Voice Exam #2

  1. What are the primary objectives of the voice evaluation?
    • - Identify the causes
    • - Describe the present vocal components
    • - Develop the management plan
  2. What are the secondary objective of the voice evaluation?
    • -Patient education
    • -Patient Motivation
    • -Establish credibility
  3. True or False Voice Therapists diagnose the pathology
  4. True or False Voice Therapists diagnose the treatment
  5. What is the most optimal type of voice referral?
    Self referral
  6. What is the most important part of the diagnostic evaluation?
    Patient interview
  7. Resonance
    • -Nose, throat, mouth
    • -Unique in each person
    • -What gives each person their unique voice
  8. What is the order of events in the voice evaluation?
    • 1. Referral
    • 2. Referral source
    • 3. History of problem
    • 4. Medical History
    • 5. Social History
    • 6. Oral-Peripheral examination
    • 7. Perceptual Evaluation
  9. What is included in the referral section of the voice evaluation?
    Establishing the referral source
  10. What is included in the "Reason For Referral" section of the voice evaluation?
    • -Exact reason for referral
    • -Establish patient understanding of referral
    • -Develop knowledge of voice disorder
    • -Establish credibility
  11. What is included in the "History of the problem" section of the voice evaluation?
    • -Establish chronology of the problem
    •          How long has this been going on?
    • -Seek historical etiologic factors
    •          How has this progressed?
    • -Determine motivation
    •          How much does it bother you?
  12. What is included in the "medical history" section of the voice evaluation?
    • -Seek medically related etiologic factors 
    •       Have you had any surgeries? Hospitalizations? Smoke? Drink? Medications?
    • -Establish awareness of patient personality

    Last question: on a day to day basis, how do you feel?
  13. What is included in the "Social History" section of the voice evaluation?
    • -Identify home, work, recreational environments
    • -Discover emotional, social, family difficulties
    • -Seek more etiological factors

    Hobbies, who are you around on a daily basis? Married? Divorced?
  14. What is included in the "Oral-Peripheral Examination" section of the voice evaluation?
    • -Determine physical condition of oral mechanism
    • -Observe whole body tension
    • -Observe laryngeal tension
    • -Check for swallowing difficulties
    • -Check for laryngeal sensations (dryness, tickling, burning, lump, thickness)

