Voice Final

What is a voice disorder?

anything that is different for their age, sex, and gender & anything different from what is excepted

What is a rigid scope used for?

- Best for structure keep the tongue protruded
- A big large image of the vocal folds, say /i/ "eee" (pulls the larynx up towards the scope)
- USE: pathology, good image, vibrations (nodules structures, polyps)

What is a flexible scope used for?

* Shows movement larynx
* higher quality of pictues
* swallowing

What kind of measures are rigid and flexible scopes?

subjective

What happens when anesthesia is used during scopes?

- Greatly reduces sensory feedback
- Numbing structures cause different not-normal movements of the stuctures
- USE: what the larynx is doing, glottal spaces

Is a videostrobostrophy objective or subjective?

subjective

How do you know when a laryngostroboscopy strobe light should flash?

have to know the frequency of the voice

Why would you use aerodynamics?

* result of physiological phenomenon
* gives exactly how much air flow for voice (numerical data)

What are the characteristics of acoustics?

- Complete sounds that hit the microphone & create a signal
- Result of a physiological response/movement, but does not tell you the physical efforts

What are the characteristics of aerodynamics?

- the physiological response
- the actual air movement (objective measurement)

Why would you do an aerodynamic evaluation?

To obtain objective measurements of glottal airflow and sub-glottal pressure - physiologic measure

When should voice rest be used?

- Only put someone on voice rest after a surgery to let tissue heal, do not use this approach during therapy
Not for other things like muscle tensions dysphonia, etc.

What does cm of water pressure per liter per second mean?

- Tells you how much pressure it takes to get one liter of air through vocal folds in one second

Complete voice rest (CVR)

elimination of all vocal fold contact

Modified voice rest (MVR)

- get away from heavy vocal load
- elimination of excessive voice
- duration should be patient specific

Who is the target population of voice therapy?

- Anyone!
- Any person who complains of a disturbance to the voice that results in an impairment, disability, or handicap regardless of age, race, and culture

What factors contributes to successful therapy outcomes?

- Motivation of patient
- Responsibility & Commitment
- Completion of home practice
- Incorporate suggest vocal lifestyle changes

What is the goal of voice therapy?

- Restore the best voice possible; adequate assessment, good data to set goals and see progress

How do you begin a voice therapy session?

- Describe: structure (anatomy) & why its there/how (physiology)
- Measure motivation for therapy: (1) will find out in a few weeks of treatment, (2) can not match when outside therapy (3) discuss timeline (4) home practice materials HAVE TO HAVE: Awareness

How is voice therapy highly individualized?

- Motivation is the most important aspect (1A)
- Competence & ability secondly important (2A)

What are the aims of long term goals?

- voice to be appropriate for age, sex, & gender
OR
-getting them back to the point where they can go back to what they want to do (in terms of speech)

A voice disorder it?

behavioral issue

How do you fix the behavior?

- voice therapy
- doing lots of work outside of therapy

Influential factors in perceptual rating scales?

- age, sex, language, culture, intrinsic & extrinsic biases

Instrumental Assessments

* only as good as the person doing it
* numbers themselves don’t necessarily mean anything
* objective only as good as normative data
* baseline with objective measures

During instrumental assessment it is important that instrument being used meet the criteria of being ___ __&__ ____?

reliable and valid

Which professional is able to diagnose?

ENT and NOT and SLP we can only refer to “rule out”

Why would increased/elevated airflow come through the glottis?

* nodule or polyps, structure sitting on the folds or incomplete glottal closure
* increase air coming through the glottis

What would you do to measure absolute subglottal pressure?

* needle inserted into the larynx (direct - absolute subglottal pressure) OR pppp-syllable train (indirect)
* Indirect measurement: just a way to measure pressure below the glottis

How will you rate voice and be consistent with rating voice?

systematic scaling

True or false? Kids are more susceptible to voice disorders?

true, due to collision fore of vocal folds not able to absorb

Laryngeal aerodynamics

* cannot apply normative data to pediatric voice, children have different aerodynamics

Where should a voice recording be obtained at?

in a quiet environment

What can affect a person’s perceptual rating scale?

* age
* language
* culture
* intrinsic and extrinsic bias

Why use hard onset vowel?

* to see hard vocal fold adduction
* “uncle eddy eats eggs”

What to do before using a pressure transducer?

* disinfect
* know how much pressure is going in/calibrate it
* hold it tight against the face to make sure it is not leaking/has good seal

What do you control for when doing aerodynamics?

Loudness

What is the process when doing acoustic analysis of voice?

* 3-5cm away from the corner of mouth to make sure not picking up aspiration
* use a unidirectional-mounted headphone
* Elicited directions to phonate “ahh” at normal pitch and loudness
* Quite environment
* Computer with high sampling rate
* calibrate loudness
* portable

Average airflow:

* how much airflow is going through the glottis
* Measure by saying /pipipipi/
* /p/ intraoral pressure
* /i/ glottal airflow
* Elevated = nodule/polyp (incomplete closure)
* Decreased = nodule/polyp (hyperfunction)

Laryngeal airway resistance:

* how much resistance does system need to overcome to set VF into motion
* 7-10cm H2O pressure send VF into vibration
* Elevated resistance: increased medial compression/hyperfunction
* Muscle tension dysphonia

What are the 5 D’s of diagnostics

* Determine **etiology**
* Determine **severity** - how its affecting everyday life
* Determine **clinical course**
* Determine the **likely response to treatment**
* Determine the **actual response to treatment**

Jitter

* cycle to cycle variation in frequency
* you want low frequency variation in voice/lack of variability - healthy voices

Shimmer

* cycle to cycle variation in amplitude
* sample during spontaneous speech/read a passage
* reading & speech F0 may vary by 6-10Hz
* Sustained ahhh or vowel

Electroglottography

* measures amount of current flow from one side of the larynx to the other
* electrodes on each side of neck at level of thyroid → current is sent from one electrode to the other
* Derived measure of VF contact

Why is the rating of voice different from person to person?

* age
* sex
* language
* culture
* intrinsic and extrinsic bias

Why do we give the Voice Handicap before anything else?

* to see self-perception with the answers not being influenced

GRBAS scale

4-point rating system 0-3

* G: grade of judgment of voice
* R: roughness - how irregular & noisy is voice?
* B: breathiness - how much additional airflow?
* A: asthenia - judgment of how weak the voice sounds
* S: strain - judgment of how compressed
* Problematic - knowing a diagnosis can influence a listener’s perceptual measure

Treatment Approaches/Efficacy

* not much research on efficacy on voice therapy approaches

Data Collection - what to ask about?

* surgery
* prior intubation
* coughing or GERD
* eating habits
* family history
* medications
* consistency of behaviors

Parameters from laryngstroboscopic exam

* glottal closure
* supraglottic activity
* mucosal wave
* adduction
* VF mobility

Videostroboscopy

* subjective
* mucosal wave
* structures and pathologies
* auditory perceptions

topical hydration

* Increase surface hydration of VF to improve vibratory function and reduce vocal effort & laryngeal irritation
* Steam inhalation (humidifier) 
* Cough drops (lozenges) 
* Saliva substitute

systemic hydration

* Consuming liquids to promote hydration 
* Avoid drying agents 
* Antihistamines 
* Diuretics (high BP meds, etc.) 
* Caffeine 
* Alcohol 
* Environmental irritants

symptomatic voice therapy

* find the symptom, change the behavior
* trying to reduce symptoms
* most common used