quiz 9 & 10 Flashcards
5 general types of voice diagnosis
- history of disorder
- auditory perceptual analysis
- instrumental measures
- descriptive scales of severity
- laryngeal imaging
acoustic approaches used in a voice laboratory
- fundamental frequency
- intensity
- perturbaation measures (shimmer and jitter)
- harmonics-to-noise ratio
- spectral analysis
aerodynamic approaches used in a voice laboratory
- flow
- subglottal air pressure
- phonation threshold pressure
- laryngeal resistance
physiologic approaches used in a voice laboratory
- electroglottography
- electromyography
- laryngeal imaging
fundamental frequency
relates to our perceived pitch
- measured in hertz (cycles per second)
- easy to understand because if relates direclty to vocal fold vibration
intensity
relates to loudness, measured in decibels
perturbation measures
(shimmer and jitter)
cycle to cycle variability in a particular sound signal (for us sustained vowel production)
- shimmer = perturbation for intensity
- jitter = perturbation for frequency
harmonics-to-noise ratio
amount of relative periodicity in the acoustic signal generated at the vocal folds compared to the level of ‘noise’ in the signal
spectral analysis
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
flow
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
subglottal air pressure
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
phonation threshold pressure
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)
laryngeal resistance
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
electroglottography
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
electromyography
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
laryngeal imaging
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
functional voice disorders
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
neurogenic voice disoders
caused by a neurologic disease/disorder (motor neuron disease)
neoplastic voice disorders
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
vocal nodules
basic cause and primary impact on the voice
structural lesion causing dysphonia
functional
vocal polyps
basic cause and primary impact on the voice
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
vocal fold cysts
basic cause and primary impact on the voice
unilateral lesions (may be reactive nodule/swelling); epidermoid or mucous retention
- long-standing (can be asymptomatic)
functional
contact ulcers and granulomas
basic cause and primary impact on the voice
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
muscle tension dysphonia
basic cause and primary impact on the voice
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
psychogenic voice disorders
basic cause and primary impact on the voice
associated with psychological disorders
- conversion aphonia and dysphonia; mutational falsetto
functional
upper motor neuron voice disorder
basic cause and primary impact on the voice
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
lower motor neuron voice disorder
basic cause and primary impact on the voice
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
extrapyramidal voice disorder
basic cause and primary impact on the voice
incules parkinsons disease and huntinton’s chorea; also can cause essential voice tremor
- hypokinetic dyarthria (pd) or hyperkinetic dysarthria (hc)
neurogenic
cerebellar voice disorder
damage to cerebellum by degenerative process or stroke
- voice: rough voice with fluctuations in loudness and pitch
neurogenic
spasmodic dysphonia
basic cause and primary impact on the voice
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
myoneural junction disorder
basic cause and primary impact on the voice
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
paradoxical vocal fold motion
what is it and how is it diagnosed
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
