COMDIS415 VOICE DISORDERS PART 2 Flashcards
DYSPHONIA
Definition
Characterized by altered: Vocal quality
Pitch
Loudness
Vocal effort
Broad, clinical term used to describe abnormal functioning of voice
Auditory-perceptual symptom: vocal quality
voice quality - something is different
with their voice that you are able to
notice right away
- Heard as: roughness, breathiness, strained, strangled, hoarse, weak, wet/gurgly
Auditory-perceptual symptom: pitch
Heard as: too high, too low, pitch breaks, decreased pitch range
Decreased pitch range (upper)
pitch glides - start with lowest pitch
then have patient go up in pitch
easy with vowel ‘e’ rise
Auditory-perceptual symptom: loudness
Heard as: too high, too low, decreased range, unsteady volume
Auditory-perceptual symptom: vocal effort
Heard as: running out of breath quickly, frequent coughing/throat clearing
- throat clearing causes vocal folds to slam against each other, causes vocal nodules
CAUSES OF VOICE DISORDERS: ORGANIC (STRUCTURAL)
Vocal fold abnormalities (e.g., vocal nodules)
Inflammation of the larynx (e.g., arthritis, reflux)
Trauma to the larynx (e.g., from intubation, chemical exposure, external trauma)
CAUSES OF VOICE DISORDERS: ORGANIC (Neurogenic)
Laryngeal nerve paralysis
Parkinson’s Disease
Multiple Sclerosis
VOICE DISORDERS: FUNCTIONAL CAUSES
phonotrauma
muscle tension
vocal fatigue
Phonotrauma
- Yelling
- Screaming
- Excessive throat-clearing
work on in therapy: focus on breathing, vocal hygiene,
relaxing muscles
Muscle Tension
Excessive squeezing,
tightness of laryngeal muscles
Vocal Fatigue
Due to effort or overuse
The process of inspiration is a passive process.
false, it is an active process
During rest breathing, the process of expiration is a passive process.
true, it recoils, so the diaphragm goes back into position
During speech breathing, the process of expiration is a passive process.
false, you have to control air flow that is coming out, so you talk in short breaths groups
Which statement is true of speech breathing?
We inhale more air
During inspiration
Thoracic volume increases causing a decrease in thoracic pressure
The inverse (opposite) relationship between thoracic volume and thoracic pressure is known as:
Boyle’s Law
What subglottal pressure is required for speech production at a comfortable volume?
6-8 cm H20
What subglottal presure is required for yelling/loud speech?
10-12 cm H20
What subglottal presure is required for minimum amount pressure needed for vibration?
3-4 cm h20
- Which statement accurately describes vital capacity:
a. It declines with age
b. It differs between males and females
c. It is dependent on level of physical activity and health status (e.g. history of smoking, recent illness)
On average, how many syllables per breath group is considered typical?
16.5
During rest breathing, we pause to breath at linguistically-appropriate boundaries (e.g. a major syntactic boundary)
False, we do not talk during rest breathing, only true at speech breathing
During vocal fold vibration, the vocal folds close: (Select all that apply)
a. Due to elastic recoil
b. Due to the Bernoulli effect
During vocal fold vibration, the vocal folds open:
Because the pressure below the vocal folds is greater than the pressure above the vocal folds
Jitter
how stable frequency/pitch is
Norms: 1.04% or lower
Shimmer
steady of amplitude (loudness)
lower than 3.8%
harmonic to noise ratio
above 20
VOCAL NODULES CAUSE
Repeated phonotrauma to vocal folds
Folds rub together, get sore, and blister Voice overuse
Use voice incorrectly
VOCAL NODULES SYMPTOMS
Sound deeper, weaker, more breathy
Hoarse quality
Voice cuts out
VOCAL FOLD PARALYSIS OR PARESIS CAUSES
Nerve impulses to larynx are disrupted, muscle
becomes paralyzed
Injury to vocal fold during surgery Neck or chest injury
Stroke
Tumors
Neurological conditions
VOCAL FOLD PARALYSIS OR PARESIS SYMPTOMS
Usually, one vocal fold is paralyzed
Breathy, hoarse voice
Noisy breathing
Loss of vocal pitch and loudness
Frequent throat clearing
MEDIALIZATION THYROPLASTY | INJECTION OF BIOMATERIALS
Injections are done every 3-6 months
MUSCLE TENSION DYSPHONIA CAUSE
Laryngeal muscles become tense
Respiratory illness, allergies, reflux
Increased vocal demand
Stressful life events
MUSCLE TENSION DYSPHONIA SYMPTOMS
Rough, hoarse, or raspy voice
Weak, breathy, airy or is only a whisper
Strained, pressed, squeezed, tight or tense
Voice suddenly cuts out
Pitch too high or too low
Pain or tension
Throat feels tired
PRIMARY AND SECONDARY TYPES
WHO ASSESSES VOICE DISORDERS?
