1. SPPA 6400 Voice Disorders: Tasko
Clinical Assessment
SPPA 6400 Voice Disorders: Tasko

2. Voice Disorders: A Multidisciplinary Effort
Speech Language Pathology
Otolaryngology
Voice Scientists
Vocal Instructors
Neurology
Gastroenterology
Pulmonology
Allergy
Psychology
SPPA 6400 Voice Disorders: Tasko

3. Medical Evaluation (Otolaryngology)
The otolaryngologist establishes medical status of the head and neck.
Otolaryngologist will view the larynx in some manner.
Indirect mirror exam
Rigid or flexible endoscopic examination
Direct laryngoscopy
Some combination of the above
SPPA 6400 Voice Disorders: Tasko

4. Some Aims of Assessment
Etiology
Diagnosis
Prognosis
Planning
SPPA 6400 Voice Disorders: Tasko

5. SPPA 6400 Voice Disorders: Tasko
Signs vs. Symptoms
SPPA 6400 Voice Disorders: Tasko

6. SPPA 6400 Voice Disorders: Tasko
Common Voice Symptoms
Hoarseness
Vocal fatigue
Breathy voice
Reduced phonational range (pitch & loudness)
Aphonia or voice loss
Pitch breaks/inappropriately high pitch
Strain/struggle
Tremor
Pain & other physical sensations
Colton et al. (2010)
SPPA 6400 Voice Disorders: Tasko

7. Primary components of Assessment
Chart Review
Case History
Clinical Evaluation
Non-instrumental evaluation
Instrumental evaluation (later)
Experimental/diagnostic therapy
SPPA 6400 Voice Disorders: Tasko

8. SPPA 6400 Voice Disorders: Tasko
Case History
Voice Symptom History
Voice Use History
Health/Medical History
Social/Vocational History
Psychosocial History
SPPA 6400 Voice Disorders: Tasko

9. SPPA 6400 Voice Disorders: Tasko
Voice Symptom History
The Voice Problem
Effect of the Voice Problem
History of the Voice Problem
SPPA 6400 Voice Disorders: Tasko

10. SPPA 6400 Voice Disorders: Tasko
Voice Use History
Establish voice use patterns
On the job
At home
In social settings
Look for,
Environmental factors (noise, air quality)
SPPA 6400 Voice Disorders: Tasko

11. Health/Medical History
Current & past health problems
Specific areas to probe
Respiratory problems
Gastrointestinal problems
Neurological problems
Endocrine problems
Allergies
Head and neck trauma, surgery, disease
Other Chronic Illness
Prescription and OTC drugs
Substance use: alcohol, tobacco, drugs, caffeine
Exercise/diet considerations
SPPA 6400 Voice Disorders: Tasko

12. Social/Vocational History
Home environment
Work environment
Social/recreational activities
SPPA 6400 Voice Disorders: Tasko

13. Psychosocial Interview
“The voice is often a sensitive to our emotional well being…”
Ask about,
Stress/emotional problems
Chronic or episodic
Hx of counseling
SPPA 6400 Voice Disorders: Tasko

14. Critical listening during history
How do signs match symptoms?
Signs of other communication impairment
Variability in signs as a function of
Duration of session (change over time)
Periods of improvement/resolution
Automatic behaviors (e.g. cough, throat clear, laugh)
Conversational content
Atypical vocal signs such as stridor (noise during respiration), tics, grunts, barks
SPPA 6400 Voice Disorders: Tasko

15. Critical observation during history
Signs of pain/discomfort
Signs of tension/strain
Function of other vocal components
Level of comfort (or anxiety) over the course of the interview
Signs of tremor, unusual movements of the body
SPPA 6400 Voice Disorders: Tasko

16. Non-instrumental Evaluation
Oral-Peripheral Examination
Auditory perceptual evaluation of voice
Selected maximal effort tasks
Assessment of laryngeal musculoskeletal tension
Self-report measures
SPPA 6400 Voice Disorders: Tasko

