Linguistics Exam 1 Speech Disorders

2. 3 Main Causes of Voice Disorders

- Misuse/abuse

- Physical trauma/accident (inc.surgical)

- Disease, including neurologicalconditions (focal, systemic, focal that become systemic) (also organic, functional & psychogenic)

3. 3 Main Options for

Sound Source After Laryngectomy

artificial larynx, esophageal speech, tracheoesophageal puncture

4. 3 Types of Spasmodic Dysphonia

adductor, abductor, mixed

5. Abductor Spasmodic Dysphonia

rarest, spasms of the abductor muscles

6. Adductor Spasmodic Dysphonia

80-90% of cases, spasms of the adductor muscles

7. ARBD

Alcohol-Related Birth Defects (malformations in the skeletal and major organ systems

8. ARND

alcohol-related neurodevelopmental disorder (functional or cognitive impairments)

9. artificial larynx

- buzzer held to throat above stoma

10. artificial larynx advantages

works instantly, no learning

11. artificial larynx disadvantages

- poor sound quality, limitedvariation in sound, must be held, must have batteries, buzz is loud & speech is quiet

- BUT technologies are improving

12. Assessment/Diagnosis of SD

clients often are repeatedly misdiagnosed

14. Cancer Basics

- cells designed to perform certain functionsundergo changes that tend to include

-- uncontrolled growth

-- a tendency to invade nearby tissues

-- a tendency to travel (metastasize) to other systems/areas

- the problem is, essentially, that ifnonfunctional cells take over then the invaded tissues cannot preform their required function

15. chemotherapy

less common & less effective as a specific treatment for the laryngeal cancer itself (may be used to shrink a tumor or to fight metastases or lymph node involvement)

16. cleft lip, cleft palate, and cleft lip and palate

when combined, are the second most common congenital problem in human live births (depending on how you count! ACPA says first by dividing up some heart conditions that most professionals lump together and count as first)

27. fetal alcohol syndrome

leading known cause of nonhereditary mental/cognitive problems and birth defects

28. Focal

Specific to the larynx - example:

spasmodic dysphonia

29. Focal that Becomes Systemic

CANCER!

30. How is each function achieved after total laryngectomy?

- safe breathing

--- through stoma, directly from neck to lungs

--- air does not flow through mouth or nose

31. How is each function achieved after total laryngectomy? (safe swallowing)

- safe swallowing

-- the closes to normal of the 3; from mouth through esophagus to stomach

-- no need to close trachea at the larynx with each swallow bc the trachea and esophagus have been permanently decoupled

32. How is each function achieved after total laryngectomy? (voice production)

not possible; sound source has been removed

- basic need/solution is to make something else vibrate to serve as the sound source for speech; that air is then shaped by the

resonating cavities of mouth & nose

33. if the cellular changes or a mass causes swelling or impinges on sensory nerves, then voice or other symptoms may include...

pain, scratchy throat, feeling of lump or "something" in throat

34. if the mass interferes with breathing or vibration on Inhalation, then voice symptoms will include

STRIDOR

18. CNS problems

cognitive disabilities, learning disabilities, short attention span, hyperactivity, poor fine and perceptual motor development

19. COMPLEXITY

THESE 4 PIECES ARE NOT

NECESSARILY CORRELATED

- laryngeal can be painless and soundfine

- your voice after a football game canbe painful and almost aphonic - the client might like her voice that way, even if the clinician would describe it as clearly anatomically,

physiologically, and perceptually abnormal

20. CURRENT treatments for SD

botox injections to weaken the affected muscles

- usually the main muscle in the center of the vocal folds, bc most cases are ADDuctor type

21. distal skeletal malformations

used, webbed, absent toes/fingers

22. esophageal speech

patient learns to use air from esophagus/stomach to vibrate tissue at back of pharynx

23. esophageal speech advantages

hands free, no device needed

24. esophageal speech disadvantages

limited sound quality, limited duration of vibration, not all clients learn to direct air correctly

25. facial abnormalities

cleft palate, micrognathic jaw, skin webbing b/w eyes and base of nose

17. - cleft lip & palate as a example of the need for a (large!)

management team

- pediatrician - or other coordinator- surgeons - multiple surgeries over many years

- dentists - multiple stages/surgeriesover many years

- otolaryngologist - ear/hearingproblems are common, especially if mandibular growth was also incomplete

- psychiatrist/psychologist/counselors - for parents and then for older children

- SLPs - for early feeding, then forprimary and secondary speech problems

42. Misuse/Abuse Voice Disorders

Causes

- overuse/extended use of voice- hard glottal attacks, screaming and/or yelling

- extended use outside of physiologicalpitch range

- smoking; exposure to smoke or otherairborne irritants

- excessive dryness/dehydrationexcessive coughing, throat clearing - any of these in an amount that is otherwise or typically not problematic,

but in the presence of existing edema or irritation

43. Misuse/abuse voice disorders

CAUSES?

