Instrumental Assessments Flashcards
0
Q
List the different types of laryngeal examination (5)
A
- Indirect laryngoscopy
- Direct laryngoscopy
- Fiberoptic laryngoscopy (flexible & rigid)
- Stroboscopy
- High-speed imaging
1
Q
List the different types of instrumental assessment (3)
A
- Laryngeal examination
- Physiological evaluation
- Acoustic analysis
2
Q
Procedure for indirect laryngoscopy
A
- Laryngeal mirror inserted into oropharynx
- Positioned to reflect vocal folds
- Mirror warmed, tongue pulled forward
- /iː/ (vocal folds lengthened, larynx raised)
- Quick, minimal trauma/pain
3
Q
Limitations of an indirect laryngoscopy
A
- Activates gag reflex
- View of larynx may be difficult
- Client unable to speak normally
4
Q
Procedure for direct laryngoscopy
A
- Requires hospitalisation & anaesthesia
- Endoscope inserted directly into oropharynx & close to larynx
5
Q
Advantages of a direct laryngoscopy
A
- Detailed exam (biopsies)
- Enables manipulation of structures
6
Q
Limitations of a direct laryngoscopy
A
- Invasive
- Costly
- Unable to observe laryngeal function
7
Q
What are fiberoptics?
A
- Bundle of fibres
- Some carry light (halogen), others carry image back
- 2 types:
- flexible
- rigid
- Connect to video camera (fiberoptic laryngoscopy is therefore also called videolaryngoscopy)
8
Q
Procedure for rigid fiberoptic laryngoscopy
A
- Rigid tube inserted into oropharynx
- Tongue pulled forward
9
Q
Limitations of a rigid fiberoptic laryngoscopy
A
- Limits speech & laryngeal activity
- Restricted access to laryngeal cavity
10
Q
Procedure for flexible fiberoptic laryngoscopy
A
- Passed through nasal cavity, over soft palate
- Local anaesthetic required
- Scope positioned slightly above epiglottis
11
Q
Advantages of a flexible fiberoptic laryngoscopy
A
- Flexibility (all areas)
- Zoom lens
- Client able to speak & sing
- All age groups
- Overcomes hyperactive gag
12
Q
Procedure for stroboscopy
A
- Stroboscopic light source (rigid or flexible scopes)
- Enables detailed view of vibratory behaviour of vocal folds
- Stobe light (emits rapid pulses at rate controlled by examiner)
13
Q
Basic principle of stroboscopy
A
- When the light pulse is the same as the vocal frequency (vibrations) the image is static
- When the light pulse is more or less than the vocal frequency a slow motion view of the vocal fold vibration is seen
- Each pulse illuminates different point of vibratory cycle
- Over successive vibratory cycles images become fused - slow motion image
14
Q
Parameters of a stroboscopy
A
- Symmetry of movement
- Regularity of successive vibration
- Glottal closure
- Amplitude (horizontal excursion)
- Presence & size of mucosal wave
- Presence of non-vibrating portions of vocal folds
- Presence of lesions & effect on vibration
15
Q
High-speed imaging
A
- Can provide imaging of vocal fold up to 2000 frames per second
- Allows a more sophisticated (clearer) examination of vocal fold vibration
- Relatively costly
- Mainly for research purposes
16
Q
List the different types of physiological evaluation (4)
A
- Electroglottography (EGG)
- Laryngeal aerodynamics
- Electromyography (EMG)
- Respiratory function
17
Q
Basic principle of electroglottograph (EGG)
A
- Human tissue conducts electrical current
- 2 electrodes are placed externally on thyroid cartilage (small electrical current passes between the 2)
- Vocal folds abducted: no electrical current passes between electrodes
- Vocal folds adducted: current passes freely between electrodes
- Changes in flow of electrical current = glottal cycle (laryngograph (Lx) waveform)
- Measures vocal fold contact area
18
Q
Instrumentation for an electroglottograph (EGG)
A
- Laryngograph (Lx)
19
Q
A
Laryngograph (Lx) waveform
- Closing phase: Initial contact + Maximum contact
- Opening phase: Maximum contact + Minimum contact
- One vocal fold vibration cycle = Closing phase + Opening phase
20
Q
Interpretation of laryngograph (Lx)
A
- Normal:
- Sharpness of closure most important feature
- Open phase more gradual
- Breathy:
- Relatively long open phase
- Harsh:
- Short open phase
21
Q
Quantitative parameters of an electroglottography (EGG)
A
- Fo:
- Period of glottal cycle
- Length of time for vocal folds to make one complete vibratory cycle
- Duty cycle:
- Also called open quotient
- Ratio of time that vocal folds are open compared to entire glottal cycle
- Closing time:
- Time from totally open to totally closed
22
Q
Clinical application for electroglottography (EGG)
A
- Assessment
- Biofeedback
- Monitoring therapy
23
Q
Limitations of an electroglottography (EGG)
