Voice Disorders Overview
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Voice Disorders Overview

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Questions and Answers

What characterizes Reinke's edema?

  • A temporary loss of voice due to stress
  • Diffuse swelling of the Lamina Propria with gelatinous material (correct)
  • A mechanical obstruction caused by foreign bodies
  • Chronic swelling of the vocal cords due to infection

    • What type of break involves a sudden interruption in phonation?

  • Phonation Break
  • Emotional Break
  • Pitch Break (correct)
  • Decibel Break

    • What is the primary factor in functional aphonia?

  • An organic throat infection
  • Vocal cord paralysis
  • Chronic inflammation of the vocal cords
  • Psychological factors leading to unintentional whispering (correct)

    • Which disorder is characterized by an unintentional high-pitched voice in males after physical maturation?

    <p>Mutational falsetto</p> Signup and view all the answers

    What is usually essential in addressing voice disorders effectively?

    <p>Proper assessment of etiology</p> Signup and view all the answers

    Which of the following is NOT a recognized abnormal voice quality?

    <p>Melodic</p> Signup and view all the answers

    Which intervention may be beneficial for treating mutational falsetto?

    <p>Voice therapy and psychological counseling</p> Signup and view all the answers

    What can be a potential cause of chronic swelling like that seen in Reinke's edema?

    <p>Vocal hyperfunction</p> Signup and view all the answers

    Which voice quality is NOT typically associated with unilateral vocal fold paralysis?

    <p>Markedly dysphonic</p> Signup and view all the answers

    What is a common characteristic of voice disorders resulting from neoplastic conditions affecting the RLN/Vagus?

    <p>Decreased loudness</p> Signup and view all the answers

    Which of the following is a distinct feature of psychogenic voice disorders?

    <p>Absence of structural abnormalities</p> Signup and view all the answers

    What type of dysfunction does spasmodic dysphonia exemplify?

    <p>Neurogenic voice disorder</p> Signup and view all the answers

    Which of the following factors can lead to hoarseness as a voice characteristic?

    <p>All of the above</p> Signup and view all the answers

    In which voice disorder is the vocal fold typically stuck in a paramedian position?

    <p>Unilateral vocal fold paralysis</p> Signup and view all the answers

    Which of the following is NOT considered a cause of vocal misuse?

    <p>Singing exercises</p> Signup and view all the answers

    What type of voice disorder is characterized by deleterious behaviors that should be avoided?

    <p>Vocal abuse</p> Signup and view all the answers

    Which condition is characterized by neurological dysfunction of motor movements and is a hyperkinetic disorder?

    <p>Dystonia</p> Signup and view all the answers

    What common symptom indicates narrowing of space in the larynx?

    <p>Stridor</p> Signup and view all the answers

    What type of voice misuse is characterized by excessive coughing or throat clearing?

    <p>Functional voice misuse</p> Signup and view all the answers

    Which of the following categories does not include a direct structural problem of the larynx?

    <p>Idiopathic</p> Signup and view all the answers

    Which vocal condition results in a harsh voice and can be the result of excessive talking or singing?

    <p>Strained voice quality</p> Signup and view all the answers

    What kind of dysphonia may occur when the ventricular folds are vibrating instead of the true vocal folds?

    <p>Ventricular dysphonia</p> Signup and view all the answers

    Excessive muscle tension can lead to which type of voice disorder?

    <p>Muscle tension dysphonia</p> Signup and view all the answers

    What characterizes adductor spasmodic dysphonia (ADSD)?

    <p>Tight laryngeal adduction</p> Signup and view all the answers

    Which condition might cause an individual to use their ventricular folds as a substitute voice?

    <p>Ventricular dysphonia</p> Signup and view all the answers

    Excessive talking or singing leading to voice problems can be classified under which type of disorder?

    <p>Functional voice disorders</p> Signup and view all the answers

    What does the term 'psychogenic' refer to in the context of voice disorders?

    <p>Psychological factors affecting voice</p> Signup and view all the answers

    Speaking with a hard glottal attack is an example of which type of vocal misuse?

    <p>Functional misuse</p> Signup and view all the answers

    Which of the following is a characteristic of neurogenic voice disorders?

    <p>Breathiness</p> Signup and view all the answers

    What is a common result of bilateral vocal fold paralysis?

    <p>Shorter utterance length</p> Signup and view all the answers

    What describes the condition known as laryngeal webbing?

    <p>A web grows across the glottis</p> Signup and view all the answers

    Which of the following symptoms would most likely be observed in an abductor type of vocal fold paralysis?

    <p>Both folds remain midline preventing airflow</p> Signup and view all the answers

    Which of the following treatment options is commonly used for vocal fold paralysis?

