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Anatomical and physiological reasons to do laryngoscopy
- 1. Note location and relative size of supraglottic, laryngeal and tracheal structures
- 2. Note movement of vocal folds as pitch, loudness and register change; movement associated with articulation
Parameters for laryngeal examination
- 1. glottal closure configuration: complete? incomplete? posterior glottal gap? hourglass?
- 2. horizontal excursion of vocal folds aka amplitude of vibration
- 3. mucosal wave
- 4. vocal edge: straight and smooth?
- 5. phase closure: amount of opening gesture vs. closing gesture
- 6. phase symmetry: L & R symmetry during vibration?
Acoustic instrumental tests
- 1. F0 charateristics
- 2. I0 characteristics
- 3. spectral characteristics -- perceived voice quality
- 4. timing/duration characteristics
- 5. harmonics/noise ratio
- 6. pertrubation
signal (harmonics) to noise ratio
Measure of ratio of energy in fundamental and harmonics to energy in aperiodic component of the voice signal
The __________ the HNR, the more noise in the voice
How do you reckon HNR?
physiological instrumentation in voice assessment
- 1. electroglottography
- 2. electromyography
- 3. inductive pletysmography
noninvasive technique for obtaining an estimate of vocal fold contact patterns during phonation
Waveforms created in electroglottography (electroglottogram or laryngogram) usually graphically demonstrate _________ vocal fold contact by going UP.
Pros to doing electroglottography
- 1. diagnostic baseline vibration pattern and biofeedback in attempting to change contact pattern (adduction level)
- 2. non-invasive
Cons to doing electroglottography
- May be difficult to obtain in:
- 1. children
- 2. adults with lots of neck tissues superficial to thyroid cartilages
Why do electromyography?
- 1. for gross motor tension in facial or neck area associated with hyperfunctional phonation
- 2. to study contraction in specific muscles during various phonatory/swallowing behaviors, also used to verify muscle location for botox injections
Two types of electromyography
- 1. surface electrodes: senses summed electrical activity associated with muscles contracting beneath it
- 2. intramuscular: senses electrical activity associated with contraction of muscle/muscle motor unit in which it has been inserted
- Inductive plethysmography employs sensors to measure changes in a crosssectional
- area of the RC and abdominal (AB) compartments during a respiratory and cardiac
A test measuring lung function, specifically the measurement of the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled.
instrument used by doctors to determine the lung volume of patients. It uses the principle of displacement to measure the amount of air the lungs can hold.
- 1. subglottal pressure
- 2. glottal airflow
- 3. inverse filtered airflow
- 4. glottal resistance
- 5. lung volume
- direct tracheal pressure
- related to intensity, adequacy of pulmonary effort for initiating and sustaining phonation
- measured at mouth with pneumotachometer
- low frequency measure of total airflow expelled during phonation
inverse filtered airflow
total airflow - vocal tract contribution (F1, F2) = estimated airflow above glottis
device that allows clinician to know relative lung volume (in terms of percentage of total vital capacity) at any point during phonation
A hyperfunctioning voice is characterized by ________.
A hypofunctioning voice is characterized by ________.
not enough glottal closure
Overall goal in voice therapy
Best voice with the least cost
Voice clinician as counselor:
- Discuss stressful situations
- Create hierarchies
- Teach behavioral approaches to minimize symptoms -- easier voice
- Counsel, don't reprimand
- Develop action plan to meet goals