1 voice assessment: instrumental. 2 instrumental analysis of voice electromyographic assessment:...
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Voice Assessment: Instrumental
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Instrumental Analysis of Voice
• Electromyographic assessment: direct measure of muscle activity; used for localization of muscle
• Aerodynamic assessment:
1. airflow rate & volume
2. subglottal (intraoral) pressure
3. laryngeal resistance
4. phonation threshold pressure
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Instrumental Analysis of Voice• Acoustic recording & analysis:
1. fundamental frequency (Fo)2. intensity (dB SPL)3. signal/ noise ratio4. perturbation measures5. spectral frequencies
• Electroglottography: measure of vocal fold contact area
• Photoglottography: measure of glottal area
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Why do instrumentation evaluation?
• Contributes to the diagnosis, etiology and severity of the disorder,
• Allows perceptual measures to be objectified (i.e documentable),
• Instrumental evaluations are “noninvasive”,
• Baseline for documentation of progress,
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Electroglottography
• Noninvasive, inexpensive,
• Demonstrates relative contact of the vocal folds during a glottal cycle,
• No information concerning area of glottal opening,
• Small electrodes on neck; – glottis opens= impedance rises, – glottis closes= impedance falls
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6• Lines between electrodes represent the electrical current
traversing through the v.f.’s
Electrodes
Glottis
Vocal fold contact area
Electroglottographelectronics
EGG
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EGG Signal (inverse filtered)
• Opening (upward trace); Closing (downward trace)
• v.f.’s touch (close) = greater current
Airflow
EGG
1000
68 MSEC
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GlottogramPoint of max opening
Opening Closing
OPEN
CLOSED
Wid
th o
f ar
ea o
f gl
otti
s(%
of
Max
imum
)
Open PhaseClosed Phase
1 Cycle (T)
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EGG: Normal & Disordered Glottal Waves
A. Normal glottal width function
B. Left recurrent nerve paralysis (Left never reaches midline & greater excursion; right fold crosses midline)
A. B.
MidlineMidline
Rel
ativ
e d
ista
nce
fro
m m
idli
ne
Lef
t V
ocal
fol
dR
igh
t V
ocal
fol
d
Rel
ativ
e d
ista
nce
fro
m m
idli
ne
Lef
t V
ocal
fol
dR
igh
t V
ocal
fol
d
Time of frame number
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Electromyography• Electrodes are either surface or needle,
• Needle inserted into specific muscles
• What do we look for?
1. onset & offset of muscle activity
2. pattern of muscle activity
4. amplitude of muscle activity
5. spont. bursts of activity
• Useful for voice problems with neurological or neuromuscular etiology.
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EMG: Hooked Wire Electrode
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EMG
Voice
CT
Long relaxation timeVoice
CT
ba ba babababa da da dadada
Buildup of EMG activity in CT
Vowel Production
CV Combos
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Aerodynamic• Define vocal efficiency through airflow
rates & pressure changes,
• Airflow rates: flow of air through the glottis, – measured using pneumotachography & body
plethesmography
• Subglottal pressure: driving pressure underneath the folds, – pitot tube & pressure transducer, tube placed in
the oral cavity, – invasive method = esophageal balloon
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Aerodynamic
• Laryngeal resistance: peak intraoral pressure divided by peak flow rate, reflects the overall resistance of the glottis,
• Phonation threshold pressure: minimal pressure to set v.f.’s into oscillation
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Glottal Resistance
*30% of F0= Most efficient function of the larynx or habitual pitch
Fundamental Frequency (% of Freq. range)
Fundamental Frequency (% of Freq. range)
Intr
atra
chea
l Pre
ssur
e (c
m H
20)
Glo
ttal
res
ista
nce
(dy
nes
/se/
cm)
A. Increased in subglottal pressureto overcome increase in glottal resistance
B. Larynx offers increased resistanceto airflow as folds are placed underincreased tension
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Importance of aerodynamic results?• Results are a reflection of the valving activity of the
larynx,
• Represents v.f. configuration, movement, structure & function,
• Intraoral pressure, transglottal airflow, & laryngeal resistance:
1. Discriminate normal & pathologic voice function,
2. Assess severity3. Suggest implications for the diagnostic
source of voice pathology
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Acoustic• Fundamental frequency: rate of vibration of the vocal folds,
expressed in Hertz, or cycles per second, measure on sustained vowel or connected speech,
– Visipitch, C-Speech, CSL
• Perturbation measures: cycle-to-cycle variation in a signal; jitter (frequency) & Shimmer (amplitude),
– Visipitch, C-Speech, CSL
• Signal to noise ratio: a measure of the energy in the voice signal over the noise energy in the voice signal, greater harmonic energy in voice= better voice quality,
– Visipitch, C-Speech, CSL
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Acoustic
• Intensity: SPL (Sound Pressure Level), measure mean and range intensity, – Sound level meter or acoustic analysis programs
• Spectral analysis: displays glottal sound source & filtered characteristics of the speech signal across time, useful to analyze changes in the spectral characteristics of the voice sound, – C-Speech, CSL
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Spectographs
Aperiodic v.f. vibration is evident by the irregularity of the spacing of the vertical voice bars
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Spectograhs: Voice Quality
Normal Nasal Breathy Harsh Hoarse
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Spectographs: Vocal Nodules
A. Vocal Nodule
B. Aperiodic vocal fold vibration& Noise
C. Six weeks post surgery
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Importance of Acoustic Measures• Provide objective & noninvasive measures of
vocal function
• Normative values help you discriminate normal and pathological voice attributes
• Measure change in vocal performance over time
• Indirect inference about the severity of voice
• No acoustic measures can differentially diagnose the source of the voice pathology
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Case # 1
• 41 year old attorney
• 4 months dysphonia
• Problem began after severe URI– chronic coughing & clearing
• Long history of cigarette smoking ( 1 pack per day)
• Moderate alcohol consumption
• Voice abuser: home, sporting event, work
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Examination Findings
• Mild-moderately hoarse- breathy
• Dramatic pitch decrease (2 months)
• Syllables per breath were normal
• Maximum phonation time = 16 seconds
• Acoustic:– F0= 105 hz
– Jitter = 1.4%
– Shimmer = .33 dB
– S/N ratio = 12.7 dB
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Examination Findings
• Aerodynamic:
– Mean airflow (l/sec)= 798 cc /sec
– Subglottal pressure = 20 cm H20
– Glottal resistence= 20 cm H20/lps
• compressoin force between vocal folds during closed
phase of vibration
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Diagnosis
• Bilateral true vocal fold hemorrhagic polyps– secondary to voice misuse & abuse
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Readings
• Colton & Casper Ch.7 (Last half particularly)