What is culture?
A set of customs, beliefs or practises of a group
What is identity?
A set of physical, psychological, and interpersonal characteristics that is not wholly shared by another person
What is intersectionality?
A framework for understanding how a number of identity markers can interact and compound as multiple forms of oppression in people, groups, or social problems
Identify markers:
- Race
- Class
- Gender
- Ethnicity
- Sexuality
- Religion
- Disability
People can have multiple identity markers that can effect inequities; for example, Māori with disabilities had poorer health outcomes than Māori without disabilities
What are three main pathways of health inequities?
- Differential access to the determinants of health
- education
- employment
- housing
- income - Differential access to healthcare
- cost
- geographical - Differences in quality of healthcare recieved
What is implicit bias?
A form of bias that occurs automatically and unintentionally that affects judgments, decisions, and behaviours
How can you retrain implicit bias?
- Individuate: see people as individuals rather than stereotypical members of their ethnic or social groups
- Try to see things from the perspective of the person who is being stereotyped
- Mix with members of other groups
- Expose yourself to media that aims to breakdown prejudices and discrimination
- Treat people as individuals but also as part of the whānau
What is phonotrauma?
- Behaviours thought to contribute or cause voice problems
-Behaviours that impair the phonatory mechanism’s capacity to work effectively and efficiently
- More intense = more likely to cause issues
What are some characteristics of vocal behaviours categorized as misuse?
- Increased tension or strain
- Hard glottal attack
- High laryngeal position
- Anteriorposterior laryngeal squeezing - Inappropriate pitch level
- Puberphonia
- Persistant glottal fry
- Lack of pitch variability - Excessive talking
- Ventricular phonation
- Aphonia and dysphonia of psychological origin
What is a glottal attack?
Rapid and complete adduction of VFs before initiation of phonation
What is the effect of laryngeal height?
Higher laryngeal position can happen in conjunction with raising pitch
- Shortening of vocal tract
- Tensing of VFs
- Tight adduction
Consistently high or low position suggests excessive energy to maintain that position
Anterior posterior laryngeal squeezing effects
Squeezing of the larynx
- Arytenoid to epiglottis
Elevating pitch and high front vowels typically separate these laryngeal structures
- tight laryngeal posture with anteroposterior shortening maintain this position during these activities
- May exhibit reduced phonational range/inability to raise pitch
What is puberphonia?
High pitched voice beyond age of expected change
Predominantly a problem for males
Must first rule out presence of endochrinological factors
-Pituitary gland or adrenal gland hypofunction
- Sex hormomes
What is vocal fry?
- Using lowest vocal register (20-70Hz)
- Tightly adducted vocal folds with increased thyroarytenoid tension
- Short, thick vocal folds
- Reduced rate of airflow and subglottic air pressure
- Multiple openings of the vocal folds, followed by a lengthened closed phase
What is lack of pitch variability?
percieved as lacking energy or interest
What is ventricular phonation?
- Excessive movement of the false Vfs towards midline during phonation
- Low in pitch, hoarse, diplophonic, rattly, reduced intensity
Can occur to:
- psychogenic dysphonia
- Compensation for poor VF closure
- Component of hyperfunctio
- Unexplained phenomenon
What are adaptive dysphonias?
- Vocal behaviours that reflect a patient’s attempt to deal with provocation or stressors (psychological or physiological)
What are some vocally traumatic behaviours?
- Excessive prolonged loudness
- Strained excessive use during period of swelling, inflammation, or other tissue changes
- Excessive coughing or throat clearing
- The screamer or noise maker
- Sports and exercise enthusiast
What are nodules?
- A reaction of VF tissure to stress induced by frequent hard oppositional movement of the VFs
- Starts as localised VF edema, the soft, red, pliable small nodules. Older nodules are typically white, hard, thick and fibrosed.
- Usually bilateral
- Often mistaken for polyps and vice versa (polyps often bigger and more red)
- Signs/symptoms: sensation of something to clear in throat, hoarseness, reduced phonational and dynamic range. Increased s/z ratio
- Physiologic signs: absence of muscosal wave at nodule site; hourglass closure
- Pathophysiology: affects mass and possibly stiffness of VFs. Glottal closure may result in air escape/breathiness
What is a polyps?
- Inflammatory benign tumour in Reinke’s space
- Usually unilateral
- Pedunculated vs sessile
- Do not respond to therapy - require surgery
- Signs/symptoms: sensation of something to clear in throat, hoarseness. Greater severity of dysphonia than nodules
- Physiologic: absence of muscosal wave at site; irregular closure pattern; movement of poly[
- Pathophysiology: affects mass and likely decreases stiffness due to soft and pilable broad area. Glottal closure may result in air escape/breathiness
What is a intracordal cyst?
- Blockage of glandular duct and retention of mucous
- Often unilateral
Different types:
- retention
- epidermal
- pseudocysts
- Symptoms
- lowered pitch, hoarseness, decreased phonational range
What is edema?
-Build up of fluid: occurs primarily in the superficial layer of the VFs
- When it occurs in the first layer of the lamina propria, it’s called Reinke’s edema
- Reinke’s edema associated with smoking
Signs:
- lowered pitch, hoarseness, sometimes shortness of breath
What is laryngitis?
- Inflammation of larynx and vocal folds
- Inflammatory conditions referred to laryngitis:
- Reflux laryngitis
- Acute laryngitis
- Non-infectious laryngitis
- Chronic abuse —> chronic laryngitis —> persistent inflammation and drying and thickening of VFs
- Can lead to tissue damage such as nodule/polyps
-Signs:
- hoarseness and dryness, difficulty achieving a loud voice, increased jitter and shimmer, reduced phonational range
- Physiologic: redness, inflamed folds in acute laryngitis, thick and dry epithelium
- Pathophysiology: increased stiffness but no chnages in mass of folds
-
What is sulcus vocalis?
- Furrow along upper medial edge of VFs
- Uncertain cause (congenital, developmental, traumatic)
- Signs: hoarseness, breathiness, reduced phonational range
-Physiological: depression or line on upper edge of the fold, unilateral or bilateral. Reduced mucosal wave
Pathophysiology: decreases mass and increases stiffness
