Diagnosis and Evaluation of Voice Disorders (Ch. 4) Flashcards
(41 cards)
1
Q
Primary aims of voice eval
A
-determine existence of problem
-discover cause of problem
(respiratory, laryngeal, digestive, social, emotional)
-describe symptoms
-assess severity
-investigate effects on pt’s life
-determine most effective way to treat
2
Q
Quality of Life Measures
A
- impact on pt’s life
- helps provide best treatment
- serves as good outcomes measure
3
Q
Voice Handicap Index
A
-most widely used; translations available
-30 item questionnaire
- scale of 1 for never to 4 for always
-120 points total
-0-30 low
-31-60 moderate
>60 severe
-proven validity
4
Q
Voice-Related Quality of Life (V-RQOL)
A
- assesses impact on
- social/emotional
- physical
- perception-2 wks prior
- partner also completes
- 10 questions
- 5-pt scale (poor to excellent)
- developed for effect of VF paralysis
5
Q
Voice Disability and Coping Questionnaire (VDCQ)
A
- assesses how pt copes w/effects of disorder
- is pt problem-focused or emotion-focused? Do they try to change enviro or change the stress?
- 15 items
- 6-pt rating (never to always)
- 4 coping strategies:
1. social support
2. info seeking
3. passive coping
4. avoidance - can ID maladaptive strategies
6
Q
Auditory-Perceptual Eval
A
- requires clinical expertise
- “professional listening”
- gold standard because it’s real life: pt’s perceptions are important
7
Q
A-P Eval: Vocal Activities
A
- MPT
- Pitch Range
- Loudness Range
- S/Z Ratio
- Vocal endurance
- Reflexive glottal valving
8
Q
Maximum Phonation Time (MPT)
A
-deep breath as possible
-sustain “ah” for as long as possible 3x:
comfortable pitch
high pitch
low pitch
-health = >20 sec
-measures glottal efficiency
9
Q
S/Z Ratio
A
-deep breath as possible
-sustain /s/ as long as possible
-deep breath
-sustain /z/ as long as possible
-divide /s/ time by /z/ time
-normal = 1-1.4
->1.4 indicates inability to sustain voicing due to glottal inefficiency
BUT wide variability and overlap b/w normal and impaired
10
Q
Pitch range
A
- sing scales, comfortable to lowest (excl pulse) & comfortable to highest (incl falsetto)
- normal = 2 1/2 octaves
11
Q
Loudness range
A
count from soft as possible (not whisper) to loud as possible
12
Q
Vocal endurance
A
- count vigorously to 100
- listen to hard glottal attacks in 80s-90s
- listen to phonation breaks in 60s-70s
- look for increased tension
- listen for loss of voice
13
Q
Reflexive glottal valving
A
- cough forcefully/clear throat
- say “uh-huh”
- laugh
- Pt can have normal reflexive valving but impaired phonation
- weak cough may be VF paralysis
14
Q
A-P Eval: Rating Scales
A
- Equal-appearing interval scales
- Semantic differential scales
- Visual analog scale
- GRBAS Voice Rating Scale
- CAPE-V
- Patinent self-perception scales
15
Q
Interval Scales
A
- numbers rep level of severity
- can be used for variety of vocal aspects
- pitch, loudness, quality
16
Q
Semantic differential scales
A
polar opposites on ends of scale: normal/abnormal pleasant/unpleasant strong/weak high/low
17
Q
Visual analog scale
A
- 100 mm line for each area rated
- normal on L, abnormal on R
- rater marks their perception
- number of mm used as score
18
Q
GRBAS Voice Rating Scale
A
- from Japan
- equal-appearing interval scale
- used in voice research
- proven reliability
- grade/roughnes/breathiness/asthenic/strain
- 0-3
19
Q
Consensus Auditory-Perceptual Eval of Voice (CAPE-V)
A
- developed by ASHA SIG3: voice
- standardized
- vocal tasks reflect minimal set of clinically meaningful parameters
- procedures/results: easy & efficient to obtain; applicable to broad range of paths
- ratings reliable within and between clinicians
- protocol: examines vocal features in different contexts
- vowel prolongations, sentence repetition, connected speech
- vocal features evaluated on 100mm line min-mod-severe
- overall severity: roughness, breathiness, strain, pitch, loudness, other
- uses visual analog scale
20
Q
Patient self-perception scales
A
Glottal Function Index
- 5 pt equal appearing interval scale
- > 4 = problem in vocal function
21
Q
A-P Eval Caveats
A
- What do definitions mean?
