Term
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Definition
a voice problem that does not result from an organic or structural pathology
Etiology: due to laryngeal and supralaryngeal shut down or psychological issues
Symptoms: harsh or breathy voice
Treatment: psychological support and search for the best voice they can produce |
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Term
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Definition
MTD occurs when the voice is affected by excessive muscle tension
Description: there are 3 subtypes and a nonadducted MTD
Treatment: voice therapy using yawn-sigh, tongue protrusion /i/, aspirate phonation onset, inhalation, phonation, and glottal fry; manual palpation |
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Term
| Thickening of the Vocal Fold |
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Definition
an enlargement of the vibrating part of the VF’s
Etiology: mainly caused by continuous vocal abuse and misuse
Treatment: voice therapy programs; surgery is an option for extensive polypoid degeneration |
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Term
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Definition
an accumulation of fluid (edema) under the VF cover in the Reinke’s space
Polypoid degeneration vs. Reinke’s edema
Etiology: usually developed bilaterally in smokers of middle age and older
Treatment: voice therapy |
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Term
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Definition
the false (ventricular) vocal folds adduct together over the true vocal folds (may also display a diplophonia)
Etiology:
a. Substitute voice
b. Compensatory voice Post-surgicalscarring Habituated (flu)
Symptoms: low pitched, little pitch variability, breathy, and hoarse
Diagnosis: Laryngoscopic examination, frontal tomographic x-ray, nasoendoscopy or endoscopic stroboscopy is needed
Treatment: inhalation phonation or pitch elevation of aspirate voice onset |
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Term
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Definition
temporary, but complete cessation of phonation
Etiology: prolonged vocal hyperfunction, excessive laryngeal muscle tension and inappropriate adjustments of an otherwise normal voice mechanism
Symptoms: situational in occurrence. Patients experience vocal fatigue, effortful speech, and the breaks are usually temporarily restored by coughing, clearing the throat or taking a drink until the next episode
Treatment: elimination of the inappropriate vocal behaviors and reduce vocal hyperfunction (tongue protrusion /i/, chant talk, nasal glide stimulation, & warble) |
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Term
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Definition
unexpected and uncontrolled sudden shifts of pitch when speaking at an inappropriate pitch level. The break goes in either an upward or downward direction by an octave or two
Etiology
a. Developmental: boys experiencing marked pubertal growth in the size of their vocal folds and other laryngeal structures
b. Prolonged vocal hyperfunction: overall vocal fatigue, vocal hyperfunction, speaking at a pitch level inappropriate for the mass and size of the their individual vocal folds for a prolonged period of time (actors)
Symptoms: sudden unwanted shifts in vocal frequency, increased pitch, restricted phonation range, and reduced maximal phonation time
Treatment: temporary voice rest, and techniques of easy phonation (glottal fry or yawn-sigh) |
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Term
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Definition
Organic-groove or infolding of mucosa along the edge of a vocal fold(s)
Etiology: congenital or acquired of unknown etiology (vocal abuse & laryngopharyngeal reflux may contribute)
Symptoms: low in loudness, breathy & hoarse
a. Long, oval-shaped glottal opening during adduction or a line running longitudinally, parallel to the glottis, down one or both vocal folds (usually bilateral)
b. Reduced phonation time, incomplete glottal closure, and mucosal wave may be interrupted
Treatment: pitch shifts, loudness changes, lateral digital pressure, experimentation with firmer glottal closure, Teflon injections, and autologous intracordal transplantation of fat and fascia |
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Term
| Cancer/Carcinoma of the Vocal Tract |
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Definition
a disease that can affect the structures of the oral cavity, pharynx, and larynx
-laryngeal cancers (usually squamous cell carcinomas) are the most serious (6% of all malignancies in the US)
- The lesion begins unilateral, but can extend to the other fold
- three classifications: supraglottal (above the glottis), glottal, and subglottal (below the glottis)
Etiology: smoking (especially pipe smoking), smokeless tobacco, chronic infections, herpes, repeated trauma to the irritated site, and leukoplakia
Symptoms: chronic and painful oral lesions that do not seem to heal, hoarseness, a lump in neck, broadening of larynx, tenderness in the neck
Treatment: microsurgery and radiation therapy, hemilaryngectomy, supraglottal laryngectomy, or a total laryngectomy |
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Term
| Laryngomalacia “soft larynx” |
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Definition
failure of cartilage of the upper larynx to stiffen with development. As a result, the epiglottis is too pliable, and collapses into the airway during inhalation.
