Be able to give examples of and explain voice disorders associated with vocal abuse, medical, and psychological conditions.
1. Vocal abuse can cause a person to gain vocal nodules or polyps. Vocal nodules or polyps are noncancerous growths on a vocal cord or sometimes on both vocal cords. This can be caused by screaming or talking loudly, coughing, singing, etc. If the behavior is addressed early enough, the nodule or polyp can become short term and can go away; otherwise, it can become permanent.
2. Medical conditions of vocal disorders can be classified into two categories. These two categories are known as hypoadduction and hyperadduction. Hypoadduction is where the vocal cords don’t come together as much as they need to. An example of hypoadduction would be Parkinson’s Disease. Hyperadduction is where the vocal cords come together more than they need to. An example of hyperadduction is Pseudobulbar palsy or spastic dysphonia.
3. Psychological conditions of vocal disorders are described as a loss of voice without a physical cause. The mechanism is okay but it is not functioning correctly. An example of this would be Aphonia which simply means without voice. Aphonia is described as the vocal cords staying open during speech.
Explain the assessment of voice disorders.
When evaluating or assessing a voice disorder, there are many steps that must be followed through. First, the patient must ALWAYS be medically evaluated before a SLP can see them. After getting medically evaluated, we then can continue with the SLP evaluation. The SLP evaluation steps in order are: getting the case history, having an interview, performing an oral peripheral examination, hearing screening, speech and language sampling, and doing a measurement and assessment of vocal behaviors.
Suggest three treatment alternatives for voice disorders
1. Medical treatment
2. Behavioral treatment
3. Combined Approach of Medical & Behavioral
List 4 key goals of voice therapy.
- 1. Restore vocal fold tissue to healthy condition
- 2. Regain clear and full vocal function
- 3. Identify and eliminate behaviors that are abusive to voice
- 4. Establish improved vocal hygiene
Be able to list/label the anatomical components of the outer, middle and inner ear.
- Outer Ear
- o Auricle (pinna)
- o External Auditory Meatus (External Ear Canal)
- o Tympanic Membrane (ear drum)
- o Cerumen (earwax)
- Middle Ear
- o Tympanic membrane
- o Eustachian tube
- o Ossicles: malleus, incus, stapes
- o Oval window
- Inner Ear
- o Bony labyrinth
- § Cochlear portion
- § Vestibular portion (semicircular canals)
- o Inner Ear Fluids
- § Endolymph
- § Perilymph
Be able to explain ear infections, outer, middle and inner.
- Outer Ear Infections
- o They take place in the external ear canal (Swimmer’s Ear)
- Middle Ear infections
- o Otitis media
- Inner Ear infections
- o Maternal viral infections, otitis media may cause cochlear hearing loss, viral infections such as mumps and measles
Be able to describe how to perform an ASHA Hearing Screening.
Performing an ASHA Hearing Screening has some specific guidelines based on different ages. Children from birth to six months are screened with electrophysiology measures. Children between 7 months and 2 years are screened with electrophysiology methods or visual reinforcement audiometry. Preschool and school age children are screened with conditional play audiometry or conventional audiometry. In hearing screening with conventional procedures, the sound is presented at 20 or 25 dB HL and only the frequencies of 500, 1000, 2000, and 4000 Hz are tested although some admit the frequency of 500. These screenings are done in a quiet environment. Students who fail the screening are scheduled for another one two weeks later. Children who fail the second one are referred for a more detailed audiometric threshold testing.
Be able to explain the types of hearing loss & recognize them on an audiogram.
- 1. Conductive hearing loss- blockage or obstruction that prevents sound vibrations from passing normally through the outer ear and middle ear; air/bone gap with bone conduction WNL
- 2. Sensorineural hearing loss- air conductions and bone conduction outside normal limits with no air/bone gap
- 3. Mixed hearing loss- air conduction and bone conduction outside normal limits with air/bone gap
Be able to explain the difference between air conduction, bone conduction & speech testing.
- 1. Air conduction- transmission of sound through the medium of air
- 2. Bone conduction- transmission of sound through the vibrations of the bones of the skull and the ossicular chain
Know the range of normal hearing.
Up to 15 dB for children and up to 25 dB for adults
Be able to list the frequencies that are important for hearing speech and that appear on the typical audiogram.
The hearing loss ranges from 35 dB HL at 250 Hz in the left
Be able to explain how the right ear is distinguished from the left ear in the graphs on an audiogram (both color and shapes).
· The right ear lines are redand use circles
· The left ear lines are blue and use x’s
Be able to discuss/recognize the different types of hearing aids and to discuss the impact hearing loss has on speech.
- Types of hearing aids:
- o The body aid’
- o Eyeglass
- o Behind-the-ear
- o In-the-ear
- o In-the-canal
- o Competely-in-the-canal
Be able to define what it means to have a cochlear implant and know what kind of hearing that can restore.
A cochlear implant is an electric device that is surgically placed in the cochlea to directly stimulate the auditory nerve endings with sound. Cochlear implants can offer the possibility of oral speech and language development in deaf children. People with implants can become aware of environmental sounds that they did not hear before. Even those who cannot learn to produce speech and language well become better speech readers than the deaf individuals without the implants.
Be able to describe the necessary compliance or flexibility of the ear drum (tympanic membrane) as tested by tympanometry (a procedure for measurement of middle ear function).
The tympanic membrane is flexible and highly sensitive to sound pressure variations. The entire tympanic membrane responds to the sounds of low frequencies but only specific portions of it respond to high-frequency sounds.