    <p>Surgical reinnervation of the muscles</p> Signup and view all the answers

    Which voice quality is characterized by incomplete glottal closure leading to turbulent airflow?

    <p>Breathy</p> Signup and view all the answers

    What is a common consequence of esophageal atresia?

    <p>Gastric Distension</p> Signup and view all the answers

    Which of the following represents a structural voice disorder?

    <p>Vocal fold nodules</p> Signup and view all the answers

    What defines a hoarse voice quality?

    <p>Strained plus Rough plus Breathy</p> Signup and view all the answers

    What condition can lead to aperiodic vocal fold vibration, producing a rough voice quality?

    <p>Vocal fold paralysis</p> Signup and view all the answers

    Which type of voice disorder results from psychological factors, where the individual exhibits abnormal voice production?

    <p>Functional voice disorders</p> Signup and view all the answers

    What is the primary reason for a strained voice quality?

    <p>Excessive medial compression of the vocal folds</p> Signup and view all the answers

    Granulomas, also known as contact ulcers, are classified under which category of voice disorders?

    <p>Organic voice disorders</p> Signup and view all the answers

    Reduced respiratory support can lead to which voice quality?

    <p>Strained</p> Signup and view all the answers

    Which of these is NOT typically linked to an organic voice disorder?

    <p>Psychological stress</p> Signup and view all the answers

    Which voice quality is typically associated with Reinke's edema?

    <p>Hoarse</p> Signup and view all the answers

    What is a common characteristic of voice disorders linked to psychogenic factors?

    <p>Unintended whispering</p> Signup and view all the answers

    Which condition is most commonly ruled out when diagnosing functional aphonia?

    <p>Organic disorders</p> Signup and view all the answers

    Which of the following is a descriptor of voice qualities associated with excessive vocal hyperfunction?

    <p>Strained</p> Signup and view all the answers

    What type of break involves a sudden interruption in phonation that is otherwise normal?

    <p>Pitch break</p> Signup and view all the answers

    What treatment approach may be appropriate for compensating mutational falsetto?

    <p>Voice therapy</p> Signup and view all the answers

    Which of the following best describes neurogenic voice disorders?

    <p>Disorders caused by physiological factors affecting nerves</p> Signup and view all the answers

    In which situation is there likely to be a unilateral and gelatinous vocal mass?

    <p>Reinke's edema</p> Signup and view all the answers

    Which voice quality is characterized by high-pitched sounds due to unilateral vocal fold paralysis?

    <p>Breathy</p> Signup and view all the answers

    What is a significant characteristic of voice disorders resulting from neoplastic conditions affecting the RLN/Vagus?

    <p>Paralysis of vocal folds</p> Signup and view all the answers

    Which type of dysphonia is marked by the voice being primarily affected by neurological dysfunction?

    <p>Neurogenic dysphonia</p> Signup and view all the answers

    Which is a common vocal quality associated with excessive muscle strain due to improper vocal use?

    <p>Strain</p> Signup and view all the answers

    In which type of voice disorder is vocal abuse more likely to result from deleterious behaviors?

    <p>Functional voice disorder</p> Signup and view all the answers

    What is an example of a condition that may cause a hoarse voice due to vocal cord paralysis?

    <p>Neoplasm</p> Signup and view all the answers

    Which of the following voice characteristics is least likely associated with functional voice disorders?

    <p>Vocal tremors</p> Signup and view all the answers

    Which phenomenon indicates a narrowing of space in the larynx commonly associated with stridor?

    <p>Mass on vocal folds</p> Signup and view all the answers

    What common behavior can result in a hoarse voice due to vocal misuse?

    <p>Frequent throat clearing</p> Signup and view all the answers

    Which abnormal voice quality results from incomplete glottal closure, causing turbulent airflow?

    <p>Breathy</p> Signup and view all the answers

    What is a common cause of harsh voice quality?

    <p>Excessive compression of vocal folds</p> Signup and view all the answers

    Which type of voice disorders are associated with structural deviations or additive growth?

    <p>Organic voice disorders</p> Signup and view all the answers

    Which abnormal voice quality indicates significant medial compression of the true vocal folds?

    <p>Strained</p> Signup and view all the answers

    Granulomas are classified as which type of voice disorder?

    <p>Organic voice disorder</p> Signup and view all the answers

    What characteristic is seen in neurogenic voice disorders?

    <p>Abnormal vocal fold vibration patterns</p> Signup and view all the answers

    A patient presents with hoarse voice quality due to a combination of strained, rough, and breathy qualities. What condition may they be experiencing?

