voice exam one

Most likely to have a voice disorder

- Adult females - Pediatric males - Teachers - Ages 40 to 59 - People with 16 or more years of education - People with a family history of voice disorders

Functional voice disorder

- Behavioral problem or inefficient use of vocal mechanism ex) Muscle tension dysphonia

Hygenic Voice Therapy

- Counseling on hydration and proper voice measures and accommodations - Indirect therapy type ex) - Reduce caffeine consumption - Speak an appropriate amount and level - Avoid Smoking - Reduce speaking in noisy or dusty environments

Psychogenic Voice Therapy

- Identification and modification of the emotional and psychosocial aspects - Requires knowledge of SLP scope of practice and counseling referrals

secondary to upper airway problems voice disorders

- Internal/external stimuli stresses laryngeal muscles - Often causing VF dysfunction, excessive coughing - Chronic cough - Paradoxical vocal fold motion

list 2 ways to obtain voicing

- Lip bubbles - Gargle phonation with water

Physiologic Voice Therapy

- Manipulated mechanism for voice (change of airflow supply or muscular contraction for phonation) Balancing of subsystems (physio) EX) Flow phonation Vocal function exercises Resonant voice therapy LaxVox Accent Method Manual Techniques

neurogenic voice disorders

- Related to neurological complication - Tremor - Spasmodic dysphonia

infrahyoid extrinsic laryngeal muscles

- Sternothyroid - Sternohyoid - Omohyoid -*Thyrohyoid

Eclectic Voice Therapy

- Using all "tools in toolbox" - Selecting a technique that the therapist is comfortable with and that works best for the client - Constantly improving your ability to administer therapy approaches

IA function

- brings cartilaginous vocal folds together

LCA function

- brings membranous vocal folds together - important for function of whisper

Lateral TA function

- brings vocal folds towards midline

advantages of cepstral analysis

- can be used in connected speech - can be used in severly dysphonic pt

why can the thyrovocalis effect pitch?

- can make the VF shorter, thicker, tenser and rounder which impacts pitch

list 2 reasons aerodynamic analysis is important

- can tell pt's ability to coordinate the respiratory and phonatory system - good pre & post treatment/surgery measure

types of cepstral measures

- cepstral peak prominence (CPP) - low to high spectral ratio (L/H ratio)

suprahyoid extrinsic laryngeal muscles

- digastric - geniohyoid - mylohyoid - stylohyoid

disadvantages of cepstral analysis

- hard to interpret - limited normative data

what is cepstral peak prominence (CPP)?

- harmonic energy - low peaks = greater severity of dysphonia

reasons why polyps are more common in women

- higher fundamental frequency - tissue edema fluctuations due to hormonal changes

Intrinsic Laryngeal muscles

- interarytenoid - thyroarytenoid - lateral cricoartenoid - posteriorcricoarytenoid - cricothyroid

Spectral measure

- jitter/shimmer - fundamental frequency

cricothyroid muscle function

- lengthens and tenses VF - may increase pitch - innervated by SLN branch of Vagus

what is low to high spectral ratio( L/H ratio) ?

- relates to breathiness

audivle inspiratory stridor

- something in the airway is creating turbulence (which can be heard) durng inhalation

Flow phonation

- used with aphonia/muscle tension aphonia - goal of improved airflow & reduced tension - voicing added once constant airflow is mastered

Indirect Mirror Examination

- using a dental mirror and a bright light to visualize the vocal folds

what is constant light good for in imaging?

- visualizing tissue health - adduction/ abduction of VF

which softwares use cepstral analysis?

-KayPENTAX -PRAAT

LIst 3 Flow phonation tasks

1. /u/ prolongation 2. voiceless to voice fricatives 3. voiceless phrases/conversation

Types of voice disorders

1. Functional 2. Organic 3. Secondary to Upper Airway Problems 4. neurogenic

3 skills needed to work with voice clients

1. Knowing anatomy and physiology 2. Counseling skills 3. Ear for voice changes

parts of a voice assessment

1. case history 2. audio-perceptual evaluation 2. patient self assessment 4. instrumental evaluation

causes of polyps

1. from vocal folds hitting together with too much force (from laryngeal muscle activity) 2. phonating longer or louder than tolerable 3. allergies 4. smoking 5. GERD

Thyromuscularis muscle

1.outer layer of the TA; aids in adducting the VF; may also shorten and relax; mass up pitch down

transglottal airflow (aerodynamic measure)

AC flow: air in gottis while phonating DC flow: air existing in glottis between cycles

innervation of the intrinsic laryngeal muscles

Cranial Nerve X - Vagus Nerve - Recurrent Laryngeal Branch - Thyroarytenoid muscle, - Lateral cricoarytenoid muscle, - Interarytenoid muscles, - Posterior cricoarytenoid

Symptomatic voice therapy

Direct modification of symptoms experienced by the patient to improve voice quality ex) - Change of loudness - Laryngeal massage - Establish a new pitch - Pitch inflections - Voice rest

cricothryoid innervation

External branch of the superior laryngeal nerve (CN X)

laryngeal abductor muscles

PCA (posterior cricoaryntenoid)

subglottal pressure (aerodynamic measurE)

PTP/ Phonation threshold pressure: minimum amt. of subglottal pressure to set the vocal folds into vibration

organic voice disorder

Primarily in tissue (VF) Includes: Nodules Cancer Polyps

Core team for voice disorder diagnosis

SLP ENT/ otolaryngologist Patient and family/ caregivers

other members in a team for a voice disorder

Singing teacher Neurologist Pulmonologist Endocrinologist Counselor

*an SLP cannot see a patient for treatment of a voice disorder before they have been seen by a physician until the tissue is examined

True

cepstral analysis

assesses energy distributed across different frequencies on the spectrum "spectrum of a spectrum"

intrinsic laryngeal muscles affect the...

control of the glottis/VF

G-R-B-A-S

grade, roughness, breathiness, asthenia, strain

Thyrovocalis muscle

inner layer of the TA, shortens & relaxes the VF; adducts

can you produce voicing with too much posterior circoarytenoid muscle contraction?

no- approximation is required

what approach to therapy is flow phonation treatment?

physiologic (due to manipulation of vocal mechanism)

extrinsic muscle function are...

to more the entire larynx (elevate or depress)

what is strobe light good for in imaging?

used for VF movement