Prevalence: 75% of all congenital abnormalities of the larynx and the most prevalent cause of stridor. Usually, outgrown by 18 months to two years of age, but may may also develop breathing difficulties.
Treatment: diagnosed and treated by a otolaryngologist |
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Term
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Definition
a narrowing of the subglottic space
Etiology:
-congenital: interruption of the cricoid cartilage or arrested development of the conus elasticus during embryonic development
-acquired: may occur after oral intubation (because of life-saving procedures or surgery). Prolonged intubation may cause scarring, resulting in hypertrophy and stenosis
Treatment: possible tracheostomy and post-op voice therapy to establish normal phonation |
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Term
| Tracheoesophageal Fistula (TEF) |
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Definition
openings that occur between the esophagus and trachea
Symptoms: excessive salivation, choking, coughing, and turning a blue color when being fed
Treatment: surgery (resection of the fistula), followed by voice and feeding therapy |
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Term
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Definition
abnormal occlusion of the esophagus, which ends in a pouch, rather than connecting normally to the stomach
Symptoms: excessive salivation, choking, coughing and sneezing
Treatment: surgery is needed to sew the esophagus together |
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Term
| Hypofunction of the pituitary gland |
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Definition
laryngeal growth is retarded
Symptoms: high voice pitch
Other possible manifestations: prevents normal development of progesterone in the ovaries and testosterone in the testes
Treatment: endocrine therapy |
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Term
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Definition
caused by insufficient secretion of thyroxin by the thyroid gland
Description: hypothyroidism increases the mass of the vocal folds
Symptoms: low pitch, hoarse voice
Treatment: thyroid hormone therapy |
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Term
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Definition
caused by overactive production of thyroxin by the thyroid gland.
Symptoms: breathiness of voice and insufficient loudness of voice
Treatment: hormonal therapy |
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Term
| Premenstrual Vocal Syndrome |
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Definition
caused by reduced level of estrogen during premenstrual period
Description: syndrome begins about 4-5 days before menstruation. Vocal folds thicken and are dryer than normal.
Prevalence: occurs in 33% of women
Symptoms: vocal fatigue, reduced pitch range, hypophonia and loss of certain harmonics.
Treatment: vocal rest and drinking lots of water. |
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Term
| Vocal changes during Menopause |
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Definition
caused by excessive secretion of androgenic hormones after menopause
Description: glottal membranes become thicker; size and mass of the vocal folds increase
Symptoms: lower pitched voice and vocal roughness
Treatment: hormonal therapy and voice therapy |
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Term
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Definition
lesions/bruises in the vocal folds that cause an inflammation or a firm granulated sac filled with capillaries that can bleed.
Etiology: there are three causes of Granuloma in the vocal folds
1) Intubation during surgery
2) Glottal trauma from abuse or misuse
3) Laryngeal Reflux Disease
Symptoms: severe dysphonia, characterized by hoarseness, breathiness and the feeling of having to clear the throat often.
Treatment: surgical removal of the granuloma and/or voice therapy. Also, elimination of vocal abuses, increased hydration and reduced reflux. Facilitating approaches have been shown to work in eliminating the granuloma. |
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Term
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Definition
similar to granulomas but a different type of lesion; it is a soft, pliable, blood filled sac. Occur on the posterior glottis.
Etiology: caused by vocal hyperfunction, hyperacidity or intubation.
Symptoms: breathing difficulties, hoarseness
Treatment: surgical removal of hemangioma by laser. |
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Term
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Definition
a pinkish, rough lesion in oral/pharyngeal cavities. Once the biopsy is done on the lesions, it can be found to be malignant or benign. Usually, they are found under the tongue, or on the vocal folds at the anterior commisure, or posteriorly on the arytenoids prominences.
Etiology: caused by chronic irritation of the oral and laryngeal membranes over time, for example, due to excessive smoking.
Treatment: eliminating the source of tissue irritation by possible surgery and voice therapy is also done to improve voice quality. |
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Term
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Definition
some people who have had traumatic laryngitis also experience infectious laryngitis when they have an upper respiratory infection. There are 2 types:1) Viral
Etiology: often develops in patient who has had a fever, headache, runny nose, sore throat, and coughing. Caused by inhaling “respiratory droplets” that are released by people who have the laryngitis virus.
Symptoms: fever, cough, hoarseness, sore throat, dry throat. Also, breathing difficulties in young children.
Treatment: antibiotics usually do not work for viral laryngitis. Vocal rest, humidification, hydration, and reduced physical activity is recommended.
2) Bacterial
Etiology: caused by bacteria that is inhaled through the air from someone who has the bacteria because they are sick or recovering from upper respiratory infection.
