quiz 9 & 10

Question 1

5 general types of voice diagnosis

Answer 1

• history of disorder
• auditory perceptual analysis
• instrumental measures
• descriptive scales of severity
• laryngeal imaging

Question 2

acoustic approaches used in a voice laboratory

Answer 2

• fundamental frequency
• intensity
• perturbaation measures (shimmer and jitter)
• harmonics-to-noise ratio
• spectral analysis

Question 3

aerodynamic approaches used in a voice laboratory

Answer 3

• flow
• subglottal air pressure
• phonation threshold pressure
• laryngeal resistance

Question 4

physiologic approaches used in a voice laboratory

Answer 4

• electroglottography
• electromyography
• laryngeal imaging

Question 5

fundamental frequency

Answer 5

relates to our perceived pitch
- measured in hertz (cycles per second)
- easy to understand because if relates direclty to vocal fold vibration

Question 6

intensity

Answer 6

relates to loudness, measured in decibels

Question 7

perturbation measures

(shimmer and jitter)

Answer 7

cycle to cycle variability in a particular sound signal (for us sustained vowel production)
- shimmer = perturbation for intensity
- jitter = perturbation for frequency

Question 8

harmonics-to-noise ratio

Answer 8

amount of relative periodicity in the acoustic signal generated at the vocal folds compared to the level of ‘noise’ in the signal

Question 9

spectral analysis

Answer 9

speech overtime: sound spectrogram (frequency on y, time on x)
- fast fourier transform (fft) and linear predictive coding (lpc) for vowel productions at a single point in time
- long term average spectrum (ltas) for connected speech

the appropriate analysis depends on the aspect of the acoustic signal under consideration

Question 10

flow

Answer 10

measures of flow volume and rate allow for the collection of average values that can reflect the degree of glottal closure
- using lung volumes available for sustained phonation, flow rate can be found by measuring volume of air in ml/sec
- higher airflow rate indicates less vocal fold closure

Question 11

subglottal air pressure

Answer 11

driving force for vocal fold vibration
- insufficient pressure means folds don’t vibrate in a predictable reliable way
- measure by needle or commonly with intraoral pressure at /p/ closure

Question 12

phonation threshold pressure

Answer 12

the least tracheal pressure needed to initiate vocal fold oscillation
- higher PTP to produce voice after vocal fatiguing task (systemic hydration delays the increase in PTP)

Question 13

laryngeal resistance

Answer 13

divide peak intraoral pressure by peak flow rate
- ask patient to say pipipipipip at a mid lung volume so airflow is stable
- can indicate if phonation is hyperfuncitonal or hypofunctional

Question 14

electroglottography

Answer 14

measures vocal fold contact area during sustained phonation (noninvasive)
- contact electrodes on thryroid laminae with a slight current–> the signal indicates the amount of contact area between the vocal folds

more current = more closure

Question 15

electromyography

Answer 15

measures nerve function by inserting a needle electrode into the muscle and measuring electrical activity during phonation or breathing
- done by otolaryngologist or neurologist
- guides injection of botox

Question 16

laryngeal imaging

Answer 16

otolaryngologists use rigid or flexible endoscopy to visualize the larynx
- laryngovideostroboscopy (lvs) can diagnos laryngeal function by showing vocal fold vibration
- the specific influence of a lesion can be diagnosed

Question 17

functional voice disorders

Answer 17

result from abuse, misuse, or overuse of the voice
- caused by producing voice in a way that disrupts balance among respiration, phonation, and resonation necessary for efficient voice production (including increased musculoskeletal tension) or abusive voice behaviors (yelling, throat clearing, etc)

inappropriate voice production can cause nodules, polyps, reinke’s edema, cysts, contact ulcers, and granulomas

Question 18

neurogenic voice disoders

Answer 18

caused by a neurologic disease/disorder (motor neuron disease)

Question 19

neoplastic voice disorders

Answer 19

vocal fold masses that arise from disease processes
- patients may develop dysfunctional voice production to compensate for lesions
- most common malignant tumore is carcinoma; leukoplakia and dysplasia are precancerous
- benign lesions: papillomas and amyloid masses

