Mid-Semester Exam Flashcards
List the steps of voice production
- Air (lungs, diaphragm, muscles of the chest; respiration is the energy source)
- Vibration (larynx)
- Resonance (oral & nasal cavities)
Functions of the voice
- Audibility (makes speech able to be heard)
- Paralinguistic features (personality, emotions)
- Linguistic features (grammar)
- Influence social interaction
- Exert control over the listener
- Enables the listener to make inferences about the speaker
What type of information does the voice convey?
- Emotion (e.g. nervous, excited, happy, sad)
- Social contexts (e.g. professional voice, phone voice)
- Unique/individual differences
- Age
- Gender
- Education
- Geographical origin
- Grammar (e.g. rising tone at end of sentence for a question)
Maximum phonation for a normal voice
- Male: ~25 secs
- Female: ~20 secs
- Child: ~ 10 secs
- Over 65: ~14 secs
Terms that describe the quality of voice
- Pleasant
- Hoarse
- Rough
- Breathy
- Strain/strangled
- Harsh
Pitch of a normal voice
Should be able to do a glide/scale:
- 5 notes minimum
- Smooth change between each note
- Roughly equal
- Distinct difference between high and low
Volume of a normal voice
Should be able to:
- Count 1-5 increasing in volume (range and control)
- Even progression
- Distinct difference between loud and soft
Who’s part of the voice team?
- General practitioner (provide referral to ENT)
- ENT/Otolaryngologist (diagnoses structural abnormalities…)
- Speech pathologist
- Radiologist
- Singing teachers, speech & drama teachers (for singing problems)
- Psychiatrists, psychologists (for psychogenic voice disorders)
What’s the role of the speech pathologist when working with voice?
- Diagnose & treat vocal behaviour
- Select & implement voice therapy program
- Develop therapeutic relationship with patient (goals, documentation, termination criteria)
- Technological assistance
- Provide information (e.g. vocal hygiene)
- Develop patient’s vocal self-perceptual skills
- Analysis of lifestyle & environmental factors impacting on voice
- Establish strategies to reduce vocal abuse
- Appropriate & sensitive referrals
Number 1 rule of voice treatment
All voice patients must be seen by an ENT prior to treatment
Symptoms
- What the patient is telling you
- Subjective experiences reported to the clinician
- Represent a departure from normal function
- Not measured
- May be misleading
- Represent abnormal function
- Include:
- Vocal fatigue
- Hoarseness (raspy/rough)
- Breathiness
- Reduced phonational range
- Aphonia
- Pitch breaks/inappropriate high/low pitch
- Strain/strangled voice
- Tremor
- Pain & other physical sensations
Signs
- Objective indication of some fact or characteristic that may be detected by a clinician during examination of the client
- Observed or tested
- Represent abnormal function
- 4 different types:
- Perceptual
- Acoustic
- Physiological
- Laryngoscopic
Perceptual signs
- Seen in the person
- Pitch:
- Monopitch
- Inappropriate pitch
- Pitch breaks
- Reduced pitch range
- Loudness:
- Monoloudness
- Inappropriate loudness
- Reduced loudness range
- Quality
- Hoarseness (reduced clarity, increased noise)
- Breathiness
- Tension
- Tremor
- Strain/struggle behaviour
- Sudden interruptions
- Diplophonia
- Other behaviours
- Stridor (“struggling to breath” - on inspiration & expiration)
- Excessive throat clearing
- Aphonia:
- Consistent (perceived as whisper)
- Episodic (involuntary)
Acoustic signs
- Abnormal frequency
- Inappropriate amplitude (sound pressure level)
- Spectral noise (signal-to-noise ratio)
- Abnormal voice rise & fall times
- Maximum phonatory duration
- Presence of voice tremor
Fundamental Frequency (Fo)
- Vibrating frequency of vocal folds
- How many times vocal folds open and close in a second
- Mean for males: 100-150Hz
- Mean for females: 180-250Hz
What is abnormal frequency measured by?
- Fo
- Frequency of variability (standard deviation (SD) of Fo)
- Phonational range (range of frequency produced)
- Perturbation (jitter - irregular vibration of vocal folds)
Sound pressure level of conversational speech
75-80dB
What is inappropriate amplitude (sound pressure level) measured by?
- Strength of tone produced by vocal folds (dB)
- Amplitude variability (SD of dB)
- Dynamic range (range of loudness)
- Perturbation (shimmer - amplitude variation)
Spectral noise (signal-to-noise ratio)
- Random, aperiodic energy in voice
- Normal: low noise
- Abnormal: high noise
Rise & fall times
- The ability of vocal folds to start & stop vibrating
- Rise time: time to produce tone full amplitude
- Fall time: time taken to stop producing tone
/s/ - /z/ ratio
- Phonation time of /s/ divided by that of /z/
- Normal: 0.4-2.0
- Abnormal vocal fold vibrations lead to a decrease in the /z/ duration and an increase in the ratio
- Vocal pathology leads to an /s/ - /z/ ratio of greater than 1.4 (even though still in normal range, start to get concerned)
Voice tremor
- Regular variation in Fo (3-5Hz = mean) or amplitude
- Association with CNS dysfunction
- Presence of voice stoppages (longer than normal)
- Observed in spectrogram
- Presence of frequency breaks (sudden shifts in Fo)
Physiological signs
- Abnormal aerodynamics
- Abnormal muscle activity
How are abnormal aerodynamics measured?
