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204 Cards in this Set
- Front
- Back
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What are the 3 primary purposes for videostroboscopy?
IDA |
1. ID physiologic correlates of perceived resonance and voice quality
2. Document status of speech anatomy & physiology during phonation 3. Assist educational & clinical discussion |
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What are the 3 secondary purposes for videostroboscopy?
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1. Confirm diagnosis
2. Improve patient motivation & counseling 3. Provide biofeedback therapy |
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What information can videostroboscopy provide?
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1. nature of VF vibration
2. visualize VF pathology 3. record of patient history 4. data on normal & disordered larynx |
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What are the components of a videostrobe?
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1. rigid oral endoscope OR
2. flexible nasendoscope 3. camera 4. monitor 5. light source (halogen & xenon) 6. laryngeal mic |
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Which phase flashes light at different times during a cycle to show a complete cycle?
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the normal phase
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What uses the Fo to determine where in the cycle to flash light dependent on periodicity of the glottal cycle?
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the normal phase
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Which phase is used to determine periodicity?
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the locked phase
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In which phase does the light flash at the same time in the cycle?
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the locked phase
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If the vibration is periodic, then the VF will appear to
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stand still, not move
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Which vowel is used at comfortable pitch and loudness to assess normal and locked modes?
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/i/
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What are the 6 patient tasks for a videostrobe protocol?
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1. sustained /i/ at comfortable pitch and loudness
2. short repeated /i/ then sniff 3. deep sniffs 4. up and down pitch glides on /i/ 5. high pitched phonation on /i/, loud and soft 6. loud and soft /i/ at comfortable pitch |
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In addition to the oral protocol tasks, what else do you do when assessing with a nasendoscope? (3)
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1. speech
2. singing (if patient is a singer) 3. therapy tasks to assess efficacy of Tx techniques |
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What 11 aspects do we evaluate during a videostrobe?
(first at normal pitch and loudness) AFM PPP ST VVV |
1. Amplitude of vibration
2. Fundamental frequency 3. Mucosal Wave 4. Periodicity 5. Phase closure 6. Phase symmetry 7. Supraglottic activity 8. Type of glottic closure 9. Vertical level of VFs 10. VF edge 11. VF mobility |
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When evaluating supraglottic activity, look for (3)
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1. AP compression
2. Medial-lateral compression 3. Supraglottic squeezing |
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How do you rate the vocal fold edge?
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scale from slight to severe
where is the irregularity? (ant 1/3, posterior 1/3, etc.) |
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What is the degree of regularity of VF vibration?
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periodicity
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What is the extent of horizontal excursion of each VF during vibration at normal pitch?
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Amplitude of vibration
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How far should the mucosal wave travel over the VFs?
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1/2-2/3 the width
should be symmetrical |
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What percentage split should be seen between open and closed phases?
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50/50 or 40/60
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What are signs of stiffness?
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lack of mucosal wave
decreased amplitude of vibration |
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How is the Fo computed?
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automatically by software obtained from a laryngeal mic worn on the thyroid lamina
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What are the four types of voice disorders?
POFN |
1. Phonotrauma
2. Organic 3. Functional & psychogenic 4. Neurological |
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What is another term for phonotrauma?
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hyperfunctional
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What type of voice disorder results from misuse or abuse of the vocal mechanism?
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phonotrauma
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What type of voice disorder results from a disease process such as cancer or acid reflux?
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Organic
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What type of voice disorder results from an underlying psychological issue and doesn't have an identifiable vocal pathology?
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Functional and psychogenic
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What type of voice disorder results from damage to the nerves that supply the larynx?
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Neurological
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What are 5 phonotrauma disorders?
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1. Nodules
2. Polyps 3. Reinke's Edema 4. Traumatic laryngitis 5. VF cysts |
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What is Reinke's Edema?
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VF swelling
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What is caused by chronic or continuous vocal misuse?
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nodules
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Where do nodules occur?
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usually bilateral in SLP
juncture of anterior 1/3 and posterior 2/3 of VF characterized by hour glass closure |
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What adds BOTH mass and stiffness to VF?
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nodules
results in interference with mucosal wave and aperiodic vibration |
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Who would be a typical nodule patient?
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adult/adolescent females
boys |
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Are nodules hard or soft initially?
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soft and gelatinous then harden over time becoming fibrous
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What are the perceptual characteristics of nodules?
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hoarse
breathy decreased loudness vocal strain/effort |
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What are the acoustic characteristics of nodules?
