Voice Disorder Final
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Questions and Answers

Which voice injury requires complete vocal rest?

  • Laryngitis
  • They all require complete rest with no speaking
  • Vocal hemorrhage (correct)
  • Nodes

    • Vascularization of the tissue of the vocal folds (or surrounding structures) is a condition that requires complete vocal rest.

    True

    What therapy technique reduces vocal fold tension?

  • Chewing (correct)
  • Semi-occluded vocal tract exercises (correct)
  • Expiratory muscle strength training
  • Biofeedback

    • Which of the following symptomatic voice therapy techniques are appropriate for hyperfunctional voice disorders?

    <p>Confidential voice</p> Signup and view all the answers

    Negative practice is counterproductive in voice therapy and should not be used.

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

    How to teach patients to hum properly?

    <p>Negative practice</p> Signup and view all the answers

    What disorder is injection augmentation used to treat?

    <p>Unilateral or bilateral VF paralysis</p> Signup and view all the answers

    A surgically created opening in the neck to allow for breathing is called a __________.

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

    Select from the list below any symptoms that patients with supraglottic cancers can present with.

    <p>referred ear pain</p> Signup and view all the answers

    Aspiration is a big concern after a total laryngectomy.

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

    Match the procedure to its description

    <p>Hemilaryngectomy = removal of one vertical half of the larynx including one false vocal fold, ventricle, true vocal fold, and portion of the thyroid cartilage on the involved side Supraglottic laryngectomy: = usually part of or all of the hyoid and epiglottis, aryepiglottic folds, and false vocal folds are removed Subtotal laryngectomy = modified technique with removal of half of the larynx vertically and the upper half of the contralateral larynx, including the ventricle and upper margin of the VF Cordectomy = removing part of or all of the vocal folds; can be used to treat very limited or superficial glottic cancers</p> Signup and view all the answers

    There is a risk of airway fire in laser (CO2) surgery.

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

    The removal of small nodules or lesions via microsurgery can be done in a quickly as 10-20 minutes.

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

    The SLPs role in the surgery process is pre- and post-operative care and helping the patient unlearn bad compensatory habits.

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

    The goal of phonosurgery is (select all that apply)

    <p>restore normal vocal fold vibrations</p> Signup and view all the answers

    What way(s) is the airway protected during laryngeal surgery?

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

    Which two conditions are usually treated by microflap surgery?

    <p>vocal polyps (large)</p> Signup and view all the answers

    What are the advantages of awake procedures?

    <p>reduced cost, no anesthetic risk, less time</p> Signup and view all the answers

    Postoperative counseling is not important.

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

    A laryngologist can remove a nodule during an awake procedure.

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

    Why would a surgeon choose to use Juvaderm or Restylane instead of a lipoinjection for vocal fold augmentation?

    <p>in the case of nerve injury that will hopefully heal</p> Signup and view all the answers

    Besides a distal chip, what other equipment do flexible scopes have that enables doctors to perform surgery with them?

    <p>Operating channles</p> Signup and view all the answers

    The procedure that involves removal of one vertical half of the larynx including one false vocal fold, ventricle, true vocal fold, and portion of the thyroid cartilage on the involved side is called:

    <p>vertical hemilaryngectomy</p> Signup and view all the answers

    Concomitant treatment involves

    <p>more than 1 treatment administered at the same time</p> Signup and view all the answers

    The TEP using a duckbill style prosthesis requires ___________ air pressure for speech than other prostheses.

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

    A supraglottic tumor staged T4b invades through the thyroid cartilage, and/or invades tissues beyond the larynx.

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

    Head and neck cancer accounts for _____% of new cases of cancer

    <p>4</p> Signup and view all the answers

    Cancer is the uncontrolled growth of _________________ cells.

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

    The ratio of male-to-female head and neck cancers is ___________.

    <p>4 to 1</p> Signup and view all the answers

    What technique involves using intraoral air pressure to inject air into the esophagus?

    <p>Consonant press injection method</p> Signup and view all the answers

    Which method creates a vacuum effect in the esophagus due to an increase in negative pressure in the thoracic cavity?

    <p>Inhalation method</p> Signup and view all the answers

    What is the primary benefit of the indwelling prosthesis compared to other prostheses?

    <p>Requires clinician insertion and extended wear</p> Signup and view all the answers

    What occurs during the consonant press injection method?

    <p>Natural intraoral air pressure is used to inject air into the esophagus</p> Signup and view all the answers

    In which technique does the patient take a deep breath through the stoma?

