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Voice > Instrumental Assessments > Flashcards

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
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1
Q

List the different types of instrumental assessment (3)

A
  • Laryngeal examination
  • Physiological evaluation
  • Acoustic analysis
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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
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3
Q

Limitations of an indirect laryngoscopy

A
  • Activates gag reflex
  • View of larynx may be difficult
  • Client unable to speak normally
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4
Q

Procedure for direct laryngoscopy

A
  • Requires hospitalisation & anaesthesia
  • Endoscope inserted directly into oropharynx & close to larynx
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5
Q

Advantages of a direct laryngoscopy

A
  • Detailed exam (biopsies)
  • Enables manipulation of structures
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6
Q

Limitations of a direct laryngoscopy

A
  • Invasive
  • Costly
  • Unable to observe laryngeal function
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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)
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8
Q

Procedure for rigid fiberoptic laryngoscopy

A
  • Rigid tube inserted into oropharynx
  • Tongue pulled forward
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9
Q

Limitations of a rigid fiberoptic laryngoscopy

A
  • Limits speech & laryngeal activity
  • Restricted access to laryngeal cavity
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10
Q

Procedure for flexible fiberoptic laryngoscopy

A
  • Passed through nasal cavity, over soft palate
  • Local anaesthetic required
  • Scope positioned slightly above epiglottis
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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
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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)
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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
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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
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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
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16
Q

List the different types of physiological evaluation (4)

A
  • Electroglottography (EGG)
  • Laryngeal aerodynamics
  • Electromyography (EMG)
  • Respiratory function
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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
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18
Q

Instrumentation for an electroglottograph (EGG)

A
  • Laryngograph (Lx)
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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
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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
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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
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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
Q

Normal laryngograph (Lx) waveform according to Motta et al. (1990)

A
  • Curved peak
  • Uniform ascending & descending portions
25
Q

Hypokinetic laryngograph (Lx) waveform according to Motta et al. (1990)

A

(Seen in 93% of patients)

  • Sharp peak
  • Decreased amplitude
26
Q

Hyperkinetic laryngograph (Lx) waveform according to Motta et al. (1990)

A

(Seen in 95% of patients)

  • Plateau-like wave
27
Q

Nodules - laryngograph (Lx) waveform according to Motta et al. (1990)

A
  • Single notch in closure phase (72%)
  • Normal closure phase (28%)
28
Q

Polyps - laryngograph (Lx) waveform according to Motta et al. (1990)

A
  • Double notch in closure phase (68%)
  • Single notch in closure phase (25%)
  • Near normal closure phase (7%)
29
Q

Reinke’s Oedema laryngograph (Lx) waveform according to Motta et al. (1990)

A
  • Double notch in closure phase (72%)
  • Single notch in closure phase (24%)
  • Irregular trace (4%)
30
Q

Functional cases - laryngograph (Lx) waveform according to Motta et al. (1990)

A

Traces normalise after therapy

31
Q

Organic cases - laryngograph (Lx) waveform according to Motta et al. (1990)

A
  • Normalise after surgery by 45%
  • Further 55% after therapy
32
Q

Parameters of laryngeal aerodynamics

A
  • Airflow rate
  • Subglottal air pressure
  • Sound pressure level (SPL)
  • Laryngeal resistance
  • Adduction/abduction rate of vocal folds
33
Q

Instrumentation for laryngeal aerodynamics

A

Aerophone II (Kay Elemetrics)

34
Q

Electromyography (EMG)

A
  • Measures electrical activity of muscles
  • 2 techniques:
    • Direct: electrodes inserted into specific muscles (cricothyroid & thyroarytenoid)
    • Indirect: surface electrodes (less precise)
35
Q

Measuring sites for electromyography (EMG)

A

4 sites:

  • Orofacial area
  • Lower facial area
  • Suprahyoid area
  • Thyrohyoid area
36
Q

Parameters for electromyography (EMG)

A
  • 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
Q

Uses of an electromyography (EMG)

A
  • 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
Q

List the types of respiratory function (2)

A
  • Spirometry
  • Kinematic assessment
39
Q

Measurements involved in spirometry

A
  • 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
Q

Instrumentation for spirometry

A

Spirometer

41
Q

Kinematic assessment

A
  • Recording of changes in circumference of rib cage & abdomen
  • Determines the presence of asynchronous/arrhythmic respiratory behaviours
42
Q

Instrumentation for kinematic assessment

A

Respitrace

43
Q

Interpretation of a kinematic assessment

A

Normal: Equal contribution of rib cage and abdomen movement to lung volume reduction

44
Q

Other parameters of a kinematic assessment

A
  • Frequency of paradoxing (oppositional breathing)
  • Mean syllables/breath, maximum phonation time, speaking rate
45
Q

Types of acoustic analysis (3)

A
  • Visipitch
  • Computerised Speech Lab (CSL)
  • Phonetogram/voice range profile
46
Q

Visipitch

A
  • 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
Q

Computerised Speech Lab (CSL)

A
  • 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
Q
A

Computerised Speech Lab (CSL) - normal voice

49
Q
A

Computerised Speech Lab (CSL) - abnormal voice (rough)

50
Q
A

Computerised Speech Lab (CSL) - abnormal voice (breathy)

51
Q

Voice range profile

A
  • 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
Q

Instrumentation for voice range profile

A

Phonetogram

53
Q
A

Phonetogram - healthy voice

54
Q
A

Phonetogram - dysphonic voice

Voice (5 decks)

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