Question 20

vocal nodules

basic cause and primary impact on the voice

Answer 20

structural lesion causing dysphonia

functional

Question 21

vocal polyps

basic cause and primary impact on the voice

Answer 21

unilateral lesion; the mass can be large (when it volves the whole vocal fold it is considered reinke’s space edema or polypoid degeneration)
- occasionally a reactive nodule forms on other fold
- can reulst from a single even of shouting or can be caused by smoking

functional

Question 22

vocal fold cysts

basic cause and primary impact on the voice

Answer 22

unilateral lesions (may be reactive nodule/swelling); epidermoid or mucous retention
- long-standing (can be asymptomatic)

functional

Question 23

contact ulcers and granulomas

basic cause and primary impact on the voice

Answer 23

at the posterior commissure & vocal processes
- result from ‘aggressive’ speaking styles that cause increased pressure and irritation at the vocal process
- also caused by intubation and gastroesophageal reflux

functional

Question 24

muscle tension dysphonia

basic cause and primary impact on the voice

Answer 24

comes from the imbalance of extrinsic and intrinsic laryngeal muscles used to produce voice–larynx can be virtually immobile in neck
- supraglottic hyperfunction and glottal ‘under closure’
- can be primary (result of psychological stressors) or secondary (result of organic disease)

functional

Question 25

psychogenic voice disorders

basic cause and primary impact on the voice

Answer 25

associated with psychological disorders
- conversion aphonia and dysphonia; mutational falsetto

functional

Question 26

upper motor neuron voice disorder

basic cause and primary impact on the voice

Answer 26

cortical and subortical strokes, pseudobulbar/supracuclear palsy, some presentations of ALS and multiple sclerosis
- voice characteristics: roughness, with a spastic and strain/strangled component
- can have phonatory apraxia (can’t initiate phonation or other nonspeech laryngeal behavior)
- tremorous quality on sustained phonation

neurogenic

Question 27

lower motor neuron voice disorder

basic cause and primary impact on the voice

Answer 27

result from damage or disorders in the brainstem and peripheral nerves
- dysphonia may be absent or minimal if affect fold is paretic and there is good compensation from the intact fold
- voice characteristics: breathiness, roughness, diplophonia
- inspiratory stridor can signal possiblity of bilateral recurrent laryngeal nerve damage (along with higher than normal habitual pitch)

neurogenic

Question 28

extrapyramidal voice disorder

basic cause and primary impact on the voice

Answer 28

incules parkinsons disease and huntinton’s chorea; also can cause essential voice tremor
- hypokinetic dyarthria (pd) or hyperkinetic dysarthria (hc)

neurogenic

Question 29

cerebellar voice disorder

Answer 29

damage to cerebellum by degenerative process or stroke
- voice: rough voice with fluctuations in loudness and pitch

neurogenic

Question 30

spasmodic dysphonia

basic cause and primary impact on the voice

Answer 30

uncertain etiology (not a disease or associated with a spcific one)
- excess of normal movement
- adductor, abductor, & chronic constriction
- tremor at high sustained pitch

neurogenic

Question 31

myoneural junction disorder

basic cause and primary impact on the voice

Answer 31

disturbances of myoneural junction or muscle
- includes myasthenia gravis, polymyositis, and oculopharyngeal dystrophy
- symptoms related to site of damage
- mg: progressive hypophonia with use

neurogenic

Question 32

paradoxical vocal fold motion

what is it and how is it diagnosed

Answer 32

vocal fold approximation during inhalation and abduction during exhalation
- this ‘contradictory’ movement pattern causes inspiratory stridor and a feeling of constriction at the throat

diagnosed by exclusion
- fold movement during quiet breathing is normal
- differential diagnoses include asthma, structural airway obstruction, and focal dystonia; pulmonary function testing, gerd, decrased laryngeal sensation
- then thoroughly asses the conditions and trigger
- perform nasal endoscopy after and attach is elicited