Voice Disorders #1

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hrichison
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129241
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Voice Disorders #1
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2012-01-26 18:20:57
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Voice
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Review for exam 1
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  1. At birth the larynx is ______ the dimension of the adult larynx.
    • one-third
    • 1/3
  2. At birth the larynx is _____ and ______.
    extremely soft and malleable
  3. At birth the larynx does not possess a _____ ____ structure and shows no ______ differentiation.
    vocal fold layer

    sex
  4. At birth the neonate's larynx is ______ in the neck than in adults.
    higher
  5. In baby's the epiglottis is in contact with the velum allowing ____?
    infants to carry out the functions of breathing and feeding simultaneously.
  6. There is a _______ relationship between the descent of the larynx and the decrease in average voice pitch.
    developmental
  7. As the pharyngeal tube elongates, it resonates ______ fundamental frequencies.
    lower
  8. The descent of the larynx is ______ unique to humans.
    NOT
  9. Evolutionary cause of the descent of the larynx: 1.______ 2. ______
    first evolved for swallowing and secondarily for voice.
  10. Ossification of the hyoid bone begins by age ____?
    TWO
  11. By the _____ or ______ decade, all the laryngeal cartilage, except the elastic epiglottis, cuniforms, and corniculates, have ______ in males.
    7th or 8th

    ossified
  12. The female larynx _____ _____ ossifies.
    Never completely
  13. The infant has a proportionally larger _____ than the adult.
    glottis
  14. Absolutes glottal dimensions _____ with age.
    increase
  15. 4 distinctive types of infant cries?
    • 1- birth signal
    • 2- pain signal
    • 3- hunger signal
    • 4- pleasure signal
  16. Acoustic characteristics from infants with neuorological damage, SIDS, prematurity, and various medical conditions _____ from _____.
    deviate from typical cry characteristics.
  17. Universal fact about the larynx: the vocal folds respond _______, depending on _________.
    differentially

    psychophysiologic state.
  18. A cry that is strained, tense, harsh, and forced owing to massive, tight, effortful closure of the entire laryngeal tract.
    Pain cry
  19. A cry that is more sonorous, lax, and devoid of strain or tension.
    Pleasure cry
  20. _____ cries are longer in duration than ______ cries.
    Pain, hunger
  21. Research suggest that crying is _______meant to communicate meaning.
    protolanguage
  22. Infant cries serve to maintain to and elicit ____ from caregivers.
    care
  23. Infant cries and other vocalizations are _______ from associated ______ expressions and _______ movements.
    inseperable, facial, bodily
  24. Two types of vocalizations?
    positive vocalizations and negative vocalizations
  25. positive vocalizations?
    Those associated with smiling facial expressions such as babbling, cooing, laughing, or squealing.
  26. Negative vocalizations?
    Those associated with grimacing, trembling of the lips, and frowning.
  27. The fundamental frequency if the voice drops towards the _____ of a sustained utterance or breath group.
    end
  28. When there is a voice drop at the end of an utterance it is because of the decline of _______ as exhalation progresses and there is _____ respiratory support.
    infraglottal air pressure, less
  29. Infants respond to ______ first before they are able to comprehend language.
    intonation
  30. Three intonational stages in the development of language?
    • 1- At an early stage, broad discrimination between different patterns of expression in intonation.
    • 2- when the total pattern emerges because of language learning, intonation, not the phonetic pattern, dominates the childs reponse at first.
    • 3- the phonetic pattern becomes the dominant feature. Although the intonational pattern is subordinated, it never completely disappears.
  31. Fundamental frequency in males drops ____% from the infant cry ____HZ to childhood voice ____ HZ and another ___% from childhood voice to adulthood ____HZ.