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decreased pitch and loudness ranges
increased aperiodicity increased noise levels SOMETIMES lowered Fo |
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What are the aerodynamic characteristics of nodules?
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increased airflow rates
increased subglottal pressure |
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What are patient complaints with nodules?
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vocal fatigue
sensation of something in the throat vocal effort/strain muscle tension pain |
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What are caused by an isolated violent episode of vocal abuse or a short period of vocal abuse?
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polyps
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What are polyps?
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soft fluid-filled outgrowth of tissue in SLP
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What is sessile?
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broad-based
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What is pedunculated?
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narrow stem or stalk
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Polyps are usually
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unilateral
can be sessile or pedunculated |
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Where can polyps occur?
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anywhere along the membranous vocal fold but are typically in same region as nodules
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Polyps can be
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glottic, supra/subglottic
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What do polyps consist of?
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can be:
fluid or serum-filled hemorrhagic (blood-filled) fibrous (connective tissue) |
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What kind of closure do polyps have?
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hour glass or
irregular |
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If polyps are fluid-filled, they
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add mass to VFs but
decrease stiffness |
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If polyps are hemorrhagic, they
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add stiffness to VFs
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What are the perceptual characteristics of polyps?
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hoarse
breathy sometimes diplophonia strained |
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What are the acoustic characteristics of polyps?
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decreased pitch and loudness ranges
aperiodicity increased noise levels |
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What are the aerodynamic characteristics of polyps?
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increased airflow
increased subglottal pressure |
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What are patient complaints for polyps?
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similar to nodules
vocal fatigue sensation of something in the throat vocal effort/strain muscle tension pain |
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What is the natural reaction of laryngeal tissue to trauma or abuse?
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edema
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What is almost always related to smoking and is more common in females?
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Reinke's Edema
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What is the buildup of fluid in the SLP (Reinke's space) of the vocal folds
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edema
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Reinke's Edema is
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bilateral
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What is the affect of Reinke's Edema?
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increases mass
increases mucosal wave decreases stiffness aperiodic vibration |
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Closure with Reinke's Edema can be
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complete or
irregular |
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What are the perceptual characteristics of Reinke's Edema?
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low Fo
hoarseness vocal effort |
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What are the acoustic characteristics of Reinke's Edema?
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loss of high pitches
decreased pitch range |
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What are the aerodynamic characteristics of Reinke's Edema?
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no data BUT
possible decreased subglottic pressure due to low stiffness |
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What are patient complaints about Reinke's Edema?
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vocal fatigue
dry throat vocal effort |
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What is caused by vocal trauma, usually from screaming or loud talking?
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traumatic laryngitis
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What does erythematous mean?
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red and swollen
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What is the voice quality of laryngitis?
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hoarse
low pitched breathy |
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How long does it take for laryngitis to get better?
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few days to 2 weeks
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What can cause vocal fold hemorrhage?
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traumatic laryngitis
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What is using more effort or straining to speak?
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negative compensatory strategies
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What may cause cysts?
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blockage of mucosal glandular duct, post vocal abuse
can be congenital or acquired in childhood |
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What do cysts consist of?
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sacs of tissue that contain either liquid (mucous) or a semisolid substance (epithelial cells)
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Where do cysts occur?
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in the SLP layer and are unitlateral
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What are the voice qualities of cysts?
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absent mucosal wave
increases VF mass and stiffness of VF cover irregular glottic closure |
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Cysts occur more in
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women
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What are the perceptual characteristics of cysts?
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hoarse
breathy possibly low pitched decreased loudness |
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What are the acoustic characteristics of cysts?
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no data BUT
similar to nodules |
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What are the aerodynamic characteristics of cysts?
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no data BUT
similar to nodules |
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What are patient complaints of cysts?
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hoarseness
vocal effort and strain vocal fatigue |
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What is ventricular phonation?
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adduction of the false or "ventricular" vocal folds
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What is often seen with patients with a primary vocal pathology?
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ventricular phonation
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Why does a patient use ventricular phonation?
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compensation for air wastage
inability to build sufficient subglottic pressure and decreased loudness |
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What happens when the false VFs adduct?
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they overlap the true VFs and load them
resulting in abnormal vibration false VFs may vibrate causing diplophonia |
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What are the voice qualities of ventricular phonation?
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hoarse
low pitched due to false VF mass or combination of false VFs and true VFs breathy monotone decreased pitch range |
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What are the 3 types of muscle tension dysphonia?
