Phonotrauma (????)

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Phonotrauma (????)
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topics

• -Factors related to pitch,loudness and voice
  quality
• -common kinds of voice disorders
• -Etiology
• -Diagnosis of Voice Problems
• -Differential Diagnosis of Voice Problems
• -Functional voice disorders
• -Hygiene(????)

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Factors related to pitch, loudness and voice
quality
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1?pitch

• Primary biomechanical determinants of the rate of
  VF vibration
• Length
• Mass
• Tension
• Other changes during pich changing
• Subglottal pressure
• Medial compression of the VF
• Glottal airflow rates

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pitch

• Primary intrinsic laryngeal muscle involved in
  pitch change
• Cricothyroid muscle
• thyrovocalis

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2?loudness

• Primary biomechanical determinants of intensity
• Subglottal pressure
• Medial compression of the VF
• Duration, speed and degree of VF closure

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3?voice quality

• Result from changes at 2 levels of the speech
  production system
• glottal source
• Resonant characteristics of the vocal tract

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voice quality

• Types of abnormal voice quality
• Breathy
• Rough
• Strained
• Harsh(???)
• Hoarse(???)

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voice quality

• Breathy
• Incomplete glottal closure-turbulent airflow
• Intensity diminished
• Rough
• Aperiodic VF vibration-irregular mucosal wave
• Intensity maybe increased

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voice quality

• Strained
• Considerable medial compression of the true
  (perhaps false)VFs
• Aperiodic VF vibration-irregular mucosal wave
• Intensity maybe increased

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voice quality

• Harsh(???)
• Strained rough
• Hoarse(???)
• Strained rough breathy

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Common kinds of voice disorders
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Functional Problems ?????

• Professional Voice Users
• 1) clergymen
• 2) teachers (females esp English), physical ed
  teacher
• 3) coaches in a prof sports team (esp football)
• 4) Singers
• 5) SLPs
• Pts w hyperfunctional(????) voice usage (mostly
  kids)
• Pts w emotional problem (females)

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Organic Problems ?????

• Organic VF lesions
• Cancer (??)
• Papilloma (????)
• webbing(??)
• Reflux(??)
• Physical trauma on the neck
• 1) a youngster who had a motorcycle accident
• 2) a pt who had a fall by her neck
• 3) a lady who got strangled by her neck by a
  robber
• -gt arytenoid cartilage was dislocated

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Neurogenic Problems ?????

• Neurogenic pts
• CVA(Cerebrovascular Accident) ?????
• TBI(Traumatic Brain Injury) ??????
• Parkinsons dis ?????
• Vocal Ford Paralysis ????

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Etiology(????)
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1?Misuse ??

• Interferes with efficiency and effectiveness
• Increased tension or strain
• Hard glottal attacks (??????)
• High laryngeal position (????)
• anteroposterior laryngeal squeezing (???????)

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Misuse continued

• Inappropriate pitch (??????)
• Puberphonia mutational falsetto (????)
• Persistent glottal fry (????)
• Lack of pitch variability (????)
• Excessive talking
• Ventricular phonation (????)

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2?Abuse ??

• Functions are harsher and tend to cause trauma
• Excessive, prolonged loudness
• Strained and excessive use when folds are
  edematous ??
• Excessive coughing and throat clearing
• Screaming and yelling
• Exercising and vocalizing

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3?Conditions Affecting Vocal folds

• Sinusitis (???)
• Xerosis drying of mucosa (???)
• Gastroesophageal reflux (GER) (????)

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4?Effects of Medications/Drugs

• CNS stimulants and depressants (???????????)
• coordination (??)
• Anesthetics (???)
• proprioception (????)
• Bronchodilators and constrictors (??????????)
• tremors (??)
• decongestants (?????)
• increases thickening of secretions

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Effects of Medications/Drugs contd

• Drying agents (???)
• reduce secretions
• Hormone (??) therapy
• increase muscle mass
• Aspirin (????)
• risk of hemorrhage(??)
• Beta Blockers ß-(?????)
• reduces inhibitions, increase tension
• Tobacco (??)
• increase edema and drying

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diagnosis
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1?Case History

• Variety of forms
• Observations made in waiting room and office
• Protocol of evaluation

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Case History contd

• Information to gain
• description of problem
• onset and progression of problem
• variability and consistency of problem
• symptoms and sensations
• voice use
• changes in their voice and affects on life
• goals

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2?Diagnostic procedures

• Examination of the voice
• Lab testing(?????)
• Physiological studies(?????)
• Critical listening(??)
• Diagnosis testing probes(?????)
• Noninstrumental objective measurement(???????)

