therapy

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therapy
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2013-11-25 17:50:43
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therapies
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  1. Tx for functional falsetto
    • -Symptomatic: hard glottal attack (a,e,i,o,u / stretch vowels long phrases)
    • -Pscychogenic  ( VFE, forward focus) 
    • -Desensitization program: who to talk to first? offer explanation, do you have another voice?
  2. What do VFE's and RVT do?
    -improve laryngeal muscle control, strength, stamina

    -balance airflow, laryngeal muscle activity and resonance
  3. MTD?
    • -vocal fatigue, stressed pressure
    • -pain in head, neck, and shoulder areas
    • -glottal fry
    • -globus sensation
    • -decreased pitch range
    • -Hoarseness
    • -swollen glands, lumps
  4. Symptoms & TX for Chronic Cough
    • -No meds causing cough
    • -Med tests-negative
    • -LPR isn't an issue
    • -Laryngeal hypersensitivity  ( forced inhalation causes enough, normal drainage causes cough) 
    • -Tx: hygiene, hand clapping example, forceful swallow, hydration ( room temp water)
  5. TX for unilateral cyst?
    • -refer to ENT to diagnose and remove
    • -follow up after surgery 
    • -Hygienic
    • VFE's and RVT
  6. Unilateral Cyst?
    • -caused by blocked mucous gland or vocal abuse
    • - hoarseness
    • -dysphonia or aphonia
    • -fatigue after talking
    • -decreased loudness
    • -stiff ( diff. btwn nodules)
  7. Strobe findings of unilateral RLN paralysis?
    • -paralyzed fold
    • -loss of tone 
    • -contralateral fold add/abd normally 
    • -glottic closure is dependent on paralyzed VF
    • -phase closure & phase symmetry affected
  8. Alternative questions for functional falsetto?
    Do you have another voice?
  9. Voice symptoms of SLN paralysis?
    • -may not be noticeable in connected speech
    • -not  mobility issuer, CT issue
    • -pitch control & range affected (esp upper range)
    • -vocal fatigue
    • -Inability to get loud 
    • -breathy, mild hoarseness

    • *look@ folds, not arytenoids
    • *If internal & external branch of SLN involved, swallowing affected
  10. Psychogenic voice disorders and management stages for all types?
    • -Conversion aphonia/dysohonia, MTD, Fx Falsetto, Juvenile Voice, paradoxical VF mvmt
    • - 1. Medication eval/ rule out organic pathology
    •   2. diagnostic voice eval (history, rational, prep for change)
    •   3. Direct manipulation of voice
    •   4. Counseling
  11. Behavioral, Medical & Surgical Management of RLN paralysis (unilateral)
    • -Behavorial: good if overcome glottal insufficiency 
    • -Medical: injection
    • -Surgical: thryoplasty ( pushing VF over in median position)
  12. Additional diagnostic questions? ( for hygiene VF)
    • -How does the child shout?
    • -Why does the child shout?
    • -Does non-play shouting occur?
    • -Does the child make vocal noises?
    • -Has the laryngeal pathology created physiologic imbalance?
    • -Has the laryngeal pathology created physiologic imbalance? 
    • -Does habitual throat clearing occur?
  13. Polypoid degeneration?
    • -SOB
    • -"rough" voice 
    • -hoarseness, husky 
    • -effortful voice production
    • -normally middle-aged female
    • -Long time smoker & other unhygienic habits, vocal abuse
    • - may have had previous surgery; but unsatisfied w/ results 
    • -VF infiltrated w/ thick, gelatinous fluid 
    • -glottic closure usually complete 
    • -lower pitch
  14. If physiologic imbalance has ben created, what therapy should be used?
    • -VFE
    • -RVT
  15. Tx or adult vocal nodules?
    hygiene: shouting education, initiate intake of more water

    RVT & VFE
  16. Vocal Nodules of Adult?
    • -women more likely to get 
    • -abuse/misuse
    • -throat clear/cough a lot 
    • -feel fatigued by end of day
    • -experience periods of dysphonia 
    • -Laryngeal area of muscle tension(compensation may lead to hyper fx)
  17. How should you shout?
    • -low pitch to decrease adductory impact of VFs
    • -adequate breath support
    • -extreme forward focus to decreased laryngeal tension
    • -shortening VF's allow them to sustain the impact better
  18. Tx for presbylaryngeus?
    • -hydration
    • -VFE's
  19. Ventricular phonation?
    • -dysphonic
    • -harshness
    • -vocal fatigue 
    • -worse throughout the day
    • -decrease loudness & intensity
  20. Presbylaryngeus?
    • -vocal fatigue
    • -difficulty projecting voice
    • -breathiness
    • -hoarseness 
    • -laryngeal ache
    • -lack of clarity in voice 
    • -hyponasal resonance 
    • -strained voiced
    • -possible visible tension
  21. Tx for ventricular phonation?
    • VFE
    • RVT
    • hygiene
  22. Summary/ Outline for Vocal hygiene plan?
    • 1. ID phonotrauma
    • 2. describe the effect
    • 3. define specific occurrences
    • 4. modify the behavior
  23. Unilateral left VF paralysis?
    • -breathy
    • -hoarse
    • -weak couldn't talk loud or for long periods of time
    • -possible swallowing problems ( "strangling" on water)
    • -monopitch 
    • -diplphonia 
    • -inability to control voice
    • -difficulty breathing during exertion
    • -inhalatory stridor 
    • * damage to RLN during surgeries ( cervical spine)
  24. Essential Voice Tremor?
    • -mvmt disorder characterized by rhythmic tremors that may involve head, arms, neck, larynx ( consistent rhythmic, modulations) 
    • -evident on sustained vowels in laryngeoscopic exam 
    • -regular waver of pitch & intensity 
    • -onset: 5th/ 6th decade of life
    • -more common in female/ may be hereditary
  25. Follow-up questions for PVFD?
    • -How long has pt had breathing difficulty?
    • -How frequent do episodes occur?
    • -Any other assistance sought by patient?
    • -How long do episodes persist?
    • -What are stressors in pt's life?
    • -Victim of verbal, emotional, sexual, abuse
  26. SD treatment?
    • -Botox 
    • -doesnt respond to voice therapy
    • - ADSD: inject into vocals muscle
    • -ABSD: botox into PCA ( 1 side) 
    • -VFE ( to reduce subsequent hyperfx)
    • -RVT 
    • -easy onset therapy
    • -watch for swallowing problems immediately following injection
    • -
  27. Contact Granuloma?
    • laryngeal pai/discomfort
    • -possible globular sensation
    • -hoarse/breathy 
    • -restricted pitch range
    • -vocal fatigue (leaking air)
    • -initial complaints: sore throat or ear pain
    • -Caused by: laryngeal intubation, LPR, voice misuse
  28. Abductor Spasmodic Dysphonia?
    • -spasms interrupt phonation w/ sudden involuntary periods of aphonia, accompanied by sudden burst of air as VF abduction
    • -involuntary breaks & intermittent aphonia
    • -breathy phonation
    • -decreased loudness
    • -voice onset= normal, spasms w/ continued speech
  29. Vocal nodules tx for child?
    hygiene ( yelling properly)

    VFE's and RVT
  30. Vocal nodules child?
    • -typically loud kid, screamer, anger in play
    • -rough strain and breathy from lack of glottic closure
    • -habitual loudness
    • -intermittent aphonia, voice breaks, pitch breaks
    • -lower pitch
    • -sports
  31. Adolescent PVFD?
    • -mistimed laryngeal valving disrupting respiration
    • -10 to 20 yrs old
    • -good student
    • -involved and successful in extracurr
    • -often sports related
    • -reaction to unacceptable level of stress or laryngospasms ( noxious stimuli)
    • ** no voice disorder-doesn't alter acoustics of voice
  32. Functional Falsetto?
    • -vocal fatigue, voice breaks
    • -no voice change during puberty
    • -slight breathiness
    • -high pitch, weak
    • -strained
    • - little intensity/pitch range
    • -high risk for hearing impaired
  33. Tx of Chronic Laryngitis?
    • -counseling for management for LPR
    • -RVT
    • -VFE
    • -surgery to shape up tissue
  34. Tx of Unilateral left VF Paralysis?
    injection

    VFE, RVT, hygiene
  35. Dx of spasmodic dysphonia?
    • -auditory perceptual features: task specificity
    • - laryngoscopic signs
    • -middle adult years
    • -more common in females
    • -no spasms during vegetative fx
    • -differentiate from MTD by SD is filled with voice breaks when hold out /ah/
  36. ABSB perceptual findings?
    voiceless sounds

    #60-70
  37. ADSD perceptual findings?
    • voiced contexts
    • #80-90
  38. Tx for functional falsetto?
    • -symptomatic: hard glottic attack (a,e,i,o,u/ stretch vowels, long phrases)
    • -VFE
    • -forward focus
    • -desensitization program 

    Do you have another voice?
  39. MTD TX?
    psychogenic: how emotions & how they feel influences the voice

    - VFE & RVT
  40. Differential dx for functional falsetto?
    -Have pt shout

    ( can't shout with fx falsetto)
  41. LPR?
    • -overweight,
    • -throat tickles/ pinpoint pain
    • - fatigue
    • -lump in throat
    • -hoarse in morning
    • -chronic throat clearing
    • -globus sensation
    • -tightness in chest
    • -increased drainage
    • -swallowing difficulty
  42. PVFD Tx?
    • -family doc usually dx asthma, so need to be aware
    • -pulmonologist ( 1. laryngeal control tx; 2. outside counseling)
    • -SLP: educate that larynx is problem,
    • --bring volitional control over the larynx ,
    • --alter habits ( don't run after eating, don't go to bed right after eating)
    • --biofeedback and negative practice
    • --
  43. Chromic Laryngitis?
    • -caused  by LPR w/ MTD and smoking 
    • -decreased loudness
    • -strained w/ hoarseness
    • -Etiologic factors: shouting, talking over noise, personal stress, LPR
    • -
  44. TX for SLN paralysis?
    • educate on pitch
    • VFE and RVT
  45. Tx of polypoid degeneration?
    • -Hygienic: post-op to use new voice correctly
    • - psychogenic: educate on emotional issues connected to voice (pre therapy)
    • - VFE, RVT
    • -pre-op therapy to inform of pitch and quality change
    • -surgery to get fluid out
  46. ADSD?
    • -hyperadduction
    • -strained and strangled Vocal quality
    • -pitch and voice breaks
    • -unable to shout 
    • -physical fatigue, tightness of neck
    • -compensate: whisper or phonate on inspired air 
    • *more common of the SD
  47. Tx for Contact Granuloma?
    • -ENT for medical tx   ( non surgical)
    • -hygiene ( elimination of strain & pressed voice)
    • -VFE , RVT 
    • - anti-reflux meds
  48. Dx of SLN Paralysis?
    • -unilateral lesion: scissoring effect
    • -incomplete glottic closure
    • -bilateral: lack of stretch on pitch increase
    • -tilt toward weaker side ( anti commisure to stronger side)
  49. TX for LPR?
    • -vocal hygiene ( diet mod, hydraion)
    • -direct voice re-education ( confidential voice=restricted voice use, amplification)
    • -VFE ( balance systems)
    • -RVT: (  lower hyperfux, posturing & slight glottal attack)
    • -Educate on silent reflux

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