    50%, 500HZ, 250HZ, 50%, 125HZ
  32. The decrease in fundamental frequency in females is _____ dramatic but also reaches adult maturity during puberty.
    LESS
  33. Until puberty, the larynx is ______ in the male and female.
    equal size
  34. At puberty, the males laryngeal growth _______ the female laryngeal growth.
    outdistances
  35. The greater enlargement of the ______ in most males resuls in a more prominent _____ in vital capacity than seen in females.
    thorax, increase
  36. During puberty the larynx continues to ______ in the neck, and the neck itself _____.
    descend, elongates.
  37. Onset of puberty occurs _____ in warmer climates and with children who are _____ weight.
    earlier, heavier
  38. In temperature climates, onset of puberty in females ranges from __ to __ and in males __ to __.
    • Females: 12-14
    • Males: 13-15
  39. Near the _____ puberty is accelerated 1 to 2 years and near the ____ it is delayed 1 year.
    equator, poles
  40. Onset of puberty may be delayedin females by _______ or _______.
    excessive exercise or nutritional deficiencies such as anorexia and bulimia.
  41. The average time from onset to completion of adolescent voice change is _____ to _____, ____ at most.
    3-6 month, 1 year
  42. Acoustic signs of puberty occur ___ to ____ months before onset.
    3-4
  43. 3 time periods of pubertal voice change:
    • 1- premutation
    • 2- mutation
    • 3- postmutation
  44. In females the voice change is complete by age ___ and in males age ____
    15, 14 or 15
  45. Males and females complete the change at approximately _______.
    The same age.
  46. During puberty, the most marked drop in fundamental frequency occurs in ____ and is thought to be related to the laryngeal growth changes resulting from _______.
    boys, hormone secretions
  47. The male voice drops by approximately ______
    1 octave
  48. pervasive sudden voice breaks from high to low pitch, or the reverse, or excessively husky or hoarse voice associated with adolescent voice change.
    Stormy voice mutation
  49. _____ _____ can span an entire octave, transcending vocal registers from high-pitched falsetto to bass.
    pitch breaks
  50. There is a high prevalence of transient dysphonia during ______ voice change.
    adolescent
  51. The majority of male adolescents have ______ voice change.
    uneventful
  52. adolescent voice change does not constitute a _____ ______.
    Voice disorder
  53. The most notable voice changes occurs between ______ and ______.
    birth and adolescence
  54. After pubertal changes the voice remains ______ until the 6th decade when _______ voice may lower in some females and around the _____ when the male fundamental frequency may rise slightly.
    • fairly stable,
    • postmenopausal,
    • 7th decade
  55. Structural changes of the respiratory system and the vocal folds occur with age including:
    • 1. atrophy of the laryngeal muscles
    • 2. thinning and dehydration of the laryngeal mucosa
    • 3. loss of elasticity of ligaments
    • 4. changes in the elasticity of the vocal folds
    • 5. calcification of cartilages
    • 6. flaccidity, bowing, and edema of the vocal folds
    • 7. a glottal gap
  56. ________ in the mass of the vocal folds may be the cause for ________ of the fundamental frequency and roughness and hoarseness of voice in elderly women.
    Increase, lowering
  57. ________ speakers have a tendency to misuse their voices.
    Older
  58. Perceptual studies indicate that listeners can identify ____________ by the sound of their voice.
    older subjects
  59. 9 cartilages:
    • 1. arytenoids- paired
    • 2. corniculates-paired
    • 3. cuniforms- paired
    • 4.thyroid
    • 5.cricoids
    • 6.epiglottis
  60. Protects the airway by acting as a moveable leaf-shaped cover.
    epiglottis
  61. Prevents food or liquid from entering the trachea during swallowing.
    Epiglottis
  62. The rocking and sliding action that are responsible for moving the true vocal folds, which are attached posteriorly to the arytenoids vocal processes.
