Voice Disorders Exam 2 - Lecture 3

What is dealt with in phono surgery?

- Bilateral nodules - Polyps - Pseudocyst - Cysts (deeper than nodule)

When doing VFE what is the measure to show mastery?

80% accuracy across 10 trials

Why is it crucial to reduce tension?

Because tension preceded the voice problem and will not go away until the tension lessens.

What is voice therapy?

Behavior-based process in which maladaptive vocal habits are replaced with appropriate use of the vocal mechanism

Medical Management of Voice Disorder

Botox, pharmacologic, etc.

Mutational falsetto

Continued use of higher pitch even after puberty in presence of normal system

What is the accent method?

Developed by Svend Smith, helps to coordinate breath, vocal function, articulation, body movements and language to establish a new natural breathing pattern. Emphasis on motor programming. May use a drum! (The weird one that made everyone uncomfortable and laugh)

Basic Principle of CLM (5)

Increase complexity of voice stimuli

Mutational falsetto

Male with mature larynx has perpetually too high pitch

What is secondary or adjunct treatment modality

Post-surgical voice therapy

Basic Principle of CLM (2)

Progress from superficial to deep pressure

Does respiratory training greatly influence improving voice disruption?

Showed little difference

Three approaches to management of voice disorders

Surgical (Phonosurgery) Medical Behavioral/Voice Therapy

Characteristics of Mutational Falsetto (MF)

Weak, thin, breathy, hoarse, effeminate, immature voice with inadequate resonance, frequent voice cracks and/or pitch breaks

Mutational falsetto (MF) treatment

- Almost want them to go into glottal fry at the beginning - Lots of negative practice training/therapy - Manual Laryngeal Reposturing Techniques early in the treatment

Conclusions of trails for voice therapy

- Amplification words and is easiest to do - Neuromuscular retraining approaches (VFE/RVT) work - Vocal Hygiene is not great but something is better than nothing - Respiratory Training is not useful - If they do nothing, the voice generally deteriorates

How to perform CLM

- Circular motion over the tips of the hyoid bone. - Thyrohyoid space - Posterior border of the thyroid c. - Medial and lateral suprahyoid m.

Signs that CLM is working

- Improved voice quality - Pain reduction/relief - Normalized laryngeal height and mobility - Reduced muscle modularity

Surgical Management of Voice Disorder

- Removal of pathological tissue - Correct position, shape, and/or tension of vocal folds - Alter or restore neuromuscular function - Reconstruction for total or partial loss or deformity of larynx

Goals of voice therapy

- Restore best possible voice - Get voice to a functional level for social, vocational, and avocational use (singing). - Get voice to a place where it functions for the pxs needs and life demands.

Role(s) of Diagnostic Voice Therapy in Medical and Surgical Voice Pathology

Can help save pxs from surgery. Example: polyp is not always the cause of a voice disorder. If there is another cause then the px doesn't need surgery to fix it.

Manual Laryngeal Tension Reduction is also called....

Circumlaryngeal massage

What aspects are critical for voice therapy?

Feeling and hearing

When is it appropriate to use voice therapy as the primary modality?

For post-op injury recovery

What is voice amplification?

Helping someone that needs to be able to project to compensate for their less effective larynx

When to do CLM

If px fails to improve from reposturing

When to use the confidential voice therapy approach?

Impractical as an endpoint goal but can be used along the way as an intermediate step on a client's way to normal loudness

How do the VFEs help?

Improves strength, endurance, and coordination of voice production - helps withstand the demands of extended loud voice use (great for teachers)

What does the accent method attempt to do?

Improving phonatory timing, reduce hard glottal attacks, reduce glottal fry at the end of sentences, improve abdominal breathing, reduced tension

What does the treatment process of voice therapy entail?

Incorporates auditory, proprioceptive, and kinesthetic awareness/feedback to produce healthy, efficient voice.

Why should vocal hygiene instruction not be used??

It's the same as a vocal diet. Can often fail.

Basic Principle of CLM (1)

Locate sites of focal tenderness, nodularity, tautness

Basic Principle of CLM

Move/transition through hierarchy pretty quickly

Basic Principle of CLM (4)

Patient vocalizes concurrently

Types of Restorative Voice Therapy

Primary Treatment Modality and Secondary or Adjunct Treatment Modality

Other names for mutational falsetto

Puberphonia Adolescent Voice Adolescent Transitional Dysphonia Persistent Falsetto Incomplete Voice Mutation Pubescent Falsetto

What is confidential voice therapy?

Resembles how you would talk when telling someone something in confidence aka the "Bedroom voice" Low volume and somewhat breathy voice

What is primary treatment modality?

The core focus of restorative/rehabilitative voice therapy where you are in charge and responsible for your progress

What is Voice Conservation?

The practice of using one's voice only when needed and not overusing the voice in unnecessary situations

Basic Principle of CLM (3)

Vary according to tolerance of patient

What are neuromuscular retraining approaches?

Vocal Function Exercises (VFEs) Resonant Voice Therapy (RVT) Training the px to use their voice in a less phonotraumatic manner

Two popular voice treatment approaches

Vocal hygiene approach and neuromuscular retraining

Types of Compensatory Voice Therapy

Voice amplification and voice conservation

Role(s) of Compensatory Voice Therapy in Medical and Surgical Voice Pathology

When a px displays significant dysphonia despite all other efforts

Functional voice disorder

absence of structural or neurological pathology

CSID Score

dysphonia severity measure

Manual Laryngeal Tension Reduction/Circumlaryngeal massage

relaxes tense muscles of the larynx using manual manipulation to increase blood flow and mobility of larynx, relieve pain, promote normal relaxed larynx (to correct position) and phonation. Use for functional problems (Muscle Tension Dysphonia, mutational falsetto/puberphonia)