- inter-rater communication - Voice quality is multidimensional
- interdependence of pitch, loudness, clarity, rate, resonance - Clinical opinions does not analyze vocal path
22
Q
Instrumental measures
A
- determine existence of problem
- assess severity or stage of progression
- ID source of problem
- allow quantitative documentation
23
Q
types of instrumental measures
A
- laryngeal mirror
- direct laryngoscopy
- rigid endoscopy
- flexible endoscopy
- videostroboscopy
24
Q
Acoustic Analysis
A
- Visi-Pitch
- C-Speech System
- Computerized Speech Lab
- Multidimensional Voice Program (MDVP)
25
Acoustic analysis - types of measures
1. Frequency
- fundamental
- Maximum Phonational Frequency Range
2. Frequency variability
3. Intensity
4. Vocal perturbation and noise
26
Frequency measures
1. FO/Avg FO
- perceived as pitch
- adult female - 210ish
- adult male = 180ish
27
Maximum Phonational Frequency Range
Female = 135-1000Hz
Male = 80-700 Hz
highly variable due to health more than age
28
Frequency variability
- variations in sustained tone or connected speech
- expressed as SD of FO in Hz
- sustained tone <10Hz
- conversation 20-35 Hz
* very sensitive indicator of disease
29
intensity measures
-perceived as loudness
-ave intensity (single words):
females = 65-77 dB
males = 70-80 dB
-dynamic range: normal = 30dB
30
Vocal perturbation and noise measures
-jitter & shimmer
-jitter = frequency/pitch
normal is 0.2-1 %
-shimmer = intensity (loudness)
normal is <5% (.5 dB)
-HNR
normal voice has more harmonics
31
Acoustic analysis: caveats
1. Analyzing severely aperiodic voices may be impossible
2. highly sensitive to outside noise
3. quality of hardware, calibrations, microphones
4. skill of clinician in collecting data
5. lack of correspondence of data and perception
32
Electroglottography (EGG)
- indirect measure of glottal competency
- used when laryngeal paralysis is suspected
- Lx waveform is interpreted based on shape and ratios of opening, closed, closing phases
- better for highly dysphonic patients b/c acoustic measures can be derived
33
EGG caveats
1. waveform does not indicate degree of closure or width of glottal opening
- wouldn't detect gaps
- wouldn't detect restrictions to opening
2. no specific norms exist to interpret waveforms
3. no standardization of waveforms
34
tasks/findings in endoscopy
phonatory tasks:
- normal respiration
- /i/
- /hi/ /hi/ /hi/
- glissando /i/
35
videostroboscopy evaluation
- VF edge
- glottic closure
- extent of opening
- -phase closure
- mucosal wave
- amplitude of vibration
- phase symmetry
- vertical approximation
- supraglottic activity
- periodicity/regularity
36
endoscopy/videoendoscopy caveats
1. vibratory patterns of severely dysphonic patients not captured
- strobe is set to FO, so if FO is variable, so are images
2. some optic devices distort image
3. phonation not truly representative
4. relies on visual interpretation
5. large amount of normal variability
37
aerodynamic measures
1. air volume
- VC
- TV
2. airflow rate
3. subglottal air pressures
4. oral pressure as pt says /p/
38
caveats for aerodynamic measures
no established norms for airflow
| not useful in tracking small changes
39
laryngeal electromyography (LEMG)
invasive: insert needles into laryngeal muscles to measure activity
differentiates b/w
- unilateral vs. bilateral paralysis
- paralysis vs. CT joint problems
- paralysis vs. muscle tension dysphonia
40
Case history
- interview should be broad - all aspects of pt's life affect voice
- pt's perception of problem
- medical history (surgeries, Rx, OTCs)
- social/professional life
- SLP listens to voice qualities
41
Components of comprehensive voice eval
1. Case history
2. Quality of Life
3. Auditory-Perceptual
4. Laryngeal exam
5. Acoustic analysis
6. Aerodynamic analysis