    <p>Granulomas</p> Signup and view all the answers

    Which of the following is an essential feature to differentiate organic and functional voice disorders?

    <p>Presence of structural anomalies</p> Signup and view all the answers

    Which abnormal voice quality is characterized by aperiodic vocal fold vibration and irregular mucosal wave?

    <p>Rough</p> Signup and view all the answers

    What describes the relationship between excessive vocal fold compression and voice quality?

    <p>It results in strained voice quality.</p> Signup and view all the answers

    Which type of voice disorder is primarily characterized by improper use of the voice?

    <p>Functional voice disorder</p> Signup and view all the answers

    Which voice quality might be produced when the ventricular folds vibrate instead of the true vocal folds?

    <p>Ventricular dysphonia</p> Signup and view all the answers

    Excessive muscle tension in the larynx can lead to which type of voice disorder?

    <p>Functional voice disorder</p> Signup and view all the answers

    What is a common characteristic of psychogenic voice disorders?

    <p>Abnormal voice production due to psychological factors</p> Signup and view all the answers

    Which of the following is NOT typically a feature of neurogenic voice disorders?

    <p>Vocal misuse leading to strain</p> Signup and view all the answers

    In which type of disorder is the presence of excessive talking or singing most likely to cause vocal issues?

    <p>Functional voice disorder</p> Signup and view all the answers

    Which condition is characterized by the tight adduction of the larynx?

    <p>Adductor spasmodic dysphonia (ADSD)</p> Signup and view all the answers

    Which type of dysphonia results from the vibration of false vocal folds rather than true vocal folds?

    <p>Ventricular dysphonia</p> Signup and view all the answers

    Which type of voice disorder could be classified as a psychogenic condition?

    <p>Functional voice disorders</p> Signup and view all the answers

    What might cause an individual to experience a harsh voice quality during excessive speaking?

    <p>Vocal misuse or strain</p> Signup and view all the answers

    Which of the following symptoms is most characteristic of congenital laryngeal webbing?

    <p>Stridor and breath shortness</p> Signup and view all the answers

    What type of voice disorder is associated with partial loss of movement in vocal folds?

    <p>Neurogenic voice disorder</p> Signup and view all the answers

    Which treatment method is specifically mentioned for managing complications of bilateral vocal fold paralysis?

    <p>Surgical reinnervation of the muscles</p> Signup and view all the answers

    What distinguishes an abductor type of vocal fold paralysis from an adductor type?

    <p>Abductor type results in breathiness, while adductor type leads to a strained voice.</p> Signup and view all the answers

    Which of the following is a common consequence of neurogenic voice disorders?

    <p>Reduction in vocal pitch range</p> Signup and view all the answers

    Study Notes

    Reinke’s Edema

    • Chronic, diffuse swelling of the Lamina Propria
    • Thick, gelatinous, fluid like material in the Reinke’s space
    • Caused by: smoking, vocal hyperfunction, LPR
    • Similar to Polyps and Nodules in AVQs:
      • Breathy
      • Strained
      • Rough
      • Harsh
      • Hoarse

    Mutational Falsetto (Puberphonia)

    • Occurs in adolescent or adult males who have completed physical maturation
    • Unintentionally high pitched voice
    • Closely tied with psychological experiences
    • Treatment:
      • Voice Therapy
      • Psychological counseling (if applicable)

    Functional Aphonia

    • Speaking in a whisper (aphonic voice) but using the same rhythm and prosody as normal speech
    • Closely tied with psychological experiences
    • Consider possible organic and non-organic causes (rule out organic causes)
    • Onset can widely vary, depending on the reason (contextual factors)

    Unilateral Vocal Fold Paralysis (UVFP)

    • High pitched sound
    • Roughness
    • Stridor (due to narrowing space)
    • Causes:
      • Mass along the voice fold
      • Lesions
      • VF paralysis
      • Scarring

    Laryngeal Cancer

    • High chance of vocal fold paralysis

    Spasmodic Dysphonia

    • Rare voice disorder characterized by a strain-strangled, harsh voice
    • Can also be a psychogenic condition and be heterogeneous (Hirano & Bless, 1993)
    • Occurs in the absence of any neurogenic lesions or it can be neurogenic and psychogenic
      • Occurence of voice problem only during communicative purposes (Aronson, 1990)
      • Psychogenic
    • Dystonia:
      • Neurological dysfunction of motor movements, a hyperkinetic disorder
      • Hyperkinetic position
    • 2 Types:
      • Adductor (ADSD) - Tight laryngeal adduction (most common)
      • Abductor (ABSD) - Normal voicing interrupted by sudden abduction

