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Voice and Resonance Disorders > Chapter 6: Instrumental Measure of Voice > Flashcards

Chapter 6: Instrumental Measure of Voice Flashcards

1
Q

Treatment outcomes measures need to be _____________, _______, ______________, and ____________ to heterogeneous voice qualities and severities.

A

objective
valid
automated
sensitive

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2
Q

What are 5 types of instrumental measures of voice?

A

1) acoustic recording and analyses
2) aerodynamic measurement
3) laryngeal imaging
4) electroglottography (EGG) (measures VF contact area)
5) laryngeal electromyography (LEMG) (direct measures of muscle activity)

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3
Q

What are the 3 basic types of technical instruments?

A

1) signal detection
2) signal manipulation or conditioning
3) signal reconversion

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4
Q

What 4 technical instruments are used for signal detection?

A

1) microphone
2) camera
3) electrode
4) flow/pressure transducers

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5
Q

What 3 technical instruments are used for signal manipulation or conditioning?

A

1) filtering
2) amplification
3) digitization

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6
Q

What 3 technical instruments are used for signal reconversion?

A

1) numerical form
2) visual display
3) speaker

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7
Q

Acoustic measurements can provide ____________ and ________________ analysis of vocal function

A

objective

noninvasive

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8
Q

Clinical utility of acoustic measures depends upon whether the acoustic measures: (3)

A

1) can discriminate between normal and disordered voices
2) correlate with auditory-perceptual judgements of voice quality and severity
3) sufficiently stable to assess real change in performance across time

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9
Q

Most acoustic measures are mathematical derivations of 5 common measures:

A

1) fundamental frequency
2) intensity
3) perturbation measures
4) ratio of signal (i.e. harmonic) energy to noise
5) spectral or cepstral features

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10
Q

What is fundamental frequency?

A

rate of vibration of the vocal folds expressing in Hz or CPS

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11
Q

What is the perceptual correlate of F0?

A

pitch

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12
Q

What are 2 clinical measures related to fundamental frequency?

A

1) mean F0 (for connected speech vs. sustained vowels)

2) F0 range (highest and lowest pitch a patient can produce)

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13
Q

What is the acoustic correlate of vocal loudness?

A

vocal intensity

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14
Q

Intensity is referenced to _________ ___________ __________ (___) and measured on a _______________ _________ (__) scale

A 
sound pressure level (SPL)
logarithmic decibel (dB)
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15
Q

What two measures of intensity are clinically useful?

A

1) habitual intensity

2) intensity range (min and max)

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16
Q

What are 3 potential instruments for measuring intensity?

A

1) sound level meters
2) acoustic analysis programs
3) aerodynamic measurement devices

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17
Q

What does frequency-intensity profiling give a thorough description of?

A

patient’s physiologic limits of frequency and intensity

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18
Q

How do you do frequency-intensity profiling? (3)

A

1) voice range profile
2) phonautogram
3) physiologic frequency range of phonation

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19
Q

What are the two major types of voice acoustic analysis?

A

1) time-based measures

2) frequency-based measures

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20
Q

What are time based measures of voice?

A

perturbation measures such as jitter and shimmer

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21
Q

What are frequency based measures of voice?

A

spectral and cepstral

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22
Q

What is perturbation?

A

cycle-to-cycle variability in a signal

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23
Q

What voice production is typically used to measure perturbation?

A

sustained vowel production

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24
Q

What is jitter?

A

cycle-to-cycle variability in frequency

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25
Q

What is shimmer?

A

cycle-to-cycle variability in amplitude

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26
Q

Calculation of perturbation measures requires a ________________ (aka Type I) signal for realizable/valid analysis

A

quasi-periodic

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27
Q

What is a signal(harmonic)-to-noise ratio?

A

ratio of periodic/harmonic signal energy to aperiodic/noise energy in the voice waveform

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28
Q

What is the SNR for normal voices?

