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Voice > Mid-Semester Exam > Flashcards

Mid-Semester Exam Flashcards

1
Q

List the steps of voice production

A
  1. Air (lungs, diaphragm, muscles of the chest; respiration is the energy source)
  2. Vibration (larynx)
  3. Resonance (oral & nasal cavities)
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2
Q

Functions of the voice

A
  • 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
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3
Q

What type of information does the voice convey?

A
  • 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)
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4
Q

Maximum phonation for a normal voice

A
  • Male: ~25 secs
  • Female: ~20 secs
  • Child: ~ 10 secs
  • Over 65: ~14 secs
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5
Q

Terms that describe the quality of voice

A
  • Pleasant
  • Hoarse
  • Rough
  • Breathy
  • Strain/strangled
  • Harsh
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6
Q

Pitch of a normal voice

A

Should be able to do a glide/scale:

  • 5 notes minimum
  • Smooth change between each note
  • Roughly equal
  • Distinct difference between high and low
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7
Q

Volume of a normal voice

A

Should be able to:

  • Count 1-5 increasing in volume (range and control)
  • Even progression
  • Distinct difference between loud and soft
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8
Q

Who’s part of the voice team?

A
  • 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)
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9
Q

What’s the role of the speech pathologist when working with voice?

A
  • 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
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10
Q

Number 1 rule of voice treatment

A

All voice patients must be seen by an ENT prior to treatment

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11
Q

Symptoms

A
  • 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
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12
Q

Signs

A
  • 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
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13
Q

Perceptual signs

A
  • 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)
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14
Q

Acoustic signs

A
  • 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
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15
Q

Fundamental Frequency (Fo)

A
  • 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
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16
Q

What is abnormal frequency measured by?

A
  • Fo
  • Frequency of variability (standard deviation (SD) of Fo)
  • Phonational range (range of frequency produced)
  • Perturbation (jitter - irregular vibration of vocal folds)
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17
Q

Sound pressure level of conversational speech

A

75-80dB

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18
Q

What is inappropriate amplitude (sound pressure level) measured by?

A
  • Strength of tone produced by vocal folds (dB)
  • Amplitude variability (SD of dB)
  • Dynamic range (range of loudness)
  • Perturbation (shimmer - amplitude variation)
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19
Q

Spectral noise (signal-to-noise ratio)

A
  • Random, aperiodic energy in voice
  • Normal: low noise
  • Abnormal: high noise
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20
Q

Rise & fall times

A
  • 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
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21
Q

/s/ - /z/ ratio

A
  • 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)
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22
Q

Voice tremor

A
  • 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)
23
Q

Physiological signs

A
  • Abnormal aerodynamics
  • Abnormal muscle activity
24
Q

How are abnormal aerodynamics measured?

A
  • 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
25
Q

How is abnormal muscle activity measured?

A

Electrical activity

  • Pathology
    • Severe decrease/increase background activity levels
    • Slow to turn on/off
    • Sudden unexpected bursts
26
Q

Laryngoscopic signs

A
  • 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
27
Q
A

Normal vocal folds

28
Q
A

Vocal process granulomas (contact ulcers)

29
Q
A

Polyp

30
Q
A

Nodules

31
Q
A

One-sided/unilateral paralysis

32
Q
A

Cancer

33
Q

Aetiology of voice disorder

A

3 general conditions:

  1. Vocal folds show structural abnormalities
  2. Structure normal but function abnormal
  3. Normal structure & function
34
Q

What causes voice disorders associated with structural abnormalities?

A
  • Inappropriate voice use
  • Infection
  • Physical trauma
  • Substance irritants
35
Q

What causes voice disorders associated with functional abnormalities (i.e. the structure is normal)?

A

Neurological issues:

  • Disorders of the CNS (e.g. dysarthria)
  • Disorders of the PNS (e.g. recurrent laryngeal nerve RLN paralysis)
36
Q

What causes voice disorders associated with normal structure & function?

A
  • Dysphonia (functional, psychogenic)
  • Hearing loss (potential for normal voice, poor auditory feedback)
  • Transsexualism (mismatch between modal range & gender
37
Q

Classification of voice disorders (3)

A
  • Functional
  • Organic
  • Neurological
38
Q

Functional voice disorders

A
  • 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)
39
Q

Organic voice disorders

A
  • 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
40
Q

Limitations of a functional vs organic classification

A
  • 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)
41
Q

Neurological voice disorders

A
  • 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)
42
Q

What is a voice disorder?

A

A voice disorder exists when quality, pitch, loudness, hygiene or flexibility differs from the voices of others of similar age, sex, & cultural group

43
Q

Prevalence of voice disorders

A

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…
44
Q

Vocal misuse

A

Voice production behaviours that prevent vocal mechanism from working smoothly & efficiently

45
Q

How does vocal misuse develop?

A
  • 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)
46
Q

Features of vocal misuse (4)

A
  • Increased tension/strain
  • Inappropriate pitch level
  • Excessive talking
  • Ventricular phonation
47
Q

Indicators of increased tension/strain

A
  • Hard glottal attack (adduction of vocal folds before initiating phonation)
  • High laryngeal position
  • Anteroposterior laryngeal squeezing (epiglottis & arytenoids approach each other)
48
Q

Indicators of inappropriate pitch level

A
  • Puberphonia
  • Persistent glottal fry (lowest Fo & least flexible)
  • Lack of pitch variability
49
Q

Indicators of excessive talking

A
  • Vocal fatigue
  • Complaints correlate with patterns of excess talking
50
Q

Indicators of ventricular phonation

A
  • Low pitch
  • Hoarse
  • Diplophonia
51
Q

Phonotrauma/vocal abuse

A
  • 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
52
Q

Superior laryngeal nerve

A
  • Branch of vagus nerve (CNX)
  • Innervates cricothyroid muscle
  • Tenses vocal folds to increase pitch
  • Contributes to vocal fold adduction
53
Q

Recurrent laryngeal nerve

A
  • Branch of vagus nerve (CNX)
  • Innervates all intrinsic muscles of larynx EXCEPT the cricothyroid

Voice (5 decks)

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