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1. AP compression
2. Mediolateral compression (may involve false VFs) 3. Supraglottic squeezing with posterior tongue carriage and contraction of pharyngeal constrictors |
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What are the 5 signs of MTD upon laryngeal palpation?
TEN IT |
1. Tense, tight thyrohyoid muscles
2. Elevated laryngeal height 3. Narrow, tense thyrohyoid space 4. Inability to move larynx left and right 5. Tension in suprahyoid muscles |
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What are the perceptual characteristics of MTD?
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harsh, hoarse
breathy tense/tight pitch and phonation breaks normal, elevated, or lowered pitch |
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What are the patient complaints with MTD?
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vocal fatigue
tight and tense throat laryngeal pain/discomfort |
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What are the 2 types of psychogenic voice disorders?
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1. puberphonia or mutational falsetto
2. psychogenic/hysterical dysphonia |
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Psychogenic voice disorders range from
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dysphonia to aphonia
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What is another name for puberphonia?
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mutational falsetto
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What is the persistence of a child-like voice quality after puberty?
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puberphonia
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What are 2 causes of puberphonia?
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learned behavior
psychogenic |
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What are the voice qualities of someone with puberphonia?
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high pitched
possibly hoarse breathy |
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What happens when someone with puberphonia shouts or lifts something heavy?
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vocal pitch often lowers
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What must a puberphonia diagnosis include?
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ruling out a possible laryngeal defect or disease
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What disorder had sudden onset or preceded by periods of voice loss or dysphonia?
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psychogenic aphonia/dysphonia
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What causes psychogenic aphonia/dysphonia?
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often associated with some type of fear, stress, or traumatic event
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With psychogenic aphonia/dysphonia, non-speech/vegetative functions show what?
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normal phonation
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What is PVCM?
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paradoxical vocal cord movement
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Adduction of VFs during quiet breathing is
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paradoxical vocal cord movement
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What results from PVCM?
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stridor
shortness of breath |
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What causes PVCM? (5)
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learned behavior with no known cause (idiopathic)
may be due to hyperactivity of the airway neurological problem psychological problem unspecified medical problem |
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What is PVCM often confused with?
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asthma
exercise included bronchospasms |
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What is the primary concern for PVCM?
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the patient's ability to breathe
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What are patient complaints with PVCM?
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throat tightness
wheezing shortness of breath chest/lung tightness irregular breathing patttern cough |
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What are the voice qualities with PVCM?
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hoarse
weak breathy |
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PVCM may be linked to
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allergies
asthma exercise stress |
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What are 8 types of organic voice disorders?
CGI LLL SV |
1. contact ulcers and granulomas
2. gastroesphageal reflux (GERD) or laryngealpharyngeal reflux (LPR 3. Infectious laryngitis 4. laryngeal cancer 5. laryngeal webs 6. leukoplakia and keratosis 7. sulcus vocalis 8. vocal fold papillomas |
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What are 3 causes of contact ulcers and granulomas?
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1. GERD or LPR
2. intubation trauma 3. vocal misuse |
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What are contact ulcers?
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inflammatory necrotic lesions
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Where do contact ulcers occur?
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on the medial aspect of the posterior 1/3 of the vocal folds in the cartilaginous portion
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Ulcers and granulomas consist of
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lymphocytes and fibrotic connective tissue
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What is the nature of the vocal folds with contact ulcers and granulomas?
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can be unilateral or bilateral
variable closure mucosal wave possibly decreased |
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What are the signs of heartburn?
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chronic hoarseness, worse in morning
nocturnal coughing excessive mucous belching sour/acid taste |
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What are the perceptual characteristics of contact ulcers and granulomas?
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may or may not be low pitched
hoarse breathy |
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What are patient complaints of contact ulcers?
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phonation pain
voice worsens with prolonged use |
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What is inflammatory response of the larynx due to an infection?
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infectious laryngitis
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What are the symptoms of infectious laryngitis?
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total voice loss
hoarseness breathiness low pitch |
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What is the treatment for infectious laryngitis?
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voice rest
water anti-inflammatory meds non-mentholated lozenges |
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What is the cause of laryngeal papilloma?
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human papilloma virus
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What are the two types of laryngeal papilloma?
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early childhood onset
adult onset |
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Where else can papilloma be found?
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trachea
oropharynx |
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With papilloma, what happens after puberty?
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80% spontaneously resolve
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What is the VF nature with papilloma?