    <p>Inhalation method</p> Signup and view all the answers

    Communication following total laryngetcomy is dependent on alaryngeal speech modes

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

    Gastric upset is a problem side-effect of medication because it may lead to laryngopharyngeal reflux.

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

    Two ways obesity can affect the voice include increased likelihood of reflux and ______________

    <p>decrease in the space in the pharynx above the glottis</p> Signup and view all the answers

    The most common cause of chronic cough in adults are upper respiratory infection, asthma, and ________________.

    <p>Gastroesophageal reflux</p> Signup and view all the answers

    It's important for those working with CCM artists to know what __________________________________ are.

    <p>healthy belt, modal register, and loft register</p> Signup and view all the answers

    Contemporary commercial musical and classical music are synonymous.

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

    Which two medications reduce mucus?

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

    Match the term with its description

    <h1>Oral endoscope = best quality image of vocal folds and may trigger the gag reflex in clients Flexible endoscope = can be used to view more complex vocal tasks and offers less magnification of vocal folds</h1> <p>=</p> Signup and view all the answers

    High-speed videoendoscopy captures vocal fold vibration in real time because the rate of frames per second is so quick.

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

    Which allows assessment of vocal fold function during more complex vocal tasks>

    <p>Transnasal Flexible Laryngoscopy</p> Signup and view all the answers

    SLPs can diagnose voice disorders

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

    Spasmodic dysphonia can affect either the ____________ or _______________ muscles.

    <p>adductor, abductor</p> Signup and view all the answers

    Match the pathology to its description.

    <p>Vocal fold nodule = Inflammatory degeneration of the superficial layer of the lamina propria Polyp = Fluid--filled lesion that develops in the superficial layer of the lamina propria Cyst = Benign mucus--filled lesion surrounded by a membrane Laryngitis = Inflammatory condition of the vocal fold mucosa</p> Signup and view all the answers

    Vocal fold nodules typically form unilaterally.

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

    _____ has its own blood supply

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

    Which of the following is not a cause of laryngitis?

    <p>Glandular blockage</p> Signup and view all the answers

    Match the perceptual rating form to the individual that will fill it out.

    <p>VHI = Client SVHI and EASE = Client CAPE-V = Clincian GRAVIS = Clincian</p> Signup and view all the answers

    Which of the following perceptual tools is the most scientifically valid and is completed by the patient?

    <p>Voice handicap index</p> Signup and view all the answers

    It's important to ask patients if they're taking ____________, ___________, and/or _________________ because they can have interactions or side-effects that may impact the voice. Allergic reactions are also possible.

    <p>herbal supplements, dietary supplements, vitamins</p> Signup and view all the answers

    If you have a patient taking several herbal supplements and you are worried about potential side effects or interactions, who should you consult?

    <p>Licensed medical professional with a specialization in herbal remedies</p> Signup and view all the answers

    What elevates the hyoid bone?

    <p>Digastric muscle</p> Signup and view all the answers

    What depresses the hyoid?

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

    What elevates the ribcage?

    <p>External intercostal muscles</p> Signup and view all the answers

    _______ when one lung ruptures.

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

    Inspiration is always active, while expiration can be passive or active

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

    Match the term to its description

    <h1>Ventilation: = bringing oxygen Circulation: = transportation</h1> <p>=</p> Signup and view all the answers

    Elastic recoil is an active force in respiration

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

    Even with training, screaming is never healthy.

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

    Match the type of treatment to its description

    <p>LSVT = Increase loudness by increasing effort and coordination during speech production – Relies on memory, learning and reliance on self– cuing and self--regulating LMRVT = for the patient to use the least amount of respiratory effort and impact stress on the vocal folds CVR = elimination of all vocal fold contact – Does not aid in the process to reprogram the patient’s behaviors – It is useful for the healing process, however studies suggest wound healing relies on vocal activity MVR: = elimination of excessive voice use, using the voice only when absolutely necessary and in a therapeutic manner</p> Signup and view all the answers

    Match the disorder with its appropriate surgical treatment.

    <p>Laryngopharyngeal Reflux Granulomas Management = Fundoplication Laryngeal papilloma = Microsurgical ablation; Microdebrider resection Laryngomalacia: = Aryepiglottic fold incision; CO2 laser supraglottoplasty Excise nodular or small polypoid lesions causing dsyphonia = Microlaryngoscopy</p> Signup and view all the answers

    Match the disorder with the appropriate surgical treatment.

    <p>Papillomata and bulky laryngeal tumors = Laryngeal Microdebrider Dissection Cysts, larger polyps or more diffuse polypoid degeneration = Microflap Dissection Larger vascular lesions = Laser Laryngoscopy Paralyzed vocal folds = Metallization thyroplasty</p> Signup and view all the answers

    Which of the following is not a medication used to treat laryngopharyngeal reflux?

