Jan 15, 2016
Definition of the terms assessment, evaluation and diagnosis
The screening process for voice disorders Medical Evaluation for Voice Disorders Assessment, Evaluation and Diagnosis for
Voice Disorders by the clinician
Assessment The process of collecting relevant data for
clinical decision making Evaluation
It’s an appraisal of the implications and significance of the assessment
Diagnosis Making a decision as to whether a
problem exists, and if so, differentiating it from other similar problems.
The Boone Voice Program for Children (Boone, 1993) Addresses respiration, phonation and
resonance Is appropriate for students in all
grades Natural samples of voice and speech Simple three-point system
The Quick Screen for Voice (Lee, Stemple and Glaze, 2005) Addresses respiration, phonation and
resonance Is appropriate for students from
preschool through high school Samples of spontaneous conversation,
picture description, imitated sentences, recited passages, counting and other natural samples of voice and speech
All patients/clients with voice disorders must be examined by a physician.
The physician’s examination may occure before or after the voice evaluation by the clincian.
Only the decision about whether to begin voice therapy need be deferred until all medical information is obtain.
On completion of the medical examination, its is equally important for the laryngologist to communicate the findings to bout the patient and the referring clinician.
Physical examination should include: General physical condition A thorough ear, nose and throat
evaluation Visual inspection of the larynx !!!
Mirror laryngoscopy Endoscopic laryngoscopy
The clinician’s role: Describe the structure and function of
the larynx Make recommendations regarding
Further testing needed to understand the etiology of the voice problem
Maintenance of the voice problem Treatment
The clinical process of the voice assessment: Review of auditory and visual status Relevant case history Standard and nonstantndardized
methods Use of noninstrumental and/or instrumental
measures Perceptual ratings, acoustic analysis,
aerodynamic measures, electroglottography and imaging tech
The clinical process of the voice assessment: Selection of standardized measures for
documented ecological validity Monitor voice status and ensure support
for patient
Includes: Behavioral observation The oral-peripheral mechanism
examination Auditory-perceptual assessment Quality of life in persons with voice
disorders
1. Behavioral observation
This tells more about patients than their histories and assessment data.
We can see: Extremely sweaty palms Avoid eye contact with people Use excessive postural changes Demonstrate facial tics
2. The oral-peripheral mechanism examination
Examination of the face, oral and nasal cavities and pharynx is also required. Mandibular restriction (下颌回缩 ) Unusual downward or upward
excursion of the larynx during the production of various pitches
3. Auditory-perceptual assessment
Factors might influence judgment The natural of the speaking task Listener experience and training The type of rating method used
GRBAS CAPE-V(the Consensus Auditory
Perceptual Evaluation of Voice)
3. Auditory-perceptual assessment
GRBAS(Hirano, 1981) G(grade):the overall severity of voice
abnormality R:rough B:breathy A:aesthenic(weakness) S:stain
A four-point system
3. Auditory-perceptual assessment
CAPE-V(Kempster,Gerratt, 2008) 2 specific psychometric properties:
Visual analog scales Unanchored
6 aspects of voice: Overall severity Roughness Breathiness Strain Pitch loudness
4. Quality of life in persons with voice disorders
Includes: Overall health-related quality of life Communication-related quality of life
Includes: Laryngoscopy Acoustic analyses Aerodynamic measurements Electroglottography
1. Laryngoscopy
Appropriately trained clinicians may employ indirect laryngoscopy and other laryngeal visualization techniques
2. Acoustic analyses
Valid acoustic measurements can: Discrimination Positive correlation Sufficient stablilization
2. Acoustic analyses
5 acoustic properties of the vocal signal: Frequency Intensity Perturbation Sound spectrography Signal(or harmonics)-to-noise ratio
2. Acoustic analyses
Frequency Speaking fundamental frequency(SFF)
Average F0 Frequency variability
F0.SD Phonational frequency range(PFR)
Maximum phonational frequency range(MPFR)
Voice range profile(VRP)
2. Acoustic analyses
Intensity Habitual intensity Intensity variability
Int.SD Intensity(dynamic)range
From softest nonwhisper to loudest shout Voice range profile(VRP)
2. Acoustic analyses
Perturbation Jitter Shimmer
Short-term cycle-to-cycle Nonvolitional variability
2. Acoustic analyses
Sound spectrography Harmonic structure of the glottal sound
source Resonant characteristics
Narrow-band filtering Good frequency resolution
Wide-band filtering Good time resolution
2. Acoustic analyses
Signal(or harmonic)-to-Noise Ratio: The lower the HNR, the more noise there is
in the voice Correlates well with the perception of
dysphonia
3. Aerodynamic Measurements
5 acoustic properties of the vocal signal: Lung volumes and capacities Air pressure Airflow Laryngeal resistant Durational measures
3. Aerodynamic Measurements
Lung volumes: Tidal volume Inspiratory reserve volume Expiratory reserve volume Residual volume
3. Aerodynamic Measurements
Lung capacities: Inspiratory capacity Vital capacity Functional residual capacity Total lung capacity
3. Aerodynamic Measurements
Air pressure: cm H2O Inside lungs Below the vocal folds
Indirect measure by /p/ Inside oral cavity
3. Aerodynamic Measurements
Airflow: CC or mL Glottal resistance to airflow Breathy vowel – higher airflow Strained-strangled voice - lower airflow
Laryngeal resistance: Repeat /pi/ at a rate of 1.5 syllables/sec
Peak intraoral pressure - /p/ Peak airflow - /i/
3. Aerodynamic Measurements
Durational measures MPT S/Z ratio
4. Electroglottogrphy
EGG: Noninvasive Tech An estimate of VF contact patterns
A Complete Example