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Anatomical and physiological reasons to do laryngoscopy
- 1. Note location and relative size of supraglottic, laryngeal and tracheal structures
- 2. Note movement of vocal folds as pitch, loudness and register change; movement associated with articulation
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Parameters for laryngeal examination
- 1. glottal closure configuration: complete? incomplete? posterior glottal gap? hourglass?
- 2. horizontal excursion of vocal folds aka amplitude of vibration
- 3. mucosal wave
- 4. vocal edge: straight and smooth?
- 5. phase closure: amount of opening gesture vs. closing gesture
- 6. phase symmetry: L & R symmetry during vibration?
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Acoustic instrumental tests
- 1. F0 charateristics
- 2. I0 characteristics
- 3. spectral characteristics -- perceived voice quality
- 4. timing/duration characteristics
- 5. harmonics/noise ratio
- 6. pertrubation
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signal (harmonics) to noise ratio
Measure of ratio of energy in fundamental and harmonics to energy in aperiodic component of the voice signal
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The __________ the HNR, the more noise in the voice
lower
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How do you reckon HNR?
harmonic÷ noise
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physiological instrumentation in voice assessment
- 1. electroglottography
- 2. electromyography
- 3. inductive pletysmography
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electroglottography
noninvasive technique for obtaining an estimate of vocal fold contact patterns during phonation
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Waveforms created in electroglottography (electroglottogram or laryngogram) usually graphically demonstrate _________ vocal fold contact by going UP.
increased
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Pros to doing electroglottography
- 1. diagnostic baseline vibration pattern and biofeedback in attempting to change contact pattern (adduction level)
- 2. non-invasive
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Cons to doing electroglottography
- May be difficult to obtain in:
- 1. children
- 2. adults with lots of neck tissues superficial to thyroid cartilages
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Why do electromyography?
- 1. for gross motor tension in facial or neck area associated with hyperfunctional phonation
- 2. to study contraction in specific muscles during various phonatory/swallowing behaviors, also used to verify muscle location for botox injections
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Two types of electromyography
- 1. surface electrodes: senses summed electrical activity associated with muscles contracting beneath it
- 2. intramuscular: senses electrical activity associated with contraction of muscle/muscle motor unit in which it has been inserted
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inductive pletysmography
- Inductive plethysmography employs sensors to measure changes in a crosssectional
- area of the RC and abdominal (AB) compartments during a respiratory and cardiac
- cycle.
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spirometer
A test measuring lung function, specifically the measurement of the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled.
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wet spirometer
instrument used by doctors to determine the lung volume of patients. It uses the principle of displacement to measure the amount of air the lungs can hold.
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aerodynamic measures
- 1. subglottal pressure
- 2. glottal airflow
- 3. inverse filtered airflow
- 4. glottal resistance
- 5. lung volume
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subglottal pressure
- direct tracheal pressure
- related to intensity, adequacy of pulmonary effort for initiating and sustaining phonation
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mean flow
- measured at mouth with pneumotachometer
- low frequency measure of total airflow expelled during phonation
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inverse filtered airflow
total airflow - vocal tract contribution (F1, F2) = estimated airflow above glottis
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respitrace device
device that allows clinician to know relative lung volume (in terms of percentage of total vital capacity) at any point during phonation
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A hyperfunctioning voice is characterized by ________.
phonotrauma
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A hypofunctioning voice is characterized by ________.
not enough glottal closure
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Overall goal in voice therapy
Best voice with the least cost
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Voice clinician as counselor:
- Discuss stressful situations
- Create hierarchies
- Teach behavioral approaches to minimize symptoms -- easier voice
- Counsel, don't reprimand
- Develop action plan to meet goals
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