CDIS 631: Disorders of Voice PDF

CDIS 631: DISORDERS OF VOICE Kerri Mitchell, M.S., CCC-SLP  Welcome Back Summer Review WELCOM E Review syllabus Class expectations  What words/emotions/descriptions are associated BRAINSTO with “voice?” RM https://www.youtube.com/watch?v=7...

CDIS 631: DISORDERS OF VOICE Kerri Mitchell, M.S., CCC-SLP  Welcome Back Summer Review WELCOM E Review syllabus Class expectations  What words/emotions/descriptions are associated BRAINSTO with “voice?” RM https://www.youtube.com/watch?v=73Y_Vp1IAfY Express emotions Carry words Produce music WHAT Convey meaning through phrasing, control of pitch and dynamic range CAN Emotional outlet (laughing and crying) VOICE Reveals the inner self (whiner, depression, salesperson) DO? Draw people in or push people away (soothing versus hard voice) Reveal physical state (crying, weakness from illness) Phonation: the physical act of sound production by means of vocal fold interaction with the exhaled airstream – puffs of air are released within an audible frequency range which resonate in the sub- and supraglottic cavities BASIC Voice: Audible sound produced by phonation TERMINO LOGY Dysphonia: abnormal voice quality which can also involve pitch, loudness, and/or flexibility – can range from mild to severe.  Measures of vocal function exist, but there is currently no standard, entirely objective method(s) for deciding whether or not a voice is “normal” Unlike measures of hearing function Current measures of vocal function are very WHAT IS useful, but need further development (tasks, norms, standardization, etc.) ‘NORMAL Will discuss further as part of clinical evaluation lecture In addition to the use of instrumental ’ VOICE? assessment of vocal function, the SLP must make judgments about whether voice is normal or abnormal based on auditory perception Such perceptual judgments depend primarily on speaker characteristics of age and gender Other factors that can influence judgments include cultural background, education, vocal training, etc. of the speaker and the listener (SLP) VOICE DISORDER A voice disorder exists when pitch, loudness, quality, and/or flexibility differs noticeably from the voices of others of similar age, gender and cultural group  Pitch: the perceptual correlate of (fundamental) frequency PERCEPT UAL Loudness: the perceptual correlate of intensity PARAMET Quality: the A purer tone ERS OF perceptual correlate of versus pertubation and/or noisiness VOICE complexity of the spectrum Flexibility/variation: the perceptual correlate of pitch, loudness, and quality PERCEPTUAL JUDGMENTS OF NORMAL VERSUS ABNORMAL VOICE Expressed in the following perceptual parameters of voice: PERCEPTUAL JUDGMENTS OF VOICE Pitch: Loudness: Normal: appropriate for Normal: loud enough to the age and gender of be heard under normal the speaker circumstances Abnormal: too high, too Abnormal: too soft, too low, monotone, pitch loud, monoloud, reduced breaks, reduced pitch loudness range range PERCEPTUAL JUDGMENTS OF VOICE Quality: Normal: clear, absence of noise Abnormal: lack of clarity, presence of noise, discordance  Once the decision is made that quality is abnormal, there is usually an attempt to further define/describe the nature of the abnormality  The subjective nature of this task has led to the proliferation of many terms (100+)  Examples: aspirate, course, grating, etc.  Ongoing effort by ASHA SIG 3 to standardize perceptual evaluation of voice COMMON TERMS TO DESCRIBE ABNORMAL VOICE QUALITIES: Roughness: also described as “hoarseness,” perception of noisiness and/or lack of clarity – related to the amount of aperiodicity and noise in the acoustic signal https://www.youtube.com/watch?v=2VmIpiv_nF4 Breathiness: perception of the audible escape of air during phonation – related to incomplete glottic closure and increased levels of air flow during phonation Do not confuse with aphonia Strain or Tension: perception of a constant level of increased effort to produce phonation – may be reflected by increased subglottal pressure COMMON TERMS TO DESCRIBE ABNORMAL VOICE QUALITIES, CONT.: Tremor: rhythmic variations in pitch and loudness which are not under voluntary control Sudden Interruption of Voicing: perceptual sign of a sudden and unexpected abduction of vocal folds, or delayed adduction from unvoiced to voiced phonemes Diplophonia: literally “double voice,” two pitches perceived at once OTHER BEHAVIORS: Stridor: Indicate a narrowing of the airway at a certain point, perceptually you will hear noisy breathing, involuntary sound accompanying inspiration and/or expiration Excessive throat clearing: Perceptual sign of voice disorder when it occurs frequently and consistently Aphonia: Absence of a definable vocal tone – voice is whisper-like, but without phonation.  