Perceptual assessment

Question 0

What is involved in the perceptual assessment of loudness?

Answer 0

Perception of how loud or soft voice is.
Determined by interaction between subglottal pressure and degree of adduction of vocal folds.
Soft voice - subglottal pressure and inadequate adduction of VF.

Question 1

What is involved in the assessment of pitch?

Answer 1

Perception of how high or low a voice is.
Determined by speed of vibration of vocal folds
- High pitch - fast rate of vibration
- Low pitch - slow rate of vibration

Variations in pitch = intonation
Variations - monotone or excess variability

Question 2

What is involved in the perception of quality?

Answer 2

How clear a voice sounds.
Oates lists the following:
Breathy
Strained
Rough
Glottal fry
Tremor
Pitch breaks
Phonation breaks
Voice arrests
Diplophonia
Falsetto

Question 3

What does breathy mean?

Answer 3

Audible air escape during phonation.
Due to incomplete adduction of VF.
Breathy + strained = whispery
Breathy + strained + rough = hoarse

Question 4

What does strained mean?

Answer 4

Sounds like excessive vocal effort.
Due to increased laryngeal muscle tension and constriction.
True VF and/or false VF.
Strained + breathy = whispery
Strained + rough = harsh
Strained + breath + rough = hoarse

Question 5

What does rough mean?

Answer 5

Lack of clarity.
Due to irregular vibration of VF.
Rough + strained = harsh
Rough + breathy + strained = hoarse

Question 6

What does glottal fry mean?

Answer 6

Rapid sense of low-pitched “pops” or “taps”.
Creaky quality.
Physiological basis - complex, not well understood.
Due to:
-Longer than normal closed phase of VF vibration
- Low frequency VF vibration
- Tightly adducted VF with free edges flaccid (slack)
- Low subglottal pressure

Question 7

What is falsetto?

Answer 7

High pitched
Thin, light quality, impression of immaturity
Excess air escape at times
Due to:
- High frequency of VF vibration
- Thinning of VF edge
- Incomplete closure along length of VF

Question 8

What are pitch breaks?

Answer 8

Sudden, short, unexpected and uncontrolled changes in pitch (up or down).

Question 9

What is diplophonia?

Answer 9

Perception of 2 pitches occurring simultaneously in voice.

Physiology not understood.

Question 10

What are phonation breaks?

Answer 10

Sudden, short, unexpected and uncontrolled breaks in voice.
Short duration.
Moment of turbulent air escape with no voice.
Due to:
- Sudden cessation of vibration of VF

Question 11

What are voice arrests?

Answer 11

Voice stoppages.
Due to uncontrolled adduction of VF.
Specific characteristic of spasmodic dysphonia.
Voice sounds strained and strangled.

Question 12

What is tremor?

Answer 12

Regular, rhythmical vibration in pitch or loudness of voice.
Voice sounds quavery.
Due to neurological impairment.
Not under voluntary control.
May be isolated symptom or part of generalised neurological disorder.
Due to:
- Alternating contractions of adductor and abductor muscles of VF
- Oscillatory movements of entire larynx in vertical direction

Question 13

What is the CAPE-V?

Answer 13

Consensus Auditory-Perceptual Evaluation of Voice.
Method:
2 vowel sounds
6 phonetically loaded sentences
Running speech
Assesses overall severity, roughness, breathiness, strain, pitch and loudness.
Mild, moderate, severe.
Consistent or intermittent?

Question 14

What is the Voice Handicap Index?

Answer 14

Assesses patient’s perception of the relative impact of his/her voice disorder on daily activities.

Question 15

What is the VHI?

Answer 15

Functional, physical and emotional sub-scales rated using 5 point scale.
0 - never
4 - always