    Arytenoid cartilages
  63. Forms a protective shield in the front and sides of the larynx.
    Thyroid cartilage
  64. Forms the most anterior portion of the larynx and the thyroid eminence (Adam's apple)
    Thyroid cartilage
  65. Forms the base of the larynx
    Cricoid cartilage
  66. The thyroarytenoid muscle that, with the vocalis muscle, forms the vocal folds.
    Intrinsic muscles of the larynx
  67. Contraction of the __________ pulls the arytenoids muscles foward causing anteriorposterior closure of the glottis.
    thyroarytenoid muscle
  68. What are responsible for abducting the vocal folds and therby opening the glottis?
    Posterior cricoarytenoid muscles
  69. What are responsible for adducting the vocal folds?
    The lateral cricoarytenoid muscles
  70. Adduction is also aided by the _____________.
    interarytenoid muscles
  71. What stabilizes the laryngeal neck posture and can raise or lower the larynx.
    The extrinsic muscles of the larynx
  72. The extrinsic muscles of the larynx are sometimes referred to as the ____________.
    Strap muscles of the neck.
  73. __________ consist of the thyroarytenoid muscle and the mucous membrane that covers the muscle.
    Vocal folds
  74. The mucosa is subdivided into the _________ and ___________.
    epithelium and the lamina propria
  75. The lamina propria is subdivided into 3 layers:
    superficial, intermediate, and deep
  76. Appears loose and pliant and it is here that edema often develops.
    Superficial layer
  77. It is made up primarily of elastic fibers.
    intermediate layer
  78. It is dense with mostly collagenous fibers.
    Deep layer
  79. The _________ is comprised of the intermediate and deep layers of the lamina propria.
    Vocal ligament
  80. The cover consist of the _________ and the ____________. AKA: ______
    epithelium, superficial layer. Reinke's space
  81. Most lesions invade the cover and affect ____ and ______.
    mass and stiffness
  82. The term used to describe the structural resistance as opposed to compliance.
    Stiffness
  83. The layering of the folds results in:
    complex vibratory patterns as the folds undulate and a mucosal wave can be observed moving across their surface.
  84. The mucosal wave is like the _________.
    "leading edge"
  85. The ___________ of the lamina propria contains few fibroblast, but the _____________ is rich in them.
    superficial layer, deep layer
  86. What are responsible for scar formation?
    fibroblasts
  87. Removal of lesions, such as cysts, that occur in the cover and do not invade the intermediate and deep layers, usually can be treated surgically without the risk of __________
    scar formation
  88. Space between the vocal folds.
    Glottis
  89. What is the point where the glottal space is widest during abduction?
    Point of maximum excursion of the folds
  90. The point of maximum excursion is the site of ___________ when the folds close during adduction.
    maximum impact
  91. The pattern of oscillation that is created by a continual opening and closing of the two masses of the vocal fold cover during voicing.
    mucosal wave
  92. What is one vibratory cycle (phase)
    Every opening and closing of the folds
  93. The folds open from the _________ to the ________ and close in similar fashion.
    bottom layer to the top layer
  94. During one phase of the mucosal wave the vocal folds:
    • 1- open at the bottom
    • 2- open at the top
    • 3- close at the bottom
    • 4- close at the top
  95. The folds open from the ___-____ and close from the _____-____.
    back to the front and from the front to the back
  96. The initiation of sound produced as the folds begin to vibrate.
    Voice onset
  97. 3 types of voice onset:
    • 1- breathy onset
    • 2- simultaneous onset
    • 3- hard glottal attack
  98. When air flows through the glottis before the vocal folds are adducted and vibrating?
    breathy onset
  99. When air is flowing through the glottis as vibration of the vocal folds and adduction begins?
    simultaneous onset
  100. When air flows through the glottis after the vocal folds are adducted and vibration begins with a jolt.
    hard glottal attack
  101. 3 ways the kind of voice onset habitually used by a particular client can be ascertained?
