Chapter 2: Assessment

Question 1

Professionals concerned with voice

Answer 1

Medical Team: physician, neurologist, radiologist
School Team: teacher, school psychologist, school nurse
Professional Voice Team: Otolaryngologist, singing teacher, nurse

Question 2

Methods of Approaching Voice Assessment

Answer 2

1. Tests and Scales
   Validity, reliability, standardization, norm-ref, listener’s perceptions, auditory perception scales, eval of voice samples
2. Research that Informs Clinical Assessment Methods
   perceptual judgments of pitch/roughness, acoustic measures (amplitude, frequency, glottal noise measures), calculating fundamental frequency, acoustic measures and auditory-perceptual dimensions. No international guidelines
3. Instrumental Analysis of Voice Production
   Electromyographic assessment, aerodynamic assessment, photographs, videoendoscopy, laryngeal mirror exam
4. Instrumental Analysis of Velopharyngeal Funciton
5. Indirect methods of measuring correlates of vocal fold vibratory behavior
   EGG, PGG, Transillumination, Inverse filtered signal, acoustic measures
6. Behavioral Analysis of Production
   Hearing screening, position and posture, oral-periph exam, elicitation of reflexes, resonance and swallowing patterns, respiration, artic, prolonged vowels
7. Analysis of Product
   Frequency, amplitude, aperiodicity, coordination and timing
8. Analysis of the Producer
   Medical history, psychological history
9. Analysis of Processor
   client description, self-perception scales, others’ perceptions

Question 3

Appraisal History/background

Answer 3

leading questions
use reflecting statements
observe nonverbal behavior
listen to audible characteristics 
note consistency and variability of symptoms

Question 4

Selecting Diagnostic Strategies

Answer 4

Testing hypothesis during interview
Confirmation of clinical impressions
Manipulation of key variables

Question 5

Eval of nose and nasopharynx

Answer 5

signs of allergies, infection
clefts
enlarged adenoids
palatal tremor
velopharyngeal closure
VPI

Question 6

Eval of oropharynx and hypopharynx

Answer 6

mass or lesion
infection
neurologic disease
tremor
tongue weakness/incoordination

Question 7

Eval of larynx with scope above epiglottis

Answer 7

reflux
tremor
motion of folds during breathing
vocal fold adduction which occurs irregularly
observation of folds during sustained vowels, various pitches, whistling, repeated vowels
MTD (muscle tension dysphonia)

Question 8

Eval of larynx with scope above folds

Answer 8

inspect folds, epiglottis
detect masses, scarring
observe sustained vowel
request sofy, high pitch to reveal lesions, weakness

Question 9

Eval of singing

Answer 9

focal tremor (folds or arytenoids)
general tremor

Question 10

Eval of spasmodic dysphonia

Answer 10

periodic breaks in voicing

normal phonation during some specific tasks

Question 11

Objective means of voice assessment

Answer 11

Acoustic analaysis
Electroglottography 
Stability of measures
Instrumental analysis profile
Interpretation of measures