Term
| what are the six elements of a voice evaluation? |
|
Definition
1. Take a thorough and accurate case history to identify factors underlying the presenting complaint
2. Observe the voice production system in spontaneous conversational speech (often during the case history)
3. Complete an oral-peripheral mech exam
4. Record perceptual observations in structured and spontaneous speech tasks. Observe singing if needed.
5. Assess instrumentally as appropriate
6. Listen for cues about the patient’s state of mind: is the voice affecting quality of life? Is quality of life affecting the voice? |
|
|
Term
| what three things are included in the cast history? |
|
Definition
| the effect of the voice problem, developmental history of the problem, onset/precipitating events/patient's ideas about etiology |
|
|
Term
| sudden onset without obvious trauma is more commonly what? |
|
Definition
|
|
Term
| What are things we want to know about the patient's social history? |
|
Definition
| you want to know if the person lives alone v. living with 5 kids, does the person have a hard of hearing husband, etc. |
|
|
Term
| how can recreation tie into the clinical history? |
|
Definition
| you want to know if the patient goes out a lot on the weekends, sings karaoke, a performer, coach, etc. |
|
|
Term
| what do we need to know about a person's profession? |
|
Definition
1. what are their daily voice use requirements?
2. have there been any recent changes in your job responsibility? |
|
|
Term
| what do we need to know about a person's heath? |
|
Definition
1. if they've had any surgeries (recurrent laryngeal nerve damage)
2. any medication's they're on (side effects, meds that produce reflux or that dry out the larynx)
3. co-existing conditions
4. overall heath status |
|
|
Term
| what is related to a strain/higher degree of tension in the larynx and surrounding musculature? |
|
Definition
|
|
Term
| what is related to aperiodicity and irregularity in the VF vibration? |
|
Definition
|
|
Term
| what is related to air leaking out of the VFs? |
|
Definition
|
|
Term
| what is related to neurogenic trouble? |
|
Definition
|
|
Term
| what are different types of pitch anomalies? |
|
Definition
| too high or too low pitch; this may be caused by a lesion on the VF or the folds |
|
|
Term
| the VFs being too high is commonly an issue with what? |
|
Definition
|
|
Term
| what is related to velopharyngeal closure issues? |
|
Definition
|
|
Term
| what is related to running out of breath support or pausing at abnormal times? |
|
Definition
|
|
Term
| what do we want to keep an eye out for during an oral-peripheral mech exam? |
|
Definition
|
|
Term
| where should we observe tension in an oral-peripheral mech exam? |
|
Definition
|
|
Term
| when we palpate the larynx during an oral-peripheral mech exam, what should we look at? |
|
Definition
| observe the position of the larynx, it's maneuverability, and the size of the thyroid space |
|
|
Term
| what are we looking at when we instruct the patient to take a deep breath during an oral-peripheral mech exam? |
|
Definition
| we are noting the relative movement of the shoulders v. abdomen |
|
|
Term
| muscle tone lets you know about what type of problem? |
|
Definition
|
|
Term
| which CN sends more impulses to the larynx? |
|
Definition
|
|
Term
| What do we need to know about the gag reflex? |
|
Definition
| a person should have one - however, do not trigger a gag-response if you are going to scope the patient a little later |
|
|
Term
|
Definition
| some women bring their VFs together for more of their speech except a little bit at the end |
|
|
Term
| what are the 6 structures speech tasks? |
|
Definition
1. vowel prolongations
2. vowel prolongation with and without occluded nares
3. s/z ratio
4. count to ten, getting louder with each number
5. glottal attack words/sentences
6. standard passage |
|
|
Term
| how many trials of vowel prolongations do you do? vowel prolongation with and without occluded nares? s/z ration? |
|
Definition
|
|
Term
| what does the s/z ratio tell us? |
|
Definition
| how efficiently the larynx is working |
|
|
Term
| why do we get s/z ratios? |
|
Definition
| Ask the patient to stretch out /s/ and /z/ and time it – if you have a patient who’s larynx is valving inefficiently then that’s a patient who is going to be producing a shorter /z/. -- because they’re produced in the same way except for voicing, a proper larynx will produce the sounds for the same amount of time. If there’s a VF pathology that allows are to leak around/air wastage then a person can’t keep a /z/ going for as long |
|
|
Term
| In general, a s-z ratio of _____ or more there is a red flag. |
|
Definition
|
|
Term
| counting to 10, getting louder with each number looks at what? |
|
Definition
|
|
Term
| glottal attack words/sentences look at what? |
|
Definition
| how many glottal attacks happen |
|
|
Term
| how is respiration for speech assessed? |
|
Definition
1. spirometry
2. the number of breaths needed to count to 50 |
|
|
Term
| what are the two ways to record perceptual observations? |
|
Definition
|
|
Term
| what does the GRBAS look at? what kind of a scale is it on? |
|
Definition
Grade (the voice overall)
Roughness/hoarseness (irregular VF vibration)
Breathiness
Asthenia (weakness)
Strain (harshness)
--- on a 0-3 scale |
|
|
Term
| what does CAPE-V stand for? how does it work? |
|
Definition
| Consensus Auditory-Perveptual Evaluation of Voice -- it has the patient read three sentences and then you make a mark on the line and measure exactly how far from the beginning to the end and it gives you a quantifiable estimate of the person's breathiness |
|
|
Term
| which test is more flexible? (GRBAS or CAPE-V) |
|
Definition
| CAPE-V --- however, they both look at the same parameters |
|
|
Term
| when do we want to palpate a singer's larynx? |
|
Definition
|
|
Term
| what do we want to know about a singer? |
