assessment of voice disorders Flashcards
(15 cards)
Body-Cover Theory?
Framework for how different layers of VF contribute to voice production; the VF is not a uniform structure but is made up of layers w varying properties.
Cover: highly pliable and elastic allowing for free oscillation, it is flexible and facilitates generation of mucosal wave during phonation
Transition: intermediate/deep layers of lamina propria, less flexible and provides structural integrity, influences pitch and quality
Body; thyroarytenoid muscles, innermost and bulk of VF mass, controls pitch and volume
What is the mucosal wave?
The mucosal wave is a critical aspect of vocal fold vibration, contributing to the richness and quality of the voice. It involves three primary components:
Horizontal (Medial-Lateral) Movement: The vocal folds move toward and away from each other, opening and closing the glottis.
Longitudinal (Anterior-Posterior) Movement: The wave travels along the length of the vocal folds, from the front (anterior) to the back (posterior).
Vertical (Inferior-Superior) Movement: The lower edges of the vocal folds open and close before the upper edges, creating a vertical phase difference
What are the neurological pathways of phonation?
Superior Laryngeal Nerve: Divides into external branch, motor innervation to the cricothyroid muscle (pitch); internal branch: sensory inn. to larynx above VF
Recurrent Laryngeal Nerve:
Right RLN goes under subclavian artery and b. Left RLN goes under aortic arch
Motor inn. to ALL intrinsic laryngeal muscles except cricothyroid, sensory inn. To larynx BELOW VF
Clinical Relevance
SLN damage → impaired pitch control, weak or monotone voice
RLN damage → vocal fold paralysis (unilateral or bilateral), hoarseness, breathy voice, possible airway compromise
What are the vocal registers?
Whistle register (also: flageolet, very high, whistle like), Falsetto (head register, high, light and airy), Modal (chest register, normal speaking range, full, used in everyday speech and standard singing), Fry (pulse, creak, Strohbass; very low, loose folds) + unofficial one: Whisper
What is vocal range?
Establishing what is the habitual pitch/loudness, highest/lowest possible pitch, loudest and softest volumes, transition qualities
What is vocal profile analysis?
Assessment of the whole vocal tract, muscle tension, prosody (pitch and loudness), other
What is the RBH system?
The RBH system: a) Roughness (irregularity) b) Breathiness (air leakage) c.) Hoarseness (overal severity of voice disorder) 0-1-2-3 scale
What is the GRBAS scales?
1) Grade: Overall severity or abnormality of the voice (0-1-2-3)
2) Roughness: vocal irreguliarity (0-1-2-3)
3) Breathiness: air leakage (0-1-2-3)
4) Asthenia: weakness (0-1-2-3)
5) Strain: effort and hyperfunction (0-1-2-3)
More simple and quick
What is CAPE-V?
CAPE-V: The Consensus Auditory-Perceptual Evaluation of Voice
Standardized tool made to assess vocal quality through auditory-perceptual judgement!
Using expert listening skills as well as a visual analog scale!
Rates: 1) severity overall, 2) roughness 3) berathiness 4) strain 5) pitch, 6) loudness
Speech tasks: sustained vowel, sentence reading, connected speech sample
What are the instrumental assessemnts?
Measuring tools include… Pulmonary function measures, neurophysiological, laryngeal imaging, measuring VF contact area, aerodynamic measurements, acoustic measures
Pulmonary function measures: lung volumes, spirometry, respiratory movements/abdominal excursions
Neurophysiological measures: EMG (electromyography) of laryngeal muscles, goes into thyroarytenoid, measures action potentials
Laryngeal imaging: static images ( CT and MRI) and dynamic (laryngeal mirror, videoendoscopy, ultrasound, videostroboscopy [has three speed settings; running (slow motion view) walking (even slower) and stop (flashes locked to fund. freq.// shows if VF vibration is regular, brain processes 5-7 images per second)
Direct laryngoscopy: metal tube down patients throat
Mirror laryngoscopy: mirror examination (need MD)
Flexible endoscope: has fiberoptic cable, viewing lens and insertion tube
Rigid scope
What are the glottic closure patterns?
Compelte, posterior gap, anterior gap, hourglass, incomplete, bowed, irregular
Pitch and mucosal wave connection?
As F0 (pitch) goes up, mucosal wave goes down, as loudness goes up, so does mucosal wave (bigger wave= stronger collisions= louder)
Measures of VF contact area?
Electroglottography (EGG): has +/- ends, current flows to and thru larynx as vocal fold opens, current goes through and there is less voltage on the other side so you can make estimations
Photoglottography (PGG): in research, not clinical, there is a light that is shone through the neck/trachea and measuers the amount of light seen
Aerodynamic measures?
Pneumotachograph: Measures differential pressure on both sides of a known flow resistance (wire mesh)
Warm wire anemometer: the wire cools and the temperature difference tells you much air has flowed)
What do you need for complete voice assesseent?
A comprehensive diagnostic interview
An auditory-perceptural evaluation
Based on variety of speech tasks
Documented by audio or video recording
Includes quantitative as well as qualitative descriptors
Laryngeal imaging; ideally, videostroboscoptc evaluation of many phonation tasks, documented with video recording
Alternatively a flexible endoscopy or mirror imaging; we usually always need flexible endoscopy because it can be cancer
Acoustic Analysis = quantitative descriptors of poor voice quality and quantity
