Voice Disorders: Definition and Incidence

Voice Assessment

• Critical elements in voice assessment include: reason for referral, medical history, onset and duration of dysphonia, occupation, social and leisure activities, eating and drinking habits, and patient's personality and psychological status.
• Self-rating of dysphonia and its impact on the patient is also essential.

Auditory Perceptual Analysis

• Auditory perceptual analysis is a crucial component of voice assessment, used to evaluate voice quality and detect any deviations from normal voice.
• This skill is developed over time as the speech-language pathologist (SLP) listens to many voices.

Voice Quality

• Voice quality includes features such as roughness, breathiness, strain, pitch, diplophonia, aphonia, tremor, vocal fry, falsetto, wet/gurgly quality, loudness, and overall severity.

Assessment Form

• The assessment form includes patient information, referral source, reason for referral, and other relevant details.

Stroboscopy

• Stroboscopy is used to assess vocal fold vibration and mucosal wave, which may be affected by pathology, scarring, pitch, loudness, hyperfunction, hypofunction, anxiety, and subglottic driving force.
• Stroboscopy parameters include phase closure, phase symmetry, and mucosal wave.

Vocal Fold Paralysis

• Vocal fold paralysis can be diagnosed through video glottic closure examples, including larger than normal posterior gap, hourglass closure, spindle-shaped, irregular closure, incomplete closure, and anterior gap.

Aerodynamic Analysis

• Aerodynamic analysis measures air pressures and air flows to diagnose voice disorders, helping to interpret valving activity of the larynx, vocal fold structure, and vocal fold configuration and movement.

Flexible Endoscopy

• Flexible endoscopy helps view the larynx during connected speech tasks, allowing a broader view of the vocal tract and supraglottic region.
• However, it has limitations, including dark image, disruptive movements of the velum or swallows, and difficulty achieving a stable image.

Laryngeal Videostroboscopy

• Laryngeal videostroboscopy demonstrates gross movements of laryngeal structures, providing an immediate image of presence or absence of pathology and a permanent visual record.
• It also demonstrates characteristics of vocal fold vibration and the integrity of the mucous membrane fold covering.

Instrumental Components of Stroboscopy

• Instrumental components of stroboscopy include a rigid or flexible endoscope, video camera, light source (halogen and xenon), digital recorder, monitor, and printer, as well as a computer interface.

Normal Vocal Folds

• Normal vocal folds have a specific structure, including the trachea, arytenoid, vocal process, true vocal fold, epiglottis, and false vocal fold.

Assessment of Voice Disorders

• Voice disorders occur when voice quality, pitch, and loudness differ or are inappropriate for an individual's age, gender, cultural background, or geographic location.
• Incidence and prevalence of voice disorders vary, with adults in the USA having an incidence of 1 in 13, and pediatric patients having a range of 41% to 73% identified with vocal nodules.

Role of SLP in Voice Disorders

• The role of a speech-language pathologist (SLP) in voice disorders includes prevention, screening and assessment, performing instrumental procedures, treatment and management, and collaboration with other medical professionals.
• SLPs diagnose voice disorders but do not provide medical diagnoses.

Psychogenic Voice Therapy

• Psychogenic voice therapy focuses on the emotional and psychosocial status of the patient that led to and maintained the voice disorder.
• It aims to treat the psychosocial problem, which in turn improves the voice.

Physiologic Voice Therapy

• Physiologic voice therapy is based on expanded knowledge of vocal function as evaluated through objective voice assessment.
• It strives to improve the balance among voice, respiratory support, laryngeal muscle strength, control, and stamina, and supraglottic modification of the laryngeal tone.

Eclectic Voice Therapy

• Eclectic voice therapy combines various approaches to affect positive vocal change.
• It acknowledges that different therapies may be effective for different patients and therapists.