Voice Evaluation

CDIS 700

Objectives of Voice Evals

Primary objective- Discover whether the client has a voice disorder, and to evaluate the present symptoms.

Secondary objective- Patient education and motivation, as well as establishing your own credibility.

Referral Source Who referred the patient

ENT Neurologist Physician SLP Family, friends, or self

Will want to know if the patient understands why they have come or if they realize there is a problem.

Establish the reason for the referral

Establish the exact reason for the patient referral.

Establish if the patient understands the reason for the referral. “What brings you to see me?”

Develop patient knowledge of the problem.

History of the Problem When was the onset of the problem? What has the course of the problem

been? How does it change over time? How does the patient define the problem? How do others define the problem? What is their motivation for change? Identifying vocal abuses and misuse.

Medical History What illnesses may be related to the

present voice problems?

Any known etiological factors?

Any medications that may be

involved?

http://www.uiowa.edu/~shcvoice/rx.ht

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Social History Gather knowledge about patient’s work, home

and social environment. Discover emotional, social and family difficulties. Establish an understanding of the patient’s

personality. Questions:

What is the home and work environment? Any social or emotional difficulties related to the

voice? Does the patient perceive any relation between

the problems?

Oral Mechanism Exam Determine the physical condition of the

oral mechanism. Observe the laryngeal area for tension. Check for any physiological difference

or signs of neurological involvement in the oral cavity.

Check for laryngeal sensations.

Voice Evaluation

Describe the present vocal properties. Examine inappropriate use of the voice. Assess respiratory status Note voice quality

Self-report Clinician observation Non-instrumental measures Instrumental measures

Quality Assessment A multitude of scaling proceduresReading, conversational speech, singing Maximum phonation time/duration (MPT/MPD)s/z ratio

Sorry my MPT and s/z ratios are so quiet on the audio narration – my video editing software dampened the sound.

Quality Assessment Quality during sustained vowels and

speaking: Hoarse or raspy– warnings for language in

this video; consider how you might educate this person

Breathy – voice is also a bit hoarse Tremulous Strained or tense Diplophonia – I found a clip! Aphonia – lack of voice/whisper

Instrumental Assessment Laryngoscopy

Flexible (nasal) – also see here for longer video

Rigid (oral) - a bit strange, but you can see pics of the scope

Note: stroboscopy is just the light source that can be attached to flexible or

rigid scopes. It slows down the motion of the vocal folds so our eyes can

see; otherwise they move too fast.

Mirror laryngoscopy – wear gloves!

Electroglottograph Visi-Pitch Nasometer Others

Direct Laryngeal Observation: Vocal Tract Visualization and Imaging:

Position Statement http://www.asha.org/docs/html/PS2004-00121.html

Knowledge and Skills for Speech-Language Pathologists With Respect to Vocal Tract Visualization and Imaging http://www.asha.org/docs/html/KS2004-00071.html

Vocal Tract Visualization and Imaging: Technical Report http://www.asha.org/docs/html/TR2004-00156.html#r5

Keep in Mind… Rely on what you hear, not solely on

instrumentation data. During an evaluation, you are making a

diagnosis of how the voice is performing, not a medical diagnosis.

Delay making recommendations for treatment unless an ENT has performed a medical evaluation and voice therapy is not contraindicated.

You can always educate patients on good vocal hygiene, even if you may not be able to make specific voice therapy recommendations.