Voice Assessment

Question 1

Signs of Voice Problems: Interrelated signs in the ______, ______, and _______ domains.

Answer 1

perceptual, acoustic, physiological

Question 2

before you proceed with voice therapy….

Answer 2

someone has to have looked at the larynx some way and some how

Question 3

what are some examples of things that can be observed without a strobe unit?

Answer 3

Some anatomical malformations or congenital anomalies

Vocal fold approximation and gross movement

Changes in pyriform sinus, ventricular folds, etc.​

Tissue changes in the vocal fold area​

Question 4

How do we rate vocal folds?

Answer 4

rate right and left VF’s separately during abduction

write in one rating per vocal fold

Question 5

what are some examples that need the use of stroboscopy

Answer 5

Glottal closure: complete/incomplete​
Symmetry of closure​
Vibratory Characteristics

Question 6

what are the three names to describe gaps in the glottis

Answer 6

anterior gap
posterior gap
spindle gap

Question 7

what are the remaining names for glottal closure patterns?

Answer 7

complete
hourglass
irregular
incomplete

Question 8

what are the major landmarks during a laryngoscopy?

Answer 8

nose
nasopharynx
tongue base
pharynx
larynx

Question 9

how do you decide which side to scope

Answer 9

sniff test

Question 10

what’s a cue you could use when scoping someone

Answer 10

You will feel pressure in your nose. It gets a little worse before it gets better.

Question 11

what are some causes of changes in the nose

Answer 11

congenital
trauma
allergies
infection
drug use
epistaxis

Question 12

what is a major structure to bypass

Answer 12

the velum

Question 13

what can we do for the pre-PO assessment of VP closure

Answer 13

sustained SH
duhnuhduhnuhduh
Pepsi, forty fat fish

Question 14

what are some tongue base pathologies

Answer 14

Lingual tonsil hypertrophy
Asymmetric tongue base
Mucous retention cyst
Tongue base mass
Foreign object

Question 15

what are some causes of swollen lingual tonsils

Answer 15

reflux
allergies
smoking
infection

Question 16

what can we do to get more information about laryngeal function?

Answer 16

Hold out a nice, long /i/ at different pitches
Pitch glides (low to high, high to low)
Laryngeal diadochokinesis
Cough or throat-clear

Question 17

what are some examples of laryngeal diadochokinesis

Answer 17

tell me “I-I-I” versus “he-he-he”

Question 18

what is included in a differential diagnosis

Answer 18

case history/patient complaint
medical history
surgical history
social history
medications

Question 19

what are some important medical conditions

Answer 19

allergies
sleep apnea
thyroid problems
reflux
asthma
stress/anxiety

Question 20

what are some medications that could impact voice

Answer 20

antihistamines
nasal steroids
Singulair
decongestants/cough suppressants
steroids
inhalers
ACE inhibiters
beta blockers
reflex medications
blood thinners
birth control
anti-depressants
stimulants
acne medication

Question 21

what numbers can we remember for a voice eval?

Answer 21

20-20-20

Question 22

what does 20-20-20 mean for a voice eval?

Answer 22

20 min interview and history
20 minutes data
20 minutes stimuability/patient education

Question 23

what is included in a quality of life assessment

Answer 23

surveys that quantify patient complaints and their effect on communication and quality of life

Question 24

what are some examples of quality of life assessments

Answer 24

Vocal Handicap Index (VHI)
Trans Woman Voice Questionnaire
Dyspnea Index
Reflux Symptom Index (RSI)
Singing Voice Handicap Index (S-VHI)

Question 25

what are some behavioral measures?

Answer 25

S to Z ratio Maximum phonation time

Question 26

what do we need to remember during behavioral measures?

Answer 26

Be very careful with your models and instructions

Question 27

what is an ideal s to z ratio

Answer 27

1.0

Question 28

what is a high s to z ratio

Answer 28

above 1.4

Question 29

what can a high s to z ratio indicate

Answer 29

difficulties with glottal valving during phonation on /z/

Question 30

what happens if we see a low s to z ratio

Answer 30

Not a problem but check patient behavior/your instructions to the patient

Question 31

what is a low s to z ratio

Answer 31

under 1.0

Question 32

what is the average maximum phonation time for an adult female?

Answer 32

15-25 seconds

Question 33

what is the average maximum phonation time for an adult male?

Answer 33

25-35 seconds

Question 34

what is the average maximum phonation time for a child?

Answer 34

8 seconds

Question 35

what are some factors affecting MPT

Answer 35

age lung health vocal pathology vocal physiology patient motivation

Question 36

normal maximum physicalogic pitch range should be...

Answer 36

24-36 semitones (18 is okay)

Question 37

f0 stands for..

Answer 37

fundamental frequency

Question 38

for pitch range we report in....

Answer 38

Hz for pitch glides and connected speech

Question 39

connected speech will have a ______ pitch range

Answer 39

smaller

Question 40

how do we determine maximum physiological pitch range on the pitch glides

Answer 40

for PRAAT: convert hz to semitones for CSL: should give semitones

Question 41

what is jitter

Answer 41

how consistent is the duration of the period

Question 42

for jitter, _____% or below is "normal"

Answer 42

0.5%

Question 43

more consistent= ______ jitter less consistent= _______ jitter

Answer 43

low; high

Question 44

jitter and shimmer is low for _______

Answer 44

modal voice

Question 45

jitter and shimmer is high for ______ and _________ voice.

Answer 45

breathy; creaky

Question 46

define shimmer

Answer 46

how consistent is cycle to cycle amplitude

Question 47

for shimmer below _____% is "normal", can also be reported in Db

Answer 47

5

Question 48

more consistent= _____ shimmer less consistent= _______ shimmer

Answer 48

low; higher

Question 49

Vocal fold vibration generates primarily _______ ________ but also some turbulent noise energy

Answer 49

harmonic energy

Question 50

HNR is the....

Answer 50

ratio between harmonic energy and noise energy

Question 51

CPP stands for

Answer 51

cepstral peak prominence

Question 52

what is the most clinically useful measure that predicts voice disorder with over 90% accuracy

Answer 52

CPP

Question 53

what is CPP?

Answer 53

the height of the peak (i.e., prominence) relative to a regression line of best fit for the overall signal

Question 54

CPP reflects...

Answer 54

the relationship of periodic versus aperiodic energy in a signal

Question 55

caution with CPP because...

Answer 55

Norms are different if using praat versus CSL

Question 56

what can you get information on with: Sustained vowel /a/

Answer 56

Mean f0 jitter shimmer CPP mean dB min dB max dB

Question 57

what can you get information on with: Softest and Loudest sustained /a/

Answer 57

min and max dB

Question 58

what can you get information on with: Pitch Glide- Low to High and high to low

Answer 58

min and max F0

Question 59

what can you get more info on with: connected speech (counting and rainbow passage)

Answer 59

mean f0 SD f0 min f0 max f0 jitter shimmer CPP

Question 60

Ideal mouth to mic distance is ___ cm

Answer 60

4

Question 61

Important to get a ______-_______ recording in a quiet setting

Answer 61

high-quality

Question 62

Any value that uses dB – _______ for mouth to mic distance is essential, even in clinical recordings!

Answer 62

control

Question 63

what are some other measures

Answer 63

aerodynamic measures laryngeal EGG Laryngeal EMG