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

    The upper esophageal sphincter is impacted in gastroesophageal reflux.

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

    What is the difference between spasmodic dysphonia and essential tremor

    <p>Essential tremor is present only at rest and the tremor associated with spasmodic dysphonia only occurs on phonation</p> Signup and view all the answers

    Adolescent males who have seemingly maladjusted growth of the larynx – Maintenance of a high--pitched voice

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

    What is the purpose of an SLP using vocal function exercises in evaluation?

    <p>See motion and mobility of vocal folds and arytenoids to see the function of the voice and if it is healthy</p> Signup and view all the answers

    Who are vocal fucntion exercises suitable for?

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

    How can weak, breathy phonation be treated?

    <p>Augmenting one or both of the VF to get better glottic closure</p> Signup and view all the answers

    Match the type of spasmodic dysphonia to its description.

    <h1>Abductor Spasmodic Dysphonia (ABSD): = Move the vocal folds in an open position when they should be closing; weak and breathy Adductor Spasmodic Dysphonia (ADSD): = Move the vocal folds in a closed position when they otherwise should be open; strained</h1> <p>=</p> Signup and view all the answers

    Match the type of perceptual rating form to its description

    <p>GRBAS = uses a 4 point rating system where: – “0” indicates a normal voice quality – “1” indicates a mildly deviant voice quality – “2” indicates a moderately deviant voice quality – “3” indicates an extremely deviant voice quality CAPE-V = Clinician fills out ; 100 ml scale Voice Handicap Scales and Quality of Life Scales = A tool that defines these impacts on a patient and/or their family needs to also help the clinician understand the broader influence of the disorder(s)/disease(s) beyond the immediate impairment Voice Handicap Index (VHI) = measures how a voice problem influences a patient's quality of life and includes a:</p> Signup and view all the answers

    Match the perceptual measure to its description.

    <h1>VoiSS = 43-item questionnaire that gathers data from patients about their voice severity Voice Related Quality of Life Scale (VRQOL) = A 10 item, patient--derived information gathering tool which is valid for its use with adult patients with voice disorders to measure both social--emotional and physical--functional aspects of voice problems Pediatric Voice Related Quality of Life Scale = 10--item instrument, adapted from the adult VRQOL instrument</h1> Signup and view all the answers

    LSVT is used for hypofunctional voice disorders.

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

    Lassac Madison voice therapy (LMRVT) is used for hypofunctional voice disorders

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

    Tasks like coughing and sneezing as well as certain speaking events can cause the abdominal wall to __________. This ________ the intra-abdominal pressure.

    <p>contract, raises</p> Signup and view all the answers

    A behavioral therapy technique important for many patients includes changing a hard glottal attack for an easier, more relaxed start to phonation.

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

    All types of acid-preventing gastrointestinal drugs are free of any harmful side effects.

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

    One advantage of digital laryngostroboscopy is __________

    <p>the ability to compare images before and after treatment to one another.</p> Signup and view all the answers

    A perceptual voice rating scale (GRBAS or CAPE-V) can be used alone for the determining of the type of voice disorder that is present?

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

    High-speed videoendoscopy captures vocal fold vibration in real time because the rate of frames per second is so quick.

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

    In the case of many neurogenic voice disorders, surgery is the best treatment option available.

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

    In ________________ the vocal folds are moving abnormally at rest, and in _______________ the vocal folds are not moving at rest. This is one of the ways we're able to tell them apart.

    <p>essential voice tremor, ADSD</p> Signup and view all the answers

    Why does a singer's assessment use both the rigid and flexible scope for imaging?

    <p>the rigid has a better picture, the flexible allows more types of phonation</p> Signup and view all the answers

    Which of the following symptomatic voice therapy techniques are appropriate for hyperfunctional voice disorders?

    <p>Confidential voice</p> Signup and view all the answers

    Which of the following is more likely to cause a globus sensation?

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

    These vocal qualities are the most common associated with vocal nodules. Check all that apply

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

    Vocal fold nodules occur in the _________ layer of the vocal folds.

    <p>superficial lamina propria</p> Signup and view all the answers

    What is the most common of the vocal pathologies?

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

    How long are surgical interventions postponed in the case of suspected trauma to the RLN?

    <p>6-9 months</p> Signup and view all the answers

    The removal of the _____________ helps symptoms for more than 70% of patients with myasthenia gravis.

    <p>Thymus gland</p> Signup and view all the answers

    What condition is ADSD often confused with?

