Gradual weakening of the aging voice - hoarse vocal quality that deteriorates during the day.
What would visual expection of an elderly pt reveal?
bowing vocal fold margins
a spindle-shaped glottis
prominent arytenoid cartilage vocal processes
vocal fold edema
On a laryngostoboscopy?
Electroglottography?
asymmetery of vocal fold vibration
Predominance of open phase
This correlates with poor health-related quality of life and a tendency to avoid social situations:
presbyphonia
What is the most common cause of hoarse vocal quality in the elderly population?
Other causes?
VF lesions (polyps)
malignant lesions
vf paralysis
functional dysphonia
When does general pulmonary functioning with aging become measurable?
40 years
What happens to speaking fundamental frequency (SFF) with age?
lowers in women
raises in men
What happens to maximum phonational frequency range (MPFR) with age?
reduces in men and women
What is less stable with age?
SFF
amplitude
Maximum intensity of vowel production...
is reduced in men and women
Perturbation (jitter, shimmer, spectral noise)...
increases in men and women
Centralization of vowels...
is common in older adults
What contributes to changes in the formnt frequencies in older speakers?
lengthening of the vocal tract
nasalance is...
higher in older speakers
What specific acoustic characteristics have been identified in the elderly voice of both males and females?
What specific acoustic characteristics have been identified in the elderly voice of both males and females? (7)
Tremor
Hoarseness
Breathiness
Voice Breaks
Decreased loudness
Slower speaking rate
Change in habitual pitch - sex dependent - increase in men, decrease in women
What are the physiological changes with aging? (5)
Lengthening of the vocal tract
Reduction in pulmonary function
Laryngeal cartilage ossification
Increased stiffening of the VFs
Reduction in VF closure
What is one thing that will have a positive influence on voice?
Overall physical fitness
________ will improve a pt's laryngeal physiology, potentially improving voice
Vocal function exercises
Direct work on ________ can have a rejuvenating effect on the sound of the older pt's voice
increasing the rate of speech
Other fascilitating approaches to improve the older voice:
Auditory feedback
Focus
Glottal fry
Masking
Respiration training
Visual feedback
What has the largest toll on development of language and a severe impact on voice production?
Severe congenital hearing loss
Voice is not usually affected in a sensorineural HL until the loss exceeds ____ (dB) in frequencies under ______
50 dB
2000 Hz
The later in life a severe to profound HL occurs, the ______ impact there will be on a child's voice
less
What are the voice characteristics of deaf or profoundly hard-of-hearing pt?
Elevated fundamental frequency
Downward formant shifts
Varied pitch and loudness changes
Resonance variations
A slower rate of speech by prolonging vowels
Variations in prosody
T/F
Older children and adults who acquire HL may eventually show changes in loudness and articulation.
True
When should voice training for severely hearing impaired pts begin?
After needed amplification has been provided - if possible
An optimum fitting hearing aid has positive effects on both speech and voice, often improving _____(3)
Vocal quality
Vowel duration
Prosody
Children with hearing impairments profit from developing an awareness of other voices, as well as of their own pitch levels. What can be used to help?
amplification feedback and instrumental tracings of pitch
What are methods to train voice in deaf or hard-of-hearing children?
Cue arrows
Placing fingers on the larynx to feel the downward excursion during lower pitch productions and upward excursion during higher ones
The ideal or optimum pitch is produced by ________ vertical movement of the larynx
minimal
What characterizes the voice of deaf children?
Alterations in nasal resonance often occompanied by excessive pharyngeal resonance
Drawn back tongue into the hypopharynx creates cul-de-sac voice
Marked variations in nasal resonance
What type of tongue posturing problem is observed in deaf children?
excessive posterior posturing of the tongue
What can be done to establish a more normal oral resonance in the voice of a deaf child?
Altering the tongue to a more forward carriage
Tongue protrusion
Professional voice users exert unusual demands on:
Repiration
Phonation
Resonance
What are some of the obstacles SLPs experience when working with professional voice users?
performance innocence
lack of meaningful shared language
What are the 2 major causes of airway obstruction?
Airflow interference
Vocal fold paralysis
What are causes of airway interference?
infectious and noninfectious
papilloma
granuloma
cysts
carcinoma
& other space-occupying lesions
What is the most common laryngeal movement obstruction to in and out air movement?
Vocal fold paralysis - unilateral or bilateral
bilateral abductor paralysis is life-threatening
What is paradoxical vocal fold movement (PVFM)
nonorganic disorder of the upper airway with both true and false vocal folds exhibiting paradoxical function of closure on inspiration, expiration, or a combination of both.
