Week 8 Study Guide - Diagnosis and Examination 2

Chapter 2

What is the difference between a sign and a symptom? Describe a situation where a patient can have a sign of a voice problem but no symptom.

• symptom is a complaint, could be something the patient feels (soreness, pain) or perceptual (hoarse/scratchy throat), may or may not be able to be verified - we cannot feel the patient’s pain

• sign is what we can observe or test, we can see/perceive it/measure it upon examination/observation

• a clinician noticing mild breathiness in someone’s speech, but the patient does not feel any different, noting higher frequency but patient doesn’t notice anything

Name the major signs of a voice problem and some of their causes

• Pitch - lack of normal variation (monopitch) caused by neurological impairment/psychiatric disability, inappropriate pitch caused by underdevelopment of larynx/endocrinological factors, pitch breaks caused by laryngeal pathology, reduced pitch range

• Loudness - lack of variation in loudness level (monoloudness) caused by neurological impairment/psychiatric disability/personality habit, loudness variation caused by loss of neural control/problems affecting respiratory system, reduced loudness range

• Quality - hoarse/rough caused by pathologies that affect the vibratory behaviour, breathy caused by peripheral neurological problems/central neurological impairment/presence of lesion affecting closure, tension caused by hyperfunctional usage patterns/compensatory strategy due to neurological or laryngeal pathology, tremor caused by CNS dysfunction, strain caused by neurological dysfunction

What are some deviances that you can see with Fundamental Frequency? How would you measure these?

• mean fundamental frequency - too low/too high

• frequency variability - monopitch/irregular pitch control

• phonational range - inability to vary pitch range -

• frequency perturbation (jitter) - unsteadniness of pitch

• visipitch is a tool to use

What are some deviances that you can see with Amplitude? How would you measure these?

• amplitude variability - too high/too low -

• dynamic range - limited/excessive - SPL

• amplitude perturbation - irregular vibration - electroglottography

• can use CSL

What are some deviances that you can see with Vocal Quality? How would you measure these?

• hoarse/rough - noisetoharmonics, shimmer/jitter perturbation

• breathy - maximum phonation time

• tension - laryngoscopy

• tremor - sustained vowel, spectrogram

• strain/struggle - SPL, laryngoscopy

• sudden interuption of voicing - spectrogram

• diplophonia - spectrogram

• CAPE-V

What are some deviances that you can see on Visualization?

• glottal closure

• amplitude

• mucosal wave

• supraglottic activity

• vertical level differences

Roy

Define both ADSD and MTD in terms of the etiology, symptoms and treatment.

• ADSD = adductor spasmodic dysphonia

• neurogenic, focal laryngeal dystonia with intermittent/continuous spasmodic hyperadduction of the true vocal folds

• strain/strangled voice quality/phonatory breaks/effortful voice

• diagnosis relies mainly on auditory-perceptual features

• severity of dysphonia depends on the demands of the vocal task

• treatment includes botox injections into one or both vf to weaken adductor muscles

• MTD = muscle tension dysphonia

• excess or dysregulated laryngeal or paralaryngeal muscle tension causing dysphonia (voice misuse/overuse)

• strained/effortful voice/hoarse/rough voice

• treatment is voice therapy

• diagnosis of ADSD and MTD can often be difficult because of the absence of a well-established set of diagnostic criteria to distinguish the two disorders.

What does “task specificity” mean? What are some tasks specific to ADSD? MTD?

• task specificity = certain vocal tasks may increase or
  decrease the likelihood of provoking spasmodic overclosure of the vocal folds and thus the severity of sign expression

• In patients with ADSD, it has been observed that vocal tasks such as whispering, singing, or speaking in falsetto can be relatively free of the strained, strangled voice quality characteristic of connected speech produced at normal pitch and loudness

• Voice produced during sustained vowels (i.e., during vowel prolongation) is less symptomatic as compared with voice produced during contextual speech

• basis of the relative loading of voiced or voiceless consonants. Sentences loaded with voiced consonants (b, d, g, z, v, j, m, n) provoked more frequent phonatory breaks as compared with sentences loaded with voiceless consonants (p, t, k, s, f, ch).

• MTD does not seem to be task specific, all vocal tasks (i.e., sustained vowels vs. connected speech, voiced vs. voiceless consonants, falsetto, singing) equally affected

According to Roy et al., what is the main difference in ADSD and MTD with respect to connected speech and sustained vowels?

• MTD: consistently strained quality in both sustained vowels and connected speech

• ADSD: more disruption during connected speech than sustained vowels

Mehta and Hillman

What is the CAPE-V and what are its drawbacks?

• CAPE V is an auditory perception evaluation of the voice for voice quality

• Provides a standardized framework and procedures for
  perceptual evaluation of abnormal voice quality - severity of dysphonia, roughness, breathiness, strain, pitch and loudness

• not designed to resolve all of the persistent reliability problems when evaluating voice

What are sources of variability in listener ratings?

• instability of internal memory standards for levels of a perceptual
  dimension

• ability to isolate single dimensions in a complex context

• scale resolution

• absolute magnitude of the attribute being measured.

What are some inherent problems using acoustic measures?

• limited by a reliance on the accurate determination
  of fundamental frequency

• acoustic measures further restricted to the analysis of sustained vowels

• F0 can be difficult or impossible to extract in disordered voices, and sustained vowels may not be representative of vocal function or voice quality during continuous speech

• sustained vowels may not represent real speaking

What are aerodynamic measures? Which measures are most used in voice analysis?*

• “Aerodynamic measures assess how the larynx functions to produce voice, measuring glottal airflow and subglottal air pressure”

• phonation threshold pressure

What are some inherent problems in videostroboscopy? High speed laryngeal imaging?

• stroboscopy only provides a highly averaged view of the vibration pattern and is not capable of resolving detailed tissue motion within individual vibratory cycles

• low quality grayscale images at slower capture rate, take a long time to process and download