Voice Disorders Exam 2

partial--removal of some parts
--results in breathy, hoarse voice (vfs may or may not be removed)

Total--all of lar. removed, trach connected to stoma in neck for respiration

-cancer (more in men, smokers, heavy drinkers, fam hx, exposure to toxins)
-trauma to larynx
-having a non-functional larynx

-discuss effects pre-op (procedure and lifestyle change)
-advice pt on suitable type of alaryngeal speech
-train in alar. speech
-ongoing counsel for max benefits

-esophogeal speech
-speech aids (electrolarynx)
-tracheoesophogeal speech (prosthetic)

Force air into the top of your esophagus via:
-Swallow
-Inhalation
-Injection (Most efficient)

High thoracic pressure forces air back up, created resonance
-occurs between C3-C6
-burp quality

-was popular until 80's
-inadequate air supply for fluency or proper loudness
-only 33% mastery rate
-takes ~6mos to gain functional use

-electro-acoustic aid: trans-cervical (placed on neck/cheek) or intra-oral (in post. oral cavity)
-often used just after surgery or as a backup to primary method
-very mechanical voice quality, high cost (batteries), difficult to get optimal position
-least preferred but most often used among SLPs

-prosthesis connecting trachea to esophagus with valve
-redirects aids through esoph. and past neoglottis for sound
-closest to normal speech sound

-airway obstruction
-resp. insufficient
-flaccid dispneumia (ALS)
-neuromuscular disorders

-tube redirects air from foval tract to artificial opening, resulting in minimal airflow across VFs
-tubes with cuff do not allow VFs to adduct (speaking vales allow for cuff deflation and speech)

-not for people with severe upper-airway obstruction, those with lots of secretions, decreased cog., or endotrach. tubes
-voice is deeper and more hoarse

-resonation
-pholo-larayngeal
-repisratory
(one or all, depending on lesion)

NOT AS MUCH...
-artic (dysarthria)
-cog-ling (aphasia, dementia)
(unless co-occurring)

-spastic (strained-strangled)
-Hyperkinetic (phonation and resp. probs)
-ataxic (incorrodination)
-hypokinetic (reduced lung volume)
-flaccid (breathy, hoarse, hypernasal, reduced loudness, diplophonia)

Spastic
hyperkinetic
ataxic
hypokinetic
flaccid

-abnormal involuntary movements (task specific) in larynx
-airflow probs. and airflow perturbation
-prob. with cnx speech, not prolonged vowels
-maybe originates in BG?

-palatal lift/CPAP for hypernasality
-modify rate/prosody
-amplification to inc. loundness
-AAC
-modify physical environment (irritants, noise, etc)
-prosthetic devices
-pace speech rate for inc. artic. precision

-health stability (after accident/surgery)
-co-existing problems that need remediation (e.g., when meds for PD or acid reflux are working)
-degenerative cases (resort to diff. methods as they degenerate--try to maintain intelligibility/independence / quality of life)
-how much does the prob affect daily life/career?

•Episodic/recurrent shortness of breath and/or stridor
•Laryngeal tightness or a sensation of being choked (globus pharyngeus)
-brought on by laryngeal irritants, psych, or bernouli (in athletes)

–Asymptomatic: laryngeal structures normal
–Symptomatic: VFs adduct almost completely during tidal breathing, with a small diamond-shaped glottal chink posteriorly(*definitive diagnosis*)
–Voluntary symptoms: VFs adduct with a bowing configuration

-hyperkinetic laryngeal dysfunction
-•Chronic laryngeal motor stimulation
–habitual postural laryngeal muscle misuse
–GER and LPR
–post-viral illnesses
–emotional distress
•Repeated noxious stimulation
•Sensorimotor pathways in hyperexcitable steady state

•Chronic, intermittent, morning hoarseness
•Chronic throat clearing
•Chronic cough
•Globus sensation
•Dysphagia
•Sore throat
•Excessive laryngeal mucous

1.Symptoms attributable to laryngeal tension
–dysphonia and/or laryngospasm
–with or without globus and/or chronic cough
2.Visible and palpable evidence of tension
–laryngoscopic lateral and AP contraction
–palpation of SH, TH, CT, pharynx
3.Presence of a sensory trigger
–airborne substance, esophageal irritant, odor

•Sex: based on biology (chromosomal pattern and genitalia)
•Gender: Socially and psychologically constructed; Based upon society’s classifications of masculinity or femininity.