INFLAMMATION

- inflammation changes vibration, creatingtemporary or intermittent hoarseness, breathiness, loss of voice - inflammation can be painful

- EXAMPLES: acute laryngitis, chroniclaryngitis

44. misuse/abuse voice disorders continued inflammation can cause

nodules or polyps

45. Misuse/abuse Voice Disorders

Most Common In

- school-age boys, teen-age girls

- women aged 20-50

- occupations with heavy voice use,especially in loud environments, poor airquality environments, absence of training or technology, combination with alcohol

46. Mixed

Spasmodic

Dysphonia

spasms of both adductor and abductor muscles

47. Neurological

Voice Disorders

- focal, systematic, focal that becomes systematic

36. Isolated cases often have no known cause,

but

- some medications taken before or during pregnancy are known to cause cleft lip and/or cleft palate (Accutane is a big one) - suspected causes or risk factor for cleft lip and cleft palate include maternal smoking, diabetes, and alcohol (but

alcohol is a better example for

SYNDROMIC)

37. ISOLATED vs SYNDROMIC cleft lip, cleft palate & cleft lip & palate

Most cases are ISOLATED - child has no other problems

38. ISOLATED vs.

SYNDROMIC cleft lip, cleft palate & cleft lip & palate

about 20% of cases are part of a known larger syndrome, many of which involve a heart condition (look back at the embryos - pre-heart cells are surprisingly close to pre-facial cells

syndromes can be

- genetic: velocardiofacial syndrome

- teratogenic: fetal alcohol syndrome

39. Laryngeal Cancer

Diagnosis & Outlook

relatively high 5 & 10 year survival rates

(67% & 61%)

- best outcome is for glottic (start in the

VF) cancers that are caught as T1N0M0 (caught early bc they cause voice symptoms early)

40. laryngeal cancer symptoms

if the cellular changes affect the vocal folds or the muscles that move them, then voice symptoms will include..

- hoarseness (harsh/effortful + breathy)

- breathiness

- low pitch

- reduced volume ("weak" voice)

54. possible symptoms in

FAS

- cognitive disabilities, learning disabilities,

behavioral problems

- distal skeletal malformations

- facial abnormalities

- organ deformities

- central nervous system problems cognitive disabilities, learning disabilities,

short attention span, hyperactivity, poor fine and perceptual motor development

55. Prevention of Laryngeal Trauma

- wear seatbelts & drive safely

- wear protective gear in any relevant sportor activity; enforce rules & follow routines/policies intended to protect participants from injury

56. PREVENTION of

Misuse/Abuse

Voice

Disorders

Primary Prevention: Awareness & Control of

Voice Use

- vocal loudness

- pitch

- amount of talking

- air quality (self-imposed or environmental) - hydration -- and exactly what is the water doing?

57. primary or obligatory:

inevitable, given the anatomy or physiology of an unrelated cleft

-- hypernasality

-- no stop consonants (except glottal)

58. radiation/ radiotherapy

for earlier cancer, effective with earlier cancer stages, & effects on voice vary (may be none & may cause even more voice problems)

49. organ deformities

congenital heart disease, kidney & urinary defects

50. Outcomes in FAS

much more likely among adults with FAS than for other adults: - unemployment & underemployment

- alcohol abuse themselves - continuing effects of physical, cognitive, and other primary issues

51. Parkinson's Disease

- a systemic disorder/condition that affects both voice and speech

-- decreased loudness

-- monotone

-- vocal tremor

-- hoarseness

-- rapid rate of speech

-- reduced articulatory precision

its an example of HYPOKINETIC

DYSARTHIA

52. Patients with

Laryngeal Trauma May Also Have

- closed head injury

- open head or neck injury

- cervical spine fracture

- esophageal injury

67. surgery

-removal of the affected tissue & surrounding tissue

- ideal is to remove ALL tissue affectedby cancer, plus a clean corder, and reconstruct to create a structure that can achieve all of the following:

- normal breathing

- normal laryngeal closure for safe

swallowing

- normal voice production

68. SURGICAL

COMPLICATION

removing just the affected tissue can often be WORSE than removing the entire larynx

- so more often than might otherwise be indicated JUST by the cancer, the surgery has to be a TOTAL laryngectomy