17. Auditory Perceptual Evaluation
Standardized to clinic/profession
Standardized with respect to
Data collection procedures
Data evaluation procedures
Data reporting procedures
SPPA 6400 Voice Disorders: Tasko

18. GET HIGH QUALITY RECORDINGS OF VOICE!!!
You need
High quality recording device
High quality microphone
Ability to adjust recording settings
Easy access to recordings
SPPA 6400 Voice Disorders: Tasko

19. Auditory Perceptual Signs
Pitch
Loudness
Quality
Dysphonia vs. Aphonia
Other Behaviors
Resonance
Rate
Articulation
SPPA 6400 Voice Disorders: Tasko

20. Auditory Perceptual Disturbances
From ASHA Consensus on Auditory Perceptual
Evaluation of Voice (CAPE-V)
Definitions of Vocal Attributes:
OVERALL SEVERITY: Global, integrated impression of voice deviance.
Roughness: Perceived irregularity in the voicing source.
Breathiness: Audible air escape in the voice.
Strain: Perception of excessive vocal effort (hyperfunction).
Pitch: Perceptual correlate of fundamental frequency. This scale rates whether the individual's
pitch deviates from normal for that person's gender, age, and referent culture. The direction of
deviance (high or low) should be indicated in the blank provided above the scale.
Loudness: Perceptual correlate of sound intensity. This scale indicates whether the individual's
loudness deviates from normal for that person's gender, age, and referent culture. The direction of
deviance (soft or loud) should be indicated in the blank provided above the scale.
SPPA 6400 Voice Disorders: Tasko

21. Pitch & Pitch Disturbances
Monopitch
Inappropriate pitch
Pitch breaks
Diplophonia
Reduced pitch range
SPPA 6400 Voice Disorders: Tasko

22. SPPA 6400 Voice Disorders: Tasko
Loudness
Monoloudness
Excessive loudness variation
Reduced loudness range
SPPA 6400 Voice Disorders: Tasko

23. SPPA 6400 Voice Disorders: Tasko
Quality
Roughness
Breathiness
Strain/struggle/tension
Tremor
Sudden interruption of voicing (voice break)
Hoarseness
SPPA 6400 Voice Disorders: Tasko

24. SPPA 6400 Voice Disorders: Tasko
Aphonia
Aphonia vs. dysphonia
Consistent vs. intermittent/episodic
SPPA 6400 Voice Disorders: Tasko

25. SPPA 6400 Voice Disorders: Tasko
Other Behaviors
Stridor
Throat clearing
Coughing
SPPA 6400 Voice Disorders: Tasko

26. Consensus on Auditory Perceptual Scaling of Voice (CAPE-V)
SPPA 6400 Voice Disorders: Tasko

27. SPPA 6400 Voice Disorders: Tasko
Other Tasks
Maximum phonation time (MPT)
s/z ratio
Voluntary cough
SPPA 6400 Voice Disorders: Tasko

28. Assessment of Laryngeal Musculoskeletal Tension
“All patients with voice disorders, regardless of etiology should be tested for excess musculoskeletal tension, either as a primary or secondary cause of dysphonia”
(Aronson, 1990)
SPPA 6400 Voice Disorders: Tasko

29. Manual Assessment of Laryngeal Musculoskeletal Tension
Pressure is directed over the
Major horns of the hyoid bone
Superior border of the thyroid cartilage
Anterior border of sternocleidomastoid and into the suprahyoid muscles
Determine size of the thyrohyoid space
Digital pressure should be just enough to
blanche (lighten in color) your nail bed
SPPA 6400 Voice Disorders Tasko

30. Manual Assessment of Laryngeal Musculoskeletal Tension
SPPA 6400 Voice Disorders Tasko
Aronson (1990)

31. Manual Assessment of Laryngeal Musculoskeletal Tension
SPPA 6400 Voice Disorders Tasko
Roy et al. (1996)

32. Self-Report of Vocal Disturbance
Voice Handicap Index (VHI)
Voice-Related Quality of Life (V-RQOL)
SPPA 6400 Voice Disorders: Tasko