lesion, nomalignant growth


7. Leukoplakia


8. Recurrent resoiratory papillomatosis


9. webbing

Neurogenic voice disorders

1. unilateral vocal fold paralysis


2. bilateral vf paralys


3. spasmodic dysphonia


4. parkinson's disease


5. essential voice tremor

Voice facilitating approaches

Head positioning


inhalaiton phonation


nasal-glide stimulation


Redirected phonation-cough,gargle, laugh,sing


Relaxation


Yawn-sigh

Surgical Management

Paryngeal flap surgery (flaccid)


Teflon injection into the posterior pharyngeal wall

Prosthetic management

Palatal lift prosthesis (flaccid)

Behavioral Management

1. Modifying the pattern of speaking


2. Resistance treatment during speech (CPAP)


3. Feedback, mirror, nasal flow transducer


4. Nonspeech velopharyngeal movement