ASSIGNMENT
VOICE DISORDERS
COURSE # 532
SUBMITTED BY FARINA BABER
SEAT # ED21783011
SUBMITTED TO: DR SUHAIL
AUDIOLOGY AND SPEECH LANGUAGE
PATHOLOGY
Voice Disorder
A voice disorder occurs when voice quality, pitch, and loudness differ or are
inappropriate for an individual's age, gender, cultural background, or geographic
location.
Dysphonia
Dysphonia is a voice disorder in which appropriate voice sound production is affected. It
is caused due to vocal fold vibration injury.
PART-A
When a patient with Dysphonia arrives at the clinic, we would perform two tests; one is
subjective and the other is objective. The subjective test is known as the Auditory
Perceptual Assessment, whereas the objective one is known as the Acoustic
Assessment.
Auditory Perceptual Assessment & Acoustic Assessment
Voice of the patient will be recorded on a recording device using a good quality
condenser microphone. In order to observe the patient’s voice quality, Phonation,
Resonance and Rate following steps will be performed. These steps will also help in
measuring pitch range, habitual pitch, intensity and phonation time.
1- The patient will be asked to do phonation of vowel sound /a/ to check the sustain
2- The patient will be asked to create /ah/ sound from low to his highest pitch range
and from highest to lowest pitch range
3- The patient will be asked to read a passage which would ascertain his speaking
rate or words per minute count
These three tasks would help us in analyzing the following things:
a- The first step of taking a deep breath before phonating vowel /a/ sound for a
sustained period helps in knowing the maximum phonation time (MPT) the
patient has which is actually a measure of the ability the patient possess to
sustain his voice for achieving appropriate phrasing while speaking, rate and
tremors in voice
b- The second step is useful analyzing voice quality attributes such as roughness,
breathiness, strain, pitch range, loudness and intensity
c- The third step helps in measuring habitual and optimal pitch along with syllable
per minute (SPM)
The objective part of the analysis pertain to the Acoustic Assessment in which readings
fall under decibels and hertz parameters which are calculated with the help of diagnostic
tools/software such as Visi-Pitch etc., whereas, the subjective part i.e. the Auditory
Perceptual Assessment is done with the help of ratings.
PART-B
INTRODUCTION:
Voice and/or speech therapy is one of the management options for people with
spasmodic dysphonia. It can be used alone or in conjunction with treatments such as
botulinum toxin injections or pre/post-surgical intervention. Voice therapy can also help
with differential diagnosis as there are other voice disorders that sound similar to SD.
The goal of voice therapy is to help manage the symptoms more effectively. A SpeechLanguage Pathologist (SLP) may work with an interdisciplinary team that includes an
Otolaryngologist (ENT) and/or a Neurologist.
Patient with Dysphonia will be suggested the following three therapy techniques:
Therapy 1
Massage for Releasing Tension
(Try 1 min each; 1-5 times a day) Directions
With the chin neutral or slightly down, (above the Adam’s apple) massage on both sides
of the front of the neck.
Move up higher on both sides under the chin (below jaw) pinching the bottom of the
tongue. Massage in the area right below the floor of the mouth.
Thumb under chin and index finger anchoring on chin, massage in a triangle rotation
(underneath the front area of the tongue).
Note: Swallow before/after each exercise; client’s throat may feel looser
Therapy 2
Blowing Out Candle Exercise
Directions
Ask client Put hand in front of mouth/breath. Blow out like candle. Use consistent,
smooth breath (not throat). Start air first, then add sound “oo”. Feel sound in front of
mouth.
Start with high pitch and then try lower pitches with “oo”. Higher pitch may be easier, but
find client’s easy voice and comfortable pitch.
Try words next using the air/breath. Initiating sound is easier, when client use his/her
breath.
Therapy 3
Breathing Properly will help client’s Speech
1) Scan client’s body to identify areas of tension and allow them to release.
For voice: ask client just let the breath relax. Inhale: Breathe in through the nose; feel
the air come in past the nose and then down through the rib cage and diaphragm
through the body. Exhale (longer than inhale) thru pursed lips relaxing the throat,
tongue, cheeks and mouth. Ask client put hand in front of mouth; should feel smooth
breath on exhale.
Visual: The diaphragm expands like a bellows – expanding brings air into the lungs
2) Adding Sound to Breath
Now ask client to let the voice ride on the smooth exhale breath feeling the energy and
sound in front of the mouth (not in throat.) Say “who” as yawn/sigh.
Visual: ask client to think of the breath as coming through an open hose with nothing
cutting it off. The exhalation of air makes the vocal folds vibrate and the sound and air
move up into the mouth. (Work with it and don’t suppress sound by tightening
throat/mouth/jaw. Keep relaxed.)
Note: tell client don’t force the breath. Use a medium breath; not too deep. I Start with
high pitch, as an easier option, but I can go lower to client’s speaking range – find an
easy pitch. Overall, if the muscles are too tight, client may become fatigued