Voice Exam-2

Speech Language Pathology 560 01 with Awan at Bloomsburg University of Pennsylvania

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By: Samantha Jansson
Created: 2012-03-01
Size: 76 flashcards
Views: 17

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Functional Voice Disorder

Voice disorders in which (1) the patient's use of the voice mechanism is the underlying cause of the voice problem(s), and (2) the laryngeal mechanism appears normal or shows the development of a secondary pathological condition (i.e., a pathological condition that has developed because of the patient's abuse/misuse of the larynx).

Functional Voice Disorder

In effect (or because of this), the patient's use of the vocal mechanism has resulted in the dysphonia—its origin is not attributable to some underlying physical or disease process.

Functional Dysphonia

In adolescents, this may originate from psychogenic causes, efforts to cope with other communicative disabilities, and/or an habituated, inefficient manner of voice production.

Organic Voice Disorder

Voice disorders in which the underlying cause is a specific lesion affecting the laryngeal mechanism itself or within the neuromotor pathways serving the phonatory mechanism. An underlying physical disruption is responsible for the observed dysphonia, not faulty voice use.

Organic Voice Disorders

Voice problems are multifarious" with effects which are "biological, psychological, and sociocultural"

Functional Voice Pathologies

Nodules, Polyps, Intracordal Cyst, Edema, Chronic Laryngitis, Mutational Falsetto, MTD, Psychogenic Disturbance

Organic Voice Pathologies

Neurologically-based Disorders, Keratosis, Granuloma, Papilloma, Ankylosis, Contact Ulcer, Carcinomas

Normal Voice

As long as a particular voice does not deviate substantially from our internal gauge in terms of parameters such as pitch, loudness, quality, and duration

Dysphonia

Voice qualities such as creaky, tense, unstable, lax, guttural, strained, and husky. Review of the voice literature reveals several quality dimensions that have been consistently used to categorize this voice quality--Breathy, Harsh/Rough, Hoarse

Mild Severity

While the listener experienced in the perceptual characteristics of the disordered voice would consider the voice abnormal, the lay listener may consider the voice to be only unusual in nature and within normal expectations. The voice characteristic is not distracting, and the ability to effectively communicate is not affected. The dysphonia does not interfere with phonation.

Moderate Severity

Both trained and untrained listeners would consider the voice abnormal. There may be intermittent periods in which the voice characteristic is highly distracting. The ability to effectively communicate is noticeably affected under certain conditions (e.g., noisy environments). The dysphonia may occasionally cause phonation to cease or become highly effortful.

Severe Voice Type

Both trained and untrained listeners would consider the voice extremely abnormal. The voice characteristic is highly distracting. The ability to effectively communicate is consistently affected. The dysphonia causes phonation to be mainly absent or extremely effortful.

Voice Diagnostic Protocol (VDP)

Provides the voice clinician with an array of test procedures by which reasonable and accurate diagnostic hypotheses may be made regarding the presenting voice disorder. This incorporates a wide range of analysis methods (perceptual, acoustic, and selected physiological methods) that meet the following criteri.

Voice Diagnostic Protocol

They present minimum discomfort to the patient.
They are noninvasive techniques.
In most cases, they require minimal amounts of time to complete the procedure.
They provide relatively immediate test results.
They require minimum expense

Areas of Assessment for the VDP

Background Info
Pitch/Freq.
Loudness/Intensity
Quality
Duration
Evaluation of muscle tone tension

Key Reasons why the addition of instrumental measures strengthens our Dx protocol

1. Evolution of the SLP’s environment(s).

2. Reimbursement issues.

3. Information re: the coordination of speech subsystems.

4. Instrumental measures may help form a more solid foundation for clinical judgments.

5. Instrumental measures allow for the comparison of vocal performance to appropriate normative data.

ALSO, objective measures often aid the clinician in identifying mild disorders and may direct the clinician towards a reexamination of perceptual judgments

Peppard on Laryngeal Examination

Stresses that, "ethical practice requires that before any management of voice pathology is started, an otolaryngologist skilled in this type of examination and voice disorders must perform a thorough examination to rule out any possible organic base for the voice disorder"

Voice Diagnostic by SLP

Although the laryngeal examination report will (generally) provide a diagnostic label for the patient's condition, this does not eliminate the need for...? Effective voice therapy recommendations will be made primarily on the basis of the detailed description of the patient's voice characteristics and voice use

Case History Examination

Provides key information by which differential diagnosis may be achieved. Several key elements may aid in identifying possible functional disordered:
•Development of the Problem
•Variability and Consistency
•Description of Voice Use
•Health Status
•Possible Causes
•Issues Dealing with Psychological Screening

Pre-Session Information

Basic Identifying Info
General Medical History
Results of Laryngeal Exacmination

Key Areas of Case History Questioning

Nature of the Problem
Development of the problem
Variability and Consistency
Discription of voice usage
Effects of Dysphonia on the patient
Vurrecnt health status
Possible Causes
Psychochological Screening

Speech and Hearing Mechanism Examination

Focus on Laryngeal Function
Hearing Evaluation

Need for Psychological Screening

A critical aspect of voice diagnosis, specifically in the case of "functional" dysphonias. Crucial for successful diagnosis & therapy because it often uncovers "a disturbance in the patient's psychologic equilibrium" that underlies the patient's dysphonia.

