1. Voice evaluation

2. TOpics 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

3. Definitions

4. Definition Assessment Evaluation Diagnosis
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.

5. The screening process

6. Screening forms 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

7. Screening forms
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

8. Medical Evaluation for Voice Disorders

9. Medical Evaluation for Voice Disorders
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.

10. Medical Evaluation for Voice Disorders
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.

11. Medical Evaluation for Voice Disorders
Physical examination should include:
General physical condition
A thorough ear, nose and throat evaluation
Visual inspection of the larynx !!!
Mirror laryngoscopy
Endoscopic laryngoscopy

12. Assessment, Evaluation and Diagnosis for Voice Disorders by the clinician

13. Assessment, Evaluation and Diagnosis
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

14. Assessment, Evaluation and Diagnosis
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

15. Assessment, Evaluation and Diagnosis
The clinical process of the voice assessment:
Selection of standardized measures for documented ecological validity
Monitor voice status and ensure support for patient

16. 1. Case history

17. Case history Description of the problem and cause directly
The patient’s reality distance
Onset and duration of the problem
Acute or gradual
Long or short
Variability of the problem
Timetable of the consistency of patient’s problem
Important for treatment
Description of vocal use (daily use-misuse)
In most life situations
Additional case history information
Previous voice therapy
Family voicing patterns

18. 2. Noninstrumental assessment

19. Noninstrumental assessment
Includes:
Behavioral observation
The oral-peripheral mechanism examination
Auditory-perceptual assessment
Quality of life in persons with voice disorders

20. 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

21. 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

22. 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)

23. 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

24. 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

25. 4. Quality of life in persons with voice disorders
Includes:
Overall health-related quality of life
Communication-related quality of life

26. 3. instrumental assessment

27. instrumental assessment
Includes:
Laryngoscopy
Acoustic analyses
Aerodynamic measurements
Electroglottography

28. 1. Laryngoscopy
Appropriately trained clinicians may employ indirect laryngoscopy and other laryngeal visualization techniques

29. 2. Acoustic analyses Valid acoustic measurements can: Discrimination
Positive correlation
Sufficient stablilization

30. 2. Acoustic analyses 5 acoustic properties of the vocal signal:
Frequency
Intensity
Perturbation
Sound spectrography
Signal(or harmonics)-to-noise ratio

31. 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)

32. 2. Acoustic analyses Intensity Habitual intensity
Intensity variability
Int.SD
Intensity(dynamic)range
From softest nonwhisper to loudest shout
Voice range profile(VRP)

33. 2. Acoustic analyses Perturbation Short-term cycle-to-cycle
Jitter
Shimmer
Short-term cycle-to-cycle
Nonvolitional variability

34. Jitter

35. Shimmer

36. 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

37. 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

38. 3. Aerodynamic Measurements
5 acoustic properties of the vocal signal:
Lung volumes and capacities
Air pressure
Airflow
Laryngeal resistant
Durational measures

39. 3. Aerodynamic Measurements
Lung volumes:
Tidal volume
Inspiratory reserve volume
Expiratory reserve volume
Residual volume

40. 3. Aerodynamic Measurements
Lung capacities:
Inspiratory capacity
Vital capacity
Functional residual capacity
Total lung capacity

41. 3. Aerodynamic Measurements
Air pressure: cm H2O
Inside lungs
Below the vocal folds
Indirect measure by /p/
Inside oral cavity

42. 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/

43. 3. Aerodynamic Measurements
Durational measures
MPT
S/Z ratio

44. 4. Electroglottogrphy EGG: Noninvasive Tech
An estimate of VF contact patterns

45. EGG Hardware

46. Use of EGG Hardware

47. Stroboscopy vs. EGG wave

48. Normal EGG wave

49. Acoustic & EGG Assessment
A Complete Example

50. Real-time Two-channel Recording

51. Perturbation of Acoustic Signal

52. Perturbation of EGG Signal

53. Advanced Assessment

54. Signal, Harmonic & Noise

55. Vocal Function Estimates

56. Its all for today!