    • 1- perceptual observation
    • 2- acoustic analysis of vowel initial words
    • 3- vocal fold imaging
  102. The vocal folds vibrate with minor fluctuations in _________ and _______.
    frequency and amplitude
  103. What is the variation in frequency during vibratory cycles?
    frequency perturbation or jitter
  104. What is variation in amplitude during the vibratory cycle?
    amplitude perturbation or shimmer
  105. What is the most sophisticated and complex valve in the vocal tract?
    Vocal folds
  106. The vibratory of air passes through two other valves before the sound waves are shaped by the ____________ and exit the body through the ____ and _________ cavities.
    articulatory mechanism, oral and nasal
  107. What are just above and paralled with the true folds?
    The ventricular folds (false vocal folds)
  108. During swallowing and physical effort the ventricular folds _____, but they remain ______ during normal phonation.
    close, abducted
  109. When the ventricular folds are adducted and actually vibrate it is called ______.
    ventricular phonation
  110. The ____ are folds of connective tissue with some muscle fibers that form a ______ to pull the epiglottis posteriorly to close the larynx entrance during swallowing.
    aryepiglottic folds, sphincter
  111. Skeletal Structures:
    thorax, ribs, sternum, vertebrae
  112. The airway:
    trachea, bronchi, bronchioles
  113. Postural muscles:
    torso musculature, chest wall and shoulder muscles, abdominal muscles
  114. Primary inspiratory muscle:
    Diaphragm (distends the abdomen, enlarges the thorax)
  115. Accessory muscles of respiration:
    Internal & external intercostals muscles
  116. What depresses the rib cage?
    Internal intercostals muscles
  117. What elevates the rib cage?
    external intercostals muscles
  118. What compresses the abdomen, also stabilizes the thorax during body functions that demand closure of the vocal folds to maintain inflation of the lungs such as lifting, pushing, bearing down and defecation.
    Abdominal muscles
  119. What are involved in clavicular breathing and may assist during inspiration?
    Neck muscles
  120. The aerodigestive tract:
    • oral cavity
    • pharynx
    • trachea
    • esophogus
  121. The bronchial tree:
    • trachea
    • main bronchi
    • bronchioles
    • lung lobes
    • mediastinal structures
    • alveoli
    • blood supply
    • epithelia
  122. Types of breathing:
    • abdominal/ diaphragmatic
    • costal/ thoracic
    • clavicular
    • mixed
    • combined thoracic and abdominal
  123. Quiet or passive respiration to sustain life invloves __________.
    little muscular movement.
  124. Only the ___ and the ____ move appreciably during quiet inspiration during at-rest breathing.
    diaphragm, external intercostals muscles
  125. _______ is accomplished without muscle movement.
    expiration
  126. The number of breaths per minute is ___ in the infant than in the adult because of lung size differentials.
    GREATER
  127. What is the amount of air inspired and expired during during a typical respiratory cycle. It is determined by the oxygen needs.
    Tidal volume
  128. What is the maximum volume of air that can be inspired beyond the end of a tidal inspiration.
    Inspiratory reserve volume
  129. What is the maximum volume f air that can be expired beyond the end of a tidal expiration.
    Expiration reserve volume.
  130. What is the volume of air that remains in the lungs after a maximum expiration.
    Residual volume
  131. What is the total amount of air that can be expired from the lungs and air passages following a maximum inhalation.
    Vital capacity
  132. __________ tends to decrease with age.
    Vital capacity
  133. What represents the total volume of air that can be held in the lungs and airways after a maximum inspiration.
    Total lung capacity
  134. What is determined by how many vibratory closing and openings (cycles) the vocal folds make in one second.
    Fundamental frequency
  135. __________ results form our perception of fundamental frequency.
