Voice Final

anything that is different for their age, sex, and gender & anything different from what is excepted

• Best for structure keep the tongue protruded

• A big large image of the vocal folds, say /i/ "eee" (pulls the larynx up towards the scope)

• USE: pathology, good image, vibrations (nodules structures, polyps)

• Shows movement larynx

• higher quality of pictues

• swallowing

subjective

• Greatly reduces sensory feedback

• Numbing structures cause different not-normal movements of the stuctures

• USE: what the larynx is doing, glottal spaces

subjective

have to know the frequency of the voice

• result of physiological phenomenon

• gives exactly how much air flow for voice (numerical data)

• Complete sounds that hit the microphone & create a signal

• Result of a physiological response/movement, but does not tell you the physical efforts

• the physiological response

• the actual air movement (objective measurement)

To obtain objective measurements of glottal airflow and sub-glottal pressure - physiologic measure

• Only put someone on voice rest after a surgery to let tissue heal, do not use this approach during therapy Not for other things like muscle tensions dysphonia, etc.

• Tells you how much pressure it takes to get one liter of air through vocal folds in one second

elimination of all vocal fold contact

• get away from heavy vocal load

• elimination of excessive voice

• duration should be patient specific

• Anyone!

• Any person who complains of a disturbance to the voice that results in an impairment, disability, or handicap regardless of age, race, and culture

• Motivation of patient

• Responsibility & Commitment

• Completion of home practice

• Incorporate suggest vocal lifestyle changes

• Restore the best voice possible; adequate assessment, good data to set goals and see progress

• Describe: structure (anatomy) & why its there/how (physiology)

• Measure motivation for therapy: (1) will find out in a few weeks of treatment, (2) can not match when outside therapy (3) discuss timeline (4) home practice materials HAVE TO HAVE: Awareness

• Motivation is the most important aspect (1A)

• Competence & ability secondly important (2A)

• voice to be appropriate for age, sex, & gender OR -getting them back to the point where they can go back to what they want to do (in terms of speech)

behavioral issue

• voice therapy

• doing lots of work outside of therapy

• age, sex, language, culture, intrinsic & extrinsic biases

• only as good as the person doing it

• numbers themselves don’t necessarily mean anything

• objective only as good as normative data

• baseline with objective measures

reliable and valid

ENT and NOT and SLP we can only refer to “rule out”

• nodule or polyps, structure sitting on the folds or incomplete glottal closure

  • increase air coming through the glottis

• needle inserted into the larynx (direct - absolute subglottal pressure) OR pppp-syllable train (indirect)

  • Indirect measurement: just a way to measure pressure below the glottis

systematic scaling

true, due to collision fore of vocal folds not able to absorb

• cannot apply normative data to pediatric voice, children have different aerodynamics

in a quiet environment

• age

• language

• culture

• intrinsic and extrinsic bias

• to see hard vocal fold adduction

• “uncle eddy eats eggs”

• disinfect

• know how much pressure is going in/calibrate it

  • hold it tight against the face to make sure it is not leaking/has good seal

Loudness

• 3-5cm away from the corner of mouth to make sure not picking up aspiration

• use a unidirectional-mounted headphone

• Elicited directions to phonate “ahh” at normal pitch and loudness

• Quite environment

• Computer with high sampling rate

• calibrate loudness

• portable

• how much airflow is going through the glottis

• Measure by saying /pipipipi/

• /p/ intraoral pressure

• /i/ glottal airflow

• Elevated = nodule/polyp (incomplete closure)

• Decreased = nodule/polyp (hyperfunction)

• how much resistance does system need to overcome to set VF into motion

• 7-10cm H2O pressure send VF into vibration

• Elevated resistance: increased medial compression/hyperfunction

• Muscle tension dysphonia

• Determine etiology

• Determine severity - how its affecting everyday life

• Determine clinical course

• Determine the likely response to treatment

• Determine the actual response to treatment

• cycle to cycle variation in frequency

  • you want low frequency variation in voice/lack of variability - healthy voices

• cycle to cycle variation in amplitude

• sample during spontaneous speech/read a passage

• reading & speech F0 may vary by 6-10Hz

  • Sustained ahhh or vowel

• measures amount of current flow from one side of the larynx to the other

• electrodes on each side of neck at level of thyroid → current is sent from one electrode to the other

• Derived measure of VF contact

• age

• sex

• language

• culture

• intrinsic and extrinsic bias

• to see self-perception with the answers not being influenced

4-point rating system 0-3

• G: grade of judgment of voice

• R: roughness - how irregular & noisy is voice?

• B: breathiness - how much additional airflow?

• A: asthenia - judgment of how weak the voice sounds

• S: strain - judgment of how compressed

  • Problematic - knowing a diagnosis can influence a listener’s perceptual measure

• not much research on efficacy on voice therapy approaches

• surgery

• prior intubation

• coughing or GERD

• eating habits

• family history

• medications

• consistency of behaviors

• glottal closure

• supraglottic activity

• mucosal wave

• adduction

• VF mobility

• subjective

• mucosal wave

• structures and pathologies

• auditory perceptions

• Increase surface hydration of VF to improve vibratory function and reduce vocal effort & laryngeal irritation

  • Steam inhalation (humidifier)

  • Cough drops (lozenges)

  • Saliva substitute

• Consuming liquids to promote hydration

• Avoid drying agents

  • Antihistamines

  • Diuretics (high BP meds, etc.)

  • Caffeine

  • Alcohol

  • Environmental irritants

• find the symptom, change the behavior

• trying to reduce symptoms

• most common used