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