    Pitch
  136. A short, thick, lax vocal fold vibrates at a _____ rate, producing a ______ pitch.
    slower, low
  137. A long, thin, tense vocal fold vibrates at a _____ rate, producing a _____ pitch.
    higher, high
  138. The ________, when contracted, stretches and thins the vocal folds and therefor increases fundamental frequency.
    cricothyroid muscle
  139. The ________, when contracted, shortens the vocal folds and therefor decreases fundamental frequency.
    thyroarytenoid muscle
  140. An increase in _______ causes an increase in perceived vocal loudness.
    subglottal pressure
  141. An increase in ______ causes an increase in perceived loudness.
    Vocal fold adduction
  142. Opening the mouth wider will cause and __ in perceived loudness.
    increase
  143. What are subdivisions within the total range of pitches produced by the voice, vocal fold vibratory patterns vary among registers.
    Registers
  144. The acoustic signal produced by the vocal folds would be a weak sounding reedy voice without the additional __________.
    component of resonance.
  145. The larynx is situated at approximately the ____ cervical vertebra, thus creating a resonating chamber to filter and amplify the acoustic signal.
    5th
  146. The _______ is constantly interrupted at various sites from the intrusion and movement of various structures.
    continuous vocal tract tube
  147. Some of the interruptions or constrictions in the vocal tract may be severe such as:
    carrying the tongue high and foward in the oral cavity.
  148. Any movement of the _____, _____, or ______ will greatly alter the opening of the oral caivty.
    mandible, tongue, or velum
  149. Some movement in the vocal tract have __ effect on the voice and some of them _____ the voice.
    NO, filter
  150. What finally comes out of the mouth or nasal cavity becomes a _____ with the ________ fundamental frequency as the vocal source, but _____ modified in its overall sound characteristic.
    complex periodic signal, same, highly
  151. By filtering the _______ we can tell if the person has a cold, is upset or angry, tired, frightened, or the meaning could even be changed by the change in quality or emphasis while saying the same words.
    glottal tone
  152. each persons voice has a unque characteristic, aka:
    voice quality
  153. Resonance does not change ____.
    pitch or loudness
  154. The configuration of the supraglottal vocal tract is ________.
    constantly changing
  155. What happens in any one portion of the tract influences both the ______.
    total flow of air and sound wave through the total tract and the sound that eventually issues out from the mouth or nose.
  156. By action of the pharyngeal constrictors and other supraflottal muscles the overall dimesnions of the pharynx are______.
    always changing.
  157. The membranes of the pharynx and the degree of relaxation or tautness of the pharyngeal constrictors have ________.
    noticeable acoustic filtering effects.
  158. The mouth is essential for ___ as the pharynx.
    resonance
  159. The ______ is capable of the most variation in size and shape.
    oral cavity
  160. The mouths fixed structures:
    teeth, alveolar processes, dental arch, and hard palate.
  161. The mouths moving structures:
    tongue, velum, cheeks, mandible, and lips
  162. The most mobile articulator:
    tongue
  163. The tongue possesses both ____to move it.
    extrinsic and intrinsic muscles
  164. The tongues extrinsic muscles can, on contraction:
    elevate or lower the tongue at its anterior, middle, or posterior points and extend it foward or backward.
  165. The tongues intrinsic muscles control the :
    shape of the tongue by narrowing, flattening, lengthening, or shortening the overall tongue body and elevating or lowering the tongue tip.
  166. The various combinations of intrinsic and extrinsic muscle contractions can produce an unlimited number of __________ with resulting _______ of the oral cavity.
    tongue positions, size-shape variations
  167. The lowering and closing of the ____ contributes to the formation of specific vowels.
    mandible
  168. The _____ and ______ of the velum are also important for the development of normal voice resonance.
    structural adequacy and normal functioning
  169. The elevation and tensing of the velum, as well as some pharyngeal wall movement, are vital for achieving _________.
    velopharyngeal closure
  170. a lack of adequate palatal movement, despite adequacy of velar length, can cause serious problems of _________.
    excessive nasality
  171. THe movement and the positioning of the velum changes the size and shape of three important resonating cavities:
    the pharynx, the oral cavity, and the nasal cavity.