A

mostly periodic and high signal/harmonic energy, high SNR/HNR

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29
Q

What is the SNR for dysphonic voices like?

A

increased aperiodic/noisy components (roughness, breathiness, turbulent), thus “low” SNR or HNR

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30
Q

What are the 2 limitations of time-based perturbation measures?

A

1) depends on accurate identification of cycle boundaries, so results become questionable in moderate to highly perturbed voice signals
2) time-based measures are based on assumption of relatively steady pitch and loudness (sustained vowels)

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31
Q

In contrast to tradition time-based analysis, spectral-based acoustic measures have the ability to characterize the voice signal by extracting characteristics such as the __________________ _______________ and the relative ___________ of ______________ versus ____________ without needing to identify cycle boundaries.

A

fundamental frequency

amplitude of harmonics vs. noise

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32
Q

The spectral-cepstral analysis methods analyzes ___________ of data rather than __________

A

frames

cycles

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33
Q

What does spectral analysis assess?

A

the interaction between glottal sound source (VFs) and the supraglottic (vocal tract) influences

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34
Q

What are types of spectral analysis?

A

1) spectrogram

2) line spectrum

35
Q

What does a spectrogram plot?

A

plots F0 and L0 in the time domain

36
Q

What does a line spectrum plot?

A

plots all harmonic energies at a single point on the horizontal axis, with amplitude on the vertical axis

37
Q

Subglottic pressure and transglottal flow indirectly asses what?

A

laryngeal valving mechanism (and vocal function)

38
Q

What are 3 additional measures that integrate pressure and flow in a ratio?

A

1) glottal power
2) laryngeal resistance
3) vocal efficiency

39
Q

What is phonation threshold pressure (PTP)?

A

the minimum subglottal pressure needed to initiate vocal fold vibration

40
Q

Instruments that measure speech aerodynamics exploit the integral and predictable relationship between what 3 things?

A

1) pressure
2) flow
3) resistance

41
Q

What is pneumotachograph?

A

uses differential pressure across a known resistance to estimate flow rate

42
Q

What are 2 common airflow measures?

A

1) mean flow rate

2) phonatory volume

43
Q

What is mean flow rate?

A

flow divided by time (ml/sec)

44
Q

What is phonatory volume?

A

1) total amount of flow during a given speech/voice task (liters or mls)

45
Q

What is pressure?

A

force per unit area

46
Q

What is subglottal pressure (ps)?

A

force beneath the adducted vocal folds

47
Q

How is ps estimated/measured?

A

indirectly using intraoral pressure during repeated productions of unvoiced /p/ and vowel syllable (e.g., /pi/)

48
Q

How is subglottal air pressure instrumentally measured?

A

oral tube between the closed lips and connected to pressure transduced records intraoral pressure

49
Q

PTP is the minimal driving ______________ to set the _________ _________ into _____________.

A

pressure
vocal fold
oscillation

50
Q

PTP is a possible predictor of __________ and ___________ of the VF vibratory capabilities?

A

structure

function

51
Q

Theoretically, the healthier the VFs, the _______ the PTP need to power vibration

A

lower

52
Q

There is some evidence that PTP is correlated with “the ________” associated with voicing/phonatory effort

A

effort

53
Q

What is laryngeal resistance (LR)?

A

the quotient of peak intraoral pressure divided by the peak flow rate

54
Q

LR is intended to reflect overall _______________ of the _________ and estimates ____________ _________ function (cm H20/l/sec)

A

resistance
glottis
laryngeal valving

55
Q

What are the 3 possible laryngeal valving functions?

A

1) hyperfunction
2) hypofunction
3) normal (as compared to normative values)

56
Q

What is laryngeal valving hyperfunction?

A

valve too tight, LR too high

57
Q

What is laryngeal valving hypofunction?

A

valve too loose, LR too low

58
Q

What type of imaging can provide more information about the severity and nature of a voice disorder than others?

A

laryngeal imaging

59
Q

What is the visible evidence that appears in laryngeal imaging?

