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Introduction to Management

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  1. Introduction to Management SPPA 6400 Voice Disorders - Tasko

  2. What do we want from a voice therapy approach? SPPA 6400 Voice Disorders - Tasko

  3. We want therapy that is … • Effective • Safe • Rational • Efficient SPPA 6400 Voice Disorders - Tasko

  4. How do we measure effectiveness? SPPA 6400 Voice Disorders - Tasko

  5. General Approaches to Management of Voice Disorder • Behavioral vs. Medical vs. Surgical • Focused vs. Broad spectrum approaches SPPA 6400 Voice Disorders - Tasko

  6. Voice Therapy: General Principles • Inform & educate patient • Provide feedback • Seek feedback • Model techniques • Gradual, step-wise presentation of concepts • Evaluate therapeutic session SPPA 6400 Voice Disorders - Tasko

  7. Prognostic Factors • Patient recognition of the problem • Motivation to participate in therapeutic activities (“DO” activities) • Motivation to refrain from certain activities (“DON’T” activities) • Psychological/emotional issues • Amenability of voice disorder to change • Appropriateness of patient expectation • Laryngeal health/general health SPPA 6400 Voice Disorders - Tasko

  8. A Sampling of Therapeutic Approaches • Vocal Hygiene • Voice Facilitating Techniques • Confidential Voice therapy • Amplification • Respiration-based techniques • Relaxation techniques • Manual Circumlaryngeal Techniques • Techniques to improve glottic closure • Vocal Function Exercises • Resonant Voice Therapy SPPA 6400 Voice Disorders - Tasko

  9. Terminating Therapy • Voice quality acceptable to patient • Elimination of pain, discomfort, fatigue • Habituation of vocal behaviors intended by therapy • Lack of improvement • Lack of compliance SPPA 6400 Voice Disorders - Tasko

  10. Voice Disorders:Organizational Framework • Organic Voice Disorders • Neurogenic Voice Disorders • Functional Voice Disorders SPPA 6400 Voice Disorders - Tasko

  11. Topics Vocal fold structure Factors implicated in vocal fold health Use patterns Irritants Infectious processes Role of hydration Pharmacologic influences Common vocal fold lesions Treatment considerations Behavioral approaches Surgical approaches Disorders with associated vocal fold pathology SPPA 6400 Voice Disorders - Tasko

  12. From Colton et al. (2006) pp. 66 SPPA 6400 Voice Disorders - Tasko

  13. SPPA 6400 Voice Disorders - Tasko From Colton et al. (2006) pp. 66

  14. Vocal use patterns Misuse Abuse/phonotrauma Exposure to Laryngeal Irritants Smoke Alcohol Pollutants Acid reflux Infection Bacterial Viral Improper hydration Medication side effects Unknown sources Why do we get vocal fold pathologies? SPPA 6400 Voice Disorders - Tasko

  15. Some Questions • What is vocal misuse? • What is phonotrauma/vocal abuse? • How do they differ? • Why should we care about these behaviors? SPPA 6400 Voice Disorders - Tasko

  16. Excessive talking Increased muscle tension* & strain Hard glottal attack High laryngeal position A-P laryngeal squeezing ↑ medial compression of TVF Approximation of ventricular folds Ventricular phonation Inappropriate pitch level Puberphonia Persistent glottal fry Lack of pitch variability May be habituated Neurologic disorders Clinical depression tension/strain – “pitch locking” Aphonia/dysphonia of psychological origin Misuse behaviors *can occur as an isolated entity (muscle tension dysphonia) SPPA 6400 Voice Disorders - Tasko

  17. Phonotrauma • Excessive, prolonged loudness • Strained & excessive use during period of swelling, inflammation and other tissue changes • Excessive coughing and throat clearing • Screaming and noise making • Sports and exercise enthusiast • Observer • Participant SPPA 6400 Voice Disorders - Tasko

  18. What is Laryngeal Hyperfunction? • Term applied to frequent vocal use and misuse behaviors SPPA 6400 Voice Disorders - Tasko

  19. Pharmacologic Agents Coordination Fluid Balance Upper airway secretions Laryngeal irritants Common Irritants Alcohol Smoking Fluid Balance Caffeine Alcohol OTC flu/cold/allergy medication Pharmacologic agents and voice SPPA 6400 Voice Disorders - Tasko

  20. Why Hydrate the Larynx? SPPA 6400 Voice Disorders - Tasko

  21. Common Vocal Fold Lesions SPPA 6400 Voice Disorders - Tasko

  22. How might the presence of lesions affect voice production? SPPA 6400 Voice Disorders - Tasko

  23. What is laryngitis? SPPA 6400 Voice Disorders - Tasko

  24. Laryngitis: Acute SPPA 6400 Voice Disorders - Tasko

  25. Cochrane Review (2007) SPPA 6400 Voice Disorders - Tasko

  26. Laryngitis: Chronic SPPA 6400 Voice Disorders - Tasko

  27. Vocal Fold Nodules SPPA 6400 Voice Disorders - Tasko

  28. Vocal Fold Nodules SPPA 6400 Voice Disorders - Tasko

  29. Vocal Fold Nodules SPPA 6400 Voice Disorders - Tasko

  30. Vocal Fold Nodules SPPA 6400 Voice Disorders - Tasko

  31. Vocal Fold Nodules SPPA 6400 Voice Disorders - Tasko

  32. Vocal Fold Polyps SPPA 6400 Voice Disorders - Tasko

  33. Vocal Fold Polyps SPPA 6400 Voice Disorders - Tasko

  34. Vocal Fold Polyps SPPA 6400 Voice Disorders - Tasko

  35. Vocal Fold Polyps SPPA 6400 Voice Disorders - Tasko

  36. Vocal Fold Polyps SPPA 6400 Voice Disorders - Tasko

  37. Vocal Fold Polyps SPPA 6400 Voice Disorders - Tasko

  38. Reinke’s Edema SPPA 6400 Voice Disorders - Tasko

  39. Reinke’s Edema SPPA 6400 Voice Disorders - Tasko

  40. Reinke’s Edema SPPA 6400 Voice Disorders - Tasko

  41. Vocal Fold Cyst SPPA 6400 Voice Disorders - Tasko

  42. Vocal Fold Cyst SPPA 6400 Voice Disorders - Tasko

  43. Sulcus Vocalis SPPA 6400 Voice Disorders - Tasko

  44. Granuloma: Intubation SPPA 6400 Voice Disorders - Tasko

  45. Granuloma SPPA 6400 Voice Disorders - Tasko

  46. Granuloma SPPA 6400 Voice Disorders - Tasko

  47. Contact ulcer SPPA 6400 Voice Disorders - Tasko

  48. Contact ulcer SPPA 6400 Voice Disorders - Tasko

  49. Keratosis (a.k.a. leukoplakia) SPPA 6400 Voice Disorders - Tasko

  50. (Hyper)keratosis SPPA 6400 Voice Disorders - Tasko