Evaluation and diagnosis of voice disorders

Question 1

What are the 4 components of a thorough voice evaluation?

Answer 1

1. Medical examination
2. Case history
3. Observation of the client
4. Testing/eval of the client

Question 2

Who should complete the medical examination?

Answer 2

The otolaryngologist

Question 3

Four areas the otolaryngologist will assess the VF for:

Answer 3

color, position, shape, movement

Question 4

What is the SLP’s role in diagnosing vocal pathologies?

Answer 4

SLPs do not diagnose voice disorders. SLPs report the function of the VF

Question 5

Name components of the case history.

Answer 5

1. Description of the problem and causal factors
2. Onset and duration
3. Variability of the problem
4. Description of vocal use
5. Previous therapy, family history, medical history

Question 6

When a voice problem is due to a stroke, there may also be concomitant __________?

Answer 6

swallowing problems

Question 7

When discussing vocal hyperfunction, the voice is usually bettter when?

Answer 7

Earlier in the day

Question 8

When voice problems are due to allergies or nasal drip the voice is usually better when?

Answer 8

Gets better throughout the day

Question 9

All voice disorders are aggravated by _________ and _________.

Answer 9

Fatigue and stress

Question 10

Why is hydration important to vocal function?

Answer 10

If the VF are not well hydrated, they are more susceptible to trauma or VF friction

Question 11

Components of voice testing and evaluation:

Answer 11

1. Oral peripheral examination
2. Respiration testing
3. Pitch
4. Intensity
5. Quality

Question 12

What should be noted during the oral peripheral examination?

Answer 12

• Any indication of neural impairment/asymmetry
• any neck tension- Do the muscles stick out during phonation?
• Any mandibular restriction
• Unusual movements of the larynx

Question 13

List the 4 areas to measure during respiration testing:

Answer 13

1. Lung volume
2. Air pressure
3. Airflow
4. Measures of motions of the torso

Question 14

What should be observed to judge the client’s lung volume?

Answer 14

• Does the speaker run out of air when speaking?

- Does the speaker need to force breaths in the middle of phrases

Question 15

How is lung volume measured?

Answer 15

A wet or dry spirometer

Question 16

What is vital capacity?

Answer 16

The maximum amount of air that can be expelled from the lungs following maximum inspiration

Question 17

If vital capacity is low, clinician must…

Answer 17

Use clinical judgements and observations to determine whether or not they have adequate lung volume to function normally

Question 18

How should the SLP judge the client’s airflow pressure?

Answer 18

Does the patient have sufficient expiratory control for normal speech?

Question 19

What is the airflow rate?

Answer 19

a measurement of the volume of air passed through the glottis during a fixed period of time

Question 20

What is a normal airflow rate?

Answer 20

100 cc of air/second

Question 21

If greater than 100…

Answer 21

there is inadequate closure

Question 22

If less than 100…

Answer 22

there is excessive closure

Question 23

What is maximum phonation time?

Answer 23

measures the ability to maintain a steady phonation sufficient for communication

Question 24

MPT is highly ______

Answer 24

variable

Question 25

How should MPT be used in therapy?

Answer 25

As a baseline measurement for future comparisons

Question 26

Average young adult MPT is:

Answer 26

23 seconds

Question 27

The /s/ is a measure of

Answer 27

expiratory control

Question 28

The /z/ is a measure of

Answer 28

phonatory expiratory control

Question 29

If /s/ to /z/ ratio is greater than ____, could indicate vocal pathology

Answer 29

1.4

Question 30

Typically /s/ to /z/ ratio should be:

Answer 30

1

Question 31

What is clavicular breathing?

Answer 31

Most inefficient type of respiratory control

Shoulders elevate on inhalation- neck muscles act as the primary muscle of inhalation

Question 32

What should be the primary muscle of inhalation?

Answer 32

Diaphragm

Question 33

What are the two reasons why clavicular breathing is unsatisfactory?

Answer 33

1. upper, apical ends of the lungs, when expanded, alone do not provide adequate respiration
2. the strain in using the neck muscles is conterproductive in trying to achieve greater relaxation in the upper thoracic area

Question 34

What is the preferred method of respiration?

Answer 34

Diaphragmatic-abdominal breathing

Question 35

Explain the inspiratory process and expiratory process during diaphragmatic-abdominal breathing

Answer 35

Inspiration- lower thoracic expansion

Expiration- gradual decrease in abdomin and lower thoracic prominence

Question 36

3 measures used in the pitch evaluation

Answer 36

1. Frequency range
2. Best pitch
3. Habitual pitch

Question 37

A higher pitch is usually indicative of…

Answer 37

tension and difficulty in relaxation of the laryngeal area

Question 38

If pitch variation is impossible….

Answer 38

VF paralysis, viralizing drugs or glandular metabolic conditions are suspected