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Clinical Assessment SPPA 6400 Voice Disorders: TaskoVoice Disorders: A Multidisciplinary EffortSpeech Language PathologyOtolaryngologyVoice ScientistsVocal InstructorsNeurology

GastroenterologyPulmonologyAllergyPsychology

SPPA 6400 Voice Disorders: TaskoMedical Evaluation (Otolaryngology)The otolaryngologist establishes medical status of the head and neck.Otolaryngologist will view the larynx in some manner.Indirect mirror examRigid or flexible endoscopic examinationDirect laryngoscopySome combination of the aboveSPPA 6400 Voice Disorders: TaskoSome Aims of AssessmentEtiologyDiagnosisPrognosisPlanningSPPA 6400 Voice Disorders: TaskoSPPA 6400 Voice Disorders: TaskoSigns vs. Symptoms5SPPA 6400 Voice Disorders: TaskoCommon Voice SymptomsHoarsenessVocal fatigueBreathy voiceReduced phonational range (pitch & loudness)Aphonia or voice lossPitch breaks/inappropriately high pitchStrain/struggleTremorPain & other physical sensationsColton et al. (2010)6SPPA 6400 Voice Disorders: TaskoPrimary components of AssessmentChart ReviewCase HistoryClinical EvaluationNon-instrumental evaluationInstrumental evaluation (later)Experimental/diagnostic therapy7SPPA 6400 Voice Disorders: TaskoCase HistoryVoice Symptom HistoryVoice Use HistoryHealth/Medical HistorySocial/Vocational HistoryPsychosocial History8SPPA 6400 Voice Disorders: TaskoVoice Symptom HistoryThe Voice ProblemEffect of the Voice ProblemHistory of the Voice ProblemExample9SPPA 6400 Voice Disorders: TaskoVoice Use HistoryEstablish voice use patterns On the jobAt homeIn social settingsLook for,Environmental factors (noise, air quality)

Example10SPPA 6400 Voice Disorders: TaskoHealth/Medical HistoryCurrent & past health problemsSpecific areas to probeRespiratory problemsGastrointestinal problemsNeurological problemsEndocrine problemsAllergiesHead and neck trauma, surgery, diseaseOther Chronic IllnessPrescription and OTC drugsSubstance use: alcohol, tobacco, drugs, caffeineExercise/diet considerationsExample11Social/Vocational HistoryHome environmentWork environmentSocial/recreational activities

SPPA 6400 Voice Disorders: TaskoExample12SPPA 6400 Voice Disorders: TaskoPsychosocial InterviewThe voice is often a sensitive to our emotional well beingAsk about,Stress/emotional problemsChronic or episodicHx of counselingExample13SPPA 6400 Voice Disorders: TaskoCritical listening during historyHow do signs match symptoms?Signs of other communication impairmentVariability in signs as a function ofDuration of session (change over time)Periods of improvement/resolutionAutomatic behaviors (e.g. cough, throat clear, laugh)Conversational content Atypical vocal signs such as stridor (noise during respiration), tics, grunts, barks

14SPPA 6400 Voice Disorders: TaskoCritical observation during historySigns of pain/discomfortSigns of tension/strainFunction of other vocal componentsLevel of comfort (or anxiety) over the course of the interviewSigns of tremor, unusual movements of the body15SPPA 6400 Voice Disorders: TaskoNon-instrumental EvaluationOral-Peripheral ExaminationAuditory perceptual evaluation of voiceSelected maximal effort tasksAssessment of laryngeal musculoskeletal tensionSelf-report measures

16SPPA 6400 Voice Disorders: TaskoAuditory Perceptual EvaluationStandardized to clinic/professionStandardized with respect toData collection proceduresData evaluation proceduresData reporting procedures17GET HIGH QUALITY RECORDINGS OF VOICE!!!You needHigh quality recording deviceHigh quality microphoneAbility to adjust recording settingsEasy access to recordingsSPPA 6400 Voice Disorders: Tasko18SPPA 6400 Voice Disorders: TaskoAuditory Perceptual SignsPitchLoudnessQualityDysphonia vs. Aphonia Other BehaviorsResonance RateArticulation19SPPA 6400 Voice Disorders: TaskoDefinitions of Vocal Attributes:OVERALL SEVERITY: Global, integrated impression of voice deviance.Roughness: Perceived irregularity in the voicing source.Breathiness: Audible air escape in the voice.Strain: Perception of excessive vocal effort (hyperfunction).Pitch: Perceptual correlate of fundamental frequency. This scale rates whether the individual'spitch deviates from normal for that person's gender, age, and referent culture. The direction ofdeviance (high or low) should be indicated in the blank provided above the scale.Loudness: Perceptual correlate of sound intensity. This scale indicates whether the individual'sloudness deviates from normal for that person's gender, age, and referent culture. The direction ofdeviance (soft or loud) should be indicated in the blank provided above the scale.From ASHA Consensus on Auditory PerceptualEvaluation of Voice (CAPE-V)Auditory Perceptual Disturbances20SPPA 6400 Voice Disorders: TaskoPitch & Pitch DisturbancesMonopitch

Inappropriate pitch

Pitch breaks

Diplophonia

Reduced pitch range

Females Male 21SPPA 6400 Voice Disorders: TaskoLoudnessMonoloudnessExcessive loudness variationReduced loudness range22SPPA 6400 Voice Disorders: TaskoQualityRoughnessBreathinessStrain/struggle/tensionTremorSudden interruption of voicing (voice break)Hoarseness

23SPPA 6400 Voice Disorders: TaskoAphoniaAphonia vs. dysphoniaConsistent vs. intermittent/episodic

24SPPA 6400 Voice Disorders: TaskoOther BehaviorsStridorThroat clearingCoughing25SPPA 6400 Voice Disorders: TaskoConsensus on Auditory Perceptual Scaling of Voice (CAPE-V)

26SPPA 6400 Voice Disorders: TaskoOther TasksMaximum phonation time (MPT)s/z ratioVoluntary cough27SPPA 6400 Voice Disorders: TaskoAssessment of Laryngeal Musculoskeletal TensionAll patients with voice disorders, regardless of etiology should be tested for excess musculoskeletal tension, either as a primary or secondary cause of dysphonia (Aronson, 1990)28SPPA 6400 Voice Disorders TaskoManual Assessment of Laryngeal Musculoskeletal TensionPressure is directed over theMajor horns of the hyoid boneSuperior border of the thyroid cartilageAnterior border of sternocleidomastoid and into the suprahyoid musclesDetermine size of the thyrohyoid space

Digital pressure should be just enough to blanche (lighten in color) your nail bed29SPPA 6400 Voice Disorders Tasko

Aronson (1990)Manual Assessment of Laryngeal Musculoskeletal Tension30SPPA 6400 Voice Disorders TaskoRoy et al. (1996)

Manual Assessment of Laryngeal Musculoskeletal Tension31SPPA 6400 Voice Disorders: TaskoSelf-Report of Vocal DisturbanceVoice Handicap Index (VHI)Voice-Related Quality of Life (V-RQOL)32