List treatment for..
Vocal nodules
-eliminate vocal abuse (do vocal hygiene)
-lower intensity (loudness)
-limit hard glottal attacks
-chant-talk, place the voice, yawn/sigh, open mouth approach, chewing
Yawn/Sign
one of the most effective techniques to lower tension and hyperfunction
automatically and immediately helps relax and recalibrate
you yawn, then exhale with easy phonation
when you yawn the larynx drops down and the vf's are aligned
All intrinsic muscles of the larynx are innervated by the recurrent laryngeal nerve except for which one?
Bonus: Which nerve is it innervated by?
The cricothyroid muscles
Bonus: Superior Laryngeal nerve
What kind of vf paralysis is an emergency requiring immediate tracheostomy?
bilateral aBductor paralysis
What is it called when a person with a trach uses their esophagus to phonate?
Esophageal speech
Polyps
Surgery for big ones but if caused by abuse, delay surgery and begin voice therapy
vocal rest, vocal hygiene, decrease hard glottal attacks, increase breath support
open mouth, yawn/sigh, place the voice
Open mouth approach
for hyperfunction, mandibular restriction
increasing oral resonance helps amplify the voice more effectively
lessens mandibular and mouth tension
creates more oral resonance, oral focus
short-term
What is it called when you can not adduct 1 vf to midline?
Unilateral Adductor Paralysis (UAP)
Can UAP spontaneously regenerate within 9 months?
T/F
True
List 3 reasons why someone could have a trach
chronic ventilator dependance
reduced airway protection
upper airway obstruction
congenital defects in upper airway
in a coma
allergic reactions
neuromuscular diseases
spinal chord injuries
airway injuries from smoke, steam, chemical burns
any age can have one
Contact ulcers
Bonus: What age and gender gets these the most
refer for gastrointestinal eval
vocal rest, establish best pitch, lessen glottal attacks/intensity, lower tension and rate
Bonus: Male in 40's
Characteristics of adult males with contact ulcers: habitual use of lower pitch, hard glottal attacks, explosive stress patterns, sharp and abrupt glottal attacks, restricted pitch variability, increase in intra-glottal pressure
Chant-Talk
Goal= reduce effort in talking
short-term technique that recalibrates the vocal mechanism
used for hyperfunction
Recite syllables/words in one continuous, monotone word
It prolongs vowels and lack of syllable stress softens glottal attack
When both fold are stuck in a paramedian position and can not close
Results in no voice
More rare
Aspiration and swallowing risk due to less airway protection
Bilateral Adductor Paralysis (BAP)
What are the 3 types of spasmodic dysphonia?
Adductor (too much adduction, hyperfunction)
Abductor (spontaneous aBduction)
Mixed (AD and AB)
Primary Causes of Head and Neck Cancer
Smoking
Excessive Alcohol use
HPV
Papilloma
Primary treatment=medical
remove with surgery to preserve airway or injections to decrease occurrence
Voice therapy:
to achieve best voice after surgery: respiration training, increase loudness or pitch
(voice therapy is never done when papilloma is present)
Place the Voice
Goal=optimize vocal resonance and projection and reduce strain on the vf's
Transfer and focus energy from the glottis into the oral cavity
go from a posterior to frontal focus
can use nasal sounds or a lip trill
UAP voice characteristics include
Harsh or hoarse
Breathiness
Weakness "Soft Voice"
Limited pitch range
T/F
Spasmodic dysphonia affects the vf's directly while spastic dysphonia involves tight, stiff muscles affecting the voice and speech in general.
True
Consequences of Laryngectomy
can't phonate
can't cough/sneeze
no sing, hum, whistle, blow nose, can't smell
caution when bathing, can't swim
Laryngeal Web
Surgery
May need minimal Voice TX after surgery
Chewing
for hyperfunction of the mandibular region (clenches teeth and jaw)
have them overexaggerate chewing and add phonation
recalibrate and reduce mandibular tension
T/F
Voice therapy is the main treatment for vf paralysis, as there is not much evidence surgery is effective
False
Surgery is the go-to, not much evidence for just using voice therapy
What is the main treatment for Spasmodic Dysphonia?
Bonus: What are other treatments?
Botox
Bonus:
Voice therapy to reduce strain, improve pitch and manage symptoms
Surgery
Clinical indication for a PMV (passy muir speaking valve)
wait 48 hours post trach placement
pt is alert and responsive
stable vitals
pt is able to tolerate cuff defilation