    Functional Voice Disorders

    • Caused by improper use of voice
    • 2 Main Causes:
      • Excessive muscle tension
      • Clinical Conditions

    Vocal Abuse vs Vocal Misuse

    • Vocal Abuse: deleterious behaviors and events you should not be doing excessively (e.g. yelling, excessive talking/singing, excessive coughing/throat clear, smoking, grunting, excessive crying/laughing)
    • Vocal Misuse: improper use of voice (e.g. speaking with a hard glottal attack, singing/speaking outside oneʼs pitch range, speaking with an excessive intensity level)

    Ventricular Dysphonia

    • May be produced by the vibration of the ventricular folds, but not strictly
    • Ventricular folds/false VF should not be adducting
    • Usually of a lower pitch than the typical voice using the TVF
    • May be used as a substitute voice for patients with severe TVF disease (cancer, papilloma, etc.)

    Tracheoesophageal Fistula (TEF) & Esophageal Atresia (EA)

    • TEF: Opening that occurs between the esophagus and the trachea
    • Atresia: Abnormal occlusion of the esophagus
    • Problems in:
      • Gastric Distension
      • Aspiration
      • Reduced diaphragmatic capabilities
    • AVQs? VF vibration should be symmetric

    Granulomas (Contact Ulcer)

    • Weak voice
    • Restricted pitch range
    • Decreased stamina
    • Shorter utterance length

    Neurogenic Voice Disorders

    • Damage from the nervous system
    • Bilateral Vocal Fold Paralysis/Paresis:
      • Paresis – partial loss of movement
      • Paralysis – total loss of movement
    • Usually a result of a lesion high in the trunk of the vagus nerve or at the nuclei of origin in the medulla
    • Adductor:
      • Neither fold is capable of moving to the midline (open position)
      • Breathiness
    • Abductor:
      • Both folds remain at the midline (close position)
      • Strained
    • Treatment:
      • Surgical reinnervation of the muscles
      • Laser surgery

    Laryngeal Webbing

    • A web grows across the glottis inhibiting normal VF vibration
    • Congenital:
      • Stridor
      • Breath shortness
      • Squealing
    • Acquired:
      • Bilateral trauma
      • Irritants

    Laryngeal Conditions Contributing to Abnormal Voice Quality

    • Breathy
    • Rough
    • Strained
    • Harsh
    • Hoarse

    Organic Voice Disorders

    • Structural Deviations
    • Additive Growth
    • Loss of Structure

    Etiology

    • Determine the origin/etiology to differentiate organic and functional voice disorders

    Adductor Spasmodic Dysphonia (ADSD)

    • Occurence of dysfunction in the absence of abnormal laryngeal structural problems and psychogenic or neurogenic etiology (Morrison, et.al., 1983)
    • Markedly dysphonic
    • Causes:
      • Deviant posture
      • Misuse of shoulder and neck muscles
      • Stress
      • Vocal abuse
      • Vocal misuse

    Abductor Spasmodic Dysphonia (ABSD)

    • Similar but neurogenic and psychogenic in nature to ADSD and other EMTs (Excessive Muscle Tension) and their AVQs

    Reinke’s Edema

    • Chronic, diffuse swelling of the Lamina Propria
    • Thick, gelatinous, fluid-like material in the Reinke’s space
    • Caused by smoking, vocal hyperfunction, and Laryngopharyngeal Reflux (LPR)
    • AVQs (same as polyps and nodules)
      • Breathy
      • Strained
      • Rough
      • Harsh
      • Hoarse

    Breaks

    • Phonation Break:
      • Temporary loss of voice for a word, whole word, or sentence
    • Pitch Break:
      • Sudden interruption in phonation in an otherwise normal laryngeal structure
      • Two types:
        • Normal pitch breaks: Occur during puberty
        • Prolonged hyperfunction speaking in an inappropriately low pitch

    Mutational Falsetto (Puberphonia)

    • Occurs in adolescent or adult males who have completed physical maturation
    • Unintentionally high-pitched voice
    • Closely tied to psychological experiences
    • Treatment:
      • Voice Therapy
      • Psychological counseling (if applicable)

    Functional Aphonia

    • Speaking in a whisper (aphonic voice) but using the same rhythm and prosody as normal speech
    • Closely tied to psychological experiences
    • Onset can vary depending on the context
    • Rule out all organic causes before diagnosing

    Unilateral Vocal Fold Paralysis (UVFP)

    • Usually a result of a lesion to the Recurrent Laryngeal Nerve (RLN) or Vagus Nerve due to trauma or surgical injury
    • The paralyzed fold is stuck in a paramedian position
    • Types:
      • Adductor: High-pitched sound, roughness, stridor (narrowing of space)
      • Abductor: The paralyzed fold remains at the midline (closed position)
    • AVQs:
      • Breathy
      • Hoarse
      • Decreased loudness
      • Short Phonation Time

