Voice Disorders, Chapter 3 - Functional Disorders

Excessive muscle tension, psychogenic
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Excessive muscle tension, psychogenic
2 causes of functional voice disorders:
Phonotrauma
trauma to the vocal folds; caused by some type of functional disorder (abuse or misuse)
Yelling and cheering
Strained vocalizations
Excessive talking
Frequent use of hard glottal attack
Throat clearing and coughing
Inhalation of dust, cigarette smoke and noxious gases
Singing with poor vocal technique
Excessive talking while the vocal folds are in a weakened condition
Name some examples of phonotrauma
Edema, Hematoma
Fluid or blood can rapidly accumulate following laryngeal trauma due to the submucossal tissue of the larynx. This can result in:
Edema
swelling
Hematoma
- localized swelling caused by collection of blood, usually clotted, which is released through a break in the wall of a blood vessel.
Falsetto
Functional Aphonia
Functional Dysphonia
Somatization Dysphonia (Briquet's Dysphonia)
List the Psychogenic Functional Disorders
Muscle Tension Dysphonia (MTD)
Ventricular Dysphonia
VF Nodules
VF Polyps
Reinke's Edema
Traumatic Laryngitis
List the Excessive Muscle Tension Functional Disorders
Muscle Tension Dysphonia
- a persistent dysphonia that results from excessive laryngeal and related musculoskeletal tension and associated hyperfunctional true and/or false vocal fold vibratory patterns.

Can also have tension fatigue syndrome.
Look for excessive tension in the muscles of the neck and face with larynx elevated in the neck area
primary, secondary
MTD can be categorized as ________ or _________ based on whether organic pathologies trigger the muscle tension.
PrimaryMTD with no current organic pathology (40% of all dysphonias)SecondaryMTD that occurs with current or recent organic pathologiesLaryngeal_____________ findings of MTD may include one of the following: Partial closure of ventricular folds Shortened vocal folds or Sphincterlike closure of the supraglottal areaAssessment_________ of MTD includes..... (using manual palpation) Laryngeal elevation Vocal tenderness Effect of voice with downward pressure Laryngeal massagerelaxation of the head and neck muscles (EX: Yawn-sigh, chewing, chant talk, digital manipulation focus laryngeal massage, and relaxation)The focus of therapy for MTD :Ventricular DysphoniaAlso known as dysphonia plicae ventricularis False fold vibration . Ventricular folds are approximated and may be used for phonation while the true vocal folds are usually held in a slightly abducted position. False folds riding the true foldsCompensatory, noncompensatory2 types of Ventricular PhonationCompensatory(Type of Ventricular phonation) - a reaction to true vocal fold disease such as paralysis, vocal fold surgeryNoncompensatoryType of Ventricular Phonation where VFs are capable of normal vibrationHabitual-excessive vocal use Psycho-emotional IdopathicNoncompensatory Ventricular Dysphonia can be broken down into what 3 types?Psycho-emotionalprovoked by physical and psychogenic tensions and stressLow pitch, decreased pitch variability - monotone, Hoarse, Breathy, diplophoniaSymptoms of Ventricular phonationdiplophoniadouble voiceeliminate source of second voiceTreatment for diplophonia?Vocal nodulesMost common benign lesions of the VFs, usually bilateral. In early stages it's is soft and pliable, but with continuous abuse it becomes more fibrous and largerYoung boys (aggressive and noisy) Adolescent females Adult females who are talkative, socially aggressive and tense People having hyperfunctional personalitiesPopulations most effected by vocal nodules...?trauma and chronic physical stress of vocal hyperfuntion; continuous abuse of the larynx and misuses of the voiceEtiology of vocal nodules?therapy, occasionally surgeryTreatment for vocal nodulesvocal nodulesAll Symptoms of __________: Breathiness, Low pitched, Hoarse, Feels as if something is on vocal fold (clears throat), Voice deteriorates with continuous phonation. Voice quality is best early in the morning and worsens as the day progresses.Boone 4 point program1. Identifying abuses - misuses 2. Reduce the occurrences of abuses/misuses 3. Search for facilitating approaches to produce easy, optimal production 4. Use approach that works bestVocal polypsBulging enlargement occurring at the juncture of the anterior middle one-third of the VFs. It is a focal abnormality of the superficial lamina propria. - More likely to be unilateral. - Related to hyperfunction Lesion is usually soft and fluid filled - gelatinous.trauma due to one or more episodes of phonotrauma, other trauma, secondary reactions to allergies, thyroid imbalance, upper respiratory tract infections, excessive alcohol use or excessive smokingEtiology of vocal polyps....?Pedunculatedthe polyp mass is attached to the