  172. Any alteration of the velum mayhave a profound influence on ________.
    resonance
  173. ________ is only one component contributing to velopharyngeal closure.
    velar movement
  174. Closure patterns that seperate the oral and nasal cavities from one another include:
    velar action coupled by posterior pharyngeal wall movement or velar action with active lateral and posterior wall movement.
  175. Voice disorders result from faulty structure or function somewhere in the vocal tract in the processes of ________.
    respiration, phonation, articulation, and resonance.
  176. We say a voice disorder exists when one or more aspects of voice such as ________ are outside of the normal range for the age, gender, or geographic background of the speaker.
    loudness, pitch, quality, or resonance
  177. Dysphonia means:
    any alteration in normal phonation.
  178. The ________ is concerned with identifying the etiological and pathological aspects for purposes of treatment.
    laryngologist
  179. The ________ uses imagery in an attempt to get the desired acoustical effect from the voice student.
    singing teacher
  180. The __________ has the labratory interest of the physiologist or physicist.
    speech-voice scientist
  181. The ______ uses the knowledge and vocabulary of all three disciplines to bring about voice imporvement throught treatment of voice.
    speech-language pathologist
  182. The ________ assesses the dynamics of voice production and uses whatever is neccessary to get the best voice.
    voice and diction teacher
  183. ASHA affirms the practive of visualization of the larynx by both __________.
    otolaryngologists and speech language pahtologist.
  184. _______ and ________ is within the scope of practice for SLP's.
    laryngeal visualization and imaging
  185. _______and ________ rarely contribute to changes in voice, but they may have negative effects on articulation.
    lip and intraoral cancers
  186. extensive oral lesions invlolving the tongue or palatal and velar cancer can seriously affect:
    articulation, vocal resonance, and swallow.
  187. Partial or total removal of the tongue?
    glossectomy
  188. Identified causes of oral cancer include:
    smoking, use of smokeless tobacco, chronic infections, herpes, repeated trauma to the irritated site, and leukoplakia.
  189. The majority of oral lesions are treated successfully with _________.
    microsurgery and radiation therapy.
  190. The most severe vocal tract malignancies involve the ______.
    larynx
  191. Laryngeal cancer comprises approximately ___ of all malignancies diagnosed annually in the U.S.
    6%
  192. 3 classifications of laryngeal cancers:
    supraglottal, glottal, and subglottal
  193. Extensive cancer requires perhaps?
    a hemilaryngectomy, a supraglottal layngectomy, or a total laryngectomy.
  194. What refers to the failure of cartilage to stiffen with development, resulting in an epiglottis that is too pliable and collapses into the airway?
    laryngomalacia
  195. ______ accounts for 75% of all congenital anomalies of the larynx and is the most prevalent cause of stridor in the neonate.
    Laryngomalacia
  196. In most children with laryngomalacia symptoms are evident _____.
    at birth or within the first few hours or days of life.
  197. laryngomalacia is managed by an ___, who normally confirms the condition using ___.
    otolaryngologist, transnasal fiberoptic layrngoscopy
  198. Children with laryngomalacia rarely present with _________.
    aute airway compromise
  199. It is common for children to outgrow laryngomalacia by _________.
    18 months
  200. Approximately ____ of cases require surgical intervention for laryngomalacia.
    5%
  201. What is the narrowing of the subglottic space?
    subglottic stenosis
  202. Subglottic stenosis can be _____ or ________.
    congenital or acquired
  203. _________ results from an interruption of teh cricoids cartilage or arrested development of the conus elasticus during embryologic development.
    congenital stenosis
  204. _________ may occur following endotracheal intubation either related to lifesaving procedures or surgery.