- Airflow (average air flow over several glottal cycles)
- Normal: 0.5-2.01L/sec
- Subglottal pressure (pressure beneath the vocal folds)
- Normal: 2-9cm H2O
- Abnormal vibratory patterns
- Information regarding opening & closing phases of vibratory cycle
How is abnormal muscle activity measured?
Electrical activity
- Pathology
- Severe decrease/increase background activity levels
- Slow to turn on/off
- Sudden unexpected bursts
Laryngoscopic signs
- Measured by an ENT
- Impaired vocal fold movement
- Tissue changes
- Abnormal anteroposterior laryngeal dimensions
- Use of ventricular folds
- Anatomical malformations (congenital abnormalities)
- Abnormal laryngeal position
- Involuntary laryngeal activity
Normal vocal folds
Vocal process granulomas (contact ulcers)
Polyp
Nodules
One-sided/unilateral paralysis
Cancer
Aetiology of voice disorder
3 general conditions:
- Vocal folds show structural abnormalities
- Structure normal but function abnormal
- Normal structure & function
What causes voice disorders associated with structural abnormalities?
- Inappropriate voice use
- Infection
- Physical trauma
- Substance irritants
What causes voice disorders associated with functional abnormalities (i.e. the structure is normal)?
Neurological issues:
- Disorders of the CNS (e.g. dysarthria)
- Disorders of the PNS (e.g. recurrent laryngeal nerve RLN paralysis)
What causes voice disorders associated with normal structure & function?
- Dysphonia (functional, psychogenic)
- Hearing loss (potential for normal voice, poor auditory feedback)
- Transsexualism (mismatch between modal range & gender
Classification of voice disorders (3)
- Functional
- Organic
- Neurological
Functional voice disorders
- Associated with vocal misuse & phonotrauma (vocal abuse)
- Examples:
- Vocal nodules
- Vocal polyp
- Reinke’s oedema
- Chronic laryngitis
- Muscle tension dysphonia
- Ventricular dysphonia
- Psychogenic voice disorders
- Signs & symptoms:
- Harsh/strident
- Hoarse
- Breathy
- Hard glottal attack
- High vocal volume
- Vocal fatigue
- Frequent throat clearing
- Pitch breaks
- Tissue changes (laryngeal pain)
Organic voice disorders
- Caused by a structural abnormality in the vocal tract
- Examples:
- Vocal process granuloma (contact ulcer)
- Intubation granuloma
- Leukoplakia
- Cancer
- Infectious laryngitis
- Endocrine changes
- Papilloma
- Laryngeal web
- Vocal fold cyst
Limitations of a functional vs organic classification
- Possibility for both functional & organic features to be present
- The way a structure is used (function) may have an effect on said structure (organic)
- Some laryngeal structures place constraints on voice use
- No complete differentiation between 2 items (may be a complex interaction)
Neurological voice disorders
- Can be caused by an imbalance in the coordination of neurological structures and processes involved in normal voice
- 2 types:
- Neurological problems of vocal fold adduction (e.g. vocal fold paralysis, spasmodic dysphonia)
- Voice problems associated with neurological disease (e.g. Hypokinetic dysphonia - associated with Parkinson’s disease)
What is a voice disorder?
A voice disorder exists when quality, pitch, loudness, hygiene or flexibility differs from the voices of others of similar age, sex, & cultural group
Prevalence of voice disorders
Varies according to demographics:
- Age & Gender:
- Older age groups
- Younger age - females more than males
- Vocal nodules and oedema are more common in early adulthood
- Vocal nodules more frequent in males under 14; females 25-44
- Occupation:
- More common in teachers, singers, executives, managers, secretaries, nurses…
Vocal misuse
Voice production behaviours that prevent vocal mechanism from working smoothly & efficiently
How does vocal misuse develop?
- Periods of increased personal tension (larynx is linked to emotional centres)
- Greater than usual demands on voice
- Episode of laryngitis
- Periods of voice difficulty that resolve spontaneously
- Increase number of episodes of voice difficulty
- Alter vocal behaviour & not be aware of change (e.g. laryngitis)
Features of vocal misuse (4)
- Increased tension/strain
- Inappropriate pitch level
- Excessive talking
- Ventricular phonation
Indicators of increased tension/strain
- Hard glottal attack (adduction of vocal folds before initiating phonation)
- High laryngeal position
- Anteroposterior laryngeal squeezing (epiglottis & arytenoids approach each other)
Indicators of inappropriate pitch level
- Puberphonia
- Persistent glottal fry (lowest Fo & least flexible)
- Lack of pitch variability
Indicators of excessive talking
- Vocal fatigue
- Complaints correlate with patterns of excess talking
Indicators of ventricular phonation
- Low pitch
- Hoarse
- Diplophonia
Phonotrauma/vocal abuse
- Harsher than vocal misuse behaviours
- Excessive prolonged loudness
- Strained & excessive voice use when swelling, inflammation & tissue changes are present
- Excessive coughing & throat clearing (abusive when habitual)
- Screaming/noise-making
- Over enthusiasm in sports & exercise
Superior laryngeal nerve
- Branch of vagus nerve (CNX)
- Innervates cricothyroid muscle
- Tenses vocal folds to increase pitch
- Contributes to vocal fold adduction
Recurrent laryngeal nerve
- Branch of vagus nerve (CNX)
- Innervates all intrinsic muscles of larynx EXCEPT the cricothyroid
