Phoniatrics and Voice Disorders Practice Questions

Q: A singer presents with difficulty singing at a high pitch. On examination, bowing of the vocal cord is observed on the right side. Which of the following muscles has likely been compromised?

Cricothyroid. ***Cricothyroid*** - The **cricothyroid muscle** is primarily responsible for **tensioning and elongating the vocal cords**, which is crucial for increasing vocal pitch. - Damage to this muscle or its innervation (superior laryngeal nerve) results in an inability to reach higher pitches and can cause **vocal cord bowing** due to reduced tension. *Posterior cricoarytenoid* - This muscle is the **primary abductor** of the vocal cords, meaning it opens the vocal cords for breathing. - Compromise would lead to difficulty breathing or a paralyzed vocal cord in the adducted position, not bowing with difficulty singing high notes. *Lateral cricoarytenoid* - The **lateral cricoarytenoid muscle** is a **vocal cord adductor** and rotator, bringing the vocal cords together to regulate voice intensity. - Dysfunction typically results in a weak and breathy voice, or difficulty bringing the cords together, not specifically difficulty with high pitch. *Thyroarytenoid* - The **thyroarytenoid muscle** (which includes the vocalis muscle) acts to **relax and shorten the vocal cords**, lowering pitch and modulating vocal cord tension. - Dysfunction would primarily lead to difficulty with lower pitches or a hoarse voice, as it prevents proper relaxation of the vocal cords.

Q: Which of the following principles forms the basis of stroboscopy?

Talbot's law. ***Talbot's law*** - **Stroboscopy** is based on the principle of **flicker fusion** and **temporal integration** described by Talbot's law. - **Talbot's law** states that when light flashes at a frequency above the critical fusion frequency, the eye perceives the average brightness as if the light were continuous. - In stroboscopy, light flashes at a frequency slightly different from the vocal fold vibration frequency, creating the **stroboscopic effect** - an optical illusion of slow-motion or stopped motion that allows detailed visualization of vocal fold movement. - The principle of **temporal integration and flicker fusion** is fundamental to how the stroboscopic illusion works. *Fechner's law* - **Fechner's law** describes the logarithmic relationship between physical stimulus intensity and perceived sensation (S = k log I). - This psychophysical principle relates to how we perceive changes in stimulus magnitude, not to the creation of apparent motion through flickering light. - It does not explain the stroboscopic effect used in laryngeal examination. *Weber's law* - **Weber's law** describes the just noticeable difference (JND) between two stimuli being proportional to the magnitude of the original stimulus. - This principle relates to discrimination thresholds in sensory perception, not to visual illusions of motion. - It is not relevant to the mechanism of stroboscopy. *Stevens' law* - **Stevens' law** proposes a power-law relationship between physical stimulus magnitude and perceived intensity. - While it is an important psychophysical principle, it does not explain the temporal integration and flicker fusion that underpin stroboscopy. - It is an alternative to Fechner's law for describing stimulus-sensation relationships but is not the basis of the stroboscopic effect.

Q: Dysphonia plica ventricularis is produced from:

Ventricular fold. ***Ventricular fold*** - **Dysphonia plica ventricularis**, also known as **ventricular dysphonia** or **false vocal cord dysphonia**, occurs when the **ventricular folds** (false vocal cords) vibrate inappropriately during phonation. - This condition often results in a **hoarse**, rough, or strained voice quality, as the false vocal cords are not designed for regular vibratory function in voice production. *Vocal cord* - The **true vocal cords** are the primary structures responsible for producing sound through precise vibration and approximation during phonation. - Dysphonia originating from the **true vocal cords** would typically be described by terms like vocal fold paralysis, nodules, or polyps, not "plica ventricularis." *Arytenoid* - The **arytenoid cartilages** are crucial in vocal cord movement and tension through their articulation with the cricoid cartilage. - While they influence voice production, they do not directly vibrate to produce sound themselves; rather, they position the vocal cords. *Epiglottis* - The **epiglottis** is a leaf-shaped cartilage that primarily functions to prevent food and liquid from entering the trachea during swallowing. - It plays no direct role in voice generation through vibration; its involvement in phonation is generally limited to resonance or protection.

Q: The primary goal of Type 1 thyroplasty is:

Medialisation of vocal cord. ***Medialisation of vocal cord*** - **Type 1 thyroplasty** (also known as medialization laryngoplasty) aims to push the vocal cord medially, improving vocal cord closure - This procedure is primarily used to treat **unilateral vocal cord paralysis** or paresis, where one vocal cord cannot move sufficiently to meet the other for voice production - By medializing the paralyzed vocal cord, the procedure restores glottic competence and improves voice quality *Lateralisation of vocal cord* - Lateralisation of the vocal cord would worsen a glottal gap and lead to a more breathy voice or aphonia - This is generally not a desired outcome for voice improvement but might be considered in cases of severe airway obstruction (e.g., Type 2 thyroplasty for bilateral vocal cord paralysis) *Vocal cord shortening* - Vocal cord shortening primarily affects pitch, typically lowering it, and is achieved through procedures like cricothyroid approximation or by altering tension - This is not the main goal of Type 1 thyroplasty, which focuses on closure rather than length *Vocal cord lengthening* - Vocal cord lengthening is done to increase vocal pitch, often through procedures that increase vocal cord tension, such as cricothyroid approximation - This is a separate surgical goal from improving vocal cord apposition, which is the aim of Type 1 thyroplasty