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Examination of the Voice

• Indirect Laryngoscopy ????
• Flexible fiberoptic laryngoscopy ????
• Stroboscopy ????

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Lab Testing ?????

• Acoustic Studies ????
• Fundamental frequencies ??
• Phonational range ????
• Vocal intensity ????
• Perturbation ??
• Spectrogram ???

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Physiological Studies ?????

• Electroglottography ????
• Subglottal Air Pressure ????
• Electromyography ???

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Critical Listening ??

• Pitch ??
• Loudness ??
• Voice quality ??
• Unusual vocal characteristics ???????
• Tasks
• Sustained vowels ????
• Syllables and sentences ?????
• Frequency range and intensity range ????????
• Rainbow Passage ??
• Sample of conversational speech ???????

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Diagnostic Testing Probes ?????

• Reflexive sounds ??????????
• Altering pitch ????
• Sustaining steady, prolonged phonation ???????
• Altering vocal loudness ???????
• Phonation with effortful glottal closure ????????
• Placing the voice ????????

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Noninstrumental Objective Measurements???????

• Maximum phonation time ????
• s/z ratio s/z?

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Diagnostic procedures

• Simple methods objectify the symptoms
• 1) MPT
• 2) S/Z ratio
• 3) Pitch range
• 4) Intensity (loudness) range

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Differential Diagnosis of Voice Problems
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Procedures

• Interview
• Examination of medical records
• Rating of auditory perceptual characteristics
• Measurement of acoustic, aerodynamic, vibratory,
  and muscle action events
• Examination of the laryngeal structures and their
  function
• Evaluation of other bodily functions and systems
  as deemed appropriate
• Experimental therapy, or treatment probing

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Symptoms vs Signs

• A symptom(??) is a complaint or perceptual
  characteristics of the voice
• A sign (??)is a characteristic of the voice that
  can be observed or tested

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Primary symptoms of voice problems

• Hoarseness ???
• Vocal fatigue ????
• Breathy voice ???
• Reduced phonation range ??????
• Aphonia ??
• Pitch breaks or inappropriate high pitch ????
• Strain/struggle with voice ????
• Tremor ??
• Pain and other physical sensation ???

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Major signs of voice problems

• Pitch
• Monopitch ????
• Inappropriate pitch ????
• Pitch breaks ??????
• Reduced pitch range ??????
• Loudness
• Monoloudness ????
• Loudness variation ?????
• Reduced loudness range????????

• Quality
• Hoarse or rough ??????
• Breathy ???
• Tension ????
• Tremor ??
• Strain/struggle????
• Sudden interruption of voicing ????
• Diplophonia ??
• Other behaviors
• Stridor ???
• Excessive throat clearing ????
• Aphonia??
• Consistent ????
• Episodic ????

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Acoustic Assessment ????

• Frequency
• Fundamental frequency ??
• Phonational range ??????
• Frequency perturbations Jitter ????
• Intensity
• Mean intensity level ????
• Dynamic range ??????
• Amplitude perturbation Shimmer ????

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Acoustic Assessment Continued

• Respiratory and Laryngeal Control
• Maximum phonation time (MPT)
• S/Z ratio
• Noise related measures
• Signal to noise ratio ???
• Spectral analysis ????
• Dr Speech
• CSL
• MDVP
• Praat

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Functional voice disorders
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1?Nodules????

• Cause/etiology
• Abuse of larynx
• Misuse of the voice
• Location
• Anterior - middle third site ??1/3???
• Lesions in superficial layer of lamina propria
  ?????????
• Bilateral ???
• Pathological changes
• Vascularized or edematous ?????
• Fibrous ???

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1?Nodules????

• Typical symptoms
• Excessive throat clearing
• Glottic foreign body sensation
• Seems have excessive mucus or sth on the VFs
• Vocal fatigue
• Voice seem to deteriorate with contimuous voicing
• Low vocal quality
• Breathness
• Lower pitch
• Increased aperiodicity

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Vocal nodule
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1?Nodules????

• Treatments

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2?Polyps ????

• Cause/etiology
• vocal hyperfunction
• Once a small polyp begins, any continued
  phonotrauma will irritate the area
• Smoking
• Location
• Anterior - middle third site ??1/3???
• Superficial layer of lamina propria ?????????
• Unilateral ???

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2?Polyps ????

• Types
• Pedunculated(narrow-necked) ?????
• Sessile(broad-based) ?????????? mostly
• Typical symptoms
• Low vocal quality
• Breathness
• Lower pitch
• Increased aperiodicity

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2?Polyps ????
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2?Polyps ????

• Treatments

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3?Edema or Reinkes edema ????????

• Cause/etiology
• Smoking
• Chronic vocal hyperfunction
• Laryngopharyngeal reflux
• Vocal Ford paralysis
• Location
• Superficial layer ?????
• Bilateral or unilateral ?????
• Pathological changes
• Gelatinous material develops in Reinks space
  ????????????

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3?Edema or Reinkes edema ????????

• Typical symptoms
• Excessive throat clearing
• Vocal fatigue
• Voice seem to deteriorate with contimuous voicing
• Low vocal quality
• hoarseness
• Lower pitch

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Reinke Edema (III)
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3?Edema or Reinkes edema ????????

• Treatments

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4?Traumatic Laryngitis ?????

• Cause/etiology
• excessive and strained vocalization
• Yelling, screaming
• Location
• Surface of true (perhaps false) VFs
• Bilateral ???
• Pathological changes
• Inflammation ??
• Increased vascularity ????
• Chronic thickening and other changes in tissue
  ????-????????

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4?Traumatic Laryngitis ?????

• Typical symptoms
• The acute stage VFs increase in size and mass
• Low vocal quality
• hoarseness
• Lower pitch
• The chronic stage become a more permanent
  polypoid thickening, such as polyps, nodules
• Vocal pain
• Low vocal quality
• hoarseness
• Lower pitch

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Acute Laryngitis after Surgery
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4?Traumatic Laryngitis ?????

• Treatments

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5?ventricular dysphonia????

• Cause/etiology
• Disease of the true VFs(paralysis, polyps,
  cancer)
• Location
• Ventricular folds
• more often is produced by the true VFs vibrating
  in an abnormal fashion due to the false fords
  riding the true ones

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5?ventricular dysphonia????

• Typical symptoms
• Lower pitch
• Little pitch variability
• Hoarse
• Breathy
• Diagnosis
• Coronal X-ray of the sites of vibration
• Nasoendoscopy
• Endoscopic stroboscopy

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5?ventricular dysphonia????

• Treatments

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6?diplophonia ??

• Cause/etiology
• Irregular VF vibration(such as VF paralysis,
  scaring, laryngitis )
• Typical symptoms
• Double voice

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6?diplophonia ??

• Diagnosis
• Auditory perceptual analyses
• Acoutice analyses

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6?diplophonia ??

• Treatments

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hygiene (????)
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Avoid!

• Smoking
• Alcohol
• Caffeine (coffee, coke, mountain dew, chocolate
  ??)
• Dairy products (milk, cheese ??)
• Screaming
• Throat clearing
• Excessive exercise while talking
• Talking in a noisy environment
• (Lombard effect)
• Gastroesophageal reflux (GERD)
• Occupational stress
• Personal stress

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Do These!

• Hydration
• 1. Drink lots of water (until urine is
  clear)
• 2. Particularly when traveling on a plane
  (esp singers)
• 3. Use lemon wedge
• 4. Operate humidifier
• 5. Inhale moisture thru mouth from a hot
  towel
• 6. Inhalator (small device producing hot
  moisture)
• Tongue-tip-up breathing (no mouth breathing)
• Protect neck head (25 of body heat)
• Maintain overall health
• Use voice amplifier

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Its all for today!