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

    The removal of the arytenoid cartilage is called a:

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

    Surgeons are focused on which priorities during excision of things causing dysphonia?

    <p>anything that interferes with vocal edge contact and the mucosal wave</p> Signup and view all the answers

    It was OK that patient A (polyp) did not attend post-operative therapy (not the one visit post-op) with an SLP because the pathology is not likely to recur.

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

    Case study: Female, age 24, first grade teacher, reports a breathy voice, loss of vocal range and reduced endurance. She reports her voice is "horrible" by Thursday afternoon. She is single, lives alones, and typically limits her social life except on weekends. What is the most likely diagnosis?

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

    When the diaphragm relaxes during inspiration it moves downward and flattens, enlarging the chest cavity.

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

    Case study: A boy, 15 years, complains of high pitch, breathy vocal quality, and reduced vocal loudness. What disorder does he present with?

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

    The diaphragm is a major muscle of inspiration

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

    Which of the following are infrahyoid muscles?

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

    The act of inspiration is always active

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

    For vocal nodules, phonosurgery is often necessary.

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

    Vocal cysts have their own blood supply.

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

    Typical symptoms for individuals that present with vocal polyp:

    <p>Effortless phonation Globus sensation Breathiness Loss of vocal endurance Hoarseness</p> Signup and view all the answers

    Gastroesophageal reflux is associated with intubation trauma and granuloma formation.

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

    Laryngopharyngeal reflux (LPR) is often referred to as silent reflux.

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

    Match the type of reflux to its description

    <p>Laryngopharyngeal reflux (LPR) = is the result of retrograde flow of gastric contents to the laryngopharynx, where it comes in contact with tissues of the upper aerodigestive tract. Gastroesophageal reflux disease (GERD) = is caused by the backflow of gastric contents into the upper digestive tract. Laryngopharyngeal reflux (LPR) = Upper esophageal sphincter Gastroesophageal reflux disease (GERD) = Lower esophageal sphincter</p> Signup and view all the answers

    Which of the following is a treatment approach for GERD?

    <p>Pharmacological drugs that may suppress laryngeal C-fiber hypersensitivity</p> Signup and view all the answers

    How does LPR differ from GERD?

    <p>LPR differs from GERD in that it is often not associated with heartburn and regurgitation symptoms.</p> Signup and view all the answers

    Study Notes

    Esophageal Speech

    • Produced by transporting approximately 45 mL of air from the oral and pharyngeal cavities into the esophagus.
    • Air is redirected past the pharyngoesophageal (PE) segment to vibrate tissue and create sound.
    • Rapid air transport can lead to the production of intelligible speech, which is articulated with the tongue, lips, teeth, and palate.

    Primary Techniques for Esophageal Speech

    • Injection Technique:
      • Involves forcing air back into the pharynx and esophagus using two methods:
        • Consonant Press Injection: Utilizes natural air pressure from plosive and fricative sounds to inject air.
        • Glossopharyngeal Press: Seals lips and tongue to create increased intraoral pressure directing air to the PE segment.
    • Inhalation Technique:
      • Engages rapid thoracic cavity expansion to draw air into the esophagus.
      • Patient breathes deeply through a stoma, creating a vacuum effect as the diaphragm moves downward.

    Tracheoesophageal Puncture (TEP)

    • A surgical procedure creating a small puncture through the posterior tracheal wall into the esophagus.
    • Can be performed during laryngectomy surgery (primary TEP) or later (secondary TEP) after adequate healing.
    • Involves inserting a one-way valve into the puncture to prevent closure and aspiration of contents into the trachea.

    Procedure Details

    • The puncture allows pulmonary air to flow into the esophagus, driving the vibration needed for TE speech.
    • Involves careful surgical creation of the puncture and valve placement.

    TEP Prosthetic Devices

    • Non-Indwelling Devices:
      • Duckbill Style: Original prosthesis with a slit-type valve.
      • Low Pressure/Low Resistance: A hinged valve that requires less respiratory effort for sound production compared to duckbill style.
    • Indwelling Prosthesis:
      • Refers to long-term wear prosthesis inserted by a clinician, reducing maintenance needs.

    Key Points

    • Esophageal speech relies on airflow manipulation from the lungs or oral cavity into the esophagus.
    • Mastery of sound production techniques is critical for intelligible speech post-laryngectomy.
    • TEP is an effective surgical option enhancing voice restoration, supported by specialized prosthetic devices.

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    Description

    Test your knowledge about voice injuries and the importance of vocal rest. This quiz will help you identify which vocal conditions require complete rest for recovery. Understand the implications of different injuries on vocal health.

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