Functional Voice disorders

Question 1

Describe vocal fatigue and its treatment

Answer 1

• deteriorating voice quality, endurance, pitch and loudness range, inefficient respiratory support
• VFs appear normal at rest but there is decreased amplitude, phase asymmetry and possible anterior gap
• Tx: physiological voice therapy and endurance exercises

Question 2

Describe vocal abuse and misuse and its treatment

Answer 2

• Involves prolonged maladaptive behaviours: extremely loud and aggressive phonation, hard voice onset, bad shouting or singing technique, aggressive laryngeal vegetative maneuvers
• Tx: voice therapy, if necessary phono surgery to address lesions

Question 3

Describe ventricular phonation and its Tx

Answer 3

• excessive supralaryngeal tension causes an approximation and vibration of the ventricular fold
• may be caused by physical or emotional trauma (psychogenic dysphonia)
  -can also be a compensatory phonation
  Tx: voice therapy, vocal re-education

Question 4

Describe muscle tension dysphonia and its Tx

Answer 4

• voice disorder accompanied by observable tension of the neck, shoulders, jaw and throat. Often related to psychosocial stress
• Tx: voice therapy and relaxation

Question 5

Describe generalized tension phonation

Answer 5

all laryngeal muscles are flexed during phonation, including abductory muscles. Activity of PCAs leads to a posterior gap. Can lead to nodules, Reinke’s edema or chronic inflammation.

Question 6

Describe lateral hyperadduction

Answer 6

FVFs are crowding the VFs but not vibrating

Question 7

Describe antero-posterior hyperadduction

Answer 7

squeeing of larynx in anterior-posterior plane

Question 8

Describe hyper adduction of ventricular folds

Answer 8

FVFs are vibrating with the true vocal folds?

Question 9

Describe puberphonia and its Tx

Answer 9

• habitual voice that is similar to prepuberty voice (never had voice drop)
• Due to habitual CT hyper function, intensity and pitch range may be limited
• Tx: voice therapy

Question 10

What is puberphonia called in males

Answer 10

Post-mutational falsetto

Question 11

What is puberphonia called in females?

Answer 11

Juvenile voice

Question 12

Describe psychogenic conversion dysphonia/aphonia and its Tx

Answer 12

• severe aphonia or dysphonia despite intact vocal anatomy and physiology.
• Sudden onset, often related to a cold with a sore throat
• Patient gets secondary gains from voice disorder
• Tx: psychotherapy and voice therapy

Question 13

Describe idiopathic paradoxical vocal fold motion and its treatment

Answer 13

• inappropriate VF adduction during inspiration leading to respiratory distress
• Associated with esophageal reflect, anxiety or panic disorders and ticks
• Tx: behavioural, respiratory training, if necessary anti-reflux meds and psychotherapy

Question 14

Describe congenital subglottic stenosis and its Tx

Answer 14

• narrowing of the trachea below the level of the glottis. Caused by malformation of the cricoid or conus elasticus during embryonic development
• Airway obstruction with inhalatory stridor, even early after birth
• Tx: if necessary, surgical removal

Question 15

Describe congenital laryngomalacia and its Tx

Answer 15

• developmental delay of epiglottis cartilage, so it stays soft and pliable and causes stridor during inspiration and expiration.
• Tx: no treatment required, as the cartilage will eventually mature by the third year. But posture adjustments (e.g. sleeping on stomach) usually help the keep the baby’s airway open

Question 16

Describe laryngeal cleft and its Tx

Answer 16

-rare congenital disorder that results in tracheoesophageal communication.
•Cleft in the posterior cricoid
-Divided into severity types I-IV. Shallow clefts may not require treatment or can be treated with injections. Deeper clefts require surgical repair.