SLP Voice Disorders & Treatment 3 — Questions and Answers
Question 1: A patient with a history of GERD presents with globus sensation, throat clearing, and mild dysphonia. Laryngoscopy reveals posterior commissure erythema and interarytenoid edema. This presentation is most consistent with:
- Muscle tension dysphonia
- Laryngopharyngeal reflux (Correct answer)
- Infectious laryngitis
- Contact granuloma secondary to intubation
Correct answer: Laryngopharyngeal reflux
Laryngopharyngeal reflux characteristically causes posterior laryngeal erythema, interarytenoid edema, globus, and chronic throat clearing.
Question 2: Which instrumental assessment provides the MOST direct visualization of vocal fold mucosal wave dynamics during phonation?
- Acoustic analysis with Praat
- Videostroboscopy (Correct answer)
- Electroglottography (EGG)
- Aerodynamic phonation threshold pressure measurement
Correct answer: Videostroboscopy
Videostroboscopy uses a strobe light synchronized to vocal frequency to create apparent slow-motion images of mucosal wave motion.
Question 3: A 45-year-old teacher with muscle tension dysphonia demonstrates elevated laryngeal position and hard glottal attacks. Which therapy approach is LEAST appropriate as a starting point?
- Confidential voice
- Yawn-sigh technique
- Pushing/pulling exercises (Correct answer)
- Chant-talk
Correct answer: Pushing/pulling exercises
Pushing/pulling exercises increase laryngeal muscle tension and are contraindicated in muscle tension dysphonia where hyperfunction is already the problem.
Question 4: Phonation threshold pressure (PTP) is defined as:
- The maximum subglottal pressure achievable during loud phonation
- The minimum subglottal air pressure needed to initiate and sustain oscillation (Correct answer)
- The pressure differential across the glottis at modal register
- The intraoral pressure during bilabial stop consonant production
Correct answer: The minimum subglottal air pressure needed to initiate and sustain oscillation
PTP is the minimum lung pressure required to set vocal fold tissue into oscillation and is sensitive to changes in vocal fold hydration and stiffness.
Question 5: Botulinum toxin injection for adductor spasmodic dysphonia is typically administered into the:
- Cricothyroid muscle
- Thyroarytenoid/lateral cricoarytenoid muscles (Correct answer)
- Posterior cricoarytenoid muscle
- Interarytenoid muscle
Correct answer: Thyroarytenoid/lateral cricoarytenoid muscles
Botox is injected into the thyroarytenoid (and sometimes lateral cricoarytenoid) muscle to weaken hyperadduction spasms in adductor spasmodic dysphonia.
Question 6: A child with bilateral vocal fold nodules and a hyperfunctional voice pattern would MOST benefit from which initial treatment approach?
- Phonosurgery to remove nodules
- Indirect voice therapy addressing vocal hygiene and vocal load (Correct answer)
- Botulinum toxin to cricothyroid muscle
- Tracheotomy to rest the larynx
Correct answer: Indirect voice therapy addressing vocal hygiene and vocal load
Pediatric vocal fold nodules typically resolve with indirect therapy focused on reducing vocal misuse, improving hydration, and decreasing vocal load.
Question 7: The s/z ratio is used clinically to identify:
- Respiratory volume adequacy
- Glottal insufficiency affecting phonation relative to airflow (Correct answer)
- Nasality in resonance disorders
- Tongue strength for articulation
Correct answer: Glottal insufficiency affecting phonation relative to airflow
An s/z ratio greater than 1.4 suggests the patient can sustain /s/ (airflow only) significantly longer than /z/ (voicing required), indicating glottal inefficiency.
SLP Voice Disorders & Treatment 3
A patient with a history of GERD presents with globus sensation, throat clearing, and mild dysphonia.
Laryngoscopy reveals posterior commissure erythema and interarytenoid edema.
This presentation is most consistent with: