2.1 Voice: assessment

referral pathway, assessments

referral pathway (4)

self-care, GP, ENT, SLT

GP role (3)

info, advice, possible med management

ENT role (1)

anatomical ax

ENT 3 options

2 week cancer pathway (>45 w persistant unexplained hoarseness/otalgia/neck lump), general ENT clinic, joint voice clinic

SLT role (3)

function and impact, may offer first treatment, symptoms may have worsened

case history assessments

PROMS (vocal handicap index, ncl laryngeal hypersensitivity questionnaire), 3Ps

perceptual analysis examples (2)

GRBAS (laryngeal tone), CAPE-V (0-100, GRBAS + loudness + resonance +)

laryngeal endoscopy: flexible laryngoscopy (2)

identify anatomy, practice therapy/speak with camera in situ

laryngeal endoscopy: stroboscopy

flashing light creates illusion slowing vibrations

acoustic analysis: why (2)

baseline/outcome measures, biofeedback

CQ%: what, norm

% of vibratory cycle vc are in contact, 50-60%

CQ%: if high could be…(3)

muscle tension dysphonia, adductor spasmodic dysphonia

CQ%: if low could be…(3)

MTI, vc palsy, abductor spasmodic dysphonia

F0: what, norms

pitch, M120Hz W225Hz C300+Hz

F0: why low, example

greater mass, less tension and elasticity, less vibration, Reinke’s oedema

F0: high example

psychogenic voice

F0: variability (called, voice quality)

jitter, roughness

Amplitude: what, norm

size of vc movement, 50-70dB

Amplitude: examples of low

vc atrophy, MTI, laryngitis

Amplitude: variability (name, quality)

shimmer, roughness

HNR: what, norm

amount of aperiodic wave not harmonic of glottic signal, >20dB

HNR: lower HNR = more external noise =…

more hoarseness (air escape in breathy, creak in strained)

Maximum Phonation Time (MPT): how, norm

one breath comfortable pitch vowel, W15-25 M25-35

MPT: assessing…

glottic efficiency

s/z ratio: what, norm

s÷z phonation time, <1.4

s/z ratio: if high…

high possibility of phonation difficulties

acoustic analysis (8)

s/z, F0, amp, jitter, shimmer, HNR, CQ, MPT

AP constriction: expected acoustic findings

increase jitter/shimmer/CQ, reduced HNR

palsy: expected acoustic findings

reduced amp/HNR/CW/sz

polpy: expected acoustic findings

increase jitter/shimmer, reduced HNR/CQ