|
Definition
| ask about their warm-up routine, rehearsal schedule, practice hours, and instructor's credentials |
|
|
Term
| where do we observe tension in singers? |
|
Definition
|
|
Term
| what are less obvious signs of tension in singers? |
|
Definition
| rolling up onto the balls of their feet |
|
|
Term
| what four ways can we visualize the larynx? |
|
Definition
1. indirect laryngoscopy
2. transnasal flexible endoscopy/stroboscopy
3. rigid endoscopy/stroboscopy
4. videokymography |
|
|
Term
| how is an indirect laryngoscopy performed? |
|
Definition
| with a small external light source and a small dental mirror - The patients sits down hunched over and sticks out their tongue and the doctor shines light onto the mirror at the back of the patients larynx. This allows the doctor to visualize the VFs |
|
|
Term
| which way to visualize the larynx is inexpensive and quick? |
|
Definition
|
|
Term
| what are the cons to an indirect laryngoscopy |
|
Definition
| it doesn't catch subtle problems, the patient isn't in normal physiological voicing position, it is less reliable, and not all patients tolerate this exam |
|
|
Term
| what is the only method that allows the examiner to visualize the nasopharynx/velum, larynx, and pharynx in normal physiologic position? |
|
Definition
| transnasal flexible endoscopy |
|
|
Term
| does a transnasal flexible endoscopy promote gag reflex? |
|
Definition
|
|
Term
| what equipment does a transnasal flexible endoscopy use? |
|
Definition
| flexible endoscope and light source |
|
|
Term
| does a transnasal flexible endoscopy use a stroboscopic light? |
|
Definition
|
|
Term
| what is a stroboscopic light? |
|
Definition
| The VFs in motion look like a blur, so this light gives us the illusion that we’re seeing this. It lets us capture parts of a number of different vibratory cycles. |
|
|
Term
| what are the pros and cons to a transnasal flexible endoscopy? |
|
Definition
pros: videorecording possible
cons: restricted image quality and a high cost of endoscope equiptment |
|
|
Term
| what type of test is this: When a flexible scope goes in through a nostril and curves down into the pharynx – the flexible scope contains its own light source and it allows the examiner to know what’s going on in the nose and then to go past that to see how the larynx looks |
|
Definition
| transnasal flexible endoscopy |
|
|
Term
| what is a dynamic voice assessment? |
|
Definition
| A thorough voice evaluation protocol using transnasal flexible endoscopy with a variety of phonatory (singing a scale) and vegetative activities (coughing, throat clearing, etc) |
|
|
Term
| when does someone use a flexible scope? |
|
Definition
| to see how a patient does in a variety of situations |
|
|
Term
| a rigid endoscopy uses what degree of endoscope? |
|
Definition
|
|
Term
| What are the pros and cons of the rigid endoscopy |
|
Definition
pros: provides a significant magnification of larynx and clear view of the structures
cons: patient may gag, nonphysiologic position |
|
|
Term
| how does a rigid endoscopy work? |
|
Definition
| you have the patient lean forward and stick out their chin, then you slide the scope into the pharynx so it’s pointing straight down at the VFs. |
|
|
Term
| what are we looking for in a videostroboscopy? (5) |
|
Definition
| symmetry, amplitude, periodicity, mucosal wave, and closure |
|
|
Term
| how does the videokympgraphy allow for? |
|
Definition
| real-time evaluation of the VF vibration using a line scan camera |
|
|
Term
| what is the mucosal wave? what's it important for? |
|
Definition
| it is the top most layer of the VFs. It's important for movement of the top most layer of the VF. In healthy VFs you can watch the mucus travel. |
|
|
Term
| what is a Rigid endoscopy with the stroboscipic light on? |
|
Definition
|
|
Term
| what does the camera capture in a videokymography? |
|
Definition
| The camera captures a small segment of the image during vibration and stacks the images on top of each other from superior to inferior on a monitor |
|
|
Term
| SLP is most likely to perform which of the scopes? |
|
Definition
|
|
Term
| what are the cons of the videokymography? |
|
Definition
| Experimental, may not be clinically useful |
|
|
Term
| visipitch allows you to measure what? |
|
Definition
| frequency and intensity of someone's voice |
|
|
Term
| what things do we measure acoustically? |
|
Definition
| frequency, intensity, perturbation, and spectrography |
|
|
Term
| what is related to perturbation? |
|
Definition
|
|
Term
| what is related to the spectrography? |
|
Definition
|
|
Term
| how can we assess speech breathing? |
|
Definition
| Aerodynamic assessment allows us to measure lung volumes/capacities, air pressure, airflow, etc. (EG: blowing bubbles in a cup of water) |
|
|
Term
| how does an electroglottalgraphy work? what does it look at? |
|
Definition
| Put an electrode on each side of the thyroid cartilage and there’s a low level current that runs through the electrodes , air and electricity run though the tissue differently – this measures the opening and closing of the VFs |
|
|
Term
| how does a photoglottography work? what does it look at? |
|
Definition
| Lets you look at VF opening and closing. Here you shine a light above the VF in the laynx and there is a sensory that records when the VF is closed they block and light and when they’re open you get the light. It lets you assess the pattern of VF opening and closing. |
|
|
Term
| what does an electromyography look at? |
|
Definition
| You can assess musculature activity in the region of the larynx |
|
|
Term
| how do we measure acoustic approaches? |
|
Definition
|
|
Term
| how often are physiological approaches used? |
|
Definition
| not often - more used for research |
|
|
Term
| what are the three types of physiological approaches? |
|
Definition
| electroglottography, photography, and electromyography |
|
|