vocal fold by a stalk-like appendage; stem-basedDysnea, stridorExtremely large polyps that fill most of the glottis may result in _______ or _______Dysneadifficult or labored breathing; shortness of breathStridorvoice quality which accompanies respiration and is characterized by the presence of a tense, nonmusical laryngeal noise; typically appears in young children during sleep.Surgical removal and Therapy (Using the laryngeal mechanism appropriately Identifying vocal abuses Reducing vocal abuses Finding patient's best voice using facilitating techniques Vocal hygiene program)Focus of treatment for vocal polypsVocal polypsAre all Vocal Symptoms of_________: Severe dysphonia Diplophonia Hoarseness Breathiness Continuous throat clearing Sudden voice breaksReinke's edemadiffuse swelling of the superficial lamina propria of the vocal folds Within the lamina propria a thick gelatinous, fluid-like material develops in Reinke's space. A degeneration of the fluid under the VF covering and the gelatinous material develops in Reinke's space AKA polypoid degenerationUsually bilateral, but may be more pronounced on one side. Affects the anterior 2/3 of the glottal margin.Laryngeal findings of Reinke's edemaSmoking, reflux, hyperfunctionCauses of Reinke's edemaVoice therapy, quit smoking, medical-surgical interventionTreatment of Reinke's edemainfectious, traumatic (Vocal folds swell after excessive and strained vocalization)2 types of laryngitishoarsness, reduced volumeSymptoms of laryngitis?therapyTreatment for laryngitisPhonation BreaksThe temporary loss of voice that may occur for part of a word, a whole word, a phrase, or sentence. Individual is phonating with no apparent difficulty when suddenly a complete "cessation" of the voice occursReduce hyperfunction Eliminate inappropriate vocal behaviors.Therapy/Treatment for Phonation BreaksPitch BreaksMay be due to vocal fatigue. A sign that the voice is being overworkedDue to development Due to prolonged hyperfunction2 types of pitch breaksTemporary voice rest Use of easy phonationTreatment for pitch breaks?Psychogenic Voice Disordersvoice disorders caused by emotional stress and voice disorders that can cause emotional stresscounseling and therapyPsychogenic Voice disorders are treated withPuberphoniathe failure to eliminate the higher pitched voice of pre-pubescence and substitute the lower-pitched voice of post-pubescence and adulthood in the presence of a structurally normal larynx Other names for include Falsetto, mutational falsetto, juvenile voice and incomplete mutation of voice.lower pitch & increase vocal qualityTherapy for puberphonia include...?PuberphoniaThis is the Etiology of ___________: use of higher pitch voice into adulthood even when the larynx is physically capable of producing the normal lower pitch. May be a result of: Psychological, Endocrine disorder, Severe hearing loss, or Neurological diseasenormal structuresA laryngealscopy of puberphonia reveals _________, so treatment includes voice therapyFunctional AphoniaSpeak with a whisper Must be examined by either indirect laryngoscopy or videoendoscopy. Described as hysterical or conversion disorderConversion Reactionany loss of voluntary control over normal striated muscles or special senses as a consequence of environmental stress or interpersonal conflict. Total loss of phonatory ability due to a conversion reactionFunctional/Conversion AphoniaEtiology: conversion reaction Onset: sudden or gradual Symptoms: complete loss of voice Laryngoscopic findings: normal appearing laryngeal structures with VFs in normal abducted position for breathing. On phonation VFs may abduct to a more lateral position or adduct into a lax approximation Treatment: voice therapyFunctional DysphoniaCauses: laxed approximation, tight approximation, complete shutdown of VF (Ventricular fold vibration), complete shutdown of ventricular and true VF. Vocal Symptoms: breathiness, harshness, hoarseness, tightness, intermittent whisper Voice frequently just gives out, no structural pathology presentFunctional Dysphoniapartial loss of phonatory ability due to a conversion reactionSotomization DysphoniaAKA Briquet's Dysphonia Symptoms: dysphonia, laryngeal pain, neck and shoulder pain, stiffness, shortness of breath, depression and extreme vocal fatigue. Should be referred for extensive medical workup and psychiatric eval.Criteria for Conversion Rections1. Are specific physical symptoms or syndromes that cannot be traced to any anatomical or physiological pathology 2. Are unconscious simulations of illness which the patient is convinced is of organic origin 3. Serve the psychological purpose of enabling the patient to "avoid awareness" of emotional conflict, stress, or personal failure which would be emotionally intolerable if faced directly. 4. Can occur in any sensory or voluntary motor system