    This is where you scope the patient
  15. What is included in the perceptual evaluation?
    • -General quality (voice quality, inappropriate use of voice components)
    • -Resperation
    • -Phonation
    • -Resonance
    • -Pitch
    • -Loudness
    • -Rhythym and rate
    • -Non speech abuses
  16. A client with shallow breathing or vocal nodules causing poor s:z ratio has an impairment in ______________
  17. A client who shows 1. Hard glottal attacks 2. Glottal fry 3. Breathiness or 4. Diplophonia  is experiencing a deficit in ______________
  18. A client exhibiting Hypernasality, hyponasality, assimilative nasality, or inappropriate tone focus is having difficulty with _____________
  19. A client with a reduced range, poor conversational inflection this person is experiencing a deficit in __________
  20. If a client is speaking too loud, they probably have a
    sensorineural hearing loss
  21. If a client is speaking too soft, they probably have....
    a Conductive hearing loss
  22. If a big man comes in with a high voice he most likely has a __________
  23. If a person is unable to shout, they most likely have some sort of _________
  24. Name 3 non-speech abuses
    • -throat clearing
    • -coughing
    • -Unusual laugh
  25. Identifying the existence of a voice problem is
  26. Assessing the stage of progression of the voice problem is
  27. Identifying the differential source of the voice problem is the
  28. Videostroboscopy
    View of the gross structure of VF and how they move and their vibratory characterisitics
  29. High Speed Digital Imaging
    How VF move, their vibratory characteristics, and onset/offset
  30. Acoustic Recording and analysis
    Qualitative picture with objective measures for pitch and intensity (fo, intensity, signal-to-noise ratio, pertubatoon measures, spectral features)
  31. Aerodynamic Assesment
    Interaction between breath support and voice production (airflow rat and volume, buglottal pressure, phonation threshold pressure, laryngeal resistance)
  32. Inverse Filter
    Glottal waveforms of acoustics or airflow
  33. Electroglottography
    Acoustic recording (measure of VF contact area)
  34. Electromyography
    Only direct measure of muscle activity (needle straight to muscle)
  35. Advantages of Rigid Endoscopy
    • -Close view of larynx
    • -Large magnification
    • -Stable lens
  36. Disadvantages of Rigid Endoscopy
    • -Limited sample (sustained /i/)
    • -Not good for those with hyperactive gag reflex
    • -Not a realistic sample of the patient's speech
    • -Not good for viewing supraglottic region
  37. Advantages to flexible endoscopy
    • -View of larynx during connected speech
    • -Broad view of vocal tract and supraglottic region
  38. Disadvantages of Flexible Endoscopy
    • -Darker Image
    • -Limited by movement of velum
    • -Difficult to acheive stable image
  39. What is Talbots Law?
    • -Images linger on eye for .2 seconds after exposure
    • -Eye can perceive no more than 5 images/second
    • -For stroboscopy, video picks up images at different points in cycle and puts them together (simulated slow motion, not real time)
  40. what is the purpose of having a client say /i/ at regular pitch?
    Assess glottic closure
  41. What is the purpose of having a patient glide up
    Assess CT and external branch of SLN
  42. What is the purpose of having a client glide down
    Assess TA
  43. What is the purpose of having the client o diadochokinesis? "he, he, he"?
    Assess IA, LCA, PCA and the RLN
  44. What is the purpose of having the client doing inhalation phonation?
    to view lesions beneath the surface
  45. What would "the left arytenoid is locked in the lateral position" mean?
    Left VF paralysis
  46. Anterior/posterior compression is a sign of
  47. Scissoring assumes damage to....
    CT and SLN
  48. T/F Stroboscopy is measured in real time
  49. T/F High Speed Digital Imaging is measured in real time
  50. What is the main disadvantage to using HSDI?
    • -There are so many images that it takes a long time to look at all of them
    • -Cannot see adduction and abduction
    • -Can only use rigid endoscope
    • -Light is very hot
  51. Advantages to HSDI
    • -Records in real time
    • -Not dependant on fo- so no tracking errors
    • -Effective with VF vibratory features
  52. What measurement would be effective in measuring whether or not a patient is dysphonic?
    • Acoustic Recording analysis
    • (measures pitch and intensity)
  53. T/F Acoustic Recording Anaysis tells you waht is happening at the true VFs
  54. Which measurement is used for pitch?
    • Routine voice acoustic measures 
    • (fo)
  55. Normal pitch for men and women
    • Men: 100-150 Hz
    • Women: 180-250 Hz
  56. Ways to mesure fo
    • -sustained vowels
    • -reading
    • -conversation
  57. Standard deviation for Fo
    Pitch sigma
  58. A higher standard deviation in pitch means
    more dysphonic voice
  59. Measured in Hx or semitones
    Phonation Range
  60. What is the phonation range of normal young adults?
    3 octaves (may be more for a singer)
  61. Jitter
    Frequency Perturbation
  62. High Jitter=
    Dysphonic Voice
  63. What is Jitter/Frequency Perturbation?
    change of frequency from one successive period to the next
  64. How to measure jitter
    sustained vowels
  65. This directly reflects the sound pressure level (SPL) of voice
  66. Direct correlate of loudness
  67. Indication of strength of the VF vibration
    • Overall SPL dB
    • Norms- 75-80 dB for normal conversation
  68. Amplitude Variability
    Standard Deviation of SPL during connected speech from the loudness
  69. Range of loudness vocal intensities a person can produce
    • Dynamic range 
    • Norms 50-115 dB SPL
  70. What is Shimmer?
    • Amplitude Perturbation
    • (peaks)
    • cycle-to-cycle changes of amplitude
    • Norm- <.35 dB
  71. Do we want high or low harmonics to noise ratio?
  72. Excessive high subglottal pressure points to
  73. excessive low subglotti pressure points to
  74. Describe Subglotic Pressure, Phonation Threshold Pressure, Laryngeal Airway Resistance, and Airflow rate for someone with Poor Subglottic Closure
    • Psub- unaffected
    • PTP- increased to initiate phonation
    • LAR- low
    • Airflow rate- high
  75. Describe Subglotic Pressure, Phonation Threshold Oressure, Laryngeal Airway Resistance, and Airflow rate for someone with Muscle Tension Dysphonia
    • Psub- increased
    • PTP- increased
    • LAR- high
    • Airflow rate- low
  76. Describe Subglotic Pressure, Phonation Threshold Oressure, Laryngeal Airway Resistance, and Airflow rate for someone with Vocal Fold Nodules
    • Psub- increased
    • PTP- increased
    • LAR- low because of hourglass opening
    • Airflow rate- high
  77. Describe Subglotic Pressure, Phonation Threshold Oressure, Laryngeal Airway Resistance, and Airflow rate for someone with Papilloma/Carcinoma
    • -Psub:tricky—depends on if they are compensating or not
    • -PTP: increased
    • -LAR: low
    • -Airflow rate: high
Card Set
Voice Exam #2
voice 2