Q: Treatment of choice in early vocal nodule is:

Voice rest and speech therapy. ***Voice rest and speech therapy*** - In cases of **early vocal nodules**, conservative management with **voice rest** and **speech therapy** is the primary treatment. - This approach aims to reduce vocal trauma and modify vocal habits, allowing the nodules to resolve naturally without surgical intervention. *Cryotherapy* - **Cryotherapy** involves freezing and destroying abnormal tissue and is not a standard treatment for vocal nodules. - Its application is more common for superficial lesions, such as certain skin cancers or warts, not benign vocal cord growths. *Microlaryngoscopic removal* - Although **microlaryngoscopic removal** is an option for vocal nodules, it is usually reserved for larger, more established nodules that have not responded to conservative measures. - This is an invasive procedure and is not the **first-line treatment** for early-stage nodules where non-surgical methods are often effective. *Radical excision* - **Radical excision** is a surgical technique for removing lesions, but it is not typically applied to vocal nodules. - The term "radical excision" is often used in the context of oncological procedures involving extensive tissue removal, not benign vocal cord lesions.

Q: Which of the following is true regarding Singer's nodule?

It occurs at junction of anterior 1/3rd and posterior 2/3rd. ***Correct: It occurs at junction of anterior 1/3rd and posterior 2/3rd*** **Singer's nodules**, also known as **vocal cord nodules**, are typically found at the junction of the **anterior one-third and posterior two-thirds** of the true vocal cords. This area experiences the most vibratory stress and contact during phonation, making it prone to trauma from vocal abuse, leading to the formation of bilateral benign lesions. *Incorrect: Laser therapy is treatment of choice* **Voice therapy** is the **first-line treatment** for Singer's nodules, aiming to modify vocal behaviors and reduce vocal strain. **Surgery**, including laser therapy or microlaryngeal excision, is reserved for cases that do not respond to conservative voice therapy and when nodules significantly impair vocal function. *Incorrect: Requires excision as its potentially malignant* Singer's nodules are **benign lesions** with no malignant potential. They are not considered premalignant and do not undergo malignant transformation. Surgical excision is considered only if voice therapy fails after adequate trial and the nodules continue to cause significant dysphonia. *Incorrect: Most common symptom is pain* The most common symptom associated with Singer's nodules is **hoarseness** or **dysphonia** (altered voice quality). The voice may sound breathy, rough, or strained. **Pain is generally not a prominent symptom** of vocal cord nodules, which helps differentiate them from other laryngeal pathologies like laryngitis or vocal cord polyps with inflammation.

Q: All are true about spasmodic dysphonia EXCEPT:

More common in children. ***More common in children*** - Spasmodic dysphonia is primarily a disorder affecting **adults**, with onset typically occurring between the ages of 30 and 50 years. - It is **rarely seen in children**, and when voice disorders occur in children, they are usually due to other causes like vocal nodules or muscle tension dysphonia. *Responds well to botulinum toxin* - **Botulinum toxin (Botox) injections** into the laryngeal muscles are considered the **gold standard treatment** for spasmodic dysphonia. - It effectively paralyzes the spasmodic muscles, providing **significant symptomatic relief** for several months. *Adductor type is more common* - The **adductor type**, characterized by a strained, choked, or squeezed voice quality, accounts for approximately **85-90% of all spasmodic dysphonia cases**. - This is due to involuntary spasms that cause the vocal cords to slam together too tightly. *Usually bilateral involvement* - Spasmodic dysphonia primarily involves the **laryngeal intrinsic muscles**, and the spasms are often **bilateral**, affecting muscles on both sides of the larynx. - While one side might be more affected, the underlying neurological dysfunction typically manifests with **bilateral muscle activation abnormalities**.

Q: What is the normal range for maximum phonation time in healthy adults?

30-35 seconds. ***30-35 seconds*** - The **maximum phonation time (MPT)** is a measure of the longest period a person can sustain a vowel sound on a single breath. - A healthy adult typically has an MPT in the range of **30-35 seconds**, reflecting good respiratory and phonatory control. *8-12 seconds* - This range is generally considered **below normal** for a healthy adult and may indicate compromised **respiratory support** or **laryngeal function**. - A short MPT could be a sign of **vocal fold pathology** or **reduced breath support**. *15-25 seconds* - While better than 8-12 seconds, this range is still often considered **slightly lower than optimal** for healthy adults. - It might suggest subtle inefficiencies in **breath control** or **vocal fold coaptation**, though it's not severely pathological. *40-45 seconds* - An MPT in this range is **unusually long** and exceeds the typical normal values for most healthy adults. - While seemingly good, excessively long MPTs are not standard and might suggest unusual respiratory capacity or an outlier measurement.