-- removal of the entire larynx and extra laryngeal muscles with major reconstruction that achieves functional

crashing & swallowing and ZERO

VOICE

69. SYMPTOMS of Unilateral VF paresis/paralysis

-breathy voice

-higher frequency/pitch

-diplophonia

-reduced volume

-coughing

70. syndromes can be

- genetic: velocardiofacial syndrome

- teratogenic: fetal alcohol syndrome

71. Systemic

System-Wide: parkinsonism

72. T1 & T2 cancers might have no symptoms & number stage 0-2

might have no symptoms

and the symptoms that do occur are not specific for cancer, and are similar to the symptoms that a person who has smoked for decades, so they are often ignored for a long time

73. tracheoesophageal puncture

SIMPLEST: a one way valve allows air from the trachea (in front) to enter the esophagus (in back) when the patient covers the stoma from the outside - air is then forced through the valve into the esophagus and causes the back of the pharynx to vibrate

60. secondary or compensatory

the result of attempted and potentially unnecessary compensation

- ex- learned substitution of glottal stops for other consonants may persist even after cleft is repaired

-- speech therapy is very effective w secondary problems if the anatomy now supports typical production physiology awareness and teaching

61. SECONDARY

PREVENTION of

Misuse/Abuse

Voice Disorders

awareness of, and acting on, warning signs - pain

- reduced vocal strength (weak voice) - changes in voice quality (pitch, breathiness)

-- multiple temporary episodes DO predict future permanent damage

62. SLPs role in early feeding

SLPs in pediatric medical settings work w nurses and lactation consultants to help new parents accommodate their baby's needs

- depending on the location & extent of the cleft, feeding might require changes in positioning (ex - upright) or equipment

(larger hole, palatal "obdurator")

63. SLPs Role in Speech: 2 Types of Speech Problems

1. primary or obligatory

2. secondary or compensatory

64. Spasmodic Dysphonia

A Focal dystonia

- a disorder of muscle tone, usually hypertonicity, limited (almost) exclusively to the larynx

65. Staging Cancer Stages

- stage 0: early mucosal involvement only

- stage 1: small, top layers of tissues only

- stage 2: invaded other parts of larynx

- stage 3: invaded throughout larynx and

VF cannot move normally

- stage 4: advanced; 4a & 4b metastasesto lymph nodes, 4c metastases to other organs/systems

75. Traumatic Injuries to Larynx

- throat-crushing or throat-piercing injuries can damage or Destroy the larynx or any of its parts or innervation --- motor vehicle accidents (one of the few MVA injuries where cars are worse than motorcycles: car, 40%; motorcycle, 25%)

--- sports injuries (20%)

--- other blunt injuries (assault, suicide attempts, fighting, or occupational accident)

76. Traumatic Injuries to Larynx - Focus

- Emergency care will focus on life first,with no immediate concern for voice - surgical repair will then focus primarily on life with some concern for voice if possible

- vocal substitution, support, orrehabilitation occurs in stages to provide alternative means of communication (writing) or alternative sound source ( artificial larynx) as the patient heals and then to optimize residual function as physical healing progresses and stabilizes

77. Traumatic Injuries to Larynx - Who's More Likely?

- females are more likely to be hurt bythe same activity or accident (longer, thinner necks)

- but males are more likely toparticipate in the relevant activities, occupations or pursuits

- so almost 80% of patients withsignificant laryngeal trauma are male

78. Treatment Options for Laryngeal Cancer

chemotherapy, radiation/radiotherapy, & surgery

79. treatments for SD

historically: psychological, nerve resection

80. TWO methods of staging cancer

1. TNM system: tumor, node, metastasis

- N0: no lymph nodes affected- N1, N2a, N2b, N2c: affected node(s), distinguished by size & side (ipsilateral vs. contra- or bilateral)

- N3: at least one lymph node affectedand larger than 6 cm across

82. unilateral incomplete cleft

lip

A cleft on one side of the lip that does not extend into the nose

83. Unilateral or Bilateral Vocal

Fold Paresis or

Paralysis

- iatrogenic: up to 10% of VF paresis/paralysis is caused by a surgical injury to RLN

--- anterior cervical spine infusion, thyroidectomy, pacemaker placement, lung resection, brainstem surgery - other damage to vagus nerve is common from accident, disease or as a complication

84. velocardio facial syndrome

- one of the more common syndromesassociated w cleft lip & cleft palate - genetic (22q11.2 deletion; 90%

spontaneous)

- VELO: velum, cleft of the secondarypalate

- CARDIO: heart anomalies

- FACIAL: long, flat face; long nose wsmall nasal bridge; small mouth - often involves learning disabilities or

other cognitive conditions

85. velocardiofacial syndrome may include

submucosal clefts & velopharyngeal incompetence

86. velopharyngeal incompetence

subtle or inconsistent problems w nasa resonance