Laryngology evaluation Flashcards
One of the first patient-based, voice-specific out-
come measures was the Voice Handicap Index.
This is a 30-question assessment that focuses on
which three domains?
Functional, physical, and emotional aspects of voice
disorders
Which voice-specific patient-reported outcome
measure uses 10 questions to assess the physical
functioning and social–emotional status of a
patient with voice disturbance, and how is it
measured?
The V-RQOL. Each question is given 1 to 5 points, with 5
representing a severe problem, and 1 representing no
problem. An equation is then used to generate a score out
of a total of 100, with a higher score representing better
quality of life.
Name three important voice parameters.
● Frequency (pitch)
● Intensity (loudness)
● Quality (i.e., timbre)
What term refers to the number of repeating
cycles per second (Hz) in the acoustic waveform?
Frequency
Define the fundamental frequency of the voice
and the ranges for adult men and women.
The predominant pitch component of speech
● Normal adult men into their 70s: 100 to 125 Hz
● Normal adult women: 190 to 225 Hz
What describes the quality of a sound determined
by its frequency (or fundamental frequency)?
Pitch
What acoustic term defines the loudness, or sound
pressure level, of speech?
Intensity (normally 70 dB for both male and female
conversational speech)
What factors most often influence loudness, or
intensity?
Subglottic pressure, frequency, speech sample, glottal
resistance, and airflow rate
Type of equipment used, distance from the sound source,
and ambient noise can also influence loudness measure-
ments.
In acoustic analysis of voice, what are the most
common parameters used to assess frequency?
● Average speaking fundamental frequency
● Maximum phonational frequency range
What describes the quality or character of voice,
separate from pitch, intensity, and prosody?
Quality (timbre): Roughness, breathiness, and strain
What is the perceptual correlate of the frequency
of a sound wave?
Pitch (perceptual correlate of frequency)
What is the perceptual correlate of the amplitude
of a sound wave?
Volume is the perceptual correlate of amplitude.
In acoustic analysis of voice, jitter is defined as cycle-to-cycle variation in what parameter?
Frequency of a wave (normal = 0.40%)
In acoustic analysis of voice, shimmer is defined as
cycle-to-cycle variation in what parameter?
Amplitude of a wave (normal = 0.50 dB).
What are the most common measurements used
to assess voice quality in acoustic analysis of voice?
Short-term perturbation measures (only reliable for nearly
periodic signals):
● Jitter: Cycle-to-cycle variation in frequency
● Shimmer: Cycle-to-cycle variation in amplitude
Note: No single test has been identified to reliably assess
voice quality.
The GRBAS scale is an assessment tool, which
attempts to standardize the auditory perceptual
evaluation of voice quality. What does GRBAS
represent, and how is this assessment scored?
G Grade: Overall severity
R Roughness: Psychoacoustic impression of irregular vocal-
fold vibration
B Breathiness: Psychoacoustic impression of air leakage
through the glottis
A Asthenia: Weakness or lack of power in the voice
S Strain: Psychoacoustic impression of hyperfunctional state
of phonation
0: No deficit in parameter
1: Mild deficit
2: Moderate deficit
3: Severe deficit
What is the major weakness of the GRBAS scale?
It does not offer a specific protocol for administration or
guidelines for analysis.
Which auditory-perceptual evaluation tool uses a
visual analog scale (100-mm line; increasing
distance from the left indicates increasing severity)
to assess six parameters of voice: overall severity,
roughness, breathiness, strain, pitch and loudness,
and how is it scored?
Consensus Auditory-Perceptual Evaluation-Voice (CAPE-V):
The score is based on two sustained vowels, six standard
sentences, and 20 or more seconds of natural running
speech. The six parameters are evaluated for resonance
differences and whether the parameter is constant or
intermittent.
Define the following terms:
- Aphonia
- Breathy voice
- Diplophonia
- Dysphonic
- Flutter
- Hoarse voice
- Hypernasal (honky, nasal)
- Hyponasal
- Resonant
- Strained (harsh, strangled)
- Tremor
- The inability to set the vocal folds into vibration either
consistently or intermittently. Note: Arrest of phonation
describes sudden stops. - Containing the sound of breathing (expiration) during
phonation - Phonation with two independent pitches
- Abnormal phonation
- Phonation with amplitude or frequency modulations in
the 8- to 12-Hz range - The combination of a rough and breathy voice
- Voice quality when excessive acoustic energy is coupled
to the nasal tract through opening of the velar port - Voice quality when inadequate acoustic energy is
coupled to the nasal tract - A voice quality that rings on or “carries” well
- A voice quality that appears effortful
- A 1- to 15-Hz modulation of a cyclic parameter (e.g.,
amplitude or fundamental frequency), either neuro-
logic in origin or interaction between neurologic and
biomechanical properties
An important adjunct to the auditory-perceptual
evaluation of the dysphonic patient is the visual-
perceptual evaluation, which evaluates visible and
physical facets of voice production related to
cause, maintenance, or effect of dysphonia. What five categories are evaluated?
● General appearance ● Posture, breathing, musculoskeletal tension ● Neurologic dysfunction ● Physical dysmorphology ● Clinical manifestations of disease
When assessing a patient who has dysphonia
suspicious of muscle tension or muscle misuse
dysphonia, what tactile-perceptual tests can be
completed in the office to provide a clinical
assessment of dysfunction?
● Palpation of the suprahyoid, thyrohyoid, cricothyroid, and
pharyngolaryngeal muscles both at rest and during
phonation
● Assessment of the thyrohyoid space for anterosuperior
supraglottic compression
● The clinician should assess for tension, muscle “knots,”
decreased space between thyroid cartilage and hyoid, or
discomfort on mobilization.
What is the aerodynamic assessment that meas-
ures the length of time a patient can sustain a
vowel after having taken a maximum inspiration?
Maximum phonatory time (indicates breath support and
phonatory efficiency
The longest of three trials should be reported. Typically,
adult women range between 15 and 25 seconds, adult men
between 25 and 35 seconds.
The subglottic air pressure (force/unit area) can be
evaluated clinically by measuring the intraoral air
pressure during a voiceless consonant. What influences the magnitude of normal pressure peak
variation, and what are normative values for men and women?
Loudness, age, gender, consonant, and speech context
● Men: 7.52 cm H2O
● Women: 6.43 cm H2O
What term describes the minimal subglottic pressure needed for vocal fold vibration?
Phonation threshold pressure
