Voice Disorders

Front 1

Functional disorder

Back 1

no physical basis psychogenic can range from mild to severe sound like someone w/ organic

Front 2

Types of functional disorders

Back 2

ventricular phonation, conversion disorder,mutational falsetto, pardoxical vf movement

Front 3

ventricular phonation

Back 3

can be functional disorder related to emotional state true vf and vent. vibrate @ diff. freq. diplaphonia

Front 4

conversion disorder

Back 4

can take place anywhere, loss of voluntary control over striate muscles. may result in paralysis, hearing loss, not caused by physical prob.

Front 5

reason for conversion disorder

Back 5

serves a purpose by removing person from stress brain's way of coping over long periods. More common in woman becoming more common in children.

Front 6

coversion disorder types

Back 6

mutism, conversion aphonia, conversion dysphonia

Front 7

mutism

Back 7

no attemps @oral prod. everything is normal/vegetative functions normal laryngeal funct. noted by coughing and throat clearing. not worried about not talking. chronic stress

Front 8

Conversion aphonia

Back 8

80% are women only produce whispering caused by anger, conflict stress in life, maybe be acute stress, had coversion b4 no distress about aphonia

Front 9

conversion dysphonia

Back 9

hoarse, breathy, harshness: ranging from one setting to hoarse all of the time.

Front 10

Treat coversion disorder

Back 10

begin with vegetative behavior (cough/throat clearing)cough->phonation->cough->sustained phonation->change vowels->then consonants->normal phonation

Front 11

Treat conversioin disorder maintenance

Back 11

come back w/ someone they trust to practice in therapy room. long term phonate in public, no need to reduce vocal abuse.

Front 12

Mutational falsetto/puberphonia

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seen in young adult males: persistent use of pre-adolescent voice after puberty not conscious, no physical prob, emotional immaturity

Front 13

characteristics puberphonia

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psychological out, high laryngeal position, weak, breathy, only medial edge vibrate, bad medial comp. sound like poor breath support, but not not using correct.

Front 14

Therapy puberphonia

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not motivated for therapy teach deep breathing, use vegetative function and shaping into speech. using voice outside diff. easier practice w/ strangers make referral psychiatrist

Front 15

Child like speech

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version puberphonia in female dress young, child like artic. and lang. exaggerated facial and intonation

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Results child like speech

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emotional respone to being treated like cute child. marry ment wo are willing to care no reason for change.

Front 17

therapy child like speech

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deep breathing, vegetative function, refer to psych

Front 18

Pardoxical vocal fold move

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vocal fold clousure when breathing in people perfectionist. eating disorders, mostly young women. nothing looks wrong misdiagnose asthma.

Front 19

Pardoxical treat

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deep breathing then constrict lips blow 5x's 15x's a day

Front 20

transgender voice

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not many female to male patients-male to female-can raise voice above 165Hz can appear female. hardest will be non-verbal and intonation

Front 21

Case History parts

Back 21

source of info, rapport w/ patient, general communication, background info

Front 22

Source of info case history

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limited to the one's patients give get from: ENT, other SLP, teachers coworkers, family

Front 23

Rapport w/ patient for case history

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not get good info if not good rapport

Front 24

General comm skills for case history

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eye contact, able to respond, good conversational skills, learn coop.

Front 25

Background info case history

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bio, health-med prob, intubation, surgery, injury, family history, overall health, onset of prob-when/percept acute/slow anything preceed, patient's descrip.

Front 26

Voice eval gen concepts

Back 26

describe voice determine appropriate treatment. may or may not get max pref. because people asked to do things they don't norm. do.

Front 27

Voice eval goals

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define charc., limits of ability, id what's wrong, need for related treat, need for treat, determine severity, prognosis therapy, cog. impair, interpersonal, cause, tailor assessment.

Front 28

Laryngectomy

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part/all larynx removed, presence of malignant tumor, severe laryngeal trauma, non funct larynx

Front 29

laryngectomy impact on communication

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partial: some ability to comm, may be hoarse breathy or other abnorm. Total: need alt. comm.

Front 30

Cause of cancer

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smoking: amount and duration alcohol add to smokers risk inc. 50%, occ. exposure chem/smoke, gentic, diet, reflux.

Front 31

cancer stats

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1-2% of all cancers comprises 20% all head/neck cancers new cases: m 10,000 f-2,200 deaths m-3,000 f-750

Front 32

Early glottic

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T! lesions involves only one vf, normal mobility, options: endoscopic laser resection, radiation

Front 33

Moderate to advance glottic cancer

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T2-T4 radiation therapy v chemo RT, partial laryngectomy, supracricoid laryngecotmy, total.

Front 34

Symptoms of laryngeal cancer

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hoarsness, dyspnea, stridor, dysphagia, coughing, expercotoration of blood.

Front 35

signs of cancer

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lump in neck tenderness in laryngeal area, lack of sound fullness, cricothyroid/thryhyoid membrane, whitish irregular lesions in vf

Front 36

Role of SLP for cancer

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per operative consule, referral by physicia, meet patient prior to admit, meet w/ patient's family, find best mode of comm.

Front 37

Other roles of slp cancer

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be cognizant of referring practices of physicians some may advocate esophageal speeech, some may pan to TEP, provide info, discuss concerns, help after sugery.

Front 38

Modes of alaryngeal speech

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artificial larynx, esophageal speech, tracheoesophageal speech

Front 39

advantages of artifical larynx

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easy to train, immediate restore of speech, portable

Front 40

disadvantages of artifical larynx

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mech. sound, require use of onne hand, limited control of pitch, operating expense, battery dependant.