    Laryngeal Cancer

    • AVQs:
      • High-pitched sound
      • Roughness
      • Stridor

    Laryngeal Webbing

    • A web grows across the glottis inhibiting normal VF vibration
    • Types:
      • Congenital: Stridor, shortness of breath, squealing
      • Acquired: Due to trauma or irritants
      • AVQs: (depending on severity):
        • Weak voice
        • Restricted pitch range
        • Decreased stamina (shorter utterance length)

    Spasmodic Dysphonia (SD)

    • Rare voice disorder characterized by a strain-strangled, harsh voice
    • Can be a psychogenic condition
    • Can occur in the absence of any neurogenic lesions or be neurogenic and psychogenic
    • Occurs only during communicative purposes (psychogenic)
    • Types:
      • Adductor (ADSD): Tight laryngeal adduction (most common)
      • Abductor (ABSD): Normal voicing interrupted by sudden abduction

    Functional Voice Disorders

    • Two broad causes:
      • Excessive muscle tension
      • Clinical Conditions

    Vocal Abuse vs. Vocal Misuse

    • Vocal Abuse: Deleterious behaviors that should not be done excessively
      • Yelling
      • Excessive talking/singing
      • Excessive coughing/throat clearing
      • Smoking
      • Grunting
      • Excessive crying/laughing
    • Vocal Misuse: Improper use of the voice
      • Speaking with a hard glottal attack (HGA)
      • Singing/speaking outside one’s pitch range
      • Speaking with an excessive intensity level

    Ventricular Dysphonia

    • May be produced by the vibration of the ventricular folds
    • Usually of a lower pitch than the typical voice using the TVF
    • Can be used as a substitute voice for patients with severe TVF disease (e.g., cancer, papilloma)

    Tracheoesophageal Fistula (TEF) & Esophageal Atresia (EA)

    • TEF: Opening between the esophagus and trachea
    • Atresia: Abnormal occlusion of the esophagus
    • Problems:
      • Gastric distension
      • Aspiration
      • Reduced diaphragmatic capabilities
    • AVQs:
      • Decrease in loudness
      • Shorter utterances (due to reduced respiratory support)

    Granulomas (Contact Ulcer)

    • Typically a result of constant irritation (e.g., intubation, vocal abuse)
    • AVQs:
      • Weak voice
      • Restricted pitch range
      • Decreased stamina

    Neurogenic Voice Disorders

    • Damage to the nervous system

    Bilateral Vocal Fold Paralysis/Paresis

    • Paresis: Partial loss of movement
    • Paralysis: Total loss of movement
    • Usually a result of a lesion in the trunk of the vagus nerve or at the nuclei of origin in the medulla
    • Types:
      • Adductor: Neither fold is capable of moving to the midline (open position)
        • AVQs: Breathiness
      • Abductor: Both folds remain at the midline (closed position)
        • AVQs: Strained
    • Life-threatening issues:
      • Adductor: High chance of aspiration and penetration
      • Abductor: Cannot breathe
    • Treatment:
      • Surgical reinnervation of the muscles
      • Laser surgery

    Muscle Tension Dysphonia (MTD)

    • “Occurrence of dysfunction in the absence of abnormal laryngeal structural problems and psychogenic or neurogenic etiology” (Morrison, et.al., 1983)
    • Causes:
      • Deviant posture
      • Misuse of shoulder and neck muscles
      • Stress
      • Vocal abuse
      • Vocal misuse
    • Differential diagnosis:
      • ADSD, Tremors, and EMT’s AVQs all have similarities, but MTD is neurogenic and psychogenic in nature

    Abnormal Voice Quality

    • Occurs due to improper use of voice
    • Common AVQs:
      • Breathy: Incomplete glottal closure → turbulent airflow
      • Rough: Aperiodic vocal fold vibration → irregular mucosal wave
      • Strained: Considerable medial compression of TVF → compressed too much
      • Harsh: Strained + Rough
      • Hoarse: Strained + Rough + Breathy

    Organic Voice Disorders

    • Three categories:
      • Structural Deviations
      • Additive Growth
      • Loss of Structure
    • Differentiate from functional voice disorders by determining the origin/etiology

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    Description

    This quiz covers various voice disorders such as Reinke's Edema, Mutational Falsetto, Functional Aphonia, and Unilateral Vocal Fold Paralysis. Each condition's characteristics, causes, and treatment options are explored, helping you understand the complexities of vocal health.

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