Voice Final

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What is a voice disorder?

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

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What is a rigid scope used for?

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  • 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)
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54 Terms

1
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What is a voice disorder?

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

2
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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)
3
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What is a flexible scope used for?

  • Shows movement larynx
  • higher quality of pictues
  • swallowing
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What kind of measures are rigid and flexible scopes?

subjective

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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
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Is a videostrobostrophy objective or subjective?

subjective

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

have to know the frequency of the voice

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Why would you use aerodynamics?

  • result of physiological phenomenon
  • gives exactly how much air flow for voice (numerical data)
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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
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What are the characteristics of aerodynamics?

  • the physiological response
  • the actual air movement (objective measurement)
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Why would you do an aerodynamic evaluation?

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

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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.
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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
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Complete voice rest (CVR)

elimination of all vocal fold contact

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Modified voice rest (MVR)

  • get away from heavy vocal load
  • elimination of excessive voice
  • duration should be patient specific
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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
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What factors contributes to successful therapy outcomes?

  • Motivation of patient
  • Responsibility & Commitment
  • Completion of home practice
  • Incorporate suggest vocal lifestyle changes
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What is the goal of voice therapy?

  • Restore the best voice possible; adequate assessment, good data to set goals and see progress
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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
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How is voice therapy highly individualized?

  • Motivation is the most important aspect (1A)
  • Competence & ability secondly important (2A)
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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)
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A voice disorder it?

behavioral issue

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How do you fix the behavior?

  • voice therapy
  • doing lots of work outside of therapy
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Influential factors in perceptual rating scales?

  • age, sex, language, culture, intrinsic & extrinsic biases
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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
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During instrumental assessment it is important that instrument being used meet the criteria of being ___ _&_ ____?

reliable and valid

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Which professional is able to diagnose?

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

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

systematic scaling

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

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

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Laryngeal aerodynamics

  • cannot apply normative data to pediatric voice, children have different aerodynamics
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Where should a voice recording be obtained at?

in a quiet environment

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What can affect a person’s perceptual rating scale?

  • age
  • language
  • culture
  • intrinsic and extrinsic bias
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Why use hard onset vowel?

  • to see hard vocal fold adduction
  • “uncle eddy eats eggs”
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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
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What do you control for when doing aerodynamics?

Loudness

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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
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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)
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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
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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
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Jitter

  • cycle to cycle variation in frequency
    • you want low frequency variation in voice/lack of variability - healthy voices
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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
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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
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Why is the rating of voice different from person to person?

  • age
  • sex
  • language
  • culture
  • intrinsic and extrinsic bias
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Why do we give the Voice Handicap before anything else?

  • to see self-perception with the answers not being influenced
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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
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Treatment Approaches/Efficacy

  • not much research on efficacy on voice therapy approaches
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Data Collection - what to ask about?

  • surgery
  • prior intubation
  • coughing or GERD
  • eating habits
  • family history
  • medications
  • consistency of behaviors
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Parameters from laryngstroboscopic exam

  • glottal closure
  • supraglottic activity
  • mucosal wave
  • adduction
  • VF mobility
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Videostroboscopy

  • subjective
  • mucosal wave
  • structures and pathologies
  • auditory perceptions
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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
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systemic hydration

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

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