A
- Electrode placement
- Need to keep resistance low
- Sub-cutaneous soft tissue
- Artifacts:
- Head movement
- Laryngeal elevation
24
Normal laryngograph (Lx) waveform according to Motta et al. (1990)
* Curved peak
* Uniform ascending & descending portions
25
Hypokinetic laryngograph (Lx) waveform according to Motta et al. (1990)
(Seen in 93% of patients)
* Sharp peak
* Decreased amplitude
26
Hyperkinetic laryngograph (Lx) waveform according to Motta et al. (1990)
(Seen in 95% of patients)
* Plateau-like wave
27
Nodules - laryngograph (Lx) waveform according to Motta et al. (1990)
* Single notch in closure phase (72%)
* Normal closure phase (28%)
28
Polyps - laryngograph (Lx) waveform according to Motta et al. (1990)
* Double notch in closure phase (68%)
* Single notch in closure phase (25%)
* Near normal closure phase (7%)
29
Reinke's Oedema laryngograph (Lx) waveform according to Motta et al. (1990)
* Double notch in closure phase (72%)
* Single notch in closure phase (24%)
* Irregular trace (4%)
30
Functional cases - laryngograph (Lx) waveform according to Motta et al. (1990)
Traces normalise after therapy
31
Organic cases - laryngograph (Lx) waveform according to Motta et al. (1990)
* Normalise after surgery by 45%
* Further 55% after therapy
32
Parameters of laryngeal aerodynamics
* Airflow rate
* Subglottal air pressure
* Sound pressure level (SPL)
* Laryngeal resistance
* Adduction/abduction rate of vocal folds
33
Instrumentation for laryngeal aerodynamics
Aerophone II (Kay Elemetrics)
34
Electromyography (EMG)
* Measures electrical activity of muscles
* 2 techniques:
* Direct: electrodes inserted into specific muscles (cricothyroid & thyroarytenoid)
* Indirect: surface electrodes (less precise)
35
Measuring sites for electromyography (EMG)
4 sites:
* Orofacial area
* Lower facial area
* Suprahyoid area
* Thyrohyoid area
36
Parameters for electromyography (EMG)
* Onset & offset muscle activity
* Pattern muscle activity
* Amplitude of activity
* Abnormal:
* Extraneous bursts of muscle activity
* Muscle activation more or less than normal amplitude
37
Uses of an electromyography (EMG)
* Confirmation of vocal fold paralysis
* Differential diagnosis of arytenoid dislocation
* Predicting the return of vocal fold movement
* Guiding of botox injections
* Differential diagnosis of functional voice disorders
38
List the types of respiratory function (2)
* Spirometry
* Kinematic assessment
39
Measurements involved in spirometry
* Vital capacity (VC)
* The total volume of an 'unforced' but complete expiration following a full inspiration
* Forced (expiratory) vital capacity (FVC)
* The maximum volume of air exhaled as rapidly, forcefully, & completely as possible from the point of maximum inhalation
* FEV1: Forced expiratory volume in the 1st second of the FVC
40
Instrumentation for spirometry
Spirometer
41
Kinematic assessment
* Recording of changes in circumference of rib cage & abdomen
* Determines the presence of asynchronous/arrhythmic respiratory behaviours
42
Instrumentation for kinematic assessment
Respitrace
43
Interpretation of a kinematic assessment
Normal: Equal contribution of rib cage and abdomen movement to lung volume reduction
44
Other parameters of a kinematic assessment
* Frequency of paradoxing (oppositional breathing)
* Mean syllables/breath, maximum phonation time, speaking rate
45
Types of acoustic analysis (3)
* Visipitch
* Computerised Speech Lab (CSL)
* Phonetogram/voice range profile
46
Visipitch
* Real time display of Fo & energy of voice
* Parameters:
* Average Fo & range
* Average intensity & range
* Frequency perturbation (jitter)
* Amplitude perturbation (shimmer)
* Noise-to-harmonic ratio
47
Computerised Speech Lab (CSL)
* Measures similar parameters as Visipitch
* More sophisticated (research tool)
* Spectrograms: reflect properties of source of sound (vocal fold vibration) & resonator (vocal tract)
* Signal-to-noise/harmonic-to-noise ratio
* Energy in harmonics of signal vs noise energy in signal
* Abnormal: more noise (low harmonics-to-noise ratio)
48
Computerised Speech Lab (CSL) - normal voice
49
Computerised Speech Lab (CSL) - abnormal voice (rough)
50
Computerised Speech Lab (CSL) - abnormal voice (breathy)
51
Voice range profile
* Measures the maximum phonational pitch and intensity range
* 2-D visual, graphical representation
* Intensity values plotted against frequency values
* Profile area = maximum phonation capacity of the individual
52
Instrumentation for voice range profile
Phonetogram
53
Phonetogram - healthy voice
54
Phonetogram - dysphonic voice