Symptoms: high fever, very sore throat, cough, hoarseness. Also, inflammation may cause difficulty in breathing.
Treatment: antibiotics |
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Term
| GERD- Gastroesophageal Reflux Disease |
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Definition
there is a backflow of food/liquid content that has already entered the stomach, into the esophagus.
Etiology: caused by a malfunction of the lower esophageal sphincter.
Symptoms: heartburn, chest pain
Treatment: lifestyle/dietary changes |
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Term
| LPR- Laryngopharyngeal Reflux (LPR) |
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Definition
there is a backflow of food/liquid content that has already entered the stomach back into the esophagus and up into the pharynx/larynx.
Etiology: initially caused by a malfunction in the lower esophageal sphincter but primarily a malfunction of the upper esophageal sphincter.
Symptoms: throat irritation, hoarseness, dysphagia, cough, sensation of something in the throat, heartburn
Treatment: vocal hygiene program, dietary changes, anti-reflux therapy, Proton pump inhibitors (PPIs), or surgery to prevent reflux. |
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Term
| Speech areas in the brain |
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Definition
• The Insula, the 5th lobe, seems to play an active role in motor planning for voice and speech.
• The temporal lobe is where the primary auditory cortex resides.
• Speech comprehension is associated with Wernicke’s area.
• Speech production is associated with Broca’s area. |
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Term
| • The cranial nerves that we are concerned with in this class are those that impact voice: |
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Definition
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Term
| Cranial nerves ? impact speech, but are not tied to the primary production of voice. |
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Definition
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Term
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Definition
| • The Vagus divides into two important branches that innervate the larynx, the superior laryngeal nerve (SLN) and the recurrent laryngeal nerve (RLN). |
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Term
| Superior Laryngeal Nerve (SLN) |
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Definition
• The superior laryngeal nerve divides into two branches, internal and external.
• Internal- sensory innervation to the mucous membrane at the base of the tongue and to the mucous membrane of the supraglottal larynx.
• External- provides motor innervation to part of the lower pharyngeal constrictor and to the cricothyroid muscles. |
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Term
| SLN- innervates the Cricothyroid |
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Definition
• Paired intrinsic laryngeal muscles.
• Divided into two parts
pars recta
pars oblique
• Contraction increases the distance between the cricoid and thyroid cartilages, increasing the length of the vocal folds.
• This decreases the mass, which increases the vibratory frequency, creating a rise in pitch.
• Contributes to adduction |
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Term
| Recurrent Laryngeal Nerve |
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Definition
• The RLN branches off of the vagus well below the level of the larynx.
• The right RLN and the left RLN take different routes to the larynx.
• The right RLN courses under the subclavian artery to the larynx, the left RLN courses beneath the aorta back up to the larynx.
• The RLN is vital to the abduction and adduction of the larynx. |
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Term
| • The RLN innervates 5 intrinsic muscles of the larynx. |
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Definition
• Thyroarytenoid
• Posterior Cricoarytenoid
• Lateral Cricoarytenoid
• Transverse Arytenoids
• Oblique Arytenoids |
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Term
| RLN innervates the Thyroarytenoid |
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Definition
• Main mass of the vocal fold
• Medial portion is known as the vocalis muscle
• The larger portion is known as the thyromuscularies.
• When adducted, serves as the primary protective valve of the airway.
• Flaccid paralysis of this muscle resulting from RLN trauma will lead to vocal fold atrophy. |
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Term
| RLN Innervates Posterior Cricoarytenoid |
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Definition
• Paired PCA is the only abductor muscle of the vocal folds.
• When the muscle contracts, it rocks and slides the arytenoid on its cricoid mount, parting the arytenoids and abducting the vocal folds.
• The primary symptom of PCA paralysis is the inability to open the glottis on the affected side |
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Term
| RLN Innervates Lateral Cricoarytenoid |
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Definition
• Paired LCA is the primary adductor muscle of the vocal folds. When the LCA contracts, it slides the arytenoids together, which adducts the vocal folds.
• Opposite of PCA
• The primary symptom of LCA paralysis is fixed, abducted vocal folds in the paramedian position. |
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Term
| RLN innervates Transverse Arytenoids |
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Definition
• Only unpaired muscles of the intrinsic laryngeal muscles.
• When they contract, they slide the arytenoid cartilages together, contributing to vocal fold adduction. |
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Term
| RLN innervates Oblique Arytenoids |
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Definition
• Paired muscles, connect the base of one arytenoid cartilage to the apex of the opposite arytenoid.