A

1) structure
2) movement
3) function

60
Q

What are the 2 types of endoscopes used?

A

1) flexible

2) rigid

61
Q

What are 3 types of laryngeal imaging techniques?

A

1) stroboscopy (most common clinically)
2) kymography
3) high speed digital imaging (HSDI)

62
Q

What are the 2 types of rigid scopes?

A

1) 90 degree

2) 70 degree

63
Q

What is stoboscopy?

A

special lighting technique wherein a stroboscopic light flashes at specific moments to form a composite vibratory cycle

64
Q

How does the strobe light flash in stroboscopy compared to the F0?

A

flashes at phase points in VF vibration that is slightly faster than the F0, which means it gets images of different points of VF vibration

65
Q

What can compromise clinical utility of stroboscopy?

A

significant apreiodicity

66
Q

What is high-speed digital imaging?

A

“direct” recording of true vocal fold vibration

67
Q

What is the light source of HSDI and how is it put into the oral cavity

A

1) very bright Xenon light source

2) rigid endoscope

68
Q

How does HSDI work?

A

samples VF vibration at 2,000-10,000 samples per second

69
Q

HSDI is fast enough to allow real-time recording of “actual” VF oscillation including what 4 things?

A

1) phonatory onset
2) phonatory offset
3) sustained voice
4) changes in pitch and loudness`

69
Q

HSDI is fast enough to allow real-time recording of “actual” VF oscillation including what 4 things?

A

1) phonatory onset
2) phonatory offset
3) sustained voice
4) changes in pitch and loudness`

70
Q

Unlike stroboscopy, HSDI doesn’t rely on ________ to create an image.

A

F0

71
Q

What is kymography?

A

real-time imaging that uses a camera to scan a horizontal line of VF vibration at a rate of 8000 lines per second

72
Q

The kymographic image is limited to the _________ and ____________ changes of a single horizontal line of bilateral fold VF movement

A

spatial and temporal

73
Q

What does kymography reveal?

A

1) cycle-to-cycle variability
2) left- or right-sided asymmetry
3) mucosal wave and amplitude
4) open or closed phase timing
5) phonatory onset and offset movements
6) upper and lower focal fold margin changes

74
Q

What are 4 gross observations that can be made from stroboscopy/imaging (visual perceptual judgements)?

A

1) glottic closure (static)
2) supraglottic hyperfunction
3) mucus
4) general appearance and movement

75
Q

What are 6 vibratory features that can be observed from stroboscopy/imaging (visual perceptual judgements)

A

1) glottic closure (vibratory)
2) phase closure
3) symmetry
4) mucosal wave
5) stiffness/nonvibrating portion/adynamic segment
6) periodicity

76
Q

What is electroglottography (EGG)?

A

non-invasive tool that uses electrical current passing through the neck to measure VF contact across time

77
Q

In EGG, there are 2 _______________ placed on either side of the ________ _____, with a small current passing through as VFs vibrate?

A

electrodes

thryoid alae

78
Q

In EGG, electrodes measure the __________ ______________ as VFs vibrate

A

variable resistance

79
Q

The EGG waveform displays/plots the variable resistance across time and serves as a ______-time __________ of the VF ______________ __________

A

real-time
analog
vibratory pattern

80
Q

What is laryngeal electromyography (LEMG)?

A

a direct measure of laryngeal muscle activity and function

an invasive procedure performed by otolaryngologists or neurologists

81
Q

How is a LEMG done?

A

needle electrodes inserted percutaneously into laryngeal muscles and pattern of electrical activity is studied, vocal tasks are used to confirm correct placement in target muscles

82
Q

What is LEMG used for? (3)

A

1) diagnosis/prognosis of suspected VF movement disorders
2) distinguish unilateral VF paralysis from mechanical fixation of cricoarytenoid joint
3) guide intramuscular injection of Botox for the treatment of spasmodic dysphonia

Voice and Resonance Disorders (14 decks)

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