    acquired stenosis
  205. If the stenosis is severe, air is not exchanged and ___ may be neccessary.
    tracheostomy
  206. What are openings that occur between the esophagus and trachea?
    Tracheoesophageal fistulas (TEF)
  207. TEF is associated with ________ to the developing esophagus.
    vascular compromise
  208. What is an abnormal occlusion of the esophagus?
    esophageal atresia
  209. The standard intervention of TEF is _ followed by __________ by the SLP.
    surgery, voice and feeding therapy
  210. What are small ulcerations that develop on the medial aspect of the vocal processes of the arytenoid cartilages due to irritation?
    contact ulcers
  211. When granulated tissue forms over these ulcer as a protective mechanism, they are called _______.
    contact ulcer granulomas
  212. ____are considered a chronic inflammatory disease of the larynx.
    contact ulcers
  213. _______ are usually bilateral.
    contact ulcers
  214. The typical symptoms of contact ulcers:
    deterioration of voice after prolonged vocalization accompanied by pain in the laryngeal area or sometimes pain that lateralizes to one ear. Hoarse or rough voice quality are also common symptoms.
  215. Contact ulcers result from one of three causes or a combination of these:
    • 1. Hard glottal attack along with throat clearing and coughing
    • 2. laryngopharyngeal reflux (LPR)
    • 3. endotracheal intubation
  216. Contact ulcers are caused by excessive slamming together of the ________ during production of low pitched phonation coupled with excessively _______ and perhaps increased loudness with frequent throat clearing and coughing.
    arytenoids cartilages, hard glottal attack
  217. The speaker is usuallyhard driving person who speaks in a loud controlling ____, often with words punctuated by _______.
    low pitch, sudden onset.
  218. Patients who develop contact ulcers and granuloma due to faulty vocal functioning alone are in the _____.
    minority
  219. In LPR, ______ is forced up the esophagus and exits the upper esophageal sphincter, thus irritating the area between the ______ or the ________.
    stomach acid, arytenoids or the vocal covering.
  220. Patients who have laryngopharyngeal reflux may be treated with:
    anitireflex medications, antacids, diet management, and voice therapy.
  221. Patients with LPR can do behavioral changes such as:
    elevating the head of the bed and reducing the size of meals and eating several hours before going to bed
  222. ______ is when the physician places a tube down the pharynx into the airway, between the open vocal folds, and on into the trachea.
    endotracheal intubation
  223. If the tube is larfer than the glottal opening, the patient runs the risk of______.
    trauma
  224. The tube being too large for the glottal opening is most common in ____ and ___ who have smaller airways and are thus more often traumatized by large tubes.
    women and children
  225. Complications from intubation may not appear immediately, but rather _________.
    develop over time.
  226. No ___ should be inititated until a laryngeal examination is completed.
    voice therapy
  227. If ________ are identified along the posterior glottis, medical-surgical treatment promotes healing and preserves the airway.
    postsurgical granulomas
  228. _______________ sometimes will produce a reactive tissue irritation leading to the formation of granulomas.
    surgery on the vocal folds
  229. THe most common reactive lesion is ____ of the larynx.
    Teflon granuloma
  230. ________ is used to give greater bulk to the paralyzed fold in unilateral adducttor paralysis, permitting better approximation of the normal fold with the paralyzed fold.
    Teflon injection
  231. Other surgical traumas such as _____________, have a possible side effect of the development of reactive tissue granuloma.
    removal of cysts or altering the glottal margin
  232. Surgically induced irritation with resulting granuloma require _________ of the problem.
    medical-surgical resolution
  233. Any inflammatory disease of the larynx, such as tuberculosis, syphilis, or sarcoidosis, can lead to ________. This may produce voice symptoms.
    granulomatous tissue changes.
  234. ______- is the overall management of voice problems related to inflammatory disease.
    pharmacologic
  235. What is the focus of voice therapy for patients with contact ulcers and/or granuloma?
    To take the effort out of phonation.