• When they contract, they assist in bringing the arytenoids together, contributing to vocal fold adduction. |
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Term
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Definition
• Flaccid
• Unilateral upper motor neuron
• Spastic
• Ataxic
• Hypokinetic
• Hyperkinetic
• Mixed |
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Term
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Definition
caused by unilateral or bilateral damage to specific cranial nerves anywhere along their path.
• Damage to the PNS causes a flaccid paralysis leading to weakness, reduced force of muscle contraction, and reduced range of motion.
• Types of Flaccid Dysarthria include: Vocal Fold Paralysis, Myasthenia Gravis and Gullain-Barre. |
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Term
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Definition
• Caused by damage of cranial nerve X (Vagus) anywhere along its path.
• The type and extent of the paralysis depends on the lesion site and whether the damage is unilateral, bilateral, partial, or complete. |
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Term
| Cricothyroid Muscle Paralysis |
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Definition
• The SLN innervates the Cricothyroid Muscle, therefore paralysis of this muscle is a result of damage to the SLN.
• Viral infection appears to be the most common cause of the damage, thus it is temporary.
• Paralysis of the Cricothyroid can be of the left, right or both of the muscles. The affected vocal fold will be rotated slightly toward the normal side and there will be a slight bowing of the vocal fold.
• The patients voice symptoms would be inability to elevate or lower pitch and some breathiness. |
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Term
| Unilateral Vocal Fold Paralysis (UVFP |
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Definition
Most common etiology is damage to the RLN, especially to the left RLN. This is due to its path around the aortic where it is often damaged during heart surgery.
When the RLN is damaged on one side, the laryngeal adductory muscles are not able to perform their role, which leaves the paralyzed fold in the paramedian position at all times.
Some phonation is possible as the non paralyzed fold does adduct approximating with a small area of the paralyzed fold. |
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Term
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Definition
Voice intervention should be attempted before any permanent corrective procedures as many traumatic vocal fold paralyses have spontaneous recovery within the first 9 to 12 months.
The techniques normally used in voice therarpy are half-swallow boom, head positioning, tuck chin, digital manipulation, focus, tongue protrusion /i/, yawn-sigh, pitch shift up, and inhalation phonation. |
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Term
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Definition
Patients with MG with voice problems experience severe voice fatigue and problems in adequate breath support.
The normal voice changes to a breathy, weak, barely audible voice. Then with a few minutes of voice rest, the normal voice will be restored. Continued usage will result in the weak voice returning. |
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Term
| Flaccid Dysarthria-Gullain-Barre |
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Definition
Gullain-Barre is a disorder of unknown cause, but is frequently preceded by viral infection. It involves the focal demyelinization of spinal and cranial nerves.
The onset of the disease is often expressed in dysphonia and dysphagia.
Patients with GB often require a tracheostomy and ventilatory support. |
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Term
| Unilateral Upper Motor Neuron Dysarthria |
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Definition
Caused by unilateral lesion to the CNS involving both the pyramidal and extrapyramidal tracts
Observed in patients who have experienced a cerebrovascular accident (CVA) but it could be also be caused by another type of tumor or trauma
CVA aka Stroke (temporary impairment of blood flow to the brain) |
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Term
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Definition
Two or more strokes that result in bilateral cerebral lesions may produce severe voice symptoms due to lesions to the pyramidal and extrapyramidal tracts bilaterally
Voice may be strained and strangled, brief in phonation time, low in pitch, monopitch with variable loudness |
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Term
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Definition
Associated with depletion of or functional reduction in the effect of the neurotransmitter dopamine on the activities of the basal ganglia
Basal ganglia are associated with providing proper background and tone for quick, discrete movements
Clinical features underlying basal ganglia pathology are rigidity, slow movement, limited range of motion, and a resting tremor that is normally ameliorated through intentional movement |
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Term
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Definition
Hyperkinetic = involuntary & uncontrolled movements
Difficult to define – many clinical presentations
Associated with damage to basal ganglia or an imbalance of neurotransmitters: acetylcholine & dopamine
May manifest in any or all of the subsystems of speech
But can manifest itself at only 1 level of speech production, sometimes only a few muscles at that level |
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Term
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Definition
Type of hyperkinetic dysarthria, relatively rare
Movement disorder of the larynx, a focal dystonia
Strangled harsh voice, observable effort in pushing air out during most voicing attempts
Should not anticipate seeing 1 particular laryngeal pattern |
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Term
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Definition
A mixture of dysarthrias characterized by two or more of the primary types
Caused by multiple lesion sites within the nervous system (both CNS and PNS) |
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