Psychological Factors

May be associated with voice disorders as:

An underlying cause
A result of coping with an incapacitating voice disorder

Psychological Factors

Should be consisered with all voice disorder types, i.e., organic and functional/psychogenic, because "all disease processes carry components of emotional stress"

Vocal Misuse & Abuse

Claimed to be the cause of voice problems. Also, thought to contibute to layngeal tissue changes resulting in the formation of such lesions, e.g., nodules, polyps, contact ulcers, etc.

Vocal Misuse

Periods of increased personal tension or a greater than usual demand on the voice are common antecedents to this

Vocal Misuse

Voice production behaviors that distort the normal ability of the phonatory mechanism to work effectively and efficiently

Increased Tension/ Strain (Vocal Misuse)

Often made on a subjective basis. Client may report the sensation of tension, even pain, during speaking. It also may be the judgement of a clinician based upon auditory and visual observations.

Increased Tension/ Strain (Vocal Misuse)

Characteristics: generally, negative laryngeal exam and/or redness, or a strand of mucous at the nodal point

Hard Glottal Attack (Vocal Misuse)

Describes a manner of initiating vowels, characterized by rapid and complete adduction of the vocal folds prior to the initiation of phonation

Hard Glottal Attack (Vocal Misuse)

Audible Characteristic: abrupt, explosive, and hard-edged onset of phonation results, i.e., medial compression of vocal folds, lateral squeezing

High Laryngeal Position (Vocal Misuse)

Closely associated with swallowing, resulting in a tight valving maneuver. Continually speaking with the larynx in this position may be considered a form of phonation during hyperadduction

High Laryngeal Position (Vocal Misuse)

Characteristic: excessive tension of the extrinsic laryngeal musculature

Inappropriate Pitch Level (Vocal Misuse)

Should not be made subjectively. Objective measurement should always be done before judgements about the acceptability of this parameter are made. Flawed, particularly if obtained from a disrupted system

Puberphonia (Vocal Misuse)

Known as mutational falsetto. Refers to the persistence of a high pitched voice beyond the age at which the male voice change is expected to have occurred. Particularly specific to men; high voice pitch is more socially acceptable in women.

Puberphonia (Vocal Misuse)

For this type of vocal misuse, it is important to note the presence of any organic abnormality. Adequacy of laryngeal growth must be assessed, and endocrinological problems ruled out.

Puberphonia (Vocal Misuse)

Characteristic: Hoarseness and some degree of breathiness may accompany the high pitch. The voice tends to be unstable and uncertain.

Persistent Glottal Fry (Vocal Misuse)

Consistent and habitual use of fry may be considered misuse of the voice. May result in increased tension when attempting to increase loudness. Poor variation of fundamental frequency may result in a monotonic voice.

Lack of Pitch Variability (Vocal Misuse)

Monotonic voice may be a characteristic of neurological dysfunction, or it may be a sign of misuse. Problem in terms of developing maximum communicative effectiveness

Excessive Talking (Vocal Misuse)

May result in vocal fatigue. The voice quality may be reported to become slightly rough or hoarse, the voice may sound weak, and the person may report that speaking requires effort

Ventricular Phonation (Misuse)

Diagnosis is usually made when laryngological exam reveals greater than expected movement of the ventricular folds toward the midline.

Ventricular Phonation (Misuse)

Characteristic : Described as being low in pitch, very hoarse in quality, rattling, rumbling, cracking, reduced in intensity, diplophonic, etc.

Vocal Abuse

tend to be harsher, with a greater likelihood of causing trauma to the laryngeal mucosa

Excessive, Prolonged Loudness (Abuse)

Habituated patterns of excessively loud voice use. Laryngeal mucosa may become irritated, inflamed, and swollen. This may result in altered mass and stiffness. Organized lesions may develop at the site of greatest impact resulting in air leakage and a breathy component.

Excessive Use Duing Periods of Tissue Change (Abuse)

Damage to the folds is increased if abusive vocal behaviors occur in the presence this. Weakened tissues are unable to withstand stress-laryngitis of the bacterial type

Excessive Coughing & Throat Clearing (Abuse)

Patterns so habituated that they are almost at involuntary levels, with limited awareness

Screamers and Noise Makers (Abuse)

Often seen in young children. Vocal nodules are often referred to as “screamers nodes”. Often seen more in boys than girls

Chronic Layngitus (Abuse)

Condition in which the vocal fold mucosa is persistently inflamed and thickened. May be associated with smoking, pollutants, alcohol, and vocal abuse.