Front 41

esophageal speech

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2 tbs of air on one max injection 2-3 words on one inject, diff to learn, cannot inject if PE segement is too tight, diff. to hold air if PE is too flaccid

Front 42

Advantages of esophageal speech

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no ext. device, more natural sound, hands free

Front 43

disadvantage of esophageal speech

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hard to learn artic. must be excellent, low vocal intensity.

Front 44

Trachesophageal speech

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small puncture is made through tracheoesophageal party wall into the esophagus and prosthesis w/ 1 way valve is place in tract.

Front 45

TEP

Back 45

primary puncture at time of laryngectomy, sec. punture 6 wks post op, maitain puncture w/ catheter.

Front 46

TEP prosthesis

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indwelling: extended wear place and removed by SLP/MD ex dwelling are removed and cleaned by patient

Front 47

General assessment of reading/conversation

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severity-perceptual, quality-perceptual, intell-if reduced why tape and listen again to see if correct

Front 48

Describe structure and funct

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need good info from ENT to deter if the funct is as good as can be for structure that is present

Front 49

respiratory adequacy for phonation

Back 49

reading, s/z ratio, max phonation time, vital capacity, phonation quotient, stridor, coughing/throat clearing, fund. freq, dB three trials each

Front 50

reading

Back 50

check for resp. support, used for one who does not converse well Do they run out of breath?

Front 51

max phonation time

Back 51

how long can sustain a vowel 20-25 sec adult/7-10 sec child

Front 52

s/z ratio

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how long sustain s/how long sustain a z. normal ratio 1 above 1.5 lesion, above 2 neurologic/big lesion, but it's not diagnostic

Front 53

stridor

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not ever normal indicative of not getting enough resp. support

Front 54

glottal closure reflex

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normal used to stabilize thorax

Front 55

coughing/throat clearing

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if can't neurological work on swallowing

Front 56

Pitch

Back 56

measure fund freq. range, habitual pitch, optimum pitch, pitch perturbation, quantifiying pitch variables.

Front 57

Pitch measured?

Back 57

reading, speaking, sustaining vowel-quantifiable measure done w/ CSL

Front 58

Uh-huh method

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gives a good estimate of optimum pitch

Front 59

Yawn sigh approach

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yawn to sigh measure middle sigh for optimum pitch

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siren method

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begin @ comfy range go as high as they can for optimum pitch

Front 61

Jitter rates

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Normal jitter rates womean .65% men .9 up to 1% okay. must used sustained vowel for jitter higher jitter typically correlated w/ hoarseness

Front 62

Pitch perturbation

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jitter cycle to cycle variation in freq.

Front 63

Intensity

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overall intensity in conversation is 50-60dB

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Range of intensity

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perceptually indicated by appropriate intensity range. If in appropriate measure w/ CSL

Front 65

Depression

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may show lack of intensity range

Front 66

intensity perturbation

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cycle to cycl variation in loudness shimmer

Front 67

Shimmer

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too much percieved as hoarseness calculated in dB should be under .5 dB and lower than men

Front 68

Qualitative

Back 68

perceptual quality, pitch loudness (hoarseness, breathiness, harshness, tremor, strain/struggle, diplphonia, vocal fry)

Front 69

Hoarseness

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lack of clairy in vocal tone, assoc. w/ increased jitter/shimmer. Due to any type of voice disorder big charac. of non normal voice can occur w/ strain/struggle, breathiness

Front 70

breathiness

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audible air escape during phonation can be learned caused by lesion/paralyzed vf not diagnostic may occur w/ harshness, tremor, assoc. w/ decrease intensity

Front 71

harshess

Back 71

assoc. w/ muscle tension hard glottal attacks, hard onset, assertive business, vocal fatigue + pain. usually learne but can be neurologic assoc. w/ degenerative disease.

Front 72

tremor

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reg. rhythmic variation in pitch and loudness not under voluntary control. always neuro. may only have tremor. rarely interferes w/ swallowing/intell.

Front 73

strain/struggle

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sound like strangle diff. in initiation and controlled phonation. voice fades in/out. phonation can stop mid utter. neuro/learned. stress and tension people who talk on res. air

Front 74

vocal fry

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poor resp support can be ween w/ any

Front 75

diplophonia

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two diff freq vibrating usually functional, but can be psysiologic.

Front 76

sites of vf hypertension

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sites of stress. observabal tens in neck, reports of v fatigue/pain @ end of day. hard gloatl attack and strained voice quality. function rarely neuro. first symptom of bad disorders.

Front 77

Role of SLP pre-op consult

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referral by physician, meet patient prior to admission, meet w/ patients family, so patient may listen better.

Front 78

Role of SLP pre op

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provide info, discuss concerns, help after surgery, reinforce essential info, correct misunderstand, allow time for ?, discuss comm. opt.

Front 79

pre op physiological impact

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can, conccern about diagnosis/survival

Front 80

post op physiological impact

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concern about comm. adjustment, fear of cancer, recovery, adjust to anatomic changes, caring for stoma, manage necess. equip.

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Psychosocial concerns

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health, cancer, econmoic, family, marriage, loss of id.

Front 82

Role of SLP laryngectomy

Back 82

support, training, ed for pre-op, w/ patient and family, maintenance and care for devices, helping w/ novel experiences and prob solve, being up to date with current