Primary care provider may send you to see an: Otolaryngologist – Ear, Nose, Throat Doctor
SLP
OTOLARYNGOLOGIST
Usually examines your vocal folds and larynx with a videostroboscopy
Why is the videostroboscopy done?
Identify cause of voice dysfunction (inflammation, infection or injury?)
Assess the movement and function of vocal folds
SLP
Assess the vocal characteristics related to respiration, phonation, and resonance:
Pitch
Loudness
Pitch range
Vocal endurance
Uses:
Standardized measures
Nonstandardized measures
SLP: ASSESSING FOR VOICE DISORDERS
Case History
Self-Assessment
Oral-Peripheral Exam
Auditory-Perceptual Assessment
Acoustic Assessment
CASE HISTORY & SELF-ASSESSMENT
We want to know:
Individual’s description of voice problem, including onset and Variability of symptoms
Individual’s assessment of how their voice problem affects them
Voice Handicap Index (VHI)
Voice-Related Quality of Life (V-RQOL)
ORAL-PERIPHERAL EXAM STRUCTURES
Lips
Tongue
Jaw
Teeth
Hard & Soft Palates
Pharynx
ORAL-PERIPHERAL EXAM FUNCTION
Respiratory Breathing Patterns (single breath
count)
Coordination of Respiration with Phonation
Maximum Phonation Time
Diadochokinetic Rates
maximum phonation time
ask patient
to take breath and then hold “ah” for as long
as you can at a comfortable loudness
NORM: 20-25 SECS
AUDITORY-PERCEPTUAL ASSESSMENT SUBJECTIVE MEASURES
Assessing voice quality during the production of sustained vowels,
sentences, and running speech
Roughness/Hoarseness
Breathiness – audible air escape in voice
Strain – perception of excessive vocal effort Pitch – highness or lowness of tone in voice Loudness – what’s the sound intensity?
ACOUSTIC ASSESSMENT
Vocal Amplitude
Measuring loudness and strength of the voice in decibels Fundamental Frequency
Measuring the vibration rate of the vocal folds in hertz
COMPARE CLIENTS VOCAL AMPLITUDE + FUNDAMENTAL FREQS TO NORMS
SLP: ASSESSING FOR VOICE DISORDERS
Case History
Self-Assessment
Oral-Peripheral Exam
Auditory-Perceptual Assessment
Acoustic Assessment
After thoroughly obtaining outcomes for these measures, and the physical findings from the ENT, you can make a diagnosis and recommend treatment
DIRECT APPROACH INTERVENTION
focus on manipulating the voice-producing mechanisms
Physiologic Voice Therapy
strive to balance the three subsystems of voice production (respiration, phonation, and resonance).
Accent Method
Facilitate abdominal breathing, reduce excessive muscular tension, normalize phonation patterns
Lee Silverman Voice Treatment (LSVT)
Initially developed for patients with Parkinson’s Disease, but used with other populations
Maximize phonatory and respiratory function
Resonant Voice Therapy
Increasing vibratory sensations on the lips, teeth or in the nose for easy phonation or easy voicing.
Indirect approaches
client education and counseling
Client education
Discussing normal physiology of voice production and the
impact of voice disorders on function.
Providing information about the impact of vocal misuse and strategies for maintaining vocal health/vocal hygiene.
Counseling
Identifying and implementing strategies such as stress management to modify psychosocial factors that negatively affect vocal health.