-pitch/range
-intonation
-pronunciation
-grammar/vocab

•Crico-Thyroid Approximation (CTA)
•Laryngoplasty
•Laser Assisted Thyro-ArytenoidResection
•Laser Assisted Voice Adjustment (LAVA)
•Vocal Fold Shortening (Anterior Web Creation)
•Thyroid Cartilage and VF Reduction

•An organic voice disorder is the product, manifestation, or symptom of a disease, disease process or illness (Andrianopoulos, 2007).
•A functional voice disorder is one that presents with perceptual voice changes, often in the presence of normal-appearing vocal folds (Stemple, 2000).

•Increase of the phonatory muscle tension in the anterior neck
•Elevation of the larynx causing an increase in vocal pitch
•A posterior phonatory gap
•Vocal fold mucosal changes secondary to abnormal points of contact
•Vocal tract discomfort
•Female predominance
•Poor control of the breath stream
•Increased frequency of hard glottal attacks
•Uneven mucous layer
•Vessel dilation
•Bilateral vibratory asymmetry

•LPR
•Steroid inhaler therapy
•Chronic postnasal drip
•High level of anxiety
•2ndary to Unilat VF Paralysis
•Paradoxical Vocal Fold Movement (PVFM)
•Presbylaryngeus
•2ndary to use of Speech Recognition System

•Phonatorya ir flow
–Normal in ADSD, but abnormal in MTD
•Task specific phonation
–ADSDs had symptoms during connected speech
•Connected speech and sustained vowel “ah”
–MTDs had symptoms during both connected speech and sustained vowel [a] prolongation
–ADSD had symptoms during connected speech, but not [a] vowel prolongation

•Manual Circumlaryngeal Therapy
•Falsetto Voice Technique
•Biofeedback Training
•Intravenous Midazolam
•Humming Exercises
•Deconstriction Vocal Exercises
•Progressive Relaxation
•Chewing Exercises
•Yawn-sigh Approach

•2% of functional voice disorders
•inability to shout or to compete with background noise
•Most often identified ~2-3 years postadolescent
•Larynx is anatomically and physiologically capable of producing normal low-pitched voice

•Have patient breathe in deeply + produce a vowel or cough with a sharp glottal attack
•If the voice is a true falsetto, a sudden extensive downward break in pitch will be demonstrated
•shallow breathing, inability to produce a hard glottal attack

1.Rhinolalia clausa, posterior-closed nasality (where nasal semivowels lose their normal resonance) due to obstruction of the posterior region of the nasal cavity. (/m/, /n/, & /ng/ are often heard as /b/, /d/, & /g/.)
2.Rhinolalia clausa, anterior-closed nasality in which all of the vowels and nasal consonants are produced with a “hollow”sound because of obstruction to the anterior portion of the nasal cavity.

-overt cleft palate with or without cleft lip
–Submucous cleft palate
–Congenitally short soft palate or large nasopharynx
–Traumatic structural damage

–Flaccid (LMN)
–Unilateral UMN
–Spastic (bilateral UMN)
–Flaccid-Spastic (mixed LMN)
–Hyperkinetic

•Primarily Organic
–Hypertrophied adenoids
–Tumors
–Inflammations
–Post surgical repair
–Patulous eustachian tube
–Nasal deformity

•Hypernasality of vowels and voiced consonants.
•Nasal emission of pressure consonants
•Weak pressure consonants
•Nonstandard laryngeal, pharyngeal, and lingual sound substitutions for standard consonants.
•Delayed artic and lang development
•Artic defects 2ndary to dental defects
•Artic defects 2ndary to HL
•Dysphonia
•Nasal/facial grimacing associated with speaking.