  236. A patient with contact ulcers and/or granulomas must learn to use a voice pitch that can be prodcued with relatively little strain, to speak with __ jaw and mouth relaxation, to speak at _____ levels of volume, and to eliminate all traces of excessively ________.
    greater, lower, hard glottal attack.
  237. Are contact ulcers common?
    NO, They comprise about 1% of total voice cases.
  238. Cysts in the larynx usually are ____, occurring on the vocal folds or on the ventricular folds.
    unilateral
  239. The cysts often appears ____________, in contrast to the _______ structure of a vocal nodule.
    soft and pliable; hard, fibrotic
  240. Cysts are often caused by an _____ of the ductal system of laryngeal mucous glands, but there are other causes.
    abnormal blockage
  241. Cysts may be _______.
    congenital or acquired.
  242. The site of lesion of the cysts determines if the patient experiences _______ or not.
    dysphonia
  243. If a SLP identifies any kind of laryngeal lesion they should refer the patient to:
    an otolaryngologist
  244. Cysts ________ resolve spontaneously.
    rarely: They require surgical excision
  245. Postsurgical voice therapy is confined to:
    eliminating any voice compensations that may have been used to minimize negative voice effects caused by the cyst.
  246. Endocrine changes often cause excesses in __________, so that an individuals voice is either too high or too low in pitch.
    fundamental frequency
  247. IN ______ of the pituitary gland, laryngeal growth is retarded.
    hypofunction
  248. A pubescent child who has hypofunction of the pituitary gland will experience a lack of secondary ___________ and a _____________.
    sexual characteristics, continued high voice pitch
  249. highpofunction of the pituitary gland may be treated by:
    endocrine therapy designed to stimulate normal pituitary function.
  250. _________ is caused by some tumors of the pituitary gland. It results in precocious puberty and acromegaly.
    Hyperfunction
  251. Hypofunctioning of the adrenal glands can also contribute to:
    lack of secondary sexual characteristics, including prepubescent voice in males.
  252. Adrenal glands are also known as:
    Addison's disease
  253. ________ of the adrenal glands can be caused by tumors in the adrenal system, producing adrenal hormone excesses. Resulting in:
    Hyperfnctioning, virilization and a deepening of the voice.
  254. _________insufficient secretion of thyroxin by the thyroid gland, can produce increased mass of the vocal folds, which lowers pitch.
    Hypothyroidism
  255. The _____ of hypothyroidism is hoarse, gravelly, and of excessive low pitch. Symptoms can be controlled by:
    dysphonia, thyroid hormone therapy
  256. IN _________ vocal symptoms are less severe, and the patients experience jumpiness and irritability, which result in a breathy voice that may lack sufficient loudness.
    hyperthyroidism
  257. What is characterized by vocal fatigue, reduced high pitch range, hypophonia, and loss of certain harmonics?
    premenstual vocal syndrome
  258. Premenstraul vocal syndrome begins ___ days before menstuation in 33% of women.
    4-5
  259. What is the time when some women may experience vocal changes, particulary a lowering of fundamental frequency?
    menopause
  260. Because of the secretion of excessive androgenic hormones after the menopause, the glottal membrane becomes _______, increasing the size-mass of the folds, and producing a lowering of pitch and sometimes vocal roughness.
    thicker
  261. The primary treatment for a hormonal imbalance is:
    hormonal therapy
  262. What can help the patient develop the best voice possible with the changing mechanism?
    voice therapy
  263. What are similar to contact ulcers and granulomas, differing only in type of lesion.
    Hemangiomas
  264. A ___________ usually is a firm granulated sac, a ____________ is a soft, pliable, blood-filled sac.
    granulomas, hemangioma
  265. Like granulomas, hemangiomas often occur on the ________, frequently associated with vocal hyperfunction, hyperacidity, or intubation.
    posterior glottis
  266. The blood-filled lesion should be removed ______. As soon as glottal healing permits a _______ should be initiated.
    surgically with cold steel or laser.

    vocal hygeine program and voice therapy

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