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incomplete glottic closure
absent mucosal wave increases VF mass and stiffness |
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What are the perceptual characteristics of papilloma?
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hoarseness
breathiness strained |
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What are the acoustic characteristics of papilloma?
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probably decreased pitch/loudness ranges
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What are the aerodynamic characteristics of papilloma?
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subglottal pressure is likely increased due to increased stiffness
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What are patients complaints with papilloma?
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trouble breathing
decreased pitch and loudness vocal effort/strain |
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What is laryngeal web?
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a band of tissue that forms in the anterior 1/3 of glottis
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What are the causes of laryngeal web?
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congenital
acquired post-surgically or trauma |
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In infants, what is the voice quality with laryngeal web?
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inhalatory stridor
shortness of breath high-pitched crying |
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What is leukoplakia and hyperkeratosis?
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pre-cancerous lesions that range from flat plaque-like whitish patches to warty lesions
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What causes leukoplakia and hyperkeratosis?
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smoking
alcohol ingestion GERD or LPR pollutants coughing/throat clearing |
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What is the nature of the VFs with leukoplakia and hyperkeratosis?
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unilateral or bilateral
rough VF edges |
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What is the affect of leukoplakia and hyperkeratosis on the VFs?
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increases VF mass and stiffness
decreases mucosal wave irregular glottic closure aperiodicity asymmetry |
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What is the voice quality of leukoplakia and hyperkeratosis?
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hoarse
breathy low-pitched decreased loudness |
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What is a longitudinal groove or indentation in the VF that parallels the free margins?
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sulcus vocalis
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Where does sulcus vocalis occur?
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in the SLP layer
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What causes sulcus vocalis?
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usually congenital
may be from misuse/abuse if acquired, may be from a history of a ruptured VF cyst |
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What may occur after a ruptured VF cyst?
|
sulcus vocalis
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What results from sulcus vocalis?
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VF bowing
glottic incompetence decreased mucosal wave increased cover stiffness decreases mass of cover |
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What are the voice qualities of sulcus vocalis?
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hoarse
breathy decreased loudness low pitch |
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What are the majority of laryngeal cancers?
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90% are malignant squamous cell carcinomas
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What are the voice qualities of laryngeal cancer?
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hoarse
dry rough low pitched breathy |
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What are patient complaints with cancer?
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globus sensation
inhalatory stridor throat pain painful swallowing shortness of breath foul breath |
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Neurological problems may cause
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1. problems with adduction and abduction
2. phonatory instability 3. incoordination |
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What accounts for 90% of unilateral vocal fold paralysis?
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unilateral vagus nerve (CN X) lesions
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What do unilateral vagus nerve (CN X) lesions cause?
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flaccidity
decreased tone dysphagia |
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What causes unilateral VF paralysis?
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1. unilateral vagus nerve (CN X) lesions
2. unilateral brainstem stroke 3. unilateral injury to RLN during thoracic or neck surgery 4. neck/laryngeal trauma 5. viral infections |
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What is the most usual cause of unilateral vocal fold paralysis?
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disease or trauma to RLN
injury to left RLN more common than right |
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In unilateral vocal fold paralysis, what position is the affected VF usually in?
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paramedian
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In unilateral vocal fold paralysis, what are the VF characteristics?
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1. some anterior approximation
2. healthy VF may cross midline to aid adduction 3. airflow sets affected fold into vibration 4. Bernoulli Effect may aid in closure |
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When may spontaneous recovery occur in unilateral vocal fold paralysis?
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8-12 months after RLN trauma
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What are 4 causes of bilateral vocal fold paralysis?
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1. bilateral damage to RLN during thyroid surgery (50%)
2. malignancy 3. neurological disease/injury 4. trauma |
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What are the 5 neuro causes of bilateral vocal fold paralysis?
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1. bilateral cerebral damage
2. bilateral damage to brainstem in CN X region 3. intubation injury 4. neurological disease 5. viral infection |
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CVAs may cause voice problems if they are
|
lower bilateral lesions in brainstem
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What are the voice qualities of abductor paralysis?
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hypernasal
low pitched/volume monotone strained |
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What is the primary concern with abductor paralysis?
|
respiratory safety
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What is the primary concern with adductor paralysis?
|
feeding safety
(aphonia and severe dysphagia) |
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What else may be affected with bilateral vocal fold paralysis?
|
weakness or paralysis in:
tongue velum pharyngeal muscles |
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When is a tracheotomy usually required?
|
bilateral vocal fold paralysis
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Damage to SLN results in paralysis or paresis of
|
CT muscle
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What is the most common cause of SLN damage?
|
thyroid surgery
can be viral as well |
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What are the symptoms of SLN damage?
|
bowing and rotation on affected side
decreased pitch range |
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Vocal fold bowing is seen in what conditions?
|
1. aging voice (presbylaryngis or presbyphonia)
2. younger patients with muscle tension |
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Aging voice - atrophy of muscles due to subtle decrease in nerve input results in
|
hypotonicity
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What are the perceptual characteristics of bowing?
|
higher pitch
hoarse breathy strained |
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What are the acoustic characteristics of bowing?
|
decreased pitch and loudness ranges
increased noise in voice possible vocal tremor |
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What are patient complaints with bowing?
|
dislike sound of own voice
strain/effort trouble being heard vocal fatigue |
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The abnormal movement in an isolated body part is
|
focal dystonia
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Spasmodic dysphonia is considered a
|
focal dystonia
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Spasmodic dysphonia has what kind of component?
|
psychogenic
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Spasmodic dysphonia is more common in
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women (60-85%)
onset is middle age |
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What is the most common form of spasmodic dysphonia?
|
adductor
harsh, strained, strangled sound |
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Spasmodic dysphonia must be differentially diagnosed from
|
muscle tension dysphonia
vocal tremor |
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What are other names for essential tremor of the larynx?
|
organic or familial tremor
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Tremor may also be in
|
the head
hands tongue |
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Tremor is characterized by
|
regular steady fluctuations in loudness & pitch
frequency range of 4-7 Hz |
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Tremor is always present
|
in sustained phonation
and can be present in speech |
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Tremor is quiet at
|
rest but present during volitional movement
onset is middle or late middle age |
|
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What affects upper and lower motor neurons?
|
ALS
amyotrophic lateral sclerosis |
|
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What causes muscle wasting, muscle twitches, weakness, spasticity?
|
ALS
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What are the voice qualities of ALS?
|
hoarseness
harshness strain/struggle hypernasal breathy |
|
|
Lesions to basal ganglia or other parts of extrapyramidal system cause
|
hyperkinesias
|
|
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What are three types of hyperkinesias?
|
1. choreas
2. athetosis 3. Huntington's Chorea |
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What exhibit quick, jerky, purposeless movements?
|
choreas
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What are voice qualities of choreas?
|
irregular pitch/loudness
irregular respiration |
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Athetosis is
|
hyperkinetic dystonia
|
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What are the voice qualities of athetosis?
|
variable:
loudness pitch vocal quality |
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What is an inherited autosomal dominant disease?
|
Huntington's chorea
|
|
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What is a degenerative disease that affects the basal ganglia?
|
Huntington's chorea
middle age onset |
|
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What are the voice qualities of Huntington's Chorea?
|
strained, strangled harsh monopitch voice
jerky irregular bursts of loud voice sudden, forced changes in breath control |
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What causes Parkinson's disease?
|
lack of dopamine in substansia nigra
|
|
|
Parkinson's is considered a
|
hypokinetic dysarthria
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What has slow, rigid movements with decreased range of motion, resting tremor, difficulty initiating movement?
|
Parkinson's
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What is the voice quality of Parkinson's?
|
breathy
weak decreased loudness monopitch monoloudness sometimes tremor |
|
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What are the laryngeal characteristics of Parkinson's?
|
bowing/incomplete closure
possible compensatory supraglottic squeezing AP compression FVF approximation |
|
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What is a demyelinating progressive disease that attacks the myelin sheath causing breaks in transmitting axons in white matter in PNS and CNS?
|
multiple sclerosis
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What is the voice quality of multiple sclerosis?
|
impaired loudness control
harshness hypernasality slow speech rate impaired articulation decreased respiratory control |
|
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What is an autoimmune disease that exhibits progressive failure to sustain maintained or repeated contraction of striated muscles?
|
myasthenia gravis
|
|
|
What is the cause of myasthenia gravis?
|
blockage of acetylcholine at NMJ
results in muscle flaccidity |
|
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When is the onset of myasthenia gravis?
|
women: 30's
men: 60's occurs twice as often in women |
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What are the voice qualities of myasthenia gravis?
|
breathy
hypernasality weak voice intermittent aphonia due to rapid fatigue |
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What is typical of myasthenia gravis?
|
patient fatigues rapidly
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