therapy

• -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?

-improve laryngeal muscle control, strength, stamina

-balance airflow, laryngeal muscle activity and resonance

• -vocal fatigue, stressed pressure
• -pain in head, neck, and shoulder areas
• -glottal fry
• -globus sensation
• -decreased pitch range
• -Hoarseness
• -swollen glands, lumps

• -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)

• -refer to ENT to diagnose and remove
• -follow up after surgery 
• -Hygienic
• VFE's and RVT

• -caused by blocked mucous gland or vocal abuse
• - hoarseness
• -dysphonia or aphonia
• -fatigue after talking
• -decreased loudness
• -stiff ( diff. btwn nodules)

• -paralyzed fold
• -loss of tone 
• -contralateral fold add/abd normally 
• -glottic closure is dependent on paralyzed VF
• -phase closure & phase symmetry affected

Do you have another voice?

• -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

• -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

• -Behavorial: good if overcome glottal insufficiency 
• -Medical: injection
• -Surgical: thryoplasty ( pushing VF over in median position)

• -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?

• -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

• -VFE
• -RVT

hygiene: shouting education, initiate intake of more water

RVT & VFE

• -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)

• -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

• -hydration
• -VFE's

• -dysphonic
• -harshness
• -vocal fatigue 
• -worse throughout the day
• -decrease loudness & intensity

• -vocal fatigue
• -difficulty projecting voice
• -breathiness
• -hoarseness 
• -laryngeal ache
• -lack of clarity in voice 
• -hyponasal resonance 
• -strained voiced
• -possible visible tension

• VFE
• RVT
• hygiene

• 1. ID phonotrauma
• 2. describe the effect
• 3. define specific occurrences
• 4. modify the behavior

• -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)

• -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

• -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

• -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
• -

• 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

• -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

hygiene ( yelling properly)

VFE's and RVT

• -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

• -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

• -vocal fatigue, voice breaks
• -no voice change during puberty
• -slight breathiness
• -high pitch, weak
• -strained
• - little intensity/pitch range
• -high risk for hearing impaired

• -counseling for management for LPR
• -RVT
• -VFE
• -surgery to shape up tissue

injection

VFE, RVT, hygiene

• -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/

voiceless sounds

#60-70

• voiced contexts
• #80-90

• -symptomatic: hard glottic attack (a,e,i,o,u/ stretch vowels, long phrases)
• -VFE
• -forward focus
• -desensitization program 

Do you have another voice?

psychogenic: how emotions & how they feel influences the voice

- VFE & RVT

-Have pt shout

( can't shout with fx falsetto)

• -overweight,
• -throat tickles/ pinpoint pain
• - fatigue
• -lump in throat
• -hoarse in morning
• -chronic throat clearing
• -globus sensation
• -tightness in chest
• -increased drainage
• -swallowing difficulty

• -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
• --

• -caused  by LPR w/ MTD and smoking 
• -decreased loudness
• -strained w/ hoarseness
• -Etiologic factors: shouting, talking over noise, personal stress, LPR
• -

• educate on pitch
• VFE and RVT

• -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

• -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

• -ENT for medical tx   ( non surgical)
• -hygiene ( elimination of strain & pressed voice)
• -VFE , RVT 
• - anti-reflux meds

• -unilateral lesion: scissoring effect
• -incomplete glottic closure
• -bilateral: lack of stretch on pitch increase
• -tilt toward weaker side ( anti commisure to stronger side)

• -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