Phoniatrics and Voice Disorders — MCQs

Phoniatrics and Voice Disorders Indian Medical PG Practice Questions and MCQs

Question 41: Treatment of choice in early vocal nodule is:

A. Voice rest and speech therapy (Correct Answer)
B. Cryotherapy
C. Microlaryngoscopic removal
D. Radical excision

Explanation: ***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.

Question 42: Which of the following is true regarding Singer's nodule?

A. Laser therapy is treatment of choice
B. It occurs at junction of anterior 1/3rd and posterior 2/3rd (Correct Answer)
C. Requires excision as its potentially malignant
D. Most common symptom is pain

Explanation: ***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.

Question 43: All are true about spasmodic dysphonia EXCEPT:

A. Responds well to botulinum toxin
B. Adductor type is more common
C. Usually bilateral involvement
D. More common in children (Correct Answer)

Explanation: ***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**.

Question 44: Hyponasal voice is seen in all except?

A. Adenoids
B. Nasal polyp
C. Deviated nasal septum
D. Cleft lip (Correct Answer)

Explanation: ***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.

Question 45: The voice in a patient with bilateral abductor paralysis of the larynx is most likely to be?

A. Weak or breathy voice
B. Normal voice (Correct Answer)
C. Voice fatigue
D. Strained voice

Explanation: ***Normal voice*** - In **bilateral abductor paralysis**, both posterior cricoarytenoid muscles (the only intrinsic laryngeal muscles that abduct the vocal cords) are paralyzed - The vocal cords remain fixed in a **paramedian position** (nearly closed but not completely closed) - This position is **ideal for phonation** as the vocal cords are adequately approximated for normal voice production - Therefore, voice quality remains **normal or near-normal** despite the paralysis - The **primary clinical problem** is severe **inspiratory stridor and respiratory distress** due to narrowed airway, not voice quality - This is a **life-threatening emergency** requiring urgent airway management *Weak or breathy voice* - A **breathy voice** occurs when vocal cords cannot adequately **adduct** (close), allowing air to escape during phonation - This is characteristic of **adductor paralysis** (recurrent laryngeal nerve injury causing vocal cord paralysis in abducted position) or **unilateral vocal cord paralysis** - In bilateral abductor paralysis, the cords are already in near-midline position, so phonation is preserved *Strained voice* - A **strained or pressed voice** is associated with **muscle tension dysphonia**, **paradoxical vocal fold motion**, or **hyperkinetic voice disorders** - It occurs when excessive laryngeal tension is present during phonation - This is **not** characteristic of bilateral abductor paralysis where the cords are passively positioned near midline *Voice fatigue* - **Voice fatigue** is a symptom of prolonged voice use or underlying pathologies like **vocal nodules**, **polyps**, or **muscle tension dysphonia** - It describes deterioration of voice quality with use, not a baseline voice characteristic - Not a primary feature of bilateral abductor paralysis

Question 46: The cause for contact ulcer in the vocal cords is:

A. Voice abuse (Correct Answer)
B. Laryngeal irritation due to smoking
C. Laryngeal malignancy
D. Tuberculosis affecting the larynx

Explanation: ***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 47: All of the following are true about spasmodic dysphonia except which of the following?

A. It may be of adductor or abductor type
B. Adductor type is characterized by a strained or strangled voice.
C. It is not a type of focal laryngeal dystonia. (Correct Answer)
D. Abductor type is characterized by a breathy quality of voice.

Explanation: ***Correct Answer: "It is not a type of focal laryngeal dystonia" - This statement is FALSE (the exception)*** - **Spasmodic dysphonia IS a form of focal laryngeal dystonia**, characterized by involuntary spasms of the laryngeal muscles during speech. - Its classification as a **dystonia** underscores its neurological origin affecting specific muscle groups. - This is the correct answer because the question asks for the FALSE statement ("except"). *Incorrect Option: "It may be of adductor or abductor type" - This is TRUE* - **Spasmodic dysphonia** can present in two main forms: **adductor spasmodic dysphonia** and **abductor spasmodic dysphonia**. - These types are distinguished by whether the vocal folds spasm in an adducted (closed) or abducted (open) position. *Incorrect Option: "Abductor type is characterized by a breathy quality of voice" - This is TRUE* - In **abductor spasmodic dysphonia**, abrupt, involuntary spasms cause the vocal folds to open too widely, leading to air escaping during phonation. - This excessive air leakage results in a **breathy** or whispered voice quality, often with voice breaks. *Incorrect Option: "Adductor type is characterized by a strained or strangled voice" - This is TRUE* - **Adductor spasmodic dysphonia** involves involuntary spasms that cause the vocal folds to clamp shut too tightly and frequently. - This excessive vocal fold adduction results in a **strained, strangled, or choked** vocal quality, with sudden voice stoppages.

Practice by Chapter

Vocal Fold Structure and Function

Practice Questions

Voice Assessment and Examination

Practice Questions

Stroboscopy and High-speed Imaging

Practice Questions

Nodules, Polyps, and Cysts

Practice Questions

Vocal Fold Paralysis

Practice Questions

Spasmodic Dysphonia

Practice Questions

Professional Voice Care

Practice Questions

Voice Therapy

Practice Questions

Phonosurgery Techniques

Practice Questions

Laryngeal Framework Surgery

Practice Questions

Gender-Affirming Voice Care

Practice Questions

Pediatric Voice Disorders

Practice Questions

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