Diagnosis
-Hyperfunctional voice disorder
-Noninfectious swelling of larynx & chronic dysphonia.
-Pt presents with abusive behaviors such as coughing, clearing throat, yelling, smoking, reflux
Physiology
How structures are working
Vocal Function Testing
-Max Phonation Time
-s/z ration
-cough (strength of glottal closure)
-speaking fundamental frequency (visipitch)
-fundamental frequency range (glides up & down)
-Jitter ( a variation in frequency of vocal fold vibration)
-Laryngeal palpatation
-Endurance
Treating Chronic Laryngitis
-Behavioral voice therapy: vocal function exercises
-Resonant voice therapy
Semi-occluded vocal tract exercises
-Vocal rest
-Counseling
-Medical Tx: laryngeal spray & reflux meds
-lifestyle modifications
Vocal Hygiene
-stay hydrated
-good posture
-reduce stress
-avoid yelling, get closer to communication partner
-Slow rate of speech
-Rest when needed
-Diet modifications (reduce acidic food) & reflux meds
What is Contact Granuloma?
-Hyperfunctional voice disorder or due to intubation or reflux
-Vocal fold lesion that restricts pitch and increases tension
-Person may have no voice symptoms but complain of sore throat & globus sensation
-Will reoccur if habits don't change
Frequency
Sound cycles of vibration/second
- Fundamental frequency → # times v.f. vibrate per second
-Males – 80-140x/sec
- Females- 175-240x/sec
-Children- 240-300x/sec
- Babies- 500x/sec
Consensus Auditory Perceptual Evaluation of Voice (CAPE-V)
-Measures perceptual characteristics through phonetically balanced sentences, sustained vowel, & spontaneous speech
-Objective Measure
-Measures a scale of mildly deviant, mod. deviant, and severely deviant
Treating Contact Granuloma
-Behavioral Voice Therapy: vocal function exercises
-Resonant Voice Therapy
-Vocal Hygiene
-Educate
-Counseling
-Medical Tx: Reflux meds & surgery if necessary
Lee Silverman Voice Tx (LSVT)
-helps individuals with Parkinson's disease
-based on pushing and pulling
Rationale: achieve an effortful glottal closure improve vocal quality and respiratory support.
What is Muscle Tension Dysphonia?
-Psychogenic dysphonia
-There is no sign of physical damage to the vocal cords but pt presents with varying voice symptoms depending on the location of tension.
-Strong counseling component
Jitter
-cycle by cycle variation in the frequency of vocal fold vibration
-Measured by VisiPitch [normal below 1.0]
Voice Handicap Index (VHI)
-Functional domain, physical domain, emotional domain
Treating Muscle Tension Dysphonia
-Behavioral voice therapy: semi-occluded vocal tract exercises, vocal function exercises
- Circumlaryngeal Massage
-Mindfulness & Relaxation Techniques
-Counseling
Environmental
-Diet modifications
-Amplification
-Changing seating
-Reduce talking/singing in the car
-reduce exposure to irritants such as dust
- use humidifier
What is Vocal Nodules?
-Hyperfunctional voice disorder
-Benign vocal fold lesions, pt presents with rough & breathy vocal quality w/ increased laryngeal tension.
-occurs equally in kids, but more with female adults
-commonly seen with singers
Intensity
-amplitude of sound
-Maximum intensity → highest intensity level a speaker can produce ( Max for adult → 80dB)
-Relative intensity range → range of intensities produced while speaking (Average → 25-80dB)
- Shimmer → cycle by cycle variation in intensity of vocal fold vibration i. Measured with VisiPitch [normal below .4]
Differential Diagnosis Task
60-80 series
-to differentiate between adductor, abductor spasmodic dysphonia or MTD
-MTD will have difficulty with both sets of numbers (tension)
-Adductor spasmodic dysphonia will have difficulty with 80s, Abductor spasmodic dysphonia will have difficulty with 60s
Treating Vocal Nodules
-Behavioral voice therapy: vocal function exercises, semi-occluded vocal tract exercises
-Confidential Voice (whisper voice)
-Resonant Voice therapy (good for children)
-environmental modifications
-Counseling
-Surgery if necessary, only recommended with pre and post behavioral therapy
Diagnostic impressions
severity, primary symptoms
-Prognosis: think about pt age, overall health, recognition of problem, motivation, familial support, and vocal demands
What is Unilateral Vocal Fold Paralysis?
-Pt presents with breathy, weak voice, reduced loudness, vocal dryness & fatigue
Max Phonation Time
- amount of time a speaker can maintain voice on one breath
-Adults → 20 sec
- Children → 12-15 sec
Case History
-voice symptoms
-voice use
-health hx
- social family history
Treating Unilateral Vocal Fold Paralysis
-Surgery is considered after the spontaneous recovery period (6-9 months)
-Behavioral voice therapy
-Head Turn
Clinical Probes
testing stimulability: gives a starting point for therapy