Voice and Fluency Disorders Study Notes

CMDS 5455: Disorders of Voice & Fluency

Lecture Information

  • Lectures: 4 & 5

  • Topics: Speech Science Review, Evaluation & Diagnosis

  • Dates: September 25, 2025, October 2, 2025

Speech Science Review

Key Concepts

Wave Characteristics

  • Frequency of Sound:

    • Definition: Rate at which the wave cycle repeats.

    • Types of Frequency:

      • Simple: Only one frequency.

      • Complex: Made up of two or more different frequencies.

    • Wave Types:

      • Periodic: Repeats itself over time.

      • Aperiodic: Random and non-repeating, e.g. "white noise."

Type

Description

Simple, periodic

Repeats with single frequency

Complex, periodic

Multiple frequencies present

Aperiodic

Non-repetitive waves

Amplitude

  • Represents the magnitude of sound waves over time in seconds as shown in waveform diagrams.

Resonators

Function of Resonators:

  • Definition: Filters acoustic energy from a sound source.

  • **Types: **

    • Helmholtz Resonators: Single resonant frequency.

    • Tube Resonators: Exhibit multiple resonant frequencies.

Spectrograms

  • Components: Time on the x-axis, frequency (in kHz) on the y-axis, showing relative amplitude (in dB).

  • Example Representation:

    • Frequency ranges from 1.0 kHz to 6.0 kHz.

    • Time measured in ms (100 ms intervals).

Evaluation & Diagnosis of Voice Disorders

Introduction

ASHA’s Definition of Voice Evaluation

  • “A comprehensive assessment is conducted for individuals suspected of having a voice disorder, using both standardized and non-standardized measures. Norms are based on age, gender, type of instrumentation used, cultural background, and dialect.” (ASHA, 2015)

Purpose of Evaluation

  • To thoroughly assess the vocal function of patients with suspected voice disorders utilizing a multi-faceted approach.

Parameters in Voice Production

  • Table 1.1: Parameters in the peripheral process of production and perception of voice (Hirano, 1975, modified).

    • Physiological Parameters: Glottal closure, vocal fold position, symmetry, amplitude, etc.

    • Acoustic Parameters: Waveform quality, amplitude, spectrum analysis.

    • Psycho-Acoustic Parameters: Perceived loudness, pitch, duration.

Protocols for Voice Evaluation

Core Set of Protocols

  • Components:

    • Case History: Initial collection of patient information.

    • Laryngeal Evaluation: Includes imaging and muscular assessments.

    • Aerodynamic Assessment: Measures airflow and pressure.

    • Auditory-Perceptual Evaluation: Subjective assessment of voice quality.

    • Acoustic Assessment: Objective measurements of voice production.

Case History

  • Importance: Collects foundational information about the patient’s history and experiences related to voice disorders.

  • Patient and Caregiver Perception Questionnaires are to be utilized for comprehensive understanding.

Measures in Laryngeal Evaluation

  1. Oral Peripheral Examination

  2. Cranial Nerve Examination (Referenced in supplemental materials)

  3. Laryngeal Imaging: Techniques may include:

    • Electroglottography

    • Electromyography (EMG)

Techniques in Laryngeal Evaluation

  • Indirect Laryngoscopy: Non-invasive observational technique.

  • Endoscopic Imaging:

    • Oral Rigid Endoscopy: Direct visualization of larynx.

    • Transnasal Flexible Endoscopy: Flexible scope for detailed imagery.

Aerodynamic Assessment

Overview

  • Investigates airflow and pressure generated during voice production, essential for understanding laryngeal aerodynamics.

Measurement Techniques

  • Airflow Assessment:

    • Using spirometry for nonspeech tasks.

    • Utilizing Rothenberg face masks for speech assessment.

Pressure Assessment Methods

  • Direct Methods:

    • Tracheal puncture for subglottal pressure (
      invasive).

  • Indirect Methods:

    • Measurement of pharyngeal or intraoral pressures.

Phonatory Aerodynamic System (PAS)

  • Collects data on airflow, pressure, and other vocal parameters for a comprehensive evaluation of phonation.

Assessment of Breath Support

  • Method: Utilize a water-glass manometer by blowing bubbles through a straw.

  • Example: Sustaining bubbles for 5 seconds at a depth of 5 cm indicates adequacy of breath support (Duffy, 2005).

Auditory-Perceptual Assessment

  • Assesses speech characteristics related to respiratory, phonatory, resonance, and articulation deficits.

  • Main Tools:

    • CAPE-V: Clinical tool for describing voice severity.

    • Tasks include sustained vowels and reading sentences.

Other Assessment Scales

  • GRBAS Scale:

    • Components: Grade, Roughness, Breathiness, Asthenia, Strain.

    • Scoring: 0 (normal) to 3 (severe).

Acoustic Assessment

Introduction

  • Purpose: Provides quantifiable measurements for voice profiling.

  • Acoustic Measures Related to Voice:

    • Pitch: Measured in Hz (Fundamental Frequency).

    • Loudness: Measured in dB (Sound Pressure Level).

    • Quality: Assessed using perturbation measures, e.g., % jitter, % shimmer.

Task Implementation for Acoustic Measurements

  • Tasks involve sustained vowels, reading passages, and assessing loudness and pitch range.

Recording Setup for Acoustic Assessment

  • Conditions should include a quiet environment, high-quality recording systems, controlled microphone distance, and calibrated sound pressure levels.

Counseling in Voice Therapy

  • ASHA Guidelines: SLPs provide educational and emotional support related to communication impairments and their impact on individual and family dynamics.