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