Chronic Layngitus (Abuse)

Not to be confused with acute laryngitis that is the direct result of infection, or with an acute episode of “functional” laryngitis following a single episode of excessive voice use.

The Sports/Exercise Enthusiast (Abuse)

Often a hobby which leads to abusive situations. The result of this type of abuse is edema and irritation, thereby increasing the mass of the folds. Often rest and refraining from this type of behavior greatly reduces the described irritation.

What should clinician fully explore regarding Misuse & Abuse?

The full range of potentially abusive vocal behaviors.

Measuring Mean Fo

It is recommended we ask our patient to read the entire 1st paragraph of the Rainbow Passage, but we will record and analyze only the 2nd sentence of the passage

Measures of Freq. Variability

standard deviation & pitch sigma

May be computed for the 2nd sentence of the Rainbow Passage, but more error may be expected (approx. 10% errors possible in relation to the entire passage)

Cont. Speech Sample for Children

Elicited via open-ended questioning techniques or picture description tasks

Collect a continuous speech sample of at least 14 seconds in duration (this duration provides an accuracy of +/- 3 Hz

Assessing Total Phonational Pitch & Freq. Range

Very important for the clinician to be aware of the difference between “physiological” range of phonation vs. the “musical” range

Physiological Range

In assesing this range , no constraints are placed upon quality, pitch, loudness, or duration of the phonation. These limits of vocal pitch/frequency range would rarely (if ever) be used in common or professional vocal situations.

Musical Range

Develops within the limits of the physiological range and is composed of artistically useable tones

Advantages of Musical Range

Range provides information in terms of vocal performance and capability used in more realistic vocal conditions.
Assessment stresses the vocal system by using vocal constraints
Avoids the possibility of vocal abuse

Speaking Pitch of the Voice

Primarily dependent upon the age, gender, and body stature of the patient (particularly as it affects the physical composition of the vocal folds).

Normal Vocal Pitch

Should be an appropriate physical match for the speaker and should not present any age or gender confusion for the listener

Mutational Falsetto

While voice change often occurs during puberty without any residual voice problem, disturbed mutation can occur. Thee male subject retains a child-like, higher pitched voice post-puberty, resulting in a voice vs. age mismatch and pitch abnormality

Mutational Falsetto

This condition may also affect females. The female may also maintain a child-like voice post-puberty.

Pitch abnormality may be less noticeable as compared to the male condition, since the female voice does not undergo as drastic a shift in pitch level

MTD

Excessive muscular activity in those muscles which increase the lengthening and tensing aspects of vocal folds function, the result may be an increase in pitch level.

May have experienced this at times of emotional stress.

MTD

Imitation of someone that is trying to speak when they are about to cry will characteristically result in tension in the laryngeal region and increased pitch level. However, decreased pitch may also be observed in this condition.

Psychogenic Voice Disorders

Cases of psychosis, schizophrenia, and clinical depression may be characterized in part by changes to the pitch of the voice.

Psychogenic Voice Disorders

Characteristic: Pitch variability appears to be substantially reduced in cases of both schizophrenia and severe clinical depression, resulting in monotone/monopitch voice consistent with flat affect.

Neurogenic Disorders

Habitual pitch may be affected by hypo- versus hypertonic states (lowered vs. raised, respectively).

Neurogenic Disorders

Pitch range and variability are also often affected by dysarthric states.

Neurogenic Disorders

Monopitch and restricted pitch range has been observed in Parkinson’s disease, superior laryngeal nerve disruption, and vocal fold paralysis

Neurogenic Disorders

Vocal tremor, often characterized as hyperkinetic in nature, is a clear example of noticeable rhythmic variation in pitch

Effects of Mass Leisons and Disturbed Tissue Change

Habitual pitch may be lowered due to the increased mass of the vocal folds.
Habitual pitch may be increased due to increased stiffness of the fold(s) and compensatory increased laryngeal tension.
Habitual pitch may not be affected at all.
Pitch variability may occur (ex. diplophonia, pitch breaks) due to altered vibratory characteristics.
Monopitch and decreased pitch ranges may be observed due to restricted range of lengthening/tensing motion within the vocal folds

Mean Fo

This is significantly lower in smokers vs. nonsmokers

May be due to a thickening of the vocal folds and the connective tissue as a result of smoking.

Fo Range

In both speech and phonational range of smokers, this was also significantly less than the mean range of the nonsmokers.

Hearing Impaired/Deafness

May affect vocal pitch, particularly in terms of variability.

Pitch variation may be limited/reduced in these patients

Also, excessive pitch fluctuations.

About this deck

By: Samantha Jansson
Created: 2012-03-01
Size: 76 flashcards
Views: 17

About StudyBlue

“Simply amazing. The flash cards are smooth, there are many different types of studying tools, and there is a great search engine. I praise you on the awesomeness.”
Dennis