DIFFERENTIAL DIAGNOSIS Flashcards

1
Q

Signs

A

Sign (can be observed or tested):
 Hoarseness (low fundamental frequency, reduced variability of fundamental
frequency, increased frequency perturbation, increased spectral noise, and
large s/z ratio.
 Provide objective information-how signs relate to each other and underlying
pathology will help SLP and otolaryngologist evaluate its significance

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2
Q

Acoustics
What do vocal acoustics give us ?

A

Acoustics is the study of sound, and voice acoustics gives us
information about the way our vocal folds move.
Acoustic signs tell us some aspect of the underlying pathology.
Acoustic parameters are easy to record and analyze
objectively.
 Visi Pitch
 Computerized Speech Laboratory
 Dr. Speech
 Praat

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3
Q

Fundamental frequency:

A

Vibrating frequency of the VF’S is known as fundamental frequency.
 Mean Fundamental frequency:
 Lots of normative data available

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4
Q

Frequency variability

A

Frequency variability
 Standard deviation of fundamental frequency reflects
frequency variability for a time segment of passage.
 The standard deviation of fundamental frequency for
the sentence of normal speaker in example was 27.97

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5
Q

Phonational range:
What’s a normal phonational range ?

A

Phonational range:
 Is the range of frequencies that a person can produce.
 Normal patients should have a phonational range of about 3 octaves. These
decrease with age and increase with singers

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6
Q

Frequency perturbation (jitter):

A

Frequency perturbation (jitter):
measures the variability of the fundamental frequency of the vocal fold tone
from one cycle to the next (Baken & Orlikoff, 2000).

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7
Q

Individuals with normal voice have a small amount of

A

Individuals with normal voice have a small amount of
perturbation.
Increased frequency perturbation is an acoustic correlate of
erratic vibratory patterns of the vocal folds, which is indicative
of a voice disorder (Beckett, 1969)

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8
Q

Amplitude
What does the amplitude tell us?

A

Amplitude
Strength of the tone
Overall sound pressure level
 Average overall SPL (dB) gives us an idea of the strength of the vocal fold
vibration. Everyday speech has a range of 70-80 db (Baken & Orlikoff,
2000)

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9
Q

Amplitude Variability

A

Amplitude Variability
 The amplitude varies depending on the sounds spoken and the message you want to convey.
Amplitude variability during speech is expressed as a standard deviation.

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10
Q

Dynamic range

A

Dynamic range
 The range of vocal intensities that a person can produce (50-115dB). Males
intensity higher than female

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11
Q

Amplitude Perturbation(shimmer)

A

Amplitude Perturbation(shimmer)
o Measures how much the peak amplitude of the vocal fold tone will vary from one cycle to the next
(Titze, 1994).
o Similar to frequency perturbation values, amplitude perturbation values quantify short term
amplitude instability (Baken & Orlikoff, 2000). Vocal fold growths or neural control issues affect
stability of VF which is reflected in shimmer values.

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12
Q

Signal to noise ratio
5

A

Signal to noise ratio
 Normal voices have low noise levels, while abnormal voices have higher
levels of noise
 Voice tremor
 Phonation time
 Voice Stoppages
 Frequency Breaks
 Normal Acoustics

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13
Q

Perceptual signs of voice problems
Pitch
4

A

Monopitch (reduce pitch variability )
Inappropriate pitch
Pitch breaks
Reduce pitch range

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14
Q

Perceptual signs of voice problems
Loudness
3

A

Monoloudness (reduced loudness variability)
Loudness variation (soft, load or uncontrolled)
Reduce loudness range

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15
Q

Perceptual signs of voice problems
Quality

A

Hoarse or rough
Breathy
Tension
Tremor
Strain or struggle
Sudden interruption of voicing
Diplophonia

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16
Q

Perceptual signs of voice problems
Other behaviors

A

Stridor
Excessive throat cleaning

17
Q

Perceptual signs of voice problems
Aphobia

A

Consistent
Episodic

18
Q

Acoustic signs of voice problems
Fundamental frequency

A

Mean or average fundamental frequency
Frequency variability
Phonation range
Perturbation

19
Q

Acoustics signs of voice problems
Amplitude

A

Average overall sound pressure level
Amplitude variability
Dynamic range
Perturbation
Signal-to-noise ratio (harmonics-to-noise ratio)
Vocal rise or fall time
Voice tremor
Phonation time
Voice stoppages
Frequency breaks
Normal acoustics
Copyright © 2011 Wolters Kuwer Health | Lippincott

20
Q

Signs that may be associated with symptoms of hoarse voice
Perceptual signs

A

Hoarseness/roughness
Breathiness
Laryngeal tension
Inappropriate pitch
Excessive throat clearing
Episodic aphonia
Pitch breaks

21
Q

Signs that may be associated with symptoms of hoarse voice
Acoustic signs

A

Restricted phonational range
Restricted dynamic range
Excessive spectral noise
Greater jitter
Greater shimmer
Reduced maximum phonation time and high s/z ratios
Reduced fundamental frequency variability

22
Q

Signs that may be associated with the symptoms of hoarse voice
Measurable physiological signs

A

Aerodynamics
Vibratory
Muscle activity

23
Q

Signs that may be associated with the symptoms of breathy voice
Perceptual signs

A

Breathiness
Little loudness variation
Hoarse/rough
Episodic aphonia

24
Q

Signs that may be associated with the symptoms of breathy voice
Acoustics signs

A

Restricted phonational range
Restricted dynamic range
Reduced sustained phonation time
Increased s/z ratio
Excessive spectral noise
Increased perturbation
Increased shimmer

25
Q

Signs that may be associated with the symptom of strain/struggle
Perceptual signs

A

Strain/struggle voice
Tension
Sudden interruption of voicing
Loudness variation (uncontrolled)
Tremor

26
Q

Signs that may be associated with the symptom of strain/struggle
Acoustic signs

A

Unexpected voice stoppages
Spectral interruptions
Reduced sustained phonation time