Consistent vs. episodic CLINICAL PERCEPTUAL EVALUATION OF VOICE – CAPE-V o Purpose: To describe the severity of o Rating: auditory-perceptual attributes of a o Overall severity voice problem o Roughness o Highly subjective – one clinician’s o Breathiness hoarseness may be another clinician’s breathiness o Strain o Increased communication among clinicians o Pitch with a standard set of language o Loudness o Additional Features o 3 Vocal Tasks: o Sustain /a/ and /i/ for 3-5 seconds in duration o Measurements: o Produce 6 sentences o Mild/Mod/Severe o Spontaneous speech: “Tell me about your voice problem” o 0-100 scale o Consistent/Inconsistent  CAPE-V PRACTICE The Rainbow Passage https://www.youtube.com/watch?v=kJ86-F wZYYI  Fortunately, we do not need to rely solely on perceptual judgments of voice CLINICAL PERCEPT UAL Simple audio recording can provide the means for documenting the voice for later comparison EVALUATI ON OF Perceptual judgments of voice can be combined/integrated VOICE, with instrumental measures of vocal function Acoustic/Aerodynamic Electroglottography CONT. Evaluation CLASSIFICATION OF VOICE DISORDERS Voice disorders can affect oIncidence of laryngeal cancer in individuals across the entire life the U.S. span – infancy to old age. 3.2 per 100,000 Overall “ballpark” figures for 5 year survival rate is 61% incidence of voice disorders among the US population: oApproximately 3,000 laryngectomies per year Children: 5% o60,000 people status post Adults: 3-9% laryngectomy INCIDENCE OF VOICE DISORDERS School Aged Children Studies using relatively small sample sizes report incidence figures as high as 23.4% Studies using larger sample sizes report ranges from 3-6% Adults Fewer studies have examined incidence in adults Estimated that 3% to 9% of the total population has a voice disorder Study of individuals age 18 to 82 (small sample size): 7.2% of males and 5% of females had voice disorders Some studies of the elderly report figures that range from 12% to 35% Mainly based on retrospective review of clinical records Across all studies, abuse/misuse/phonotrauma-related disorders had the highest frequency of occurrence THE ROLE OF OCCUPATION 24.49% of the total US working It has been shown that occupation population have jobs that requiring high levels of voice use are at a greater risk for voice disorders critically require voice use Risk Factors for a Voice Disorder in the US (“2” would mean twice the risk): 3.29% have jobs which voice Singer 575.00 function is necessary for public Counselor/social worker 8.42 safety (e.g., air traffic controller) Teacher 4.67 Telemarketer 2.95 Ticket sales 1.90 Compiled by National Center for Voice and Speech  Medicine (otolaryngolog Speech- y or Language Voice/Speech laryngology) “Voice Pathology (SLP) Science THE VOICE specialist” TEAM “THERE ARE MANY PROFESSIONALS Neurolaryngol REPRESENTING NUMEROUS Neurology Radiology DISCIPLINES OR FIELDS OF ogy STUDY WHO ARE CONCERNED WITH THE VOICE” (COLTON AND CASPER, 1996) Teachers with Gastroenterolo Psychology singing/voice gy coaches  Primary members: MD (laryngologist) and SLP Both see the patient together or in sequence The MD is responsible for medical diagnosis and management The SLP is responsible for the assessment of vocal function and behavior and for providing voice therapy services Most cases are presented and discussed by the “Team,” informally in the clinic or at weekly Voice Rounds Other specialties are called upon as needed Need for further specialization within the SLP team SLPs that are professionally trained singers and work with the singing population Work closely with teachers of singing, keeping HIPPA in mind Head and Neck cancer specialist THE VOICE TEAM The more one uses the voice, the more careful one has to be. Rely on voice to earn living THE Use voice as a vehicle for self- VOICE – expression (mental health) and overall safety HOW Rely on voice for daily and more IMPORTA personal social interactions NT IS IT? Voice is one of the main ways in which we communicate