What are the 3 possible etiologies of PVFM?
+ one trigger
psychogenic - a conversion reaction
sensitivity
neurological - a form of laryngeal dystonia
strenuous exercise
What is a tracheostomy?
an external opening to the trachea
it fundamentally alters the physiology of voice and swallow because the stoma is lower than the level of the larynx and bipasses the upper airway
What is a tracheostomy speaking valve?
A one-way removable valve attached to the open end of the tracheostomy tube
Laryngeal cancer accounts for approximately _______ of all cancers and _______ of all head and neck cancers.
1-2%
20%
Where does laryngeal cancer usually occur?
supraglottis
glottis
subglottis
What is the first consideration after a diagnosis of laryngeal cancer?
how to best cure the disease and preserve the pt's life
What is removed during a laryngectomy?
laryngeal and hypolaryngeal cartilages
hyoid bone
all intrinsic and extrinsic muscles of the larynx
and upper rings of the trachea
What is an electrolarynx (EL)?
An instrument placed externally against the throat (throat type) or inserted into the mouth (intraoral) while speaking
What is esophageal speech (ES)?
2 methods: injection and inhalation
once air is in the esophagus, external forces compress the air within it which sets up vibration of the PE segment
What is a tracheoesophageal puncture (TEP)?
A puncture is made through the posterior wall of the trachea extending through to the esophagus, a prosthesis is inserted into the puncture which shunts pulmonary air into the esophagus causing the upper esophageal sphincter and surrounding tissues to vibrate
What are the candidacy requirements for successful TE speech?
1. Adequate pulmonary support
2. cognitive/sensorimotor abilities to occlude the stoma for speech and clean/remove the prosthesis
3. PE segment that vibrates adequately
What are the 2 types of TEP prosthesis?
Those that are inserted/manipulated by the pt, and those done by the physician
What problem results if the TEP prosthesis is too long?
Too short?
Long - it will make contact with the esophageal wall and interfere with voice production, cause a leak, or enlarge the fistula
Short - may be expelled during forcefull coughing
What is the definition of vocal resonance?
The perceptual increase in loudness of the laryngeal tone due to the concentration and reflection of sound waves by the oral, nasal, and pharyngeal cavities during voice production
Is the velopharyngeal port open or closed during the production of nasal phonemes?
Open
What is the most common resonance disorder?
hypernasality
What is velopharyngeal insufficiency?
A tissue deficiency
What is velopharyngeal incompetence?
impaired motion of the VP mechanism
What is velopharyngeal inadequacy?
a mix of tissue deficiency and impaired motion
What are the speech characteristics of of VPD?
inappropriate nasal air emission
reduced intraoral pressure
excessive nasal resonance
What is hyponasality?
reduced nasal resonance for the phonemes m, n, and ng
How are the phonemes m, n, and ng produced by a hyponasal speaker?
b, d, and g
What are possible causes of hyponasality?
hypertrophied adenoids and tonsils, a deviated septum, an obstructed naris, choanal atresia, nasal cavity turbinate swelling, allergic rhinitis, and nasal polyps
What is assimilative nasality?
vowels or voiced consonants preceding and following nasal consonant resonance assimilates the nasality
What are possible causes of assimilative nasality?
overexposure to faulty speech models or exaggerated regional dialect patterns
Considered a functional disorder
What are 3 procedures used to analyze voice?
Listen during spontaneous speech
Tape-record samples of pt's connected speech
- reverse playback is most helpful
Ask pts to repeat or read aloud passages that are totally free of nasal consonants (hypernasality) or loaded with nasal consonants (hyponasality)
What are screening procedures for voice?
1. With the nares pinched/unpinched say, "my name is money" - no difference = hyponasality, big difference = hypernasality
2. The Snap Release /s/ - pt sustains a loud /s/ while nares are pinched and quickly released. if a snap is heard = VP mechanism is partially open - hypernasality
3. "The horse eats grass"and "I see the teacher at church" snorting back in the pharynx = hypernasality
4. "Maybe baby" no difference between the /m/ in maybe and /b/ in baby = hypernasality, if both sound like /b/ - hyponasality
5. Nasal Flutter test - /i/ and /u/ while fluttering the nares - pulsing change in acoustic signal = hypernasality
6. fogging mirror and say a nonnasal sentence
pts with hypernasality are at increased risk for ______ associated with vocal hyperfunction
