Evaluation of Voice Disorders

Question 0

Indirect laryngoscopy

Answer 0

Uses a mirror and bright light source. Lifts velum and presses against the laryngeal wall. Used to observe phonation.

Question 1

What info is needed for the case hx?

Answer 1

onset, duration, causes, variability of voice problems
patient perceptions and descriptions of vocal use
associated symptoms (slurring speech, dysphagia, excessive coughing, etc.)
health, environment, family hx
previous tx, medical intervention
perceptions of culturally/appropriate voice

Question 2

Direct laryngoscopy

Answer 2

Surgical procedure with general anesthesia. Used for biopsy, view of inactive structures. Can get microscopic view of tissues.

Question 3

Endoscopy

Answer 3

can be flexible or rigid. Rigid is inserted through the mouth and flexibile is inserted through the nose. Videoendoscopy can record, and stroboscopic (flashing) endoscopy can be used to observe mucosal wave.

Question 4

Acoustic Analysis

Answer 4

Used to determine the effectiveness of voice therapy/effectiveness of a surgical procedure. Includes spectography. (spectograms, waveforms displays with amplitude and frequency, can be real time or recorded)

i.e. Sona-Graph, Computer Speech Laboratory (CSL)

Question 5

videostroboscopy

Answer 5

Helpful in distinguishing organic vs functional voice disorders. Can detect tumors as well. View cycle to cycle vibration because of the flashing light.

Question 6

electroglottography

Answer 6

EEG - noninvasive procedure to measure vocal fold closure. Some professionals disagree on its effectiveness for diagnosis, since many factors influence its accuracy.

Question 7

Aerodynamic Measurements

Answer 7

Measures airflow, volume, and average air pressure. Used to evaluate dysphonia, monitor changes and treatment, and differentiate between respiratory and laryngeal problems. (e.g. wet spirometer) Can measure tidal volume, vital capacity, and total capacity.

Question 8

Pitch Measurements

Answer 8

Such as VisiPitch. Popular clinical tool that can make subjective measurements about dynamic range, intensity and frequency variability (i.e. shimmer and jitter), pitch and loudness.

Question 9

Components of Perceptual Evaluation (5)

Answer 9

1. Pitch
2. Loudness
3. Resonance
4. Respiration
5. Phonation
   PLRRP

Question 10

Pitch

Answer 10

Clinician needs to determine client’s habitual pitch, and determine optimal pitch (most comfortable and healthy). Decide if client is monopitch.

Question 11

Loudness

Answer 11

Evaluate hoarseness, harshness, breathiness, and vocal tension. Consider external factors (e.g., asthma).

Question 12

Resonance

Answer 12

Determine is client is hyponasal (nasal resonance is absent on nasal sounds), or hypernasal (too much nasal resonance is present on non-nasal sounds)

Question 13

Respiration

Answer 13

Determine types of breathing:

1. clavical breathing
2. diaphragmatic/abdominal breathing
3. thoracic breathing (combination of the first two)

Question 14

Phonation

Answer 14

Assess ability to sustain phonation. Use MPT with 3 trials. Use s/z phoneme ratio (pt. sustains /s/ and /z/ twice. Clinician times in seconds. Divide longest /s/ by longest /z/ value. If the answer is more than 1.4, it is indicative of possible laryngeal pathology.)