Q: Hyponasal voice is seen in all except?

Cleft lip. ***Cleft lip*** - A **cleft lip** primarily affects the appearance of the lip and a portion of the nose but doesn't typically obstruct the nasal passages to cause a hyponasal voice. - The voice quality in individuals with a cleft lip, without an associated cleft palate, is usually normal. *Adenoids* - **Enlarged adenoids** can obstruct the nasopharyngeal airway, leading to reduced nasal resonance and a **hyponasal (rhinolalia clausa)** voice. - This obstruction prevents air from exiting through the nose during speech, making sounds like 'm' and 'n' sound like 'b' and 'd'. *Nasal polyp* - **Nasal polyps** can physically block the nasal passages, impairing airflow through the nose during speech. - This blockage leads to a reduction in nasal resonance, resulting in a **hyponasal voice**. *Deviated nasal septum* - A **deviated nasal septum** can significantly narrow one or both nasal passages, restricting airflow. - This structural obstruction can cause a **hyponasal voice** due to reduced nasal resonance.

Q: The cause for contact ulcer in the vocal cords is:

Voice abuse. ***Voice abuse*** - **Contact ulcers** on the vocal cords are primarily caused by traumatic impact due to forceful voice use, such as **shouting**, **speaking loudly**, or **excessive throat clearing** - This repetitive trauma leads to **mucosal erosion** typically at the posterior aspect of the true vocal cords, at the vocal process of the arytenoid cartilages - These are benign lesions resulting from **vocal hyperfunction** and mechanical trauma *Laryngeal irritation due to smoking* - Smoking can cause chronic **laryngitis**, generalized inflammation, and increase the risk of precancerous lesions and malignancy - While it irritates the larynx, it does not typically cause the focal, traumatic lesions known as contact ulcers *Laryngeal malignancy* - Laryngeal malignancy presents as a **mass**, **ulceration** (often irregular), or **fixation** of a vocal cord, leading to hoarseness - It arises from abnormal cell growth and not primarily from vocal cord trauma associated with voice abuse *Tuberculosis affecting the larynx* - Laryngeal tuberculosis is a **granulomatous inflammation** of the larynx, usually secondary to pulmonary tuberculosis - It can cause diffuse or localized **ulcerations**, granulomas, or pseudotumors, but these are distinct from contact ulcers, which are traumatic in origin

Question 1

A singer presents with difficulty singing at a high pitch. On examination, bowing of the vocal cord is observed on the right side. Which of the following muscles has likely been compromised?

Accepted Answer

Cricothyroid

Answer

Posterior cricoarytenoid

Answer

Lateral cricoarytenoid

Answer

Thyroarytenoid

Question 2

Which of the following principles forms the basis of stroboscopy?

Accepted Answer

Talbot's law

Answer

Weber's law

Answer

Fechner's law

Answer

Stevens' law

Question 3

Dysphonia plica ventricularis is produced from:

Accepted Answer

Ventricular fold

Answer

Vocal cord

Answer

Arytenoid

Answer

Epiglottis

Question 4

The primary goal of Type 1 thyroplasty is:

Accepted Answer

Medialisation of vocal cord

Answer

Lateralisation of vocal cord

Answer

Vocal cord shortening

Answer

Vocal cord lengthening

Question 5

Treatment of choice in early vocal nodule is:

Accepted Answer

Voice rest and speech therapy

Answer

Cryotherapy

Answer

Microlaryngoscopic removal

Answer

Radical excision

Question 6

Which of the following is true regarding Singer's nodule?

Accepted Answer

It occurs at junction of anterior 1/3rd and posterior 2/3rd

Answer

Laser therapy is treatment of choice

Answer

Requires excision as its potentially malignant

Answer

Most common symptom is pain

Question 7

All are true about spasmodic dysphonia EXCEPT:

Accepted Answer

More common in children

Answer

Responds well to botulinum toxin

Answer

Adductor type is more common

Answer

Usually bilateral involvement

Question 8

What is the normal range for maximum phonation time in healthy adults?

Accepted Answer

30-35 seconds

Answer

15-25 seconds

Answer

40-45 seconds

Answer

8-12 seconds

Question 9

Hyponasal voice is seen in all except?

Accepted Answer

Cleft lip

Answer

Adenoids

Answer

Nasal polyp

Answer

Deviated nasal septum

Question 10

The cause for contact ulcer in the vocal cords is:

Accepted Answer

Voice abuse

Answer

Laryngeal irritation due to smoking

Answer

Laryngeal malignancy

Answer

Tuberculosis affecting the larynx

Phoniatrics and Voice Disorders — MCQs

Phoniatrics and Voice Disorders — MCQs

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