Voice Conditions PDF - SLPLE Review 2024

Clinical Conditions SLPLE Review 2024 TRACHEOESOPHAGEAL FISTULA (TEF) & VOICE CONDITIONS...

Clinical Conditions SLPLE Review 2024 TRACHEOESOPHAGEAL FISTULA (TEF) & VOICE CONDITIONS ESOPHAGEAL ATRESIA (EA) ABNORMAL VOICE QUALITY TEF: Opening that occurs between the esophagus and the trachea 1. Breathy Atresia: Abnormal occlusion of the esophagus ➔ Incomplete glottal closure → turbulent Problems in: airflow ○ Gastric Distension 2. Rough ○ Aspiration ➔ Aperiodic vocal fold vibration → irregular ○ Reduced diaphragmatic capabilities mucosal wave AVQs? VF vibration should symmetric ○ Decrease in loudness 3. Strained ○ Shorter utterances ➔ Considerable medial compression of true Due to reduced respiratory support vocal folds (TVF) Compressed too much 4. Harsh ➔ Strained + Rough 5. Hoarse ➔ Strained + Rough + Breathy ORGANIC VOICE DISORDERS 1. Structural Deviations 2. Additive Growth 3. Loss of Structure GRANULOMAS (CONTACT ULCER) There are some functional voice d/o that will have structural deviations and additive growth—but this is not their origin. To differentiate the two, determine the origin/etiology! SUBGLOTTIC STENOSIS Small ulcerations that develop in the vocal process of the Arytenoids Multifactorial causes ○ Hard glottal attacks ○ Throat clearing Narrowing of subglottic space ○ Laryngopharyngeal Reflux (LPR) 1. Congenital ○ Intubation Problems in embryological Symptoms: development ○ Voice deterioration post vocal fatigue 2. Acquired ○ Laryngeal pain As a response to intubation AVQs? Caused by trauma from ○ Breathy intubation ○ Roughness Abnormal Voice Quality (AVQ)? ○ Stridor (inhalation with sound) ○ Shorter utterances Due to limited respiratory support Clinical Conditions SLPLE Review 2024 CYSTS REFLUX LARYNGITIS Among the three: polyp, nodules, and cysts, this is the Laryngitis - inflammation of VF only d/o considered as organic due to blockage of duct. Focal lesions on the SLP Gastroesophageal Reflux (GERD) ○ Cysts may be intracordal ○ Passage of gastric juices to the Often unilateral esophagus Due to blockage of duct Laryngopharyngeal Reflux (LPR) Soft & pliable ○ Once GERD moves superiorly or into the Fluid filled pharyngeal area AVQs The stomach acid causes the inflammation ○ + Increased Glottal Attack AVQs? ○ Roughness ○ Roughness ○ Breathiness ○ Breathiness Symptoms: INFECTIOUS LARYNGITIS ○ Morning hoarseness ○ Heartburn ○ Sleeping troubles ○ Sour mouth taste ○ Glotal redness ○ Contact irritations Inflammation of the larynx d/t virus or bacteria, SULCUS VOCALIS d/t: ○ Upper Respiratory Tract Infection (URTI) post-traumatic laryngitis ○ RARE event d/t colds, sore throat, cough, etc AVQs? ○ Roughness + Strained (from traumatic A furrow or indentation along the vocal folds laryngitis) = Harsh Etiology: 1. Acquired (Abuse, LPR) PAPILLOMAS 2. Congenital 3. Unknown (Idiopathic) AVQs? ○ Strained ○ Little pitch change (monopitch) ○ Low intensity Wart-like growths that are viral in origin Human papillomavirus infection (HPV) ○ Most common cause of pediatric hoarseness ○ Posts a threat to the airway ○ Red flags: shortness of breath, hoarseness Clinical Conditions SLPLE Review 2024 PRESBYLARYNX Lingual and oral cancers rarely cause direct voice Presby – age related concerns Laryngeal (location of mass) a. Supraglottal b. Glottal c. Subglottal Risk Factors (RFs): ○ Smoking ○ Infections Age related atrophy of the VF ○ Herpes Symptoms ○ Trauma AVQs? ○ Weak voice ○ Restricted pitch range NEUROGENIC VOICE DISORDERS *Damage from the nervous system ○ Decreased stamina Shorter utterance length BILATERAL VOCAL FOLD PARALYSIS/PARESIS Paresis – partial loss of movement; Paralysis – total loss LARYNGEAL WEBBING 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) A web grows across the glottis inhibiting normal Strained VF vibration ○ *Both types have life threatening issues Congenital Adductor – high chance of aspiration and ○ Stridor penetration ○ Breath shortness Abductor – cannot breathe ○ Squealing Treatment: Acquired ○ Surgical reinnervation of the muscles ○ Bilateral trauma ○ Laser surgery ○ Irritants AVQs? UNILATERAL VFP ○ High pitched sound ○ Roughness Whenever there’s mass along the VF ○ Stridor d/t narrowing space LARYNGEAL CANCER Disease or trauma to the RLN/Vagus due to trauma or surgical injury ○ The paralyzed fold is stuck in a paramedian position Clinical Conditions SLPLE Review 2024 Treatment: Voice Therapy “Occurence of dysfunction in the absence of 4 Etiological Categories abnormal laryngeal structural problems and ○ Neoplastic (RLN/Vagus Compression) psychogenic or neurogenic etiology” (Morrison, ○ Traumatic (surgical/non surgical) et. al., 1983) ○ Idiopathic *Differential diagnosis from ADSD, Tremors w/out any issue with the RLN/Vagus These and EMT’s AVQs have similarities but ○ d/t Medical Disease these two are neurogenic and psychogenic in Voice Characteristics nature. ○ Markedly dysphonic Causes: ○ Breathy ○ Deviant posture ○ Hoarse ○ Misuse of shoulder and neck muscles Excessive muscle strain on the neck d/t ○ Stress compensation → hoarseness ○ Vocal abuse ○ Decreased Loudness ○ Vocal misuse ○ - Phonation Time VOCAL ABUSE VS VOCAL MISUSE SPASMODIC DYSPHONIA Vocal Abuse – deleterious behaviors and events Rare voice disorder characterized by a You should not be doing! Done excessively strain-strangled, harsh voice ○ Yelling Can also be a psychogenic condition and be ○ Excessive talking/singing heterogeneous (Hirano & Bless, 1993) ○ Excessive Coughing/Throat Clear It can occur in the absence of any neurogenic ○ Smoking lesions or it can be neurogenic and psychogenic ○ Grunting ○ Occurence of voice problem only during ○ Excessive crying/laughing communicative purposes (Aronson, Vocal Misuse – improper use of voice 1990) Mali lang paggamit, anything na sobra Psychogenic ○ Speaking with a hard glottal attack Dystonia: (HGA) ○ Neurological dysfunction of motor ○ Singing/speaking outside oneʼs pitch movements, a hyperkinetic disorder range Hyperkinetic position ○ Speaking with an excessive intensity 2 Types: level ○ Adductor (ADSD) - Tight laryngeal adduction (most common) VENTRICULAR DYSPHONIA ○ Aductor (ABSD) - Normal voicing May be produced by the vibration of the interrupted by sudden abduction ventricular folds, but not strictly Ventricular folds/false VF should not be adducting FUNCTIONAL VOICE DISORDERS Usually of a lower pitch than the typical voice *Improper use of voice using the TVF 2 BROAD CAUSES: May be used as a substitute voice for patients 1. Excessive Muscle Tension with severe TVF disease (cancer, papilloma, etc.) 2. Psychogenic Compensatory (VF incapable of normal vibration) EXCESSIVE MUSCLE TENSION (EMT) ○ Reaction to TVF Disease MUSCLE TENSION DYSPHONIA Noncompensatory (VF capable of normal Persistent dysphonia resulting from excessive vibration) laryngeal musculoskeletal tension ○ Habitual (excessive vocal use) Persistent, not acute, chronic in nature ○ Psycho-emotional (psychogenic tension) Hyperfunctional behaviors for TVF and FVF ○ Idiopathic Clinical Conditions SLPLE Review 2024 BENIGN PATHOLOGIES FROM EMT TRAUMATIC LARYNGITIS NODULES Benign, focal lesions on the SLP VF swelling Often bilateral d/t Excessive strain, or phonotrauma Usually in the anterior half of the VF Acute Continuous VF irritation ○ VF increase in mass and size Hyperfunction ○ d/t actual trauma Nodules = hard Chronic Can present in the “hourglass” configuration ○ d/t trying to “speak above” the acute laryngitis → compounding of the POLYPS problem Tinuloy pa rin yung hyperfunctional behaviors (i.e., breathy, strained, roughness) VOICE CHARACTERISTICS WITH EMT DIPLOPHONIA Lesion on the SLP Two distinct frequencies occurring Deeper than nodules simultaneously That’s why it’s not hard There’s almost always a second site of vibration. Usually unilateral and gelatinous Aside from TVF, it can be FVF or other masses Precipitated by a SINGLE vocal event (e.g. and lesions (i.e., nodes, polyps) screaming) Usually due to mass, lesions, VF paralysis, scarring, etc. REINKE’S EDEMA Proper assessment of etiology is crucial in effective intervention BREAKS Phonation Break ○ Temporary loss of voice for a word, whole word or sentence Pitch Break Chronic, diffuse swelling of the Lamina Propria “Piyok” Thick, gelatinous, fluid like material in the ○ Sudden interruption in phonation in an Reinke’s space otherwise normal laryngeal structure d/t smoking, vocal hyperfunction, LPR ○ 2 types of pitch breaks AVQs (same with polyps and nodules) Normal pitch breaks occurring in ○ Breathy boys experiencing puberty ○ Strained Prolonged hyperfunction ○ Rough speaking in an inappropriately ○ Harsh low pitch ○ Hoarse Clinical Conditions SLPLE Review 2024 PSYCHOGENIC DISORDER 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 same rhythm and prosody as normal speech Closely tied with psychological experiences “Unintentional” Onset can widely vary, depending on the reason (contextual factors) *